Get Aetna Gc-1395-4 2010-2025
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How to fill out the Aetna GC-1395-4 online
The Aetna GC-1395-4 form is a Transition Coverage Request that allows users to request approval for ongoing care from out-of-network healthcare providers. This guide provides a clear and supportive walkthrough for completing the form online, ensuring that all necessary information is submitted correctly.
Follow the steps to complete the Aetna GC-1395-4 form online.
- Click ‘Get Form’ button to access the Aetna GC-1395-4 form and open it in your preferred online document editor.
- Complete Section 1 labeled 'Employer Information'. Fill in the employer's name, group number, and the plan effective date as required. Ensure the information is accurate and legible.
- Move to Section 2 titled 'Employee and Member Information'. Enter the employee's name, social security number, or Aetna identification number, employee address, birthdate, member's name, and telephone number as indicated.
- In Section 3, read the authorization statement carefully. You, or the patient if they are 17 years or older, must sign and date the form. If the patient is younger than 16, a parent's signature is required.
- After completing the above sections, provide the form to the treating doctor. They need to complete Section 4, which is 'Doctor Information'. This includes the name, address, and telephone number of the doctor, the date, and their signature.
- Once the doctor has filled out Section 4, ensure that the completed form is faxed to SRC, An Aetna Company, at 1-859-455-8650 for review.
- Lastly, make sure to save your changes, download the completed form for your records, print a copy if needed, or share it as required.
Complete your Aetna GC-1395-4 form online to manage your transition coverage request efficiently.
The class action lawsuit against Aetna addresses concerns over claim denials and the handling of policyholder claims. Many consumers allege that Aetna improperly denied claims that should have been covered under their plans, including Aetna GC-1395-4. This lawsuit aims to hold Aetna accountable and ensure fair treatment for all policyholders. If you believe you have been affected, consult with legal experts and consider seeking information through uslegalforms to understand your rights.
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