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. Working closely with these providers, UnitedHealthcare continues to pursue the delivery of an enhanced customer experience and improved health outcomes for plan members.By clicking on “I Accept”, I acknowledge and accept that: With these additions throughout California, members can access care at over 200* hospitals and from more than 22,000* providers in local communities through the Harmony network: Sharp HealthCare, UC San Diego Health, Optum (previously AppleCare Medical Group, HealthCare Partners, Monarch Healthcare), Empire Physicians Medical Group, Primary Care Associates, PrimeCare, Valley Physicians and now MemorialCare Medical Group, Beaver Medical Group and the Canopy Health Network. The Beaver Medical Group network includes many facilities with onsite lab and radiology, Redlands Oasis Pediatrics – which offers Saturday appointments, 3 urgent care centers and is affiliated with Redlands Community Hospital and Banning’s San Gorgonio Memorial Hospital. MemorialCare offers more than 2,000 physicians in Los Angeles and Orange counties through MemorialCare Medical Group, Greater Newport Physicians IPA (Long Beach, Orange Coast and Saddleback), Edinger Medical Group, four award-winning hospitals, and an extensive network of locations for primary/ specialty care, urgent care, imaging, surgery, dialysis, women’s services/breast care, and physical therapy.īeaver Medical Group celebrates its 75th anniversary as one of the largest multi-specialty medical groups in the Inland Empire, operating 14 clinics with over 200 physicians located in Riverside and San Bernardino counties.
The addition of MemorialCare and Beaver Medical Group to the Southern California Harmony network delivers broader access to care in Los Angeles, Orange, Riverside and San Bernardino counties.
The Canopy Health Network offers access to popular medical groups, including John Muir Health Physician Network, Hill Physicians Medical Group, Dignity Health Medical (Santa Cruz), Meritage Medical Network and Santa Clara County IPA.Īccess to more care in Southern California with MemorialCare and Beaver Medical Group With the addition of the Canopy Health Network, members can choose from over 5,000 doctors and 23 hospitals in 9 Bay Area counties. Previously only available in Southern California, the SignatureValue Harmony plan now offers coverage in Northern California. In the Bay Area, SignatureValue Harmony offers a performance network with a more integrated, doctor-driven care experience. Working in harmony for better health in Northern California This unique collaboration between UnitedHealthcare and local providers offers access to, patient-focused health care for employer-sponsored health coverage – now with the addition of a Northern California network and more network offerings in Southern California for members effective January 1, 2022. UnitedHealthcare SignatureValue ® Harmony plan (HMO) just got better. UnitedHealthcare SignatureValue Harmony announces expanded access to member-centered care throughout California
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