Get California Hmo Transition Of Care Policy And Form Public ... - Aetna

This guide provides clear instructions on completing the California HMO Transition Of Care Policy And Form for users navigating the process online. Ensuring continuity of care is essential, and this form allows individuals to request ongoing treatment from their healthcare provider under specific conditions.

Follow the steps to successfully complete your Transition Of Care form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill out Section 1 with employer information, including the employer’s name and plan control number. Ensure the plan effective date is also entered.
3. Complete Section 2 with subscriber and patient information. Provide the subscriber’s name, Aetna number, address, patient’s name, birthdate, and contact information. This information is crucial for identifying the individuals involved.
4. In Section 3, read the authorization carefully, and then sign and date the form. If the patient is 17 years or older, they must also sign the form.
5. Hand the form to your healthcare provider for them to complete Section 4, which includes their information and signature.
6. Fax the completed form to Aetna for review. It is important to note that a separate form is required for each out-of-network provider.
7. Ensure all fields are filled out accurately on each page to expedite the processing of your transition-of-care request. After submission, wait for a written decision from Aetna detailing approval or denial.

Complete the California HMO Transition Of Care Policy And Form online to ensure continuity of your care.