Patients who are currently undergoing active treatment for a medical condition – for example, patients who are in their 24th week of pregnancy, undergoing chemotherapy or in the post-operative period – may be approved for Transition of Care Coverage. This means the patient will receive his or her ongoing care for a particular medical condition at the in-network level of coverage.
Transition of Care Coverage decisions are made by Aetna. Here are the steps to follow:
- Transition of Care may be requested by either the member or the treating physician.
- The Aetna Transition Coverage Request Form (pdf) is to be completed by the member with assistance, as needed, from his or her treating physician.
- The member or the treating physician faxes the completed form to the designated Aetna fax number listed on the form: 800-228-1318.
- An Aetna medical director will evaluate the treatment program and, if necessary, establish contact with the treating physician.
- The member and the treating physician will be notified of the coverage decision in writing. If the Transition of Care request is approved, the notification will indicate the length of time for which the transition benefits apply.