Aetna Better Health endorses a variety of nationally recognized clinical practice, preventive care, and behavioral healthcare guidelines. Clinical practice, preventive care and behavioral healthcare guidelines made available by Aetna Better Health are not a substitute for the professional medical judgment of treating physicians or other health care providers.
Evidence based clinical practice guidelines are based on information available at a specific point in time and during review and adoption by the Quality Management/Utilization Management Committee (QM/UMC). The most current guidelines are published and made available through a variety of professional organizations such as the American Academy of Pediatrics, the American Academy of Family Practice, the National Institute for Health, the American Psychiatric Association and the American College of Obstetrics and Gynecology. The guideline review and update process are implemented for each guideline at least every two years. Reviews are more frequent if national guidelines change within the two-year period.
A hard copy of the guidelines is available to providers upon request. A provider can request a copy by contacting their provider relations representative. Disclosure of clinical guidelines is not a guarantee of coverage.
These guidelines are intended to clarify standards and expectations. They should not:
- Take precedence over your responsibility to provide treatment based on the member’s individual needs
- Substitute as orders for treatment of a member
- Guarantee coverage or payment for the type or level of care proposed or provided