You can also add Part D coverage to: Supplemental Plans (more on this next) Medicare Cost Plans Medicare Medical Savings Account Plans Private Fee-for-Service Plans Now, when it comes to Medicare’s Part D coverage, there are four drug coverage phases you’ll need to learn: 1. Deductible...
Elastic support garments (e.g. made of material such as neoprene or spandex [elastane, Lycra]) do not meet Aetna's definition of covered DME because they are not durable (not made to withstand prolonged use). Note: Most Aetna traditional plans cover durable medical equipment (DME) as a st...
Brand Selection for Medically Necessary Indications for Commercial Medical Plans As defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results....
administrative activities. Acquisition cost is not disclosed and close is expected by end of year. It will be an ‘operationally independent entity’ in an Enterprise group, but complement other in-house technologies such as Interpreta. A bit of catch up here as larger plans Anthem, UnitedHealth...
Indeterminate bone lesions (IBLs) detected by WBS cause a diagnostic dilemma, which hampers further management plans. In the advent of hybrid imaging, SPECT/CT has been gaining popularity as a tool to improve the characterization of IBLs detected by WBS. As yet, there has not been a ...
and Releuko are superior to the lower cost short-acting Hematopoietic Colony Stimulating Factor: Zarxio. Therefore, Aetna considers Granix, Leukine, Neupogen, Nivestym, Nypozi, and Releuko to be medically necessary only for members who have a contraindication, intolerance or ineffective response to ...
This Clinical Policy Bulletin addresses vascular endothelial growth factor inhibitors for ocular indications for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of aflibercept [(Eylea), (Eylea HD)], aflibercept-jbvf (Yesafili...
Note: The intent of this policy is to permit the nutritional counselor to function as a consultant to evaluate the member and coordinate ongoing care with the referring physician. Some plans require referrals for nutritional counseling. Please check benefit plan descriptions. ...
Although its cost and logistical complexities hinder the current accessibility to this therapy, efforts are being made to enhance its availability, and its scope is expected to expand further. Moreover, these researchers stated that further investigations are needed to understand this therapy method in...
This Clinical Policy Bulletin addresses alpha 1-proteinase inhibitors for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note:Requires Precertification: Precertification of alpha 1-proteinase inhibitors (Aralast NP, Glassia, Prolastin-C, and Zemaira) is required of all ...