Aetna Definition Of Medical Necessity

Health Care & Insurance Glossary of Terms | Aetna

https://www.aetna.com/glossary.html

The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical …

Medical Necessity Definition in Health Insurance

https://www.verywellhealth.com/medical-necessity-1738748

Medical necessity refers to a decision by your health plan that your treatment, test, or procedure is necessary to maintain or restore your health or to …

Applied Behavior Analysis (ABA) Medical Necessity …

https://www.aetna.com/health-care-professionals/newsletters-news/office-link-updates-june-2021/behavioral-health-updates/applied-behavior-analysis-aba-medical-necessity-guide-revised-edition.html

Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published …

Medical Necessity: Is It Really Necessary ... - AAPC …

https://www.aapc.com/blog/77660-medical-necessity-is-it-really-necessary/

“Medical necessity” is an important concept for medical coders and auditors to understand. Health insurance companies (payers) use criteria to determine whether items or services provided to their …

Skilled Home Private Duty Nursing Care - Medical …

https://www.aetna.com/cpb/medical/data/100_199/0136.html

Speech Therapy - Medical Clinical Policy Bulletins | Aetna

https://www.aetna.com/cpb/medical/data/200_299/0243.html

Aetna considers home-based speech therapy medically necessary in selected cases based upon the member's needs (i.e., the member must be homebound). This is usually used in …

Infertility - Medical Clinical Policy Bulletins | Aetna

https://www.aetna.com/cpb/medical/data/300_399/0327.html

As defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce …

Bathroom and Toilet Equipment and Supplies - Medical …

https://www.aetna.com/cpb/medical/data/400_499/0429.html

Policy. Aetna's HMO-based and health network plans (HMO, QPOS, Health Network Only, Health Network Option, Golden Medicare, and U.S. Access) generally follow Medicare's …

Pillows and Cushions - Medical Clinical Policy Bulletins

https://www.aetna.com/cpb/medical/data/400_499/0456.html

Aetna considers the MedCline Positioning Device experimental and investigational for gastroesophageal reflux disease and other indications. For the Zzoma Positional Device …

Medical Necessity Definitions | Cigna

https://www.cigna.com/health-care-providers/coverage-and-claims/policies/medical-necessity-definitions

"Medically Necessary" or "Medical Necessity" means health care services that a physician, exercising prudent clinical judgment, would provide to a patient. The service must be: For …