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. Information is believed to be accurate as of the production date however, it is subject to change.By clicking on “I Accept”, I acknowledge and accept that:
Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Provider participation may change without notice. Providers are independent contractors and are not agents of Banner l Aetna. This material is for information only and is not an offer or invitation to contract. 98point6 is a registered trademark of 98point6 inc. 98point6 is not available in all Banner|Aetna plans offered through employers. Aetna and CVS Pharmacy® are part of the CVS Health family of companies. Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are both within the CVS Health family.Īccess to the 98point6 application is included in all Banner|Aetna ACA individual & family plans. Aetna and Banner Health provide certain management services to Banner|Aetna. Each insurer has sole financial responsibility for its own products. Banner|Aetna is an affiliate of Banner Health and of Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance plans are offered, underwritten, and/or administered by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. It gets the providers focused on really being close to the patients and understanding what the patient's needs are and taking ownership of that.Īs an owner of Banner|Aetna, Banner Health passes along preferred unit costs for Banner|Aetna, which enables us to drive greater savings for our plan sponsors and their members. So, Banner Health Network and our team is responsible for prior authorization, case management, Multi-Disciplinary Care Team. We've transferred much of the responsibility for the care delivery model to the provider. And it enables us to bring more affordable, more connected plans to our members. We are aligned with the largest health system here in Arizona with the goal of transforming the way we deliver care. We're financially aligned to figure out ways to improve the quality and the efficiency of the care to our members. We're in a joint venture, which is the most advanced form of value-based care. We found out that, "Hmm … this is working pretty good.” Maybe we should be equity partners and we should really be building the long-term value of this. We saw some improvement in our performance. We started to see some good, shared savings.
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