Get Aetna Prior Authorization Form

Aetna Better Health® of California requires prior authorization for select acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services. A current list of the services that require authorization is available on ProPAT, our online prior authorization search tool.

All Aetna Medicare Advantage plan members will have 12-digit member ID numbers beginning with “10.” We will no longer use the “ME” prefix for Medicare Advantage plans after that date. Consol Energy will transition from ID numbers beginning with “ME” to those beginning with “10” on April 1, 2022.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

Medical Necessity Aetna considers magnetic resonance imaging (MRI) medically necessary for appropriate indications without regard to the field strength or configuration of the MRI unit. Aetna considers intermediate and low field strength MRI units to be an acceptable alternative to standard full strength MRI units.

Some procedures (For instance, an MRI, CAT scan or surgery.) need approval in advance. Your doctor can ask for this approval up to six months ahead of time. You can share a copy of this guide with your doctor.

Aetna considers annual low-dose computed tomography (LDCT) scanning, also known as spiral CT or helical CT scanning, medically necessary for current or former smokers ages 50 to 80 years with a 20 pack-year or more smoking history and, if a former smoker, has quit within the past 15 years.

Insurance companies often will agree to cover MRIs if patients obtain pre-approval for the imaging. This process, called prior authorization, entails giving the insurer additional information about why the doctor has prescribed the scan and what circumstances, such as an injury, led to the order.