![]() ![]() Applies to: Aetna Choice ® POS, Aetna Choice POS II, Aetna Medicare ℠ Plan (PPO), Aetna Medicare Plan (HMO), all Aetna HealthFund ® products, Aetna Health Network Only ℠, Aetna Health Network Option ℠, Aetna Open Access ® Elect Choice ®, Aetna Open Access HMO, Aetna Open Access Managed Choice ®, Open Access Aetna Select ℠, Elect Choice, HMO, Managed Choice POS, Open Choice ®, Quality Point-of-Service ® (QPOS ®), and Aetna Select ℠ benefits plans and all products that may include the Aexcel ®, Choose and Save ℠, Aetna Performance Network or Savings Plus networks.It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. 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. The new Omnia health insurance plans provide access to all of Horizon's network hospitals with some of them being designated as Tier 1 with greater cost savings for consumers.By clicking on “I Accept”, I acknowledge and accept that: In January 2016, Horizon BCBS announced their newest endeavor to improve care quality and lower costs through their Omnia Health Alliance. The insurance provider has long been based in Newark, for many years occupying 33 Washington Street, and now owning its own building at Penn Plaza East. The company later became the nation's first Blue Cross Plan. was formed as a multi-hospital prepayment plan. Horizon BCBSNJ traces its history back to 1932 when Associated Hospitals of Essex County, Inc. Horizon Blue Cross Blue Shield of New Jersey is best known for their managed care and traditional indemnity plans for individuals and employers. ![]() It is a not-for-profit health service corporation with a 17-member Board of Directors which governs the company for its members. Horizon Blue Cross Blue Shield of New Jersey, headquartered in Newark, New Jersey is the only licensed Blue Cross and Blue Shield Association plan in New Jersey, providing health insurance coverage to over 3.2 million people throughout all of New Jersey. Horizon Blue Cross Blue Shield of New Jersey Office in Newark, New Jersey 3 Penn Plaza East ![]()
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