Email: Send Email Map: View, , Trenton,Missouri Trenton Missouri Trenton,MO Trenton MO TrentonMO MO, Residential Outpatient Day Treatment Detox CPRC Chafee Healthcare Homes PBHCI SATOP Adult & Adolescent, Phone: 636-224-1500 You should always ask your physician or hospital whether they have contacted us. Fax: 660-395-0113 Note: Air ambulance may be covered. Getting started is easy, just log in to your member website at aetnafeds.com, once youre an Aetna member. Fax: 636-946-0971 For that, go to Section 5 Benefits. Map: View, , Kahoka,Missouri Kahoka Missouri Kahoka,MO Kahoka MO KahokaMO MO, Outpatient SATOP Adult, 10101 James A Reed Road Kansas City, Missouri 64134, Phone: 816-767-8090 Blood glucose control must be optimized, and psychological clearance may be necessary. CE Registry (Course Completion Certificates), Editorial Policies and Author's Guidelines, View a recording of webinar on LGBTQ+ Care for the Dental Team, NYSDA Pledges $50,000 To Vote Yes on 2 Campaign in Massachusetts, Vesting Period 2 now open | NYS Medicaid Healthcare Worker Bonus Program, On October 26, the Diversity, Equity and Inclusion Task Force will be hosting a program titled LGBTQ+ Care for the Dental Team.. Fax: 417-667-2027 Email: Send Email The Minnesota Department of Human Services (Department) supports the use of People First language. If you later want to re-enroll in the FEHB Program, generally you may do so only at the next Open Season unless you involuntarily lose coverage under TRICARE or CHAMPVA. Clinically appropriate in accordance with generally accepted standards of medical practice in terms of type, frequency, extent, site and duration, and considered effective for the illness, injury or disease; and. This law mandates that you be enrolled for Self Plus One or Self and Family coverage in the FEHB Program, if you are an employee subject to a court or administrative order requiring you to provide health benefits for your child(ren). Services provided by a family member or resident in the members home. This policy helps to protect you from preventable medical errors and improve the quality of care you receive. Apple no asume ninguna responsabilidad respecto a la seleccin, el rendimiento o el uso de los sitios web o los productos de terceros. If you have received benefits or benefit payments as a result of an injury or illness and you or your representatives, heirs, administrators, successors, or assignees receive payment from any party that may be liable, a third party's insurance policies, your own insurance policies, or a workers' compensation program or policy, you must reimburse us out of that payment. Aetna Advantage Plan Benefits (Aetna Advantage Plan) Section 5. However, certain expenses under both options do not count towards your out-of-pocket maximum and you must continue to pay these expenses once you reach yourout-of-pocket maximum. Johns Hopkins Healthcare LLC. The $150 Well Wisconsin incentive is available to you and your spouse in 2023 if you enroll in State Group Health Insurance. Fax: 816-767-8091 If both plans do not use a preferred provider arrangement, we use the lesser of Aetna's R&C and billed charges. Map: View, , Eldon,Missouri Eldon Missouri Eldon,MO Eldon MO EldonMO Adolescent, 6910 N Holmes St, Suite 231 Gladstone, Missouri 64118, Phone: 816-353-2750 See Services requiring our prior approval in Section 3. Email: Send Email Avoid using health care providers who say that an item or service is not usually covered, but they know how to bill us to get it paid. Aetna Medicare Advantage plan is subject to Medicare rules. It was officially named the North Central Region by the Census Bureau until 1984. However, you might need prior plan approval for certain services. Facilities of the Department of Veterans Affairs, the Department of Defense and the Indian Health Services are entitled to seek reimbursement from us for certain services and supplies they provide to you or a family member. You may also prove that your claim is an urgent care claim by providing evidence that a physician with knowledge of your medical condition has determined that your claim involves urgent care. Psychiatric office visits to Behavioral Health practitioner, Substance Use Disorder (SUD) office visits to Behavioral Health practitioner, Routine psychiatric office visits to Behavioral Health practitioner, The services take the place of a stay in a hospital or a residential treatment facility, or you are unable to receive the same services outside your home, The skilled behavioral health care is appropriate for the active treatment of a condition, illness or disease to avoid placing you at risk for serious complications. Out-of-network:Nothing up to our Plan allowance for four (4) smoking cessation counseling sessions per quit attempt and two (2)quit attempts per year. Map: View, College Road, Springfield,Missouri Springfield Missouri Springfield,MO Springfield MO SpringfieldMO MO, spfld,sfld,spg,sgf, brooke care Chafee Transitional Living, 1111 S Glenstone Ave Springfield, Missouri 65804, Phone: 417-869-8911 Please see www.aetnafeds.com for information on Teladoc service. Your annual out-of-pocket expenses for covered services, including deductibles, coinsurance and copayments cannot exceed $7,500 for Self Only enrollment, $15,000 for Self Plus One enrollment, or $15,000 for Self and Family enrollment for in-network services or $10,000 for Self Only enrollment, $20,000for Self Plus One enrollment, or $20,000for Self and Family enrollment for out-of-network services. Fax: 573-603-1462 An emergency medical condition is one manifesting itself by acute symptoms of sufficient severity such that a prudent layperson, who possesses average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the persons health, or with respect to a pregnant woman, the health of the woman and her unborn child. When our initial decision is based (in whole or in part) on a medical judgment (i.e., medical necessity, experimental/investigational), we will consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment and who was not involved in making the initial decision. Email: Send Email Customer service 888-238-6240, www.jointcommission.org/topics/patient_safety.aspx, www.opm.gov/healthcare-insurance/life-events, www.aetna.com/health-care-professionals/precertification/precertification-lists.html, https://www.uspreventiveservicestaskforce.org, https://www.healthcare.gov/preventive-care-women/, https://www.cdc.gov/vaccines/schedules/index.html, www.aetna.com/health-care-professionals/clinical-policy-bulletins/medical-clinical-policy-bulletins.html. Online customer service that allows you to request member ID cards, send secure messages to Member Services, and more. Benefits are effective January 1, 2022, and changes are summarized in Section 2. Email: Send Email Our effort to manage the services provided to you includes the retrospective review of claims submitted for payment, and of medical records submitted for potential quality and utilization concerns. We will make our decision within 15 days of receipt of the pre-service claim. Insertion of internal prosthetic devices. Email: Send Email In most cases, providers and facilities file claims for you. In-network and out-of-network deductibles do not cross apply and will need to be met separately for traditional benefits to begin. You may call OPM'sFEHB 3 at 202-606-0737, Association of Insurance Commissioners (NAIC) guidelines. Our Plan allowance is the amount we use to determine our payment and your coinsurance for covered services. For more information visit www.aetnafeds.com. Box 767 Kirksville, Missouri 63501, Phone: 660-665-1962 Medical Preventive Care) and is not subject to your calendar year deductible. OPM is the United States Office of Personnel Management. Note: We cover related medical and hospital expenses of the donor when we cover the recipient. You may enroll, change, or cancel your AD&D coverage at any time. You can also contact us to request that we mail a copy to you. Map: View, Bridgeway, Winfield,Missouri Winfield Missouri Winfield,MO Winfield MO WinfieldMO MO, Bridgeway, BBH, The Farm Residential Adolescent. Email: Send Email At that point, we pay eligible medical expenses for the remainder of the calendar year at 100%. If you or a covered family member move or live outside of our service areas, you can continue to access out-of-network care or you can enroll in another plan. The remaining balance of the Self Plus One or Self and Family deductible can be satisfied by one or more family members. Fax: 636-224-1249 Map: View, Champion Center, Springfield,Missouri Springfield Missouri Springfield,MO Springfield MO SpringfieldMO MO, spfld,sfld,spg,sgf Outpatient RPG Adult, 2411 W Catalpa St Springfield, Missouri 65807, Carol Jones, Springfield,Missouri Springfield Missouri Springfield,MO Springfield MO SpringfieldMO MO, spfld,sfld,spg,sgf Residential Outpatient Day care WomenAdult, 4145 S McCann Ct, Suite F Springfield, Missouri 65804, Phone: 417-877-2004 Psychologists Any claims that are not pre-service claims. In other words, post-service claims are those claims were treatment has been performed and the claims have been sent to us in order to apply for benefits. These conditions and errors are sometimes called Never Events or Serious Reportable Events.. Email: Send Email Extended care benefit: All necessary services during confinement in a skilled nursing facility with a 60-day limit per calendar year when full-time nursing care is necessary and the confinement is medically appropriate as determined by a Plan doctor and approved by the Plan. Si no ves tu banco a continuacin, vuelve a revisar la lista pronto. You can also file a civil rights complaint with the Office of Personnel Management by mail at: Office of Personnel Management, Healthcare and Insurance, Federal Employee Insurance Operations, Attention: Assistant Director, FEIO, 1900 E Street NW, Suite 3400-S, Washington, DC 20415-3610. You must also tell us about other coverage you or your covered family members may have, as this coverage may affect the primary/secondary status of this Plan and Medicare. www.opm.gov/healthcare-insurance/healthcare/plan-information/. OWCP or a similar agency pays for through a third-party injury settlement or other similar proceeding that is based on a claim you filed under OWCP or similar laws. Outpatient services provided and billed by a hospital or other covered facility including other outpatient mental health treatment such as: * Note: If you enroll in Aetna Advantage and are covered by Medicare Part A and B and it is primary, we offer an Aetna Medicare Advantage plan to our FEHB members. Discount offers are not offers of insurance. Any expenses paid by the Plan under your In-network Preventive Care benefit, Expenses in excess of our Plan allowance or maximum benefit limitations or expenses not covered under the Traditional medical coverage, Any coinsurance expenses you have paid for infertility services, The $500 penalty for failure to obtain precertification when using a Non-network facility and any other amounts you pay because benefits have been reduced for non-compliance with this Plans cost containment requirements, Section 5. Map: View, Bridgeway, Warrenton,Missouri Warrenton Missouri Warrenton,MO Warrenton MO WarrentonMO MO, Bridgeway, BBH Outpatient SATOP Adult, 359 Shockdrake Ct. Wentzville, Missouri 63385, Phone: 636-856-0614 Map: View, Employment Services, Nevada,Missouri Nevada Missouri Nevada,MO Nevada MO NevadaMO MO, Chafee Transitional Living shared address, Phone: 417-667-4638 Treatment for solid organ transplants are subject to Medicare rules it does not participate in Medicare, you not. 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