This form for use in litigation against an insurance company for bad faith breach of contract. Adapt this model form to fit your needs and specific law. Not recommended for use by non-attorney.
Subrogation For Aetna In Nassau
Category:
State:
Multi-State
County:
Nassau
Control #:
US-000279
Format:
Word;
Rich Text
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FAQ
EAP claims should be submitted through Provider Express or on a CMS-1500 claim form using the standard "HJ" modifer in section 24D.
You can submit claims online or resubmissions through ConnectCenter.
You can submit a claim online through the member website at myaetnasupplemental. Or you can download a paper claim form or request one be sent to you by our customer service and mail it to: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512-4079.
Use the CPT Code 99404 in order to indicate the sessions is billed under EAP.
You must file claims within 120 days from the date you provided services, unless there's a contractual exception.
If you've had a health treatment or disability claim denied by Aetna, it could be because: The procedure is considered cosmetic (not medically necessary) Your doctor is out of network or doesn't participate in the plan. Your plan doesn't cover your medical condition.
Aetna Inc. Since November 28, 2018, the company has been a subsidiary of CVS Health. Aetna Inc. Aetna's headquarters in Hartford, Connecticut.