If you fail to provide the information, your claim will be denied. In this case, Aetna will notify you of the extension before the original notification time period has ended. A decision on your claim will be made within 48 hours after the additional information is provided.įor non-urgent pre-service and post service claims: The time frames may be extended for up to 15 additional days for reasons beyond the Plan’s control. You will then have at least 48 hours to provide the information. The time periods described in the chart may be extended.įor urgent care claims: If Aetna does not have sufficient information to decide the claim, you will be notified as soon as possible (but no more than 24 hours after Aetna receives the claim) that additional information is needed. Post-service claim: a claim for a benefit that is not a pre-service claim. With enough advance notice to allow the plan participant to appeal. Urgent care claim - as soon as possible, but not later than 24 hours, provided the request was received at least 24 hours prior to the expiration of the approved treatment.Ĭoncurrent care claim reduction or termination: a decision to reduce or terminate a course of treatment that was previously approved. Pre-service claim: a claim for a benefit that requires Aetna’s approval of the benefit in advance of obtaining medical care.Ĭoncurrent care claim extension: a request to extend a previously approved course of treatment.
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