Some care will require your Provider to get our approval first. This process is called prior authorization or preapproval. Some common services that need prior authorization include:
Certain outpatient services and planned hospital admissions
Some Durable Medical Equipment (DME) and related supplies
Aetna Assure Premier Plus (HMO D-SNP) has specific prior authorization guidelines and certain steps are needed to obtain an approval in advance:
Your Primary Care Provider (PCP) will tell us about the services you may need.
Aetna Assure Premier Plus (HMO D-SNP) will review the claim.
You and your provider will get a letter telling you if the service has been approved or denied and provide a reason for the decision.
If a service is denied, you or your provider, with your written permission, can file an appeal.
If you have any questions about these guidelines, you can call Member Services at 1-844-362-0934 (TTY: 711).
Members must use participating/network providers, pharmacies, and durable medical equipment (DME) suppliers. No referral is required to receive covered services by in-network providers.
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