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Coverage Criteria Research

 

1.  Aetna Coverage Policy Bulletins

Aetna Coverage Policy Bulletins provide public access to its Coverage Policy Bulletins on its Web site.  From the home page, you can use the scroll bar and select "coverage determinations".  Coverage Policy Bulletins can be helpful when assisting Aetna-working with consumers not insured by Aetna.  The Coverage Policy Bulletins generally list the specific criteria used by Aetna in determining whether a service or treatment is medically needed, a background section describing the treatment and conditions for which it is used, and a bibliography of references for related medical literature.

 

2.  Health Partners

Health Partners, a family of nonprofit Minnesota health care organizations, provides public access to all the services for which HealthPartners has specific coverage criteria, including those requiring prior approval. It covers medical procedures, durable medical equipment (DME), behavioral health services and Minnesota public programs services. Health Partners Behavioral Health Criteria topics include home-based mental health services, short term treatment of acute psychological illnesses, weight loss surgery, and chemical health lodging.

 

3.  Vytra Health Plans

Vytra Health Plans, is a New York-based health care organization that provides unrestricted online access to benefits information.  The Web site includes health plan descriptions, emergency benefit information, prescription drug benefit information, and more.
 

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