How will I know if a particular medical service is covered under the Aetna Medicare OpenSM Plan?
Like all Medicare Advantage plans, the Aetna Medicare OpenSM Plan must provide those benefits covered under Original Medicare and must use Medicare coverage rules to determine which services are medically necessary. If you have a question whether the Aetna Medicare OpenSM Plan will pay for a service, including inpatient hospital services, you have the right to request a written advance coverage determination to ensure the service requested will be covered. Initial organization coverage determinations for medical services would be requested through the Aetna Patient Management Department. Coverage Determinations related to Medicare prescription drugs being offered under a PFFS plan would be requested through the Aetna Pharmacy Management Precertification Department. Contact the number on your ID card for more information. If Aetna has denied or will not pay for a service that you feel is medically necessary or would be covered under Original Medicare, you may file a Medicare Appeal with
Related Questions
- My spouse is covered under a pre-Medicare plan. Does my transition into the Aetna Medicare Open Plan affect my spouses coverage?
- How will I know if a particular medical service is covered under the Aetna Medicare OpenSM Plan (PPFS)?
- How will I know if a particular medical service is covered under the Aetna Medicare OpenSM Plan?
