We may evaluate your patient’s care while the person is in the hospital or undergoing outpatient treatment. Our goal is to help make sure the person gets the right level of care at the right time. And at a reasonable cost. A concurrent review also determines if the person’s plan covers the treatment under review.
The concurrent review process includes:
Concurrent review may be done by phone, fax or on-site at the facility.
For the purposes of this policy, "coverage" means either the determination of (i) whether or not the particular service or treatment is a covered benefit pursuant to the terms of the particular member's benefits plan, or (ii) where a provider is required to comply with Aetna's utilization management programs, whether or not the particular service or treatment is payable under the terms of the provider agreement.
More stringent state requirements may supersede the requirements of this policy.