Aetna considers physical therapy (PT) medically necessary when this care is prescribed by a chiropractor, DO, MD, nurse practitioner, podiatrist or other health professional qualified to prescribe physical therapy according to State law in order to significantly improve, develop or restore physical functions lost or impaired as a result of a disease, injury or surgical procedure, and the following criteria are met:
Full Answer
What does Aetna Medicare Advantage cover?
Nov 01, 2021 · Preventive care glossary. By Noah Hughes. Preventive care is a key part of meeting your health goals. That’s one reason why it’s so important to take advantage of the preventive services covered by Medicare Advantage (MA). Preventive care and screenings can benefit your health. So, you need to know how to take advantage of them.
What is the Aetna Medicare PCP program?
May 06, 2022 · Aetna Medicare insurance is not to only be used when you’re sick or injured. It also provides coverage for most preventive health services, one of them being an annual wellness …
Is Aetna an authorized health plan to facilities?
Preventive care covered with no cost sharing. Get checkups, screenings, vaccines, prenatal care, contraceptives and more with no out-of-pocket costs. www.aetna.com. 00.03.537.1 E (9/15) …
Does Aetna Insurance cover physical therapy?
The Aetna Supplemental Retiree Medical Plan is a fully insured, non-network-based commercial retiree group health product. In all states but Florida and Minnesota, it is offered as a …
What is the difference between a Medicare physical and a regular physical?
What is a Medicare preventive Visit?
What should be included in the annual Medicare physical exam?
- A review of your medical and family history.
- A review of your current providers and prescriptions.
- Height, weight, blood pressure, and other routine measurements.
- Personalized health advice.
What are preventive services Aetna?
What is the difference between a wellness check and a physical?
Does Medicare require annual wellness visits?
What is not included in a wellness visit?
What is not covered in Medicare Annual Wellness visit?
How often can you have a Medicare Annual Wellness visit?
Is a colonoscopy considered preventive care Aetna?
Does Aetna cover pap smears?
Does Aetna cover bone density test?
Does Aetna cover medical insurance?
Aetna Medicare insurance is not to only be used when you’re sick or injured. It also provides coverage for most preventive health services, one of them being an annual wellness visit. Medicare Advantage plans (also called Medicare Part C) like the ones provided by Aetna are required by law to cover everything that's covered by Medicare Part A ...
What is Medicare Part B?
During your first 12 months having Medicare Part B (you must have Part B in order to have an Aetna Medicare Advantage plan), you are eligible for a “ Welcome to Medicare ” preventive care visit. The Welcome to Medicare visit is similar to your annual wellness visit and provides your doctor with a baseline of your health ...
Is a wellness visit a physical?
A Medicare annual wellness visit is similar to a physical exam but not quite as extensive. While a wellness visit includes checking many of the same routine measurements as a physical exam, it does not include blood work and other tests that might be performed in a physical. Compare Aetna Medicare Advantage Plans.
What does a medical history review reveal?
Reviewing your family’s medical history can reveal any hereditary conditions worth monitoring, as some health conditions could become risks for you if they are prevalent in your family health history.
What is measured at a wellness visit?
Your height, weight, blood pressure and other vitals will be measured at each wellness visit. This helps your doctor see how your body has changed since your last visit and can be critical as they prescribe medications or other health recommendations.
What is wellness visit?
The annual wellness visit is not just about reviewing the previous year of your health; it’s also about planning for the upcoming year. Your doctor will use the information gathered during your visit to offer advice and formulate a plan to address any problem areas of your health.
What is the part of personalized health advice?
Part of the personalized health advice you’ll receive is a list of your risk factors based on your medical history and your basic health measurements. Accompanying this list of risk factors will be a list of treatment options for you to pursue at your doctor’s recommendation.
Is Aetna a Medicare Supplement?
The Aetna Supplemental Retiree Medical Plan is a fully insured, non-network-based commercial retiree group health product. In all states but Florida and Minnesota, it is offered as a supplementary medical plan, not a Medicare plan. In Florida and Minnesota, it is approved as a group Medicare Supplement product.
What is Aetna insurance?
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance plans contain exclusions and limitations. See all legal notices.
Can you transition Part D drugs?
Members who are taking Part D drugs that are not on the plan's formulary, or that are subject to utilization management requirements, can get a transition supply of their drug under certain circumstances. They can work with you to complete a successful transition and avoid disruption in treatment.
Does Aetna Medicare cover PCP?
Medicare and Aetna Medicare won’t be responsible either. Generally, you must get your health care coverage from your primary care physician (PCP). Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna Medicare.
What is prior authorization?
Prior authorizations are often used for things like MRIs or CT scans. Your doctor is in charge of sending us prior authorization requests for medical care. Each plan has rules on whether a referral or prior authorization is needed. Check your plan’s Evidence of Coverage (EOC) to see if or how these rules apply.
What is a referral for medical care?
Sometimes you need a referral or prior authorization before you can get care. A referral is a kind of preapproval from your primary care doctor to see a specialist. A prior authorization or precertification is when your doctor has to get approval from us before we cover an item or service.
What is a referral for a doctor?
Sometimes you need a referral or prior authorization before you can get care. A referral is a kind of preapproval from your primary care doctor to see a specialist. A prior authorization or precertification is when your doctor has to get approval from us before we cover an item or service.
What is telehealth coverage?
Telehealth coverage. Telehealth – or telemedicine – means virtual care you can get at home or away. These visits are live, video conferences between you and a doctor over a computer or smart phone. Consider using telehealth when you have a time sensitive medical need or can’t get to the doctor in person.
What is telehealth in medical terms?
Telehealth – or telemedicine – means virtual care you can get at home or away. These visits are live, video conferences between you and a doctor over a computer or smart phone. Consider using telehealth when you have a time sensitive medical need or can’t get to the doctor in person.
What is Aetna's medical record?
Aetna® health plans have established medical record criteria and documentation standards. Their intent is to facilitate communication and coordination of care and promote effective patient care. These criteria provide a guideline for organizing and documenting diagnostic procedures and treatments.
Does Aetna have a PIN?
Physicians, hospitals and health care professionals contracted with us also have an Aetna-assigned PIN, which is used in our internal systems and in certain transactions on our provider portal.
Can you charge more than contracted rate for Aetna?
Billing an Aetna® member who has exhaustedtheir benefits: When a member has exhausted their benefits, you cannot charge them more than the contracted rate if you continue to see them. For example, if a plan covers 10 visits but you provide 12.
What is a clean claim?
To reduce payment delays, have your office submit “clean claims.” A clean claim is a claim that is received in a timely manner and includes all the information we need to process it for payment.
What is Medicare Secondary Payer?
Medicare Secondary Payer (MSP) is the term used by Medicare when Medicare is not responsible for paying claims first. Under MSP, an active employee of a group plan with 20 employees has the group plan as their primary payer when covered by both the group plan and
Can you get Medicare if you have limited income?
People with Medicare who have limited income and resources may get help paying for their out-of-pocket medical expenses from their state Medicaid program. There are various benefits that may be available to “dual eligibles.” These benefits are sometimes also called “Medicare Savings Programs.”
What is the working age?
The “working aged” are employed people age 65 or older , and people age 65 or older with employed spouses of any age, who have Employer Group Health Plan (EGHP) coverage because of their or their spouse’s current employment.
Does Aetna prescribe physical therapy?
Aetna considers physical therapy (PT) medically necessary when this care is prescribed by a chiropractor, DO, MD, nurse practitioner, podiatrist or other health professional qualified to prescribe physical therapy according to State law in order to significantly improve, develop or restore physical functions lost or impaired as a result of a disease, injury or surgical procedure, and the following criteria are met:
What is a qualified physical therapist?
A qualified physical therapist for benefit coverage purposes is a person who is licensed as a physical therapist by the state in which he or she is practicing. A physical therapy assistant (PTA) is a person who is licensed as a PTA, if applicable, by the state in which he or she is practicing.
Is home based physical therapy necessary?
Aetna considers home-based physical therapy medically necessary in selected cases based upon the member's needs (i.e., the member must be homebound). This may be considered medically necessary in the transition of the member from hospital to home, and may be an extension of case management services.
Is augmented soft tissue mobilization experimental?
Aetna considers augmented soft tissue mobilization experimental and investigational because it has not been proven to be more effective than standard soft tissue mobilization. There is no reliable evidence that outcomes of soft tissue mobilization (myofascial release) are improved with the use of hand-held tools (so-called "augmented soft tissue mobilization"; e.g., the Dynatronics ThermoStim probe).
What is physical therapy?
Physical therapy is the treatment of disorders or injuries using physical methods or modalities.
What is a PT?
Physical therapy is the treatment of disorders or injuries using physical methods or modalities. A PT modality is often defined as any physical agent applied to produce therapeutic changes to biologic tissues.
What is the Metronome program?
The Interactive Metronome (IM) program is designed for processing speed, focus, as well as coordination. Trainees wear headphones and hear a fixed, repeating reference beat; they press against a hand or foot sensor to try to match it, while receiving visual and auditory feedback. The IM program has been promoted as a treatment for children with attention-deficit hyperactivity disorder (ADHD) and for other special needs children to increase concentration, focus, and coordination. It has also been promoted to improve athletic performance, to assess and improve academic performance of normal children, and to improve children's performance in the arts (e.g., dance, music, theater, creative arts). Furthermore, the IM program has also been implemented as part of a therapy program for patients with balance disorders, cerebrovascular accident, limb amputation, multiple sclerosis, Parkinson's disease, and traumatic brain injury.
What is a Medicare Annual Wellness Visit?
If you choose standard Medicare coverage, you can opt to have an Annual Wellness Visit (AWV) with the purpose of creating a personalized prevention plan. In addition, topics such as advance care planning are discussed.
What is an annual physical exam, and does Medicare Advantage cover this?
An annual physical exam is more extensive than an AWV. It involves a physical exam by a doctor and includes bloodwork and other tests. The annual wellness visit will just include checking routine measurements such as height, weight, and blood pressure.
