Prior authorization

Aetna Better Health must pre-approve some services before you can get them. We call this prior authorization. This means that your providers must get permission from us to provide certain services. They’ll know how to do this. We’ll work together to make sure the service is what you need.

Except for family planning and emergency care, all out-of-network services require pre-approval. You may have to pay for your services if you do not get pre-approval for services that:

  • Are given by an out-of-network provider
  • Require pre-approval
  • Are not covered by Aetna Better Health of New Jersey

All services by providers that are not in our network need pre-approval.

Following are the steps for pre-approval:

  • Your provider gives Aetna Better Health of New Jersey information about the services they think you need.
  • We review the information.
  • If the request cannot be approved, a different Aetna Better Health of New Jersey provider will review the information.
  • You and your provider will get a letter when a service is approved or denied.
  • If we deny your request, we will explain our reasons in the letter.
  • If we deny a service, you or your provider can file an appeal.