Aetna to Require Prior Authorization in 4 States

September 5, 2018
Rick Gawenda

Effective September 1, 2018, Aetna will begin requiring prior authorization for physical therapy and occupational therapy in 4 states. The 4 states are

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  1. I attended the webinar that Aetna held and they stated that Self Funded plans do not require authorization. When eligibility is checked through Navinet, the Health Benefits section will indicate if it’s a Self Funded plan. To be sure, I tried to get authorization on one of my patients who has a Self Funded plan. I received a response stating authorization is not required.

    1. JUST FYI, we send every patient with Aetna through precert because… Aetna will say that you do not need precert then when you file the claim it will be denied precert not on file. I have argued and appealed denials because aetna said no precert needed. We were told that we should have contacted the precert company, we use optum, to verify that patient does not need precert. We were burned on this a couple of times. So, we send them all and get written documentation saying that percert is not needed. Then when they try their denial tactics I have ammunition from the precert people and denial is reversed.

    1. Please read the Physical Medicine FAQ for each state as Aetna addresses not participating providers.