![]() The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage.Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. 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. They can provide services similar to a psychiatrist including assessments, diagnosis, and may provide treatment through medication management and therapeutic interventions.By clicking on “I Accept”, I acknowledge and accept that: These individuals are independent practitioners licensed in the state in which they practice. Psychiatric Nurse Practitioner (PNP): PNPs also called Mental Health Nurse Practitioners have master’s or doctoral degrees in psychiatric-mental health nursing.If you are interested in a psychiatrist who has a specialty be sure to inquire as to whether or not they have been trained in that specialty. Some psychiatrists have sub-specialties in the area of child psychiatry, adolescent psychiatry, addictions or geriatrics. Most often they conduct a thorough evaluation and may prescribe medications, then monitor the effects of the medications. They are commonly known as M.D.s or D.O.s. They are licensed in the state in which they practice and most are Board Certified in their specialty. Psychiatrist (Physician): Psychiatrists are Medical Doctors that specialize in psychiatry.They provide a variety of services including assessments, psychological testing for diagnostic purposes, and most offer therapy services for behavioral health conditions. They are commonly known as Psy.D or Ph.Ds. Psychologists are independent practitioners licensed in the state in which they practice. Psychologist: Psychologists generally have doctoral degrees in the area of educational, child, clinical or counseling psychology.In some cases, they may recommend that you consult with a psychiatrist, primary care physician or nurse practitioner to evaluate whether medication could contribute to achieving the best outcome. They provide various services including assessment, diagnosis, and therapy for behavioral health conditions. They are commonly known as LCSW’s, LMFTs, or LPCCs. These individuals are independently licensed in the state in which they practice. Masters Level Clinician: Masters Level Clinicians have Master’s degree in one of the following mental health disciplines: Social Work, Professional Counseling, Marriage and Family Therapy, Psychology, or Nursing.A description of the types of providers and the services they provide are listed below. We have different types of providers in our network that provide a variety of services to meet your behavioral health needs.
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