Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change. (d/b/a Advanta FX), Black Diamond Investment Group LLC, Advanta Capital Markets Ltd., f/k/a Black Diamond Capital Ltd., f/k/a Black Diamond Forex Ltd. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Salerno, Black Diamond Forex LP, BDF Trading LP (d/b/a Advanta FX), Advanta Capital Markets, Inc. The member's benefit plan determines coverage. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.
As healthcare's leading source of the knowledge, processes and components we can transform your supply chain to ensure healthcare is always available. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The leading healthcare services online marketplace and the world's largest provider of medical parts, products, and solutions. Treating providers are solely responsible for medical advice and treatment of members.
The ABA Medical Necessity Guide does not constitute medical advice. 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. Secure provider website opens in secure siteīy clicking on “I Accept”, I acknowledge and accept that:.Claims, payment & reimbursement overview.Patient care programs & quality assurance.
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