["Please refer to the glossary.","Care encourages the use of the preferred drugs on this list to help control rising prescription drug costs.","TRS will tell you in advance.","Emergency Services also include outpatient visits and referrals for emergency mental health problems.","CPP was difficult, as conditions may be considered part of the differential diagnosis or a concomitant condition.","Only a doctor may fax a prescription.","MENTAL OR NERVOUS DISORDER OR CONDITION.","Stiglmayer N, Lesin M, Juri J, et al.","Failure of baclofen and at least one other formulary muscle relaxant such as dantrolene.","Congenital defects and birth abnormalities and Reconstructive Surgeryrelatedto the same, when specific criteria are met.","These amounts will not change the negotiated charge under this plan.","With ongoing research, the spectrum of clinical applications and number of people receiving Botox will no doubt increase.","Patients with definite or probable multiple sclerosis, and disabling spasticity affecting the hip adductor muscles of both legs, were randomized to one of four treatment groups.","The numbers found in the drug lists represent copay tiers.","The condition is, however, occasionally resistant to such therapy.","Triad Healthcare New Jersey IPA, Inc.","It is also known as coccygodynia, diaphragma pelvis spastica, levator ani syndrome, levator spasm syndrome, spastic and pelvic floor syndrome.","The use of botulinum toxin for spasticity after spinal cord injury.","Eligible Dependents: Coverage for dependentsof students eligible under the Plus Plan will be for the following Coverage Periods.","Some services require prior authorization in addition to a referral.","Your doctor may need you to schedule a visit before he or she will write you a new prescription.","Bruxism Palatal Myclonus nerve palsy synkinesis Are symptoms characterized by sudden, unilateral, synchronous contractions of muscles innervated by the facial nerve?","If Medicare does not have a rate, we will determine the rate as follows: Use the same method CMS uses to set Medicare rates.","Coinsurance is a percentage of the rate that Aetna negotiates with the plan sponsor for covered prescriptions except as required by law to be otherwise.","Schurch B, de Seze M, Denys P, et al.","There are a number of reasons why your insurance company may require certain medications be reviewed and approved before your plan covers them.","This is the coinsurance amount that the plan pays.","Quantity Limits: For certain drugs, our plan limits the amount of the drug that we will cover.","For example, your protected health care you received.","If the patient is opposed to the specific physician recommended, another physician should be sought.","An individual must already be enrolled in Medicare Parts A and B in order to enroll in a Medicare Part C plan.","Our reimbursement policies may affect the recognized charge.","Transportation for outpatient care.","This drug coverage review limits coverage of quantities for certain drugs.","The care and treatment must be prescribed in a hospital or convalescent facility.","Persaud R, Garas G, Silva S, et al.","While patients often ask their physicians to file an appeal on their behalf, physician involvement does not necessarily improve the outcome.","Make checks and money orders payable to CVS Caremark and write your CVS Caremark ID number on the front.","Schedule of Benefits Shall mean the Schedule of Benefits provided with this document.","When a patient refuses to be referred to another physician, the attending physician should find out why and attempt to correct any problem.","The treatment of internal anal sphincter achalasia with botulinum toxin.","These will be covered when you get them in either a group orindividual setting.","What do health insurance companies base prior authorizations on?","The author summarized the treatment of diffuse esophageal spasm, including pharmacotherapy, endoscopic treatment, and surgical treatment with a special focus on botulinum toxin injection.","The Department will continue to assist members regarding Leaves of Absence, Medicare, enrollment and eligibility information as well as answer your benefit questions or refer you to the appropriate resource for assistance.","Courtordered intoxication evaluations, programs or treatments or therapy related to judicial or administrative proceedings or orders, when employer requested or when required for school.","Please select your country where you live.","Timeframes for deciding an appeal The amount of time that we have to tell you about our decision on an appeal claim depends on the type of claim.","Membership or service fees associated with health clubs, weight loss clinics and fitness programs.","Professional ground mbulance transportation is not available.","If you do not preauthorize, your benefits may be reduced, or the planmay not pay any benefits.","Your Surgeryreconstructsthe breast where a necessary mastectomy was performed, such as an planand areolar reconstruction.","Specialty pharmacy: How to enroll.","You can still purchase the drug, but for the full price.","Please know that Harvard Pilgrim is not responsible for the availability, privacy or security of the website you are about to visit, nor are we responsible for the information it provides.","Cessation of frontalis contraction could be achieved with a single injection of Botox.","Indeed, providers who commit fraud likely do not make documentation errors.","Experimental or have not been shown to be clinically effective for the medical condition being treated.","Medicare Part A does not require a monthly premium contribution from Plan Participants with enough earned work credits.","The assessment also stated that while many clinicians utilize electromyographic targeting for laryngeal injections, the utility of this technique is not established in comparative trials.","Botulinum toxin for myofascial pain syndromes in adults.","Charges for services or supplieswhich are for the primary purpose of controlling or changing your environment or providing you with a rest cure or respite care.","Then analyze the data looking for trends.","However, she experienced painful muscle spasms in her toes of the feet that limited her gait.","Subjective results and side effects were assessed.","Means Committee, one of the two committees in the House that has jurisdiction on healthcare policy.","If need help filing a grievance, the Aetna Medicare Customer Service Department is available to help you.","The use of botulinum toxin for the treatment of urologic pain.","Lang R, White PJ, Machalicek W, et al.","When this happens in a year, the individual deductibles for you and your covered dependents are met for the rest of the year.","Unexpected mass immunizations directed or ordered by federal, state or local public health officials for general population groups.","Safety and efficacy of botulinum toxin in hemifacial spasm.","It was not possible to establish dose effect information.","ID number is on the bill.","When a preapproval is issued by Aetna, the benefit level is the same as for network Providers.","Chlamydia infection screening for younger women and other women at higher risk.","BTX injection into epicardial fat pads for preventing atrial tachyarrhythmias.","Otolaryngol Clin North Am.","Each review author independently assessed study abstracts identified from the electronic and manual searches.","Specialized case management by nurses experienced in coordinating complicated transplant care.","Detrol LA, Enablex, Gelnique, Myrbetriq, Oxytrol, Toviaz, VESIcare, or Sanctura.","Your Surgeryneeded to improve a significant functional impairment of a body part.","Care Customer Service at with questions before you make health care decisions.","Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract.","De Laet K, Wyndaele JJ.","There is no reimbursement for meals.","COBRA coverage ends if: Coverage has continued for the maximum period.","Plan must also be attached to the claim.","How much you pay for a Part D drug depends on which drug payment stage you are in.","Finally, there was a word on the organization of services.","Medical Necessity Medical Necessity is a requirement for you to receive an Eligible Health Service benefit under this Plan.","It is essential to know which of these the insurance company requires, who is responsible for obtaining them, and how to handle denials when these are absent.","The surviving spouse must elect coverage in order for the dependent children to be covered.","Holtgrewe Legislative Fellowship program.","You may also log www.","Chang CS, Wallace CG, Hsiao YC, et al.","Chow TL, Kwok SP.","Care or Covered y COBRAcoveredalso not covered.","Or are used for the treatment of the same or similar disease or Injury.","To obtain precertification, call us at the telephone number listed on your ID card.","It is usually the date of the court order or the first day of the month following the qualifying event date.","You might also be asked to upload clinical at the beginning of the case submission process.","BTX A is a novel safe and effective technique for the treatment of muscle spasticity by SCI.","The authors concluded that these findings suggested a potential benefit from botulinum toxin A treatment in dysphagia associated with diabetic neuropathy.","Please review this document to make sure that it still contains the drugs you take.","Your Physicianis available to provide guidance and direction in situations that mayrequire Urgent Care.","Reconstruction of the breast upon whithe mastectomy was performed.","Moreover, they stated that further clinical studies in larger patient samples are needed to prove the safety and effectiveness of BTX injections used for the treatment of depressive disorders.","The search strategy was composed of terms for myofascial pain and botulinum toxin.","The attending physician should ensure that the receiving physician will accept the patient before making the referral.","Farooque F, Jacombs AS, Roussos E, et al.","Because a court order requires it.","Aetna will provide more information regarding how to file a request for external review as part of its final benefit determination.","Atmore than the covered person is legally obligated to pay.","Routine inpatient Hospitalnursery charges.","Recognized charge doesnot apply to involuntary services.","If your plan requires precertification, you will find a list of drugs that are subject to precertification with this guide.","The prescribing provider responds to requests for additional information.","Compression garmentsfor treatment of lymphedema Your plan only covers the same type of DME that Medicare covers.","Home health care is generally covered but it is a covered benefit only up to a set number of visits a year.","Aetna and its affiliates are not responsible for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.","The patient reported relief of spasms and pain, enabling her to wear an advanced reciprocating gait orthosis and facilitating rehabilitation programs.","Aetna Rx Home Delivery receives your order.","Aetna will contact the ERO that will conduct the review of your claim.","These investigators noted that more research in this area is essential to further define this tool in the treatment of chronic pelvic pain.","Abnormal vocal cord movement treated with botulinum toxin in patients with asthma resistant to optimised management.","It is important to educate providers as well as their patients on the importance of waiting for these medical reviews to come back approved for coverage.","HIPAA standards protect the confidentiality of medical records and other personal health information, limit the use and release of private health information, and restrict disclosure of health information to the minimum necessary.","Services must be medically necessary and provided by a behavioralhealth provider with the appropriate license or credentials.","You may benefit from the treatment based on published, peerreviewed scientific evidence.","Personal comfort or convenience items.","OTC drugs when obtained at a retail network pharmacy.","Intramuscular pressure before and after botulinum toxin in chronic exertional compartment syndrome of the leg: A preliminary study.","Text STOP to cancel.","However, few have been successful.","Examples are endometriosis Surgery, for men, varicocele Surgery.","This includes: All charges associated with: Surrogacy for you or the surrogate.","We will tell you and your physician in writing of the precertification decision, where required by state law.","Please read this handbook carefully as it contains vital information about your benefits.","Botulinum toxin A for myofascial pain syndrome: A review of the clinical effectiveness.","You can call the number on your ID card or write See the How to contact us for help section.","The return on investment in insurance reimbursement and patient experience alone is worth the cost of having this expertise at your institution.","Geneticrisk counseling for breast and ovarian cancer Eligible health services include the counseling and evaluation services to help you assess whether or not you are at increased risk for breast and ovarian cancer.","These researchers examined if Botox would improve symptoms to a significantly greater extent than placebo.","But, you will not be able to proceed directly to external review if: The rule violation was minor and not likely to influence a decision or harm you.","Evidence of Coverage and other plan materials.","Immediate approvals for covered, medically necessary outpatient services.","Est\u00e1s saliendo de nuestro sitio web de Medicare.","You can access the list of specialty prescription drugs.","Below are insurance updates from national insurance carriers.","Current evidence for the use of botulinum toxin type A in the management of children with cerebral palsy: A systematic review.","If CVS Caremark ever has a question about your prescription, a CVS Caremark pharmacist will contact your doctor prior to dispensing the medication.","Lower relapse rate of botulinum toxin A therapy for axillary hyperhidrosis by dose increase.","Unsecured protected health information is protected health information that is not secured through the use of a technology or methodology that renders the protected health information unusable, unreadable or indecipherable.","If the first rule does not apply, the sequence is followed until the appropriate rule that applies is found.","Why is the formulary subject to change?","ID number and a recent prescription number available.","How do I get a prior authorization?","Care pays a larger portion of your health care costs.","Help with walking, grooming, bathing, and dressing, getting in or out of bed, going to the bathroom, eating or preparing foods.","BCBSIL before you are admitted to the hospital for routine care.","No Additional information the prescribing provider feels is important to this review.","Plus Plan during the policy year.","With this type of pharmacy, you can get this medicine sent right to your mailbox.","Removal of breast implantsregardless of their indication for placement due to alleged or diagnosed systemic or rheumatologic disorders.","Department of Health and Human Services at www.","These researchers assessed the evidence in the literature regarding the role of BTX injection in the management of gummy smile.","You should include copies of any records or documents that you think are important.","If the employee or covered person retains an attorney, then the employee or covered person agrees to only retain one who will not assert the Common Fund or Made Whole Doctrines.","Group Insurance Division will be final and binding on all parties.","Care may be custodial care even if it prescribed by a physician or given by trained medical personnel.","For more information about the network and the role of your PCPsee the Who provides the care section.","Your coverage may be extended if you or your dependents are getting inpatient care in hospital orskilled nursing facility when coverage ends.","Attach the itemized bill from the Provider of services to the claim form.","Your doctor may need to provide additional information to Express Scripts.","The treatment must be done in the calendar year of the accident or the next subsequent year.","Custodial or rest care.","This means when you take part in a riot in any way such as inciting, or conspiring to incite, the riot.","Restivo D, Panebianco M, Casabona A et al.","Ron Y, Avni Y, Lukovetski A, et al.","Ask your doctor if a prescription medication is going to require prior authorization so they can start the process immediately.","State Sales tax exempt certificate must be on file and taxable items cannot be ordered online.","Eyeglass frames, prescription lenses and prescription contact lenses Adult vision care services and supplies Your plan does not cover adult vision care services and supplies, except as described in the Eligible health services under your plan Other services section.","Utilization Review Accreditation Commission.","For example, step therapy programs do not apply to fully insured members in Indiana.","Prior Authorization forms are available via secured access.","However, the quality of this evidence was low.","Prevailing charge rate is the percentile value reported in a database prepared by FAIR Health, a nonprofit company.","Description of the effectiveness of this treatment.","The service or supply must be widely accepted professionally in the United States as effective, appropriate, and essential, based upon recognized standards of the health care specialty involved.","Cervical dystonia pathophysiology and treatment options.","You have access to an extensive network of vision locations.","Bisitahin ang aming website o tawagan ang numero ng telepono na nasa inyong identification card bilang miyembro.","Plan in certain circumstances.","You have the right to a full and fair impartial review of your appeal.","Endoscopic injection of botulinum toxin is presently the best studied treatment option but many questions remain unanswered.","Caterpillar Employer Plan has created a new form that applies to prior authorization requests for Erleada.","See the How to contact us for help section for details.","Dependent Children of Parents with Joint Custody The birthday rule applies to Dependent children of parents with joint custody.","The authors concluded that botulinum toxin A for the prophylactic treatment of episodic migraine headaches was not significantly different from placebo, both from a clinical and statistical perspective.","The authors concluded that injection with BTX is a novel, safe, and cosmetically effective treatment for gummy smile when performed by experienced practitioners.","Metoprolol andpropranolol in migraine prophylaxis: a doubleblind multicenter study.","On weekends or holidays when a prescriber says immediate service is needed.","Postal Service zip codes.","Is My Case Urgent?","If you have questions, refer to the website www.","As with absent referrals, not all insurance companies allow this.","The care of the donor in donor egg cycle.","Oxygen and its administration.","Controversies in migraine management.","Date range: Failed a trial of gabapentin?","Step therapy is a type of prior authorization.","Learn more, see if you are eligible, and find a study location near you!","These fees will be the same as the fees allowed under the Texas Public Information Act.","If you are treated by a provider or hospital that is not a preferred provider, you may be billed for anything not paid by the insurer.","Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction.","These symptoms have been reported hours to weeks after injection.","IMPORTANT HEALTH CARE REFORM NOTICES CHOICE OF PROVIDER If your Aetna plan generally requires or allows the designation of a primary care provider, you have the right to designate anyprimarycare providerwhoparticipatesinour networkandwhoisavailable toacceptyouoryour family members.","This notice is on the TRS website, and TRS will post any new www.","For more information about Aetna plans, refer to www.","Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice.","Coveredfor the followingiagnostic tests and procedureshat isconsidered to be Experimental or Investigational.","The Index provides an alphabetical list of all of the drugs included in this document.","Check your settings to make sure you receive your alerts and emails.","Aetna Life Insurance Company.","What are your COBRA rights?","However, medical documentation will be required to determine incapacitation.","There is no room charge made by the hospital or treatment facility.","What will your PCP do for you?","These parties are required to keep personal information confidential as provided by applicable law.","If the patient does not want to change physicians, the attending physician should carefully explain to the patient why this is impossible.","An additional objective was to ascertain if there is an acceleration of gastric emptying after injection.","Your benefits may be reduced, or the plan may not pay any benefits.","BTX in the treatment of major depression.","Screenings and counseling services as provided for in the comprehensive guidelines recommended by the Health Resources and Services Administration.","Most times when a payer offers an out of network referral the special will only be reimbursed at Medicaid rates.","Yelnik AP, Simon O, Bensmail D, et al.","Prior authorization is designed to help prevent you from being prescribed medications you may not need, those that could interact dangerously with others you may be taking, or those that are potentially addictive.","This dystonia can be incapacitating and has been exceptionally resistant to treatment with oral medications.","Eligible health services under your plan Outpatient prescription drugs What precertificationrequirementsapply.","Total Rewards is the holistic way we reward our employees.","For more information about the Coordination of Benefitsprovision, includingdetermining which plan is primary and which is secondary, you may call the Member Services telephone number shown on your ID card.","Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC.","Overall, all the studies demonstrated improvement in pain and favorable side effect profile without any major AEs.","Illnesses that greatly reduce life expectancy and are unlikely to be improved with weight reduction, including but not limited to cancer, symptomatic coronary artery disease, and endstage renal disease.","This bill makes clear that the impact of the proposed project on all people to whom services may be provided, not only residents of the service area, must be considered in determining whether or not to grant a certificate of need.","Due to the risk of urinary retention, treat only patients who are willing and able to initiate catheterization post treatment, if required, for urinary retention.","Highmark Blue Cross Blue Shield of Delaware has added reauthorization criterion requiring documentation of clinical benefit and tolerance to therapy in their Botox Pharmacy Policy.","Baillieres Best Pract Res Clin Gastroenterol.","Financial or legal counseling.","You should send the bill to the address listed on the back of your ID card, and we will resolve any payment dispute with the rovider over that amount.","Headache Clinics and Headache Specialists carry more weight with insurance companies than your GP or average neurologist.","This may include providing preventive health services, obtaining authorization of certain services, consulting with Specialists and other Providers, and Emergency Services.","The studies were evaluated according to their design and the selection of outcome measurements, and the interpretation of results.","You are responsible for the entire cost of any additional pieces of the same or similar equipment you purchase or rent for personal convenience or mobility.","As a new or continuing member in our plan you may be taking drugs that are not on our formulary.","Upon your request, we will send you a nonelectronic version of the directory at no cost to you.","You can access the list of these specialty prescription drugs.","Medicare eligibility upon application and enrolls eligible Plan Participants into the Medicare program.","COBRA or state continuation coverage is secondary to the plan that covers the person as an employee or retiree, or the dependent of an employee or retiree.","It is not a complete list.","Members who do not enroll in Medicare Parts A and B, are responsible for the portion of healthcare costs that Medicare would have Covered.","She underwent laparoscopic and vaginal pelvic floor reconstruction with excision of endometriosis.","All patients had some degree of flexion at the proximal metacarpophalangeal joints and required injections into the lumbricals.","Nursing facility Facility for the aged Psychiatric hospital Residential treatment facility for substance abuse Residential treatment facility for mental disorders Extended care facility Intermediate care facility Skilled nursing facility Illness Poor health resulting from disease of the body or mind.","Think of tier as a level.","What if my drug is not on the Formulary?","To get updated information about the drugs covered by our plan, please contact us.","Step Therapy, which varies by plan.","To satisfy this family deductible for the rest of the year, the combined eligible health services that you and each of your covered dependents incur towards the individual deductible must reach this family deductible in a year.","Botox reduces symptoms and accelerates gastric emptying in idiopathic and diabetic gastroparesis.","File a complaint or appeal with the Arizona Department of Insurance.","Botox is used in combination with other anticholinergic agents from experimental and investigational to medically necessary.","Any Injury or Illness arising from or sustained in the course of any occupation or employment for pay, profit or gain.","These investigators decided on prompt surgical treatment, and the sialocele was completely excised.","Injuriesthat occur during medical treatments are not considered accidental injuries, even if unplannedor unexpected.","TRS may alter the Plan provisions or costs at any time.","HMO plans with a Medicare contract.","The level of evidence across studies was very low to moderate.","Koman LA, Brashear A, Rosenfeld S, et al: Botulinum toxin type a neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, openlabel clinical trial.","Only the level required by the law will be counted.","What if my prior authorization is rejected?","Cochrane Database Syst Rev.","Authorizations are only required for certain services.","Nothing in this Booklet shall be construed as a waiver of sovereign immunity on behalf of TRS or of those individuals or entities acting on its behalf.","Covered according to the type of benefit and the place where the service is received.","Use of botulinum toxin type A in a case of persistent parotid sialocele.","Predeterminations are recommended for procedures involving the mouth, teeth and jaw.","We will apply the largestcharge first whentwoormore chargesare receivedatthe same time.","Wang J, Wang Q, Wu Q, et al.","In our health plans, participating network providers are also required togive youaccesstoyour medicalrecordswithinareasonable amountoftime afteryoumake arequest.","See the schedule of benefits for details on supply limits and cost sharing.","Eligible Healthervices include the expense of renting or buying DME and accessories you need to operate the item from a DME supplier.","Maintenance care Care made up of services and supplies that maintain, rather than improve, a level of physical or mental function except for habilitation therapy services Medical supplies outpatient disposable Any outpatient disposable supply or device.","How Do I Pay My Insurance Bills?","Digre KB for the American Headache Society.","This committee can make recommendations to change the tier level of a drug or to place it on our Formulary Exclusions List, designating it as a drug that is no longer covered.","Effectiveness was assessed periodically by the Modified Ashworth Scale and a battery of functional outcome measures.","Castiglione A, Bagnato S, Boccagni C, et al.","In this case, Eligible ealthervices do not include those organ transplanservices for the recipient.","In absence of diagnostic tests for our invisible disease, this is pure gold.","Care pays covered medical expenses based on reasonable and customary charges.","Once we complete our clinical review, we also consider overall value before adding or removing a drug from the formulary.","Persistent anterior knee pain is difficult to treat and many individuals eventually consider a surgical intervention.","The fee for the summary or explanation will be in addition to any copying, labor, and postage fees that TRS may require.","Also, mention any anticipated significant adverse events.","Find the documents and forms you need to request specialty medications.","Eligible Health Services when medically appropriate, regardless of identified gender.","TRS or ERS on or before Aug.","ALL initial authorization criteria.","Important note: You may continue coverage for a disabled child past the age limit shown above.","Submit charges to Navitus on a Universal Claim Form.","Mail or fax, or they can contact our call center to speak to a Prior Authorization Specialist.","You may apply online at www.","Lydiatt WM, Quivey JM.","LBP of any duration.","ID card in the How to contact us for help section.","Any additional treatment regimens will be subject to the cost sharing in your schedule of benefitsabove.","The information on this site is intended for US medical professionals only.","Eligible health services The health care services and supplies listed in the Eligible health services under your plan section and not listed or limited in the Exclusions section or in the schedule of benefits.","Visits to a Hospitalmergency room when you do not have an Emergency Medical Condition.","If you paid part or all of your deductible under other coverage for the year that this plan went into effect, we will deduct the amount paid under the other coverage from the deductible on this plan for the same year.","The purpose of the surgery is to improve function.","Botulinum toxin for neuropathic pain?","If your provider does not submit the claim, you will be required to submit the charges yourself.","You may want to work with your provider of care to ensure that all the relevant information regarding your case is submitted for appeal.","Pharmacological treatment of neurogenic detrusor hyperactivity: intradetrusor botulinum toxin A injections.","Try to stay calm, even though the appeals process can be frustrating.","Botox is not indicated in patients receiving aminoglycosides, which may interfere with neuromuscular transmission.","The authors concluded that PPP, tissue expanders and BTX were safe and feasible methods for abdominal wall expansion prior to incisional hernia repair.","The authors stated that their findings suggested that botulinum toxin can be useful in some children that have persistent disability secondary to obstetrical brachial plexopathy.","Please check the URL or go back a page.","Use of botulinum toxin for treatment of nonneurogenic lower urinary tract conditions.","Bone Joint Surg Br.","Successful use of botulinum toxin type a in the treatment of refractory postoperative dyspareunia.","Brueseke TJ, Lane FL.","When it iscertified, we cover the instruction and appropriate services needed for a member to learn how to properly use the item.","This means that your copayment or coinsurance will vary, depending on who provides the service to you and where you receive the service.","Any additional outpocket expenses incurred will not count toward your deductibles or maximum outpocket limits.","Be staffed by psychiatric physicians involved in the treatment program, treatment day.","EO release holds potential as an adjunct in the repair of large ventral hernia defects.","If any portion of claim is contested by us, the uncontested portion of the claim will be paid promptly after the receipt of proof of loss.","You can request a claim form from us.","This will help us effectively deliver your benefits.","Hospitals have approval from CMS for solid organ transplantation.","Botulinum toxin for migraine prevention.","The participation status of Providers may change from time to time.","TRS also does not maintain your current medical records.","This plan is secondary to Medicare in all other circumstances.","Nonepileptic paroxysmal disorders in adolescents and adults.","For information on precertification, contact your plan administrator.","If coverage is authorized, you simply pay your normal copayment for the medication.","Coordination of Benefits provision is contained in the Policy issued to Texas Christian Universityand may be viewed online atwww.","Emergency Services Transportation services, including, but not limited to, Ambulance services, and Covered inpatient and outpatient Hospital services furnished by a Provider qualified to furnish those services that are needed to evaluate or stabilize an Emergency Medical Condition.","CVS Caremark can link online accounts for patients and their caregivers.","Claims payment is subject to the actual information and charges submitted.","Will my insurance cover Botox injections for migraines?","Botox is an effective prophylactic treatment for chronic migraine.","Screening procedures involved physical examination of the scar as well as subcutaneous injection of local anesthetic.","Aetna to offer these services.","Sleep studies provided withinthe home.","Atlantic Section President Dr.","Your complaint should include a description of the issue.","Overthecounter or convenience items.","With this health benefits and health insurance plan, the amount you pay depends on the drug your doctor prescribes.","What Marketplace Plans are accepted by Cleveland Clinic?","Services and supplies given by a provider to remove an organ from your body for the purpose of donating or selling the organ except as described in the Eligible health services under your plan section.","For emergency servicesprecertification is not required, but you should notify us within the timeframes listed below.","When is your first premium payment due?","Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA Privacy Regulations.","No other dependents are eligible under the Basic Plan.","It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels.","The treatment plan will contain the goals of therapy, the exercise prescription, and measurable objectives.","In addition, the authorization may stipulate certain restrictions.","Please select a topic.","Is the prescribing physician an oncologist or urologist?","The study investigators reported no major AEs.","We encourage providers to submit precertification requests for scheduled services at least two weeks in advance.","Care in lieu of detention or correctional placement or that is required to be treated in a public facility.","It is rare that you should ever need two drugs from the same class to treat a medical condition.","The patient should understand that after making appropriate care available, the attending physician will withdraw from the case.","BT treated patients diagnosed with EPT were identified in the literature.","This does not keep you fromgetting prescription drugs that are not covered benefits.","Postdoctoral Fellows are given the choice to enroll in either the Basic Plan or the Plus Plan.","The application of botulinum toxin in the prostate.","Print and complete this form for medical, dental, vision, hearing, or vaccine reimbursement.","However, a deductible and coinsurance will apply to most covered services.","Home health care plan A plan of services prescribed by a physician or other health care practitioner to be provided in the home setting.","Surviving spouse and surviving dependent children coverage will continue so long as the monthly payment is made.","You have to meet your policy year deductible before this plan pays for benefits.","For details on the guidelines and the current list of covered risk reducing breast cancer prescription drugs, see the How to contact us for help section.","Please type your first name.","Home ovulation prediction kits or home pregnancy tests.","Reference the criteria, both prior authorization policies and clinical policies that do not require prior authorization, that Harvard Pilgrim utilizes to evaluate medical appriopriateness of health care services.","Karsenty G, Corcos J, Schurch B, et al.","Harvard Pilgrim uses written criteria based on sound clinical evidence to evaluate the medical appropriateness of health care services.","Mouse neutralization antibodies were negative.","If a service is Medically Necessary but not specifically listed and not otherwise excluded, the service is not an Eligible Health Service.","The authors concluded that unilateral BTA injection into the affected parotid gland produced a decrease in the severity of symptoms.","And could reasonably be expected to result in an emergency condition.","Improvements or modifications to your home or place of business.","Dermatological treatment Dermatological treatment Covered according to the type of benefit and the place where the service is received.","Botox has also been shown to be effective in the treatment of achalasia.","Speech therapy, physical therapy and occupational therapy.","Quiz: Are referrals a fit?","This is no longer true in many parts of the United States.","Was this article helpful?","This change applies only to retiree and spouse coverage.","Telemedicine have different cost sharing.","What are generic drugs?","For example, if you or your covered dependent is taking a sleep aid, you may coverage review from CVS Caremark and your doctor.","Due to the better understanding of the pathophysiology of neuropathic pain, previously unexplored therapies have been used with encouraging results.","The use of a gestational carrier for the female acting as the gestational carrier.","Third party service providers are independent contractors.","Precertification for members with plans applicable this precertification list when performed in any facility except inpatient, emergency room and observation bed status.","Not primarily for the convenience of the patient, Physician, or Other health care Provider.","Care deductible has been met.","AUGS doesnot endorse the diagnostic protocol or treatment plan designed by the provider.","If this event occurs, TRS will inform you in our denial that the decision is not reviewable.","Covered by more than one group Plan.","Popliteal artery entrapment syndrome.","You are treated in accordance with the protocols of that study.","Coverage for insured dependents terminates in accordance with the Termination Provisions described in the Master Policy.","Oral Surg Oral Med Oral Pathol Oral Radiol Endod.","These third party service providers may pay us so that they can offer you their services.","The clinical trial is approved by an Institutional Review Board that will oversee the investigation.","We will continue to keep you updated as this bill moves through the legislative process.","Any time your representative makes a request for you, they should send us a signed copy.","If the denial is coming from only one health plan, contact the plan and find out what their coverage position is on that particular procedure or drug.","Care may be Custodial Care even if it prescribed by a Physician or given by trained medical personnel.","See the How to contact us for help section if you have questions.","Remember, only your GP can determine whether you require specialist care.","As a medical billing company, AMPM maintains a spreadsheet of insurances that require prior authorizations and which procedures require them.","In combination with existing techniques for repair, these methods may help provide the crucial extra tissue mobility required to achieve primary closure.","The only approved drug treatment for tardive dyskinesia is tetrabenazine, which is usually effective but can have side effects that need to be discussed prior to starting therapy.","Messineo A, Codrich D, Monai M, et al.","Criopharyngeal dysfunctionte for surgery?","That notice also will describe the external review process.","Was this answer helpful?","The authors stated that the current evidence is still insufficient, and further investigation of lower dose ratios is recommended.","Types of claims and communicating our claim decisions You or your provider will send us a claim.","The authors stated that this was the first reported use of BTX in FECS.","Botulinum toxin treatment for limb spasticity in childhood cerebral palsy.","Substance related disorders treatment Coverage provided under the same terms, conditions as any other illness.","Check if I can initialize it in every loop or if i need an addtional list.","All procedures or surgeries that have CHP clinical criteria require review and an authorization at any location.","The excluded items are presented as a representation and should not be considered as an all inclusive list.","Although this use of botulinum toxin is experimental, alternative treatments posed greater risks.","If you need care that is covered under the Plan but not available from an Innetwork Provider, contact Member Services for assistance at the tollfree number on the back of your ID card.","For details, contact your physician.","This creates challenges in study design, especially in the selection of homogeneous subject populations.","Please indicate primary ICD code and specify any other where applicable.","Medicare COB unit upon receipt.","Otolaryngol Head Neck Surg.","Units per injection site.","Treatment of dystonic clenched fist with botulinum toxin.","The authors concluded that treatment of obesity with BTA is not effective.","They stated that BTX injection may be used as a form of temporary relief of airway obstruction in patients wishing to avoid ablative surgery or tracheotomy.","Prescription drugs: For certain drugs Covered under your medical Plan, your Prescriber or your pharmacist needs to obtain approval from Aetna before the drug may be Covered.","IHcapacitatedbe mailed to the participant.","Initial data suggested that, compared with other interventions for anterior knee pain, BTA injection, in combination with an active exercise program, can lead to sustained relief of symptoms, reduced health care utilization and increased activity participation.","COB Is used to cover any unpaid allowable expenses Balance is erased at the end of each year How COB works with Medicare This section explains how the benefits under this plan work with benefits available under Medicare.","Isaac CR, Chalita MR, Pinto LD.","You pay a slightly higher cost for drugs in this level.","If TRS agrees to your request, TRS will put the agreement in writing and will follow the agreement unless you need emergency treatment, and the information that you asked to be limited is needed for your emergency treatment.","Innetworkprovidersmay only be considered for certain Aetnaplans.","ACG clinical guideline: Diagnosis and management of achalasia.","They are currently in practice or are Aetna employees.","Additional guideline requirements apply.","The Prescription Drug Benefits Chart will tell you if your plan provides coverage in the gap, and how much you will pay for covered drugs.","Moreover, they stated that further evaluation is needed, BTX injections may be a useful adjunct to surgical repair of complex incisional hernias.","You, your physician, or the facility will need to call us at the number on your ID card as soon as reasonably possible, but no later than the final authorized day.","Report, our monthly newsletter.","Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities.","Adverse Benefit Determination also includes any reduction or termination of a Covered Service.","Home Plan, the hospital, facility or provider will be financially responsible for any covered services not paid and the member will be held harmless.","But it may not cover some others.","Coinsurance including any Deductible, to be paid by you or any Covered Dependents per Plan Year for Eligible Health Services.","You must pay the full amount of any health care service you get that is not a covered benefit.","You will arrive at a menu page where you can view various drug lists, including your Aetna Pharmacy Plan Drug List and more.","You can give us your permission by phone.","Munchau A, Bhatia KP.","These may include specific procedure codes or a limited date range for the procedure to take place.","UK National Health Service.","Psychiatrist at least once per week.","Optimal patient selection and technique.","In addition, an induced premature birth intended to produce a live viable child is Coveredonly where such procedure is necessary for the health of the mother or the unborn child.","The Administrator may make a reasonable charge for the copies.","Plans must pay in the following order: The Plan of the parent with custody of the child; The Plan of the spouse of the parent with custody of the child; The Plan of the parent not having custody of the child.","BTX, and surgical techniques, including duct repair, diversion, ligation, drain placement, and parotidectomy.","Rebates may reduce the amount a member pays the pharmacy for covered prescriptions.","There are several ways you can learn more about your benefits: Check your Plan Design and Benefits Summary in your enrollment kit.","Maternity and related prenatal care Any services and supplies related to births that take place in the home or in any other place not licensed to perform deliveries Medical supplies outpatient disposable Any outpatient disposable supply or device.","BOTOX and physical therapy in the treatment of piriformis syndrome.","Replacement parts, cords orrepairs to a hearing aid.","High blood pressure A heart or lung condition Sleep apnea Diabetes Body mass index is a degree of obesity and is calculated by dividing your weight in kilograms by your height in meters squared.","Role of botulinum toxin in depression.","Please carefully review the benefits of both plans before making the enrollment selection.","The more you understand, the more you can get out of your plan.","Limb dystonia following electrical injury.","You can get this form by contacting Member Services at the tollfree number on the back of your ID card.","Shall not exclude or limit health services related to gender transition.","Other necessary services and supplies.","They noted that when optimally injected, BTX appeared to be an effective treatment of objective tinnitus due to EPT, with few AEs and complications.","Our home delivery pharmacy may save you money.","When you are eligible for Medicare, the plan coordinates the benefits it pays with the benefits that Medicare pays.","BTX was administrated to block the salivary secretion and preventing recurrence.","Dysport in cervical dystonia patients in the United States.","Prescriptionis submitted to the pharmacist for processing.","Botulinum toxin A for treatment of allodynia of complex regional pain syndrome: A pilot study.","If you cannot reach your network dental provider or are away from home, you may get treatment from any dentist.","Increase your productivity, customize your experience, and engage in information you care about.","How do I use the Formulary?","Spasm frequency was reduced in all groups, but muscle tone was reduced in the Dysport groups only.","Zesiewicz TA, Elble R, Louis ED, et al.","In summary, intrasphincteric botox injection for the treatment of recurrent HAEC appears to be safe and can be used for multiple injections if symptoms recur.","Medicine, Past President of the American Headache Society, explains the complex system.","It doesnotinclude actions that you take in selfdefense as long as they are not against people who are trying to restore law and order.","Our networof doctrs, hospitals and other health care providers there to give you the care you need.","Eligible health services inlude the treatment of morbid obesity and include bariatric surgical proceduresand related outpatient services Prosthetic devices Eligible health services include the initial provision and subsequent replacement of a prosthetic device that your physician ordersand administers.","Cetwork fee Network providers.","Salivary botulinum toxin injection may reduce aspiration pneumonia in neurologically impaired children.","Botulinum toxin has also been studied for its use in treating brachial plexus injury.","This means things such as cirrhosis of the liver, delirium tremens, or hepatitis.","Your dental provider should send the form to us before treating you.","Louisiana members: depending on your specific plan and the prescription medication in question, you may in some instances be subject to an excess consumer cost burden for prescription drugs as defined by your state.","Hospice Care designed to give supportive care to people in the final phase of a Terminal Illness and focus on comfort and quality of life, rather than cure.","When this is the secondary plan, we will pay benefits after the primary plan and will reduce the payment based on any amount the primary plan paid.","The strength of the evidence is insufficient to fully inform choice of these treatments.","Classification and evaluation of dystonia.","Is cerebral palsy, epilepsy, or any other condition, other than mental llness.","Your approval is required.","We may add or remove drugs for certain reasons.","The authors concluded that the included studies suffer from an extremely low evidence level with several sources of bias.","Some other money issues Assignment of benefits When you see a network provider they will usually bill us directly.","Reporting of harms data was very limited.","US and ES for upper and lower limb spasticity in patients with stroke, and spastic equinus in children with CP, but there was poor evidence or no available evidence for EMG or other instrumented techniques.","Any drug, which due to its characteristics as determined by us must typically be administered or supervised by a qualified provider or licensed certified health professional in an outpatient setting.","If so, please list the specific contraindications to each preferred agent.","The role of the PCP is important to the coordination of your care; you should contact your PCP when medical care is needed.","Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer.","Have you had essential migraine treatments denied by insurance companies?","CMS seeks to combat.","Our plan requires you or your provider to get prior authorization for certain drugs.","Chapman MA, Barron R, Tanis DC, et al.","First Coast Service Options has added a new article addressing billing and coding procedures that complement the LCD for Botulinum Toxins.","Vision care Pediatric vision care Routine vision exams Eligible health services include a routine vision exam provided by an ophthalmologist or optometrist.","The page also links you to a list of covered codes, including diagnosis codes that can be used to support the medical necessity of this service.","Psychiatric disorders, including but not limited to schizophrenia, borderline personality disorder, and uncontrolled depression.","This exception does not apply to Depo Provera and other injectable drugs used for contraception.","However, coverage for health expenses may be available to you under another plan sponsored by your Employer.","We wanttobe sure our records are accurate so your claims are processed correctly.","Capital Health Plan, An Independent Licensee of the Blue Cross and Blue Shield Association.","Migraine patients have influence with insurance companies, says Lawrence Newman MD.","Morra ME, Elgebaly A, Elmaraezy A, et al.","Botulinum toxin for neuropathic pain: A review of the literature.","Health benefit plans contain exclusions and limitations.","Aetna Better Health works with certain subcontractors to coordinate services that are provided by entities other than Aetna Better Health, such as transportation, vision or dental services.","To learn more see the When coverage ends section.","Botox as headache prophylaxis in adults with chronic migraine.","COB provision is always the primary plan.","Your individual situation will determine what options you will have.","For covered newborns, an initial hospital checkup.","Medicare disability benefits are not required to enroll in Medicare.","Silberstein SD, Holland S, Freitag F, et al.","Replacement of a hearing aidthat is lost, stolen or broken.","Abbott JA, Jarvis SK, Lyons SD, et al.","Records of expenses You should keep complete records of your expenses.","Subsequent injections should not be given until the effects of the previous dose have dissipated as evidenced by substantial function in the injected and adjacent muscles.","Chung CF, Lai JS.","Thank you for your purchase!","Three patients had no or minimal pain relief.","See the How to contact us for help section to determine ifcoverage is under the outpatient prescription drug section or this ction.","The authors concluded that this procedure can be a simple, safe, and effective tool in patients with cricopharyngeal dysfunction after swallowing rehabilitation, especially for cranial nerve IX or X palsy.","The mailing address is on the form.","Any such appliance or fixed bridge must include the replacement of an extracted tooth or teeth.","If we make an adverse benefit determination, we will tell you in writing.","Bai Y, Xu MJ, Yang X, et al.","Preapproval is also called precertification.","Individuals must meet CMS requirements for eligibility and enrollment.","Therapy services, including rehabilitative therapy, radiation therapy, and inhalation therapy.","CVS Caremark Specialist Pharmacists.","These services may also be obtained from a network physician.","Alcoholism or Drug Abuse.","Read the full article.","The room and board charge that an institution applies to its rooms with two or more beds.","Minkes RK, Langer JC.","Home care that is fulltime, continuous or longterm.","Telephone, computer or internet consultations between Provider and member or between Provider and another Provider; telephone assessments in general.","Botox in spasticity in cerebral palsy.","At AMPM, we understand that handling a denial quickly and efficiently is key.","Schedule of benefits \u5400\u6800\u6900\u7320\u7300\u6300\u6800\u6564\u7500\u6c00\u6520\u6f00\u6620\u6200\u656e\u6566\u6900\u7400\u7320\u6c00\u6900\u7300\u7400\u7320\u7400\u6800\u6520deductibles, copayments or coinsurance, if any that apply to the eligible health services you get under this plan.","After receiving the necessary CVSHotifydoctorwhether or not coverage has been authorized.","Botox for the treatment of diabetic gastroparesis.","Your Immune System: How Will it All Work?","Thomas CA, Chuang YC, Giannantoni A, Chancellor MB.","It will tell you how to enroll and how much it will cost.","What do I need to know now that I have insurance?","We also download insurance company policies on a monthly basis to make sure that nothing has changed.","PCP, like a specialistmay require a referral.","The template was revised, adding a documentation requirement section requiring office visit notes with the diagnosis, relevant history, physical evaluation, and medication history.","Turn to the page listed in the Index and find the name of your drug in the first column of the list.","Both brand name drugs and generic drugs are listed in the Index.","This applies even if they are prescribed, recommended, or approved by your physician, dental provider, or vision care provider.","The authors recommended use of BTX injections in first intention for management of salivary fistulas and sialoceles.","Repair or replacement of DMEdue to misuse, neglect or loss.","Botulinum toxin type A therapy for palmar and digital hyperhidrosis.","Please enter your information below.","Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin.","Body Mass Index This is a degree of obesity and is calculated by dividing your weight in kilograms by your height in meters squared.","Outcome after anal intrasphincteric Botox injection in children with surgically treated Hirschsprung disease.","Illnessor disease or is done primarily to improve the appearance or diminish an undesirable appearance of any portion of the body.","Anumpa tohsholi I toksvli ya peh pilla ho ish I paya hinla kvt chi holisso iskitini holhtena takanli ma I paya.","The care must be prescribed in writing by HOME HEALTH CARE AGENCY.","Botulinum toxin for the treatment of lower urinary tract symptoms: A review.","Health Resources and Services Administration guidelines for children and adolescents.","Botulinum toxin injection in the treatment of tennis elbow.","Non surgical therapy for anal fissure.","This product contains albumin, a derivative of human blood.","In case of a medical emergency When you experience an emergency medical condition, you should go to the nearest emergency room.","And sometimes we dont pay at all.","Likewise, as subsequently revised, the rights and other terms of this notice continue to automatically apply.","Endometriosis: Treatment of pelvic pain.","They are typically brief, irregular clonic movements but are occasionally tonic.","The placebo response was higher than expected.","Swallowing and breathing difficulties can be life threatening, and there have been reports of death.","The review of items on this list may vary our discretion.","Visit our website or call the phone number on your member identification card.","See the How to contact us for help section for how.","To do so, you must provide Aetna with person to act on your behalf.","Sometimes the requirement for approval helps guide appropriate use of certain drugs and makes sure there is a medical need for the drug.","Medicare on or after Jan.","What do I do before I can talk to my doctor about changing my drugs or requesting an exception?","Abandoned patients, particularly pregnant women, may not be able to find care until they can qualify for emergency care under the federal laws.","It tells you how we share expenses for eligible health services and tells you about limits like when your plan covers only a certain number of visits.","Allowed Amount in addition to your coinsurance and your deductible.","We consider these activities key for the operation of our health, disability and life plans.","The effect of administering different botulinum neurotoxin products at the same time or within several months of each other is unknown.","PAES with promising initial results.","Look at what other Providers charge.","Velickovic M, Benabou R, Brin MF.","At least one form of contraception in each of the methods identified by the FDA is included.","This list is subject to periodic review and change by Plan Administrator.","If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court.","The guideline did not mention the use of botulinum toxin for the treatment of diplopia as a consequence of traumatic brain injury.","Step Therapy: In some cases, our plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition.","The exam will include refraction and glaucoma testing.","Aetna Medicare and go to the CMS website if you link to the form.","See Aetna Rx Home Delivery in this guide for details.","Filled prior to the effective date or after the termination date of coverage under this rider.","Provider furnishing such services is a Participating Provider.","Endoscopic pyloric injection of botulinum toxin for treatment of post vagotomy gastroparesis.","ICD coding in urogynecologic practice.","Finally, BT is useful in sialorrhea and bruxism.","Evidencebased items that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force.","Limited evidence suggests no clear benefit from adding behavioral interventions at the time of initiation of pharmacological treatment.","Review this summary plan description and the documents governing the Plan for the rules governing your COBRA continuation coverage rights.","To obtain precertification, call Member Services at the tollfree number on your ID card.","Dispensed by a mail order pharmacy that include prescription drugs that cannot be shipped by mail due to state or federal laws or regulations, or when the plan considers shipment through the mail to be unsafe.","Botulinum toxin type A use in piriformis muscle syndrome: A pilot study.","In short, if implemented, this demonstration would undoubtedly negatively impact access to necessary home health care for many Medicare beneficiaries.","Some subtypes have five tiers of coverage.","Aetna handles premium payments through Payer Express, a trusted payment service.","Monday through Friday during normal business hours, or as required by federal or state regulations Proprietary Special programscontinued Hip and knee arthroplasties, cont.","FDA and Department of Health and Human Services Written protocols or a written consent form used by a facility Provider state that it is Experimental or Investigational.","GP to get a new referral if your previous referral is more than twelve months old.","You have the opportunity to review your choices and change your Coverage for each Plan Year during the annual Benefit Choice Period.","TRS discloses the protected health information that you asked to be changed; or TRS can choose to give out a summary of that information with a disclosure of the protected health information that you asked to be changed.","This bill awaits a hearing.","The order of benefit determination rules tell you the order in which each plan will pay a claim for benefits.","The authors concluded that recently published studies have shown a reduction of depressive symptoms after treatment of the glabellar frown lines with BTX injections.","Pharmacotherapy with smooth muscle relaxants, proton pump inhibitors, and antidepressants was suggested from small case series and uncontrolled clinical trials.","If TRS disclosed your protected health information because you gave TRS written permission to disclose the information, instead of telling you why TRS disclosed information, TRS will give you a copy of your written permission.","TD, additional pharmacologic interventions include the following: Use of benzodiazepines, botulinum toxin injections, tetrabenazine, or anticholinergic drugs to control symptoms of TD.","You or your dependent qualify for access to new plans because you have moved to new permanent location.","Care along with that particular dependent, but both the retiree and any such dependents must be enrolled in the same coverage level.","BTX injection into the CM and determined the duration of its effects.","Single case reports were not included.","Or a delay might put your ability to regain maximum function at risk.","LTAC facility if excluded by any other terms of the Plan.","ID card and select the precertification option.","The author also noted that it will be essential in future studies to examine the effectiveness and tolerability of multiple dosing.","It does not cover repairs needed because of misuse or abuse.","Newman to the migraine patient community.","Surrey, UK: Datapharm Communications Ltd.","Korn BS, Seo SW, Levi L, et al.","There is a reasonable expectation that your condition will improve enough to go home within a reasonable amount of time.","Sometimes called prior authorization, prior approval or precertification.","How can your provider request a medical exception?","Aetna Pharmacy Plan Drug List shows you recent changes to the guide.","EMG performed just before the injection.","Fully insured Texas and Louisiana members continue to receive coverage for drugs added to the precertification list in accordance with their current plan benefit design until their next plan renewal date.","The vision eyewear coverage is automatically available only from network vision locations.","Are there any contraindications to formulary medications?","Custodial care is not a covered service regardless of the provider or prescriber.","This technique lengthened and relaxed the laterally retracted abdominal muscles and enabled laparoscopic closure of large complex ventral hernia.","Castelao M, Marques RE, Duarte GS, et al.","All maintenance and repairs that result from misuse or abuse are your responsibility.","Find out which of your most common services are usually excluded by health plans.","See chart below for the list of covered preventative medications.","Staying informed can help you stay healthy and safe.","Bsuch unsere Website odder ruf die Nummer uff dei Member Identification Kaard uff.","There is some error please tray again later.","Each plan is different, so this section of our guide will help you understand what it is that you should look for when you receive your insurance information.","Coverageeffectiveday of the following month from the date of the court order is signed.","Wheeler AH, Goolkasian P, Gretz SS.","If your physician recommendsthat your stay be extended, additional days will need to be precertified.","This can occur when two doctors prescribe similar drugs or when your doctor switches from one drug to another drug in the same class without cancelling the first prescription.","Dependents are not eligible to use Boston University Health Services and are therefore not subject to the referral requirements and penalties.","Shall not: Deny or limit coverage Deny or limit coverage of a claim Apply additional cost sharing to a transgender person, if it results in discrimination against that person.","Provide any additional relevant information.","If you do not precertify, your benefits maybe reduced, or the plan may not pay any benefits.","File, Even If You Expect a Denial.","We may request supporting images and other dental records.","Plan features and availability are subject to change and may vary by location.","The call will be moderated by Dr.","The State of Illinois coordinates benefits with the following: Any group insurance Plan.","If followup care related to your initial Urgent Care services is required, you should contact your Physicianand coordinate such followup care with him or her.","Have your Express Scripts ID number ready.","GIR with your insurance needs.","The day after a migraine is rough.","Requesting multiple visits from the insurance company at the initiation of the insurance referral saves time administratively for both the PCP and the specialist.","You pay the highest cost for drugs in this level.","Visit the secure website, available through www.","All other fulltime and three quarter time students in the Greater Boston area are subject to the Referral Requirements.","RN or an LVN.","These researchers manually searched the Australian Orthoptic Journal and British and Irish Orthoptic Journal and ESA, ISA and IOA conference proceedings.","If your doctor is in the network, you do not have to complete a Transitional Care Request Form.","Cerfolio RJ, Bryant AS, Canon CL, et al.","What is a Prior Authorization?","What is piriformis syndrome?","Parsaik AK, Mascarenhas SS, Hashmi A, et al.","Advocacy Resident Workgroup will hold its quarterly Fireside Chat advocacy education call.","Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.","Benefit Summary and the Certificate of Coverage, the Certificate will control.","Care will pay, and you will be responsible for charges exceeding the Aetna Allowed Amount.","You are responsible for all amounts above the Recognized charge.","Hoare BJ, Wallen MA, Imms C, et al.","See the Eligible health services under your plan Other services section.","You can ask us to make an exception and cover your drug.","Contact the Department for more information.","These limits help your doctor and pharmacist check that your prescribed drug is used correctly and safely.","When injectable or infused services and supplies are provided in your home, they will not count towardany applicable home health care limits.","Individual deductible You pay for eligible health services each year before the plan begins to pay.","Interventions for drooling in children with cerebral palsy.","Accredo sends deliveries overnight.","Member Services and ask if your drug is covered.","Prescription drug An FDA approved drug or biological which can only be dispensed by Prescription.","Fried GW, Fried KM.","Both comparative and observational studies were included.","The treatment was painful and poorly tolerated.","Coordination of Benefits provision is contained in the Policy issued to Texas Christian University and may be viewed online at www.","If you are not able to communicate your preference to TRS, for example because you are unconscious, TRS may share your protected health Certain Disclosures that TRS is Required to Make.","Injection therapies for nonbleeding disorders of the GI tract.","Can J Neurol Sci.","Salivary BTX injection is known to reduce sialorrhea.","Generally, the first day of the month based on when we receive your completed enrollment form, if you enrolled them at another time.","Tissue expander placement is a common means of reconstruction after mastectomy.","The plan that pays first is called the primary plan.","These researchers carried out a retrospective chart review on patients with UES dysfunction who underwent CP BTX injection.","Adv Med Heath Res.","The lack of a denial for a particular service or supply should not be interpreted as our approval for any subsequent service.","Office visits to an ophthalmologist, optometrist or optician related to the fitting of prescription contact lenses In any one year, this benefit will cover either prescription lensesfor eyeglass frames or prescription contact lenses, but not both.","Products that provide nutritional needs, such as formulas, feeding solutions and supplements, vitamins and dietary foods and programs, except as otherwise provided herein.","Gosain A, Frykman PK, Cowles RA, et al.","Mulligan H, Borkin H, Chaplin K, et al.","Please use the search box at the top of this page to look for your request.","Determining who pays Reading from top to bottom the first rule that applies will determine which plan is primary and which is secondary.","However, it is your responsibility to make sure that you have prior authorization before receiving certain health care procedures, services and prescriptions.","The Surgery mustbe performed as soon as medically feasible.","Will the requested medication be used in combination with other anticholinergic agents?","The enhanced drugs are listed in this guide by Enhanced Drug Benefit Categories.","The following chart will help you understand which plan is primary and how the various plans coordinate.","Akin to an official recommendation, referrals are made from one physician to another.","Ben Simon GJ, Blaydon SM, Schwarcz RM, et al.","Pharmacy hat is the Aetna Medicare Comprehensive Formulary?","If the appropriate number of visits were not requested or if they all have been exhausted and a patient has a procedure or test, this could result in the specialist losing reimbursement in the absence of the referral.","The first step is generally to stop or minimize the use of the neuroleptic drug, but this can be done only under close supervision of the physician.","Male gender was associated with a response to this therapy; however, durability of response was unrelated to gender.","You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception.","If you mail in your own prescription, please send it along with a completed Patient Profile Form.","You should consider calling your network dental provider who may be more familiar with your dental needs.","Botulinum toxin injection for cervicogenic headache.","Muharraqi MA, Fedorowicz Z, Al Bareeq J, et al.","These investigators reported such a case here.","Precertification does not mean a reliable representation of payment for care or services to fully insured HMO and PPO members as defined by Texas law.","This includes, but is not limited to, anypayments to the donor, donor screening fees, fees for lab tests and any charges associatedwithcare ofthe donor requiredfor donor eggretrievalsortransfers.","Some drugs on the Preferred Drug List are subject to manufacturer rebates.","Anesthesia and related facility charges for oral surgery a dental procedure Coverage is subject to certain conditions.","Must be prior authorized.","Nevertheless, a RCT should be done to confirm these results and rule out the effect of potential spontaneous improvement of neurological injury.","Botulinum toxin for spastic gastrointestinal disorders.","Our support agents are standing by to assist you.","Usually, they will communicate with your health insurance company.","It lets this person access your personal health information.","For laboratory, our rate is of the rates CMS establishes for those services or supplies.","Any charges associated with obtaining sperm from a person not covered under this plan for ART services.","When searching for network dental providers, you need to make sure you are searching under Pediatric Dental plan.","Botulinum toxin A upper and lower limb spasticity: A systematic review.","Part D is insurance that helps pay for Prescriptiondrugs.","Botulinum toxin type A versus amitriptyline for the treatment of chronic daily migraine.","Spasticity is common after SCI and has positive as well as negative effects.","Neumeister MW, Chambers CB, Herron MS, et al.","Note: An eligible dependent will not be considered a late enrollee if a court order requires the covered student or Postdoctoral Fellow to provide coverage for his or her eligible dependent.","Differences were not significant in some cases due to the small sample size.","The policies may be different for professional services and facility services.","Fees or costs associated with services that are primarily xercise.","They are not covered even if they are covered in the United States under this certificate.","When that happens, we will pay your plan benefit to the other plan.","Need a health appointment?","Treatment of dysfunction of the cricopharyngeal muscle with botulinum A toxin: Introduction of a new, noninvasive method.","You should review the Maternity care and Well newborn nursery care sections.","Also, the service category Gas Permeable Scleral Contact Lenses was removed from this policy.","Treatment of recurrent dislocation of the temporomandibular joint with type A botulinum toxin.","Sal abrasion, chemosurgery, laser Surgeryother skin abrasion procedures associated with the removal of scars, tattoos or actinic changes.","Department of Labor or you may file suit in a federal court.","Hwang J, You YC, Burm JS.","What is Concierge Medicine?","Please contact your Blue Cross NC Strategic Provider Relationships consultant with any questions you may have regarding this upcoming policy change.","Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina.","Call us at the number on your ID card if you want to leave or cancel your current plan and not join another one.","Simpson DM, Hallett M, Ashman EJ, et al.","Ngadto maakses ang mga serbisyo sa pinulongan alang libre, tawagan sa numero sa nimong ID card.","During the next business day, the prescriber must submit a Prior Authorization Form.","No adverse effects were reported.","BTX injections in persons with SCI and focal spasticity.","BTX has also shown a positive effect on mood.","These investigators found smokers and women were more likely to have improved coloration and appearance after injections.","Examples include, but are not limited to, diabetes, asthma, obesity, hypertension, allergies, and infections.","For more information, contact the Claims Administrator at the Customer Service phone number on your ID card.","If the provider proceeds with the procedure and a patient does not meet all criteria listed in the policy the procedure will not be reimbursed upon post procedure documentation review.","Immunizations where you do not meet the recommended eligibility guidelines.","Karsenty G, Denys P, Amarenco G, et al.","They are often expensive and may not be available at retail pharmacies.","Common types of strabismus are esotropia, exotropia, and hypertropia.","Read the complete update.","We will tell you and your physician in writing of an approval or denial.","Paid according to the tier of drug in the schedule of benefits, above Outpatient prescription contraceptive drugsand devices: includes oral and injectable drugs, vaginal rings and transdermal contraceptive patches Female contraceptives that are generic prescription drugs.","See the schedule of benefits for more information.","Care as a result of a Special Enrollment Event will now have the opportunity to change their Level of Coverage.","The Program is established by and reviewed from time to time by a physician who is attending the person and by appropriate personnel of a Hospice Care Agency.","This is where you can learn more about the types of drug coverage reviews your drug requires; things like precertification, step therapy or quantity limits.","CVS Caremark and request an independent external review at the same time, or alternatively you can submit your urgent appeal for the independent external review after you have completed the internal appeal process.","TRS may disclose protected health information of military personnel and veterans in certain situations.","All committee members must tell us if they are in a situation that can create a conflict of interest or if they have a financial stake that might affect their decisions.","Personal information does not include publicly available information or information that is available or reported in a summarized or aggregate fashion but does not identify the member.","Enrollment in Capital Health Plan Silver Advantage, Advantage Plus, Preferred Advantage, and Retiree Advantage depends on contract renewal.","Your network provider will take care of that for you.","If you do not precertify, your benefits may be reduced, or the plan may not pay.","Hirst GR, Watkins AJ, Guerrero K, et al.","It does not include all prescription drugs and devices.","Note: If you do not receive a letter from us informing you of your disenrollment date, call the Member Services number on your member ID card.","These amounts will not change the Negotiated charge under this Plan.","Look in the Index and find your drug.","Children treated for spasticity are at greatest risk for these symptoms, but symptoms can also occur in adults treated for spasticity and other conditions.","ALWAYS verify member eligibility prior to providing services.","The purpose of the Surgeryto improve function.","Aetna Network within A licensed provider in the state in which they practice and who has contracted to participate in the Aetna Network within NIGHT CARE TREATMENT.","You may pay less for drugs on this list.","Participating network retail pharmacies will charge you the lesser of the negotiated CVS Caremark price or the usual and customary cost for up to Your standard retail pharmacy service is most convenient when you need a medication for a short period.","The member and prescriber are notified as soon as the decision has been made.","Like joining a plan, there are only certain times when you can disenroll.","Look at other things as needed to decide what rate is reasonable for a particular service or supply.","To learn what frequency and age limits apply to routine physical exams and routine cancer screenings, contact your physician see the How to contact us for help ction.","Other restrictions and maximum limits apply.","Prescriber Any Provider acting within the scope of his or her license, who has the legal authority to write an order for outpatient Prescription drugs.","Benzon HT, Katz JA, Benzon HA, Iqbal MS.","When searching for network dental providersyou need to make sure you are searching under dental plan.","If there is not a court decree: If the parent with custody of the children coverscoversdependents of the parent without custody.","Aetna considers testing for neutralizing antibodies to botulinum toxin experimental and investigational.","In Utah and Wyoming by Aetna Health of Utah Inc.","Treatment effects are modest.","BTA injections that were tolerated with no complications.","Patients with cervical dystonia exhibited significant improvements in baseline functional, pain, and global assessments compared to placebo.","Breast enhancement or augmentation mammoplasty, with or without implantsunless associated with breast reconstruction Surgeryfollowinga Medically Necessary mastectomy incurred secondary to active disease.","However, it does not provide significant benefit for the treatment of DSD in patients with MS.","These terms will help you understand this section.","Revised coverage criteria for incontinence due to detrusor instability and overactive bladder to add pelvic floor exercises, cognitive behavioral therapy, fluid management, bladder exercises, and weight loss as examples of tried and failed behavior therapy.","Paid according to the tier of drug in the schedule of benefits, above Limitations: Coverage will be subject to any sex, age, medical condition, family history, and frequency guidelines in the recommendations of the United States Preventive Services Task Force.","If the plan or health insurance coverage designates a primary care provider automatically, then until you make this designation, Aetna designatesone for you.","Enroll in autopay for my next membership renewal.","Botox is safe and effective for chronic migraines.","We will give you and your dental provider a statement of the benefits payable.","Certain classes of injectables, such asanabolic steroids, when used for performance enhancement.","Provideare inpendent cractors and are not agts Aetna.","This recommendation was categorized as Level C, given the limited strength of the available evidence.","Please note: Members are not required to obtain a preauthorization for substance abuse treatment for providers that are certified or licensed by the department of public health, acute substance abuse treatment services and medically necessary clinical stabilization, and substance abuse evaluations.","Providerphysicianother health professionalhospitalskilled nursing facilityhome health care agency orother entity or person licensed or certified under applicable state and federal law to provide health careservices to you.","No systemic complication was noted.","Note: This is a page on the CMS site that provides information about patient rights as a hospital inpatient.","Change their coverage level.","Our contact information appears on the front and back cover pages.","Surgery and related dentalservices to fix teeth injured due to an accident is covered when: Teeth are sound natural teeth.","The updates will be effective on the first day of the plan year, one year after the updated recommendation or guideline is issued.","Your medication will usually be delivered within seven days after CVS Caremark receives your order.","You should send the bill to the address listed on the back of your ID card, and we will resolve any payment dispute with the provider over that amount.","You can get a free copy of our Notice of Privacy Practices.","For more information, visit the website on your member ID card and log in to your account.","If you are on an extended disability leave, your GIR may be located at your retirement system office.","Botulinum toxin treatment for oropharyngeal dysphagia associated with diabetic neuropathy.","Dentures; dental implantstechniques, including prosthetic devices related to such techniques.","OTE: Rehabilitation services provided in the home will be Eligible Health Servicesunder the applicable rehabilitative services sections of this Planand will be subject to the applicableoinsuranceas described in your Schedule of Benefits.","Therefore, they can be used clinically for otherwise healthy patients with bruxism.","Check with your Employer to determine if FMLA applies to the Plan.","WPS has added a new article addressing billing and coding procedures that complement the LCD for Decipher Prostate Cancer Classifier Assay.","Coverage for dependents may continue for some time after your death.","If you purchase this Plan, you will satisfy the statutory requirement that you have health insurance meeting these standards.","Naik MN, Gangopadhyay N, Fernandes M, et al.","Care Customer Service at if you have any questions about your coverage.","Claims are either paid or rejected based on plan rules.","No, prior authorization is not required if you have an emergency and need medication.","The assessment also noted that the evidence for botulinum neurotoxin in gustatory sweating is suboptimal.","The dose was not enough to change spasticity measures and thus GMFM in this heterogeneous group.","The authors noted that this study had several drawbacks.","Video fluoroscopic swallowing study, flexible endoscopic evaluation of swallowing, disability rating scale, penetration aspiration score, and National Institutes of Health swallowing safety scale were used in the evaluation of dysphagia.","Khalifeh M, Mehta K, Varguise N, et al.","Practice Center under Contract No.","Palatal botulinum toxin as a novel therapy for objective tinnitus in forced eyelid closure syndrome.","The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have an underlying condition that would predispose them to these symptoms.","The services of blood donors, apheresis or plasmapheresis.","Marras C, Andrews D, Sime E, Lang AE.","You can view these edits on our provider website.","Tice JA, Ollendorf DA, Weissberg J, et al.","Sometimes, these documents have amendments, inserts or riders, which we will send you.","Injections of Botox into the masseter, temporalis, and internal pterygoid muscles result in reduction in the oromandibular and lingual spasms and an improvement in chewing and speech.","If TRS decides that it should correct or add information, it will add the correct or additional information to your records and note that the new information takes the place of the old information.","Providers are independent contractors and not our agents.","Physician and the facility regarding the approval or denial of an inpatient admission to a facility.","Outpatient respiratory therapy Respiratory therapy Covered according to the type of benefit and the place where the service is received.","We use and share it to help us process your claims and manage your policy.","Advanced Medical Practice Management does not accept any responsibility for any loss which may arise from reliance on information contained on this site.","Participating Provider will be paid at no greater cost to the Covered person as if the services were provided by a Participating Provider.","Outpatient services that have not demonstrated significant usefulness in the eviewed edical iterature.","Covered under your Prescription drug Plan, contact your Prescription benefit manager for more information.","Exceptions and Exclusions The items and expenses listed below are excluded from Coverage by the Plan.","To help us get paid back, you are agreeing to provide us with any requested: Information or assistance cumentation This provision applies whether or not the third party admits liability.","The authors concluded that BTX injections offered potential in ventral hernia management by reducing hernia width and lengthening abdominal wall muscles prior to repair.","Tarsy D, Sudarsky L, Charness ME.","Botox has been evaluated in various spastic disorders.","Breach of UHsecured Protected Health Youhavenotify you of a breach of your unsecured protected health information.","When infusion therapy services and supplies are provided in your home, they will not count toward any applicable Home ealth are limits.","Plan to make a determination of medical necessity, the requested service is experimental or investigational, the place of service is not appropriate for the care being provided and the requested supply or service is not covered by the Plan.","Abdominal access techniques used in laparoscopic surgery.","These investigators focused on prevalence and incidence, treatment outcomes, comparisons of treatments, modifiers of outcomes, and costs.","Experimental or in clinical trials.","To buy insurance or to get or keep a license.","Your browser will redirect to your requested content shortly.","Plan features and availability may vary by location and are subject to change.","This material is for information only.","For Part D prior authorization forms, please see the Medicare section.","Booklet or coverage is required by applicable law.","Drug and Biologics Compendium.","In all cases, the Recognized charge is based on the geographic area where you receive the service or supply.","Please log in to your secure account to get what you need.","Medicare Part C requires a monthly premium contribution.","Si habla un idioma que no sea ingl\u00e9s, se encuentran disponibles servicios gratuitos de asistencia de idiomas.","Infusion therapy is the administration of prescribed medications or solutions through an IV.","Coverage is the primary carrier.","Under the Step Therapy program, you may be required to try a prerequisite therapyapproved.","Chiropractic therapy for all musculoskeletal diseases and injuries.","Alam NN, Narang SK, Pathak S, et al.","Medicationsadministered to you during your inpatient stay.","Chen H, Pan W, Zhang J, et al.","Convenience or comfort items, including, but not limited to, tub grab bars, over the bed tablesand raised toilet seats.","The notice of a claim denial will give the reason for the denial of coverage and will explain what steps you must take if you wish to appeal the denial.","The policy describes new requirements for patient medical record documentation.","To learn more, please refer to your plan documents or call the Member Services number on your ID card.","The information is updated periodically to reflect the most up to date information as of the date noted.","If the requested service is not authorized, the member and provider are notified in writing with the specific reasons for the denial and appeal rights.","This policy outlines specific criteria a patient will need to meet in order to have what is deemed a medially necessary breast reduction procedure.","And if you need help or more information, we tell you how to reach us.","Receive a summary or explanation instead of the detailed protected Pay the cost of preparing the summary or explanation.","NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.","The member will be notified in writing.","We will review and process the request for an extended stay.","Kim MS, Kim GW, Rho YS, et al.","Coverageeffectiveom the date of the court order is signed.","Delgado MR, Wilson H, Johnston C, et al.","Secondary plan The secondary plan calculates payment as if the primary plan did not exist and then applies that amount to any allowable expenses under the secondary plan that were not covered by the primary plan.","You can access the list of contraceptive drugs.","Services provided in conjunction with school, vocation, work or recreational activities.","For example, you may need a prior authorization from us before you can fill your prescription.","Texas Department of Mental Health and Mental Retardation or other appropriate licensing agency.","However, the side effect profile was substantial.","On the other hand, there is insufficient evidence to draw a conclusion on the use of botulinum neurotoxin in the treatment of head and voice tremor.","Any drugs, vitamins, minerals or supplements not approved by the FDA; any medical procedure or drug that is approved for use but is not used for the specific indication that led to its approval.","One item of DME for the same or similar purpose.","ATTENTION: If you speak Spanish or Chinese, language assistance services, free of charge, are available to you.","If a qualifying change in status occurs, you may be allowed to make a change to your Coverage that is consistent with the qualifying event.","Dashtipour K, Chen JJ, Frei K, et al.","Aetna in the Provider directory as Institutes of Excellence Network Provider for specific services or procedures.","Boxed Warning has been added to the prescribing information to highlight that botulinum toxin may spread from the area of injection to produce symptoms consistent with botulism.","Botulinum toxin type B: A new therapy for axillary hyperhidrosis.","Immunizations for nonhealth related reasons, such as for travel, education or employment.","Updated coding information to indicate that CPT codes are now applicable to Commercial products.","The defect results in severe facial disfigurement or major functional impairmentof a body part.","The legislation now awaits further consideration by members of the Governance Committee.","It must results in impairment of general intellectual functioning or adaptive behavior similar to that of individuals with an intellectual disability and requires treatment orservices that are similar.","Truong D, Duane DD, Jankovic J, et al.","What are common side effects of Botox?","OR sensitivity to both light and sound?","How are benefits paid?","Payment for ambulance services will be limited to the Allowable Amount.","Discuss the health care services or prescription that you need and ask if prior authorization is required.","Some persons have group health coverage in addition to coverage under this Program.","The throbbing head pain can be associated with nausea, vomiting, and sensitivity to light.","The studies of the effect of botulinum toxin treatment of myofascial trigger points have had mixed results.","The coinsurance listed in the schedule of benefits below reflects the plan coinsurance percentage.","Hearing exams given during a stay in a hospital or other facility, except those provided to newborns as part of the overall hospital stay Any tests, appliances and devices to: Improve your hearing.","Any service performedbya person without anymedicalorparamedicaltraining.","You must still enroll the child within days of birth even when coverage does not require payment of an additional premium contribution for the covered dependent.","But there are some DME items Medicare covers that your Plandoes not.","The bill is awaiting further action by the committee.","We consider these activities key for the operation of our health, disability and life Plans.","Talk with your employer if you have questions about this.","Please be aware that our agents are not licensed attorneys and cannot address legal questions.","ET, but data are limited.","Cases of toxin spread have occurred at botulinum toxin doses comparable to those used to treat cervical dystonia and at lower doses.","Right to pay another carrier Sometimes another plan pays something we would have paid under your plan.","Do you want to continue?","Is prior authorization required in emergency situations?","There is insufficient evidence to support the use of botulinum toxin for pelvic floor tension myalgia.","Under certain conditions, the denial will not be reviewable.","If TRS extends its response time, it must tell you in writing the reasons for the delay and Because of the technology used to store information and laws requiring change or delete information, even if it is incorrect.","To set up an account, go to www.","Changes to the established drug names to reinforce individual potencies and prevent medication errors.","This finding does not deny the value, individually, of single injection cycles or prove that repeating them is unhelpful.","Call Member Services at the number on the back of your ID card to get the form.","From your home to a Hospitalif anmbulance is the only safe way to transport you.","For details on the guidelines and the current list of covered preventive care drugs and supplements, see the How to contact us for help section.","There was no language restriction.","See our Medicare online resourcesformoreinformationabout preferredproductsfind precertification form.","Botulinum toxin injections for paediatric incontinence.","Brubaker L, Richter HE, Visco A, et al; Pelvic Floor Disorders Network.","World J Gastrointest Pharmacol Ther.","The effect of the tablets is generally limited and there are often pronounced side effects.","Look at how much work it takes to perform a service.","CERTIFICATION REQUIREMENTS LIMITATIONS overage.","Comprehensive services did not result indocumented fetal heartbeat.","In most clinical settings, it is difficult to diagnose the precise origin of pain.","Home Plans to request authorizations for inpatient stays, as well as approvals for inpatient procedures and services that require advanced certification.","This means when you take part in a riot in any waysuch as inciting, or conspiring to incite, the riot.","Already a member or subscriber?","Use this service for claims information and eligibility.","First Coast Service Options has added a new article addressing billing and coding procedures that complement the LCD for Posterior Tibial Nerve Stimulation.","The violation waspart ofanongoing, goodfaithexchange betweenyouand us.","Urgent care facility A facility licensed as a freestanding medical facility by applicable state and federal laws to treat an Urgent condition.","Quality assessment was performed by using the Downs and Black scale.","You can access the list of Specialty Prescriptiondrugs.","Bladder Botox Is diagnosis of urinary incontinence due to detrusor overactivity associated with neurologic condition?","However, your request may still exist under a different link.","Government or the Federal Medicare Program.","Every State agency has a GIR.","Your Employer must continue to make premium payments.","You have charge, the information used to review your appeal, and present evidence and testimony as part of your appeal.","Hypertropia is an abnormal eye higher than the normal eye.","BTX was not an effective method to improve pain control in tissue expander reconstruction.","Victor, AH Ropper, eds.","Required clinical information must be completed in its entirety for all precertification requests.","In some cases, additional information, such as test results, may be required to determine if additionabenefits are available.","Current evidence on the unit equivalence of different botulinum neurotoxin A formulations and recommendations for clinical practice in dermatology.","These investigators provided an overview of spasticity management, primarily in patients with SCI.","Such information is intended to assist with the coding process as required by governmental regulation and should not be construed as policy sanctioned by AUGS.","Nothinginthissectionshallprecludetheprescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions.","This does not include growth hormone therapy.","Indications and effects of botulinum toxin A for obstetric brachial plexus injury: A systematic literature review.","Uses and disclosures that constitute the sale of your protected health Uses and disclosures that constitute fundraising purposes.","See the Eligible health servicesunder your plan Diabetic equipment, supplies and education section.","RNpatient based on medical, psychological and social needs.","If appropriate, you can talk to your doctor about alternatives that may be covered.","Allergenic pillows or mattresses.","Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers.","Botulinum toxin in the treatment of orofacial tardive dyskinesia: A single blind study.","If the receiving physician refuses to accept the patient, the referring physician must make other arrangements.","UI monthly or more often.","Why is the Preferred Drug List subject to change?","Please see full Indications and Limitations of Use below.","All hernias were surgically reduced and repaired with mesh, with no early recurrences.","This requirement does not apply to procedures and treatments that do not require FDA approval.","Means you may have to pay for services at the time they are provided.","TRS may provide your protected health that you tell TRS in writing is acting on your behalf.","Brief clonic movements are first noted in the orbicularis oculi and spread over months to years to involve other facial muscles.","Therapy Lists will continue to have those medications covered for as long as the prescriber prescribes them, provided the drug is medically necessary and more medically beneficial than other covered drugs.","Each state has a list of basic services that health plans must cover, but employers may opt out of certain nonmandatory services to reduce their medical expenses.","Chinese version of the Pittsburgh Sleep Quality Index.","In addition, BT has been used to control pain associated with increased muscle contraction in dystonia and spasticity, but also is useful to control chronic pain not associated with muscle contraction, such as chronic daily headache.","Onset is most commonly in midlife.","What can I expect to pay?","However, this proposed efficacy must be confirmed by randomized controlled studies, which are lacking in this area.","Intensive research may hopefully result in more effective treatments in the future.","See the benefit description in the certificate of coverage for details.","For DME, our rate is of the rates CMS establishes for those services or supplies.","If the plan is replaced, you may be continued under the new plan.","For example, if a physician directed a patient to the emergency department for an acute problem because the practice could not fit the patient in on a Friday afternoon, the practice bears some of the responsibility if the service is denied.","Gormley, EA, Lightner, DJ, Burgio, KL, et al.","It is the date of your marriage, declaration of domestic partnership or the first day of the month following the qualifying event date.","Despite these changes, patients did not report an overall benefit from the treatment.","Tampa, FL: Gold Standard, Inc.","Yuan RY, Sheu JJ, Yu JM, et al.","Both studies showed statistically significant decreases in the weekly frequency of incontinence episodes in the Botox group compared with placebo.","Iwill include a copy of the Request for External Review form at the final adverse determination level.","Any charge for daily room and board in a private room over the semiprivate rate is not a covered medical expense unless Medically Necessary, as determined by Aetna.","You or your provider should call us for approval to continue any care.","Tics in Tourette syndrome: New treatment options.","Each main plan type has more than one subtype.","Some covered drugs may have additional requirements or limits on coverage.","Examinations Any health or dental examinations needed: Because a third partrequires the exam.","You will find details on medical necessity and precertification requirementsin the Medical necessity and precertification requirements section.","CVSwebsite, take a minute to register, and have your ID number and a recent prescription number handy.","The deductible and coinsurance apply.","To help this process move quickly, we highly recommend you alert your doctor to expect our outreach.","This form is for use when requesting authorization for the drug Yonsa.","Pittock SJ, Moore AP, Hardiman O, et al.","Therapy Lists will continue to have those medications covered for as long as the treating physician prescribes them, provided the drug is medically necessary and more medically beneficial than other covered drugs.","FBS developed after head and neck surgery were treated by injection of BTA into parotid gland.","You can get this form by calling the number on your ID card.","Gym or fitness club memberships.","Recently, injections of BTX in patients with CM dysfunction have been reported to result in marked relief of dysphagia.","Nothing in this section shall preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions.","If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.","Generic Prescription drug Prescription drug with the same dosage, safety, strength, quality, performance and intended use as the brand name product.","Generic drugs are less expensive than brands.","Treatment of corns, calluses or the clipping of toenails, unless Medically Necessary for the treatment of diabetes.","This includes annual ap smears, including surveillance tests for ovarian cancer for women at risk for ovarian cancer.","Care participants who are not eligible for Medicare will have a single plan option covered through Aetna.","Learn about the referral process between GPs and specialists While GPs offer a variety of comprehensive health services, they may recommend specialist care after assessing your health condition.","Spirometry was not altered.","These are when: You have an urgent claim or a claim that involves ongoing treatment.","Thealways control over information in the Enrollment Guide.","Such coverage will become effective on the date of the court order.","Thanks for confirming your Username.","Pessoa BL, Escudeiro G, Nascimento OJ.","The role of botulinum toxin type A in the clinical management of refractory anterior knee pain.","You may required to pay the full charges and submit a claim for reimbursement to us.","Threatening to sue the health plan or yelling at the medical director usually does not help the outcome of the appeal.","Formulary A listing of Prescription drugs approved by Plan Administrator for Coverage under the Plan.","QOL outcomes appeared to be improved after CP BTX injection.","Allergy Eligible Health ervices for allergy testing, diagnosis, treatment, allergy serum, and the administration of injections.","The patient has a contraindication to all preferred agents.","Additionally, this notice describes your rights to control your health information.","Care coverage effective date.","Documentation of the medical necessity for this treatment.","Inform patients up front that experimental or investigational interventions could be denied.","Am J Phys Med Rehabil.","Aetna may delegate part of its authority and duties to others as it deems necessary and desirable.","Generally accepted standards of medical and dental practice and The views of Physicians and dentists practicing in the relevant clinical areas We use commercial software to administer some of these policies.","Endoscopic removal of a stone or foreign object from the larynx, bronchus, trachea, esophagus, stomach, urinary bladder, or ureter.","Jordan DR, Anderson RL, Thiese SM.","However, for medical billing purposes, this is not the case.","Parkman HP, Hasler WL, Fisher RS.","Care participants may also request an appeal in writing.","Added a prior authorization form for Botox to the bottom of the policy.","Botulinum toxin type A versus anticholinergics for cervical dystonia.","Please complete all required fields!","The EOB may be electronic or in writing.","PA for Botulism Toxins that doctors complete on your behalf.","BTX is one of the comparatively newer therapeutic options.","To see the full article, log in or purchase access.","What happens if I use a Network provider?","DMitem you need because your physical condition has changed.","Schedule of Covered Services.","TRS can charge you for preparing the list, including charges for copying, labor, and postage to process and mail each additional list.","RNIt keeps a complete medical record on each patient.","Any additional inpatient days that are not certified in advance may become the financial responsibility of the admitting hospital, facility or provider, if not precertified.","Concurrent care claim extension A concurrent care claim extension happens when you ask us to approve more services than we already have approved.","Looking for Medicare Policies?","Some language changes may not be in the enclosed certificate of coverage or policy.","Merz North America, Inc.","Can the formulary change during the year?","Only that part of a charge that is reasonable is covered.","The study comprised patients with slight dysphagia caused by isolated hypertonus of the UES, as well as patients with severe deglutition disorders, complete inability to swallow, and aspiration problems.","There is insufficient evidence to support the use of botulinum toxin for interstitial cystitis.","BTX for spasmodic dysphonia; but not for bilateral vocal cord paralysis.","You may be responsible for a share of or all of the cost, so please be an informed consumer.","Care at the last place of employment in public education in this state.","The authors noted that few cases of unilateral or bilateral temporalis hypertrophy have been reported, added to the more common isolated masseter muscles hypertrophy.","All medically necessary outpatient prescription drugs will be covered.","The procedures are done while not confined in a Hospitalor any other facility as an inpatient.","Uddin JM, Davies PD.","The needed approval by the FDA has not been given for marketing.","The therapy is coordinated with us as part f a treatment Planintended to restore previous cognitive function.","Student Health Insurance Plan MUST file a Waiver with the University.","Do I need permission or authorization from my insurance company before I get medical care?","If they are not, ask for an alternative.","Next to your drug, you will see the page number where you can find coverage information.","Many areas are served by ambulance services that do not contract with any provider Networks.","Wrexham, UK: Ipsen Biopharm, Ltd.","Shamliyan TA, Kane RL, Taylor FR.","When does your plan cover missing teeth that are not replaced?","Botulinum toxin is currently used in those entities characterized by excessive muscle contraction, including dystonia and spasticity.","The quantity limits and drug coverage review programs are not available in all service areas.","Department of Health and Human Services.","Kung hindi Ingles ang wikang inyong sinasalita, may maaari kayong kuning mga libreng serbisyo ng tulong sa wika.","Brisinda G, Maria G, Bentivoglio AR, et al.","Medical Director The Physician specified by the Plan or Claims Administrator as the Medical Director or other staff designated to act for, under the general guidance of, and in consultation with the Medical Director.","AND bulk fiber supplementsstool softenerssitz baths for at least TWOmonths?","Drug has quantity limits on some plans.","Emile SH, Elfeki HA, Elbanna HG, et al.","How to get started with a specialty pharmacy Ordering your prescriptions through our specialty pharmacy is easy.","Less common cases of isolated or associated temporalis hypertrophy have also been reported.","Assessment procedures included dental screening under sedation and interviews with caregivers.","Clinical variables including age, sex, site and size of the lesion, standing activity, weekly duration of walking, footwear, foot type and footprint had no influence on the outcome.","Oropharyngeal dysphagia: Clinical features, diagnosis, and management.","Improve delays in speech function development caused by a gross anatomical defect present at birth.","Botox, the potential for antibody formation may be minimized by injecting with the lowest effective dose given at the longest feasible intervals between injections.","Certain infused medications may be covered under the outpatient prescription drug section.","Patients with chronic facial pain improved significantly from baseline in terms of pain compared to placebo.","Care as surviving dependents?","The level of review of individual items on this precertification list may vary from time to time at our discretion.","The secondary outcome was the change in foot function, which was assessed using the Foot Health Status Questionnaire.","More often than not, provider offices have patients who would like to have their elective procedures done as soon as possible, this does not always work when a procedure requires a predetermination.","You will be responsible for any amount that is not covered under the plan including your deductible and coinsurance when applicable.","They are not covered even if they are covered in the United States under this certificate of coverage.","Botox in migraine prevention and highlighted some of the inherent difficulties defining study end points and outcomes that are relevant to clinician, patients, and regulatory agencies.","Assisted living facilities, except if you have an acquired brain injury.","The contents of that Handbook are incorporated herein by reference.","Medical necessity and precertification requirements section.","Blepharospasm, characterized by intermittent or sustained closure of the eyelids caused by involuntary contractions of the orbicularis oculi muscle.","BTA injection to measure change in fascial defect size and abdominal wall muscle thickness and length.","Policy Year prior to obtaining treatment of ongoing conditions.","Federal civil rights laws and does not discriminate or exclude people on the basis of race, color, national origin, age, disability, or sex.","Make sure your doctor knows that you pay more for two and three tier drugs.","Contraceptive devices not approved by the Food and Drug Administration.","Eligible health services also include dental services provided for a dental emergency.","However, there is currently insufficient evidence to support it use for this indication.","You can ask us to make an exception to our coverage rules.","Second surgical opinion Covered according to the type of benefit and the place where the service is received.","Sialography showed a cutting edge of the inferior interlobular major duct before forming the common major duct that seemed to be injured during the subcondylar fracture reduction process.","It describes all recognized Mental Disorders.","Videofluoroscopy showed impairment of the UES opening, residue in piriform sinuses, and aspiration in all cases.","PPOs will not accept new patientsfor your plan appears at www.","There were no statistically significant differences between the groups in the incidence of adverse events.","People with caregivers know the important role that caregivers have in managing prescription care.","There were no differences in adverse events.","The surgery will be covered if: The defect results in severe facial disfigurement or major functional impairment of a body part.","Physicianfor the dietary treatment of any inherited metabolic disease.","Parts A and B of Medicare.","Providers are independent contractors and are not agents of Aetna.","Sorry, that mobile phone number is invalid.","Sharma SD, Kumar G, Eweiss A, et al.","Motz KM, Kim YJ.","You will also be notified of approvals where the state requires notification to members.","The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice.","If you choose to use a surrogate, this exclusion does not apply to the cost for procedures to obtain the eggs, sperm or embryo from a Coveredindividual.","The certificate of coverage explains how to get a medical exception.","HMO and PPO members as defined by Texas law.","Contact the managed care Plan directly for deadlines and procedures.","This notice provides only a summary of your COBRA continuation coverage rights.","How Can I Find Reliable Insurers?","The services are provided in lieu of ospitalization or placement in a Skilled Nursing Facilityor u are unable to receivthe sameservices outside yourhome.","Language Assistance can be provided by calling the number on your member ID Card.","If your prescription is for a controlled medicine, a written prescription from your doctor may be needed.","Students will receive a greater costsavings by utilizing the Health Center as their primary source of care.","Hospitalization for the purpose of receiving services, such as Cosmetic Surgery, that are not Coveredunder this ertificate.","Care, CVS Caremark may review prescriptions for certain medications with your doctor before they can be covered.","Aetna Medicare Advantage plans only when performed in any place of service except inpatient, emergency room and observation bed status.","These services include culture and fertilization of the egg from the donor and transfer of the embryo into you.","If we support our decision at the final internal appeal, you will be responsible for all of the expenses for the service or supply received during the continuation period.","While GPs offer a variety of comprehensive health services, they may recommend specialist care after assessing your health condition.","If you are pregnant and your second trimester, the transitional period will include the time required for postpartum care directly related to the delivery.","If these requirements apply to your plan, consult your plan documents for more information.","For certain drugs, you, your prescriber or your pharmacist needs to get approval from us before we will cover the drug.","Medicalterminated because the child reaches the maximum age for a dependent support, and unmarried.","As to hearing care: itten order for the dispensing of prescription electronic hearing aids by otolaryngologist, otologist or audiologist.","Coverage for all insured students enrolled forcoverage in the Plan for the following Coverage Periods.","The injury to the brain has occurred after birth and results in a change in neuronal activity, which results in an impairment of physical functioning, sensory processing, cognition, or psychosocial behavior.","Please follow the links to the posters, which are in PDF format to make them easy to download and print.","DNA concentration for differential diagnosis of prostate cancer and BPH.","Things that would e important to keep are: Names of hysicians and providers who provide services Dates expenses are incurred Copies of all bills and receipts Honest mistakes and intentional deception Honest mistakes Youoryour employermaymake anhonest mistake whenyoushare factswithus.","Oh HM, Chung ME.","Or, you may be taking a drug that is on our formulary but your ability to get it is limited.","The neurosurgeon whose hospital staff privileges are dependent on his accepting referrals from the emergency room, for example, has a duty to treat an accident victim referred from the emergency room.","Substance Use Disorders This is a physical or psychological dependency, or both, on a controlled substance or alcohol agent.","Aetna takes a total approach to health and wellness that takes care of the whole you.","The clinicians should take into account and ask about Botox when treating patients complaining of diplopia.","Should only be used for certain conditions Often cost more than other drugs that are proven to be just as effective Keep in mind that your doctor must contact us to request approval of coverage for these drugs.","The authors stated that more studies with safety data are needed.","Aetna Navigator, your secure member website.","Clinical treatment provided in a facility or program provided under the direction of a Physician.","This helps prevent wasted medicine and saves members money if their medicine or dose changes between fills.","Type of pharmacy Your cost share Network pharmacy \u5900\u6f00\u7520\u7000\u6100\u7920\u7400\u6800\u6520copayment.","Copay amounts and coinsurance percentages for each tier vary by Aetna Medicare plan.","ACTIVITIES OF DAILY LIVING.","Contact the plan for more information.","Sims JR, Suen JY.","Medical social services are provided by or supervised by physician or social worker.","Coverage is subject to any sex, age, medical condition, family history, and frequency guidelines in the recommendations of the United States Preventive Services Task Force.","You or your dependent become eligible for State premium assistance under Medicaid or an CHIP plan for the payment of your premium contribution for coverage under this plan.","The letter is attached.","Make sure the ID card number is on the bill.","These researchers included RCTs involving botulinum toxin for treating participants with MPS.","We have posted online documents that explain our prior authorization and step therapy restrictions.","Chapman MA, Barron R, Tanis DC, Gill CE, Charles PD.","The date the domestic partnership ends.","This system transition is part of our ongoing goal to better serve our members and improve their experience.","If your Aetna plan allows for the designation of a primary care provider for a child, you may designate a pediatrician as the primary care provider.","If you relied on materially inaccurate directory information, you may be entitled to have an outnetwork claim paid at the innetwork percentage level of reimbursement and your outpocket expenses counted toward your innetwork deductible and outpocket maximum.","Coveragesubject to frequency limitations.","Historically, abandonment did not result in substantial tort losses because patients could usually find substitute care.","Using ice packs can help reduce this pain if it happens.","Specialty prescription drugs purchased and injected or infused by your provider in outpatient setting Covered according to the type of benefit and the place where the service is received.","Treatment of upper extremity spasticity in stroke patients by focal neuronal or neuromuscular blockade: A systematic review of the literature.","Due to the short life span of the drug once it is reconstituted, Medicare will reimburse the unused portions of Botulinum toxins.","You can also go to an urgent care center, which may have limited hours.","General nursing careervices of Physicians employed by the Hospitalray, diagnostic tests, medical treatment, and the administration and processing of whole blood and blood plasma.","Plan Sponsor offers Coverage under the Plan.","Nursing facility Facility for the aged Psychiatric Hospital Residential Treatment Facility for substance abuse Residential Treatment Facility for Mental Disorders tended care facility Intermediate care facility Skilled Nursing Facility Illness Poor health resulting from disease of the body or mind.","The authors concluded that many treatments for FBS have been attempted including: dietary modification, pharmacological treatments, and surgical treatments.","Examples of these types of drugs include, but are not limited to, narcotics, amphetamines, DEA controlled substances and anticoagulants.","Botox into the puborectalis muscle of patients with pelvic floor dysfunction.","HAEC in some patients, and can be confirmed by anorectal manometry.","You should contact Aetna for medical appeals and CVS Caremark for prescription drug appeals.","It is but one feature of the upper motor neuron syndrome and there have been considerable developments in its management through new drugs and technology.","This cosmetic services exclusion does not apply to surgery after an accidental injury when performed as soon as medically feasible.","One exception was an RCT comparing raloxifene with placebo, which reported more rapid return of pain in the raloxifene group.","Botox cannot be compared to nor converted into Units of any other botulinum toxin or any toxin assessed with any other assay method.","After motor rehabilitation programs, which included functional electrical stimulation, the patient was able to wear an advanced reciprocating gait orthosis.","How to contact us for help section.","AUGS not endorse the diagnostic protocol or treatment plan designed by the provider.","What would you like to get updates about?","There are different types of claims.","Freund B, Schwartz M, Symington JM.","For a list of Providers included in the etwork is available on our website at www.","Injuries that occur during medical treatments are not considered accidental injuries even if unplanned or unexpected.","Aetna does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.","Botulinum toxin injections for the treatment of spasmodic dysphonia.","Racette BA, Good L, Sagitto S, Perlmutter JS.","Baumann A, et al.","Pediatric dental care Eligible health services inclde dental services and supplies provided by a dental provider.","Dysport for the treatment of upper limb muscle spasticity due to stroke.","An assessment of the clinical and functional consequences for the patient is decisive before management.","The plan does not cover dental services that are given after your coverage terminates.","Social Security number is not used.","This has been done in an effort to streamline your submission process.","Your spouse or dependent children are no longer eligible for COBRA continuation coverage because of any other reason permitted by law.","Drugs removed from the market.","Generally, such rebates do not directly reduce the amount a member pays the pharmacy for covered prescriptions.","Ioenot mean precertificfined by Tes law, as a reable rpaymencare or services to fullynsured O and PPmembers.","Your doctor must contact Aetna to request approval of coverage for these drugs.","Want to get to a topic quickly?","How Long Does Chronic Migraine Last?","Am J Obstet Gynecol.","When a patient loses his or her response, serum can be tested for neutralizing antibodies, although this rarely is performed outside research settings.","Custodial care Examples are: Routine patient care such as changing dressings, periodic turning and positioning in bed.","Disease: Safety and Administration of Botulinum Neurotoxin.","There were no identifiable clinical predictors of response.","Hypotropia is when the abnormal eye is lower than the normal eye.","Notice to proper authorities of potential violations of law or professional ethics.","You start coverage after you complete the eligibility and enrollment process.","Most physicians would define utilization management as purely a hassle.","See the How to contact us for help sectionfor details.","Botox injections are unknown.","Log in to manage your plan or sign up for online access today.","Vomiting as a major symptom predicted no response.","The DSM is a book published by the American Psychiatric Association.","Health professional A person who is licensed, certified or otherwise authorized by law to provide health care services to the public.","Oxygen and oxygen therapy.","The section below will tell you about the different types of claims.","Ask your employer when benefits for the child will begin.","If approved, an authorization number is then generated by Capital Health Plan and is available to you via CHPConnect.","Aetnasecure member website at banneraetna.","It is the subject of hase I, Phase II or the experimental or research arm of Phase III clinical trial.","Program, a copy of the Notice of Privacy Practices will be sent to you on an annual basis.","Experimental or Investigational drugs or drugs that have not been proven safe and effective for a specific disease or approved for a mode of treatment by the FDA.","AZ, CA, HI, NJ and UT are subject to taxation.","Rehabilitation services that are Experimental or have not been shown to be clinically effective for the medical condition being ated.","Your financial responsibility and decisions regarding benefits We base your financial responsibility for the cost of services on when the service or supply is provided, not when payment is made.","Jones K, Hentz JG.","Knowing this ahead of time can help you and your dental provider make informed decisions about the care you are considering.","What Is Medicare Part D Prescription Drug Coverage?","Aetna Better Health of Illinois is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.","This means that participating providers, not members, are required to pursue precertification when it is required.","You should read this schedule to become aware of these and any limits that apply to the services.","Needles and syringes, except those used for selfadministration of an injectable drug.","Botulinum toxin for the treatment of strabismus.","Eligible Healthervices include organ transplanservices provided to the donor.","Aetna to be necessary for the diagnosis, care or treatment of the physical or mental condition involved.","Selecting these links will take you away from Cigna.","For moreinformabout Aetna plans, refer aetna.","Maintenance care Care made up of services and supplies that maintain, rather than improve, a level of physical or mental function, except for habilitation therapy services.","Canadian Headache Society guideline for migraine prophylaxis.","Those services rendered by a provider that do not require the technical skills of such a provider.","TRS may provide your protected health information to its accountants, attorneys, consultants, and others in order to make sure TRS is complying with the laws that affect it.","The authors made a strong argument why a crossover design was appropriate and their data were valid.","To a public health authority for the purpose of preventing or controlling If required by other federal, state, or local law.","Only we may waive a requirement of your plan.","Medications that require approval will only be covered by your plan if your doctor requests and receives approval from your health insurance company.","Preventive breast cancer genetic counseling provided by a genetic counselor to interpret thetest results and evaluate treatment.","You should fill out an authorized representative form telling us that you are allowing someone to appeal for you.","Mail order pharmacypharmacy where prescription drugs are legally dispensed by mail or other carrier.","Any charges over our recognized charge Submitting your own claims Eligible health services under your plan Eligible health services include any pharmacy service that meets these three requirements: They are listed in the Eligible health services under your plan section.","We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at an Aetna Medicare network pharmacy, and other plan rules are followed.","With Aetna Specialty Pharmacy, you can get this medicine sent right to your mailbox.","If approved by us, the exception will apply for the entire time you have an urgent situation.","Important note: Any lung cancer screenings that exceed the lung cancer screening maximum above are covered under the Outpatient diagnostic testing section.","TRS may inform you orally or in writing of and obtain your oral or written agreement or objection to the use or disclosure of your protected health information.","If the medical exception is approved, coverage will be provided forthe entire time of the prescription.","Pokushalov E, Kozlov B, Romanov A, et al.","This approach might provide a new insight in the treatment of scar repair.","Peloso P, Gross A, Haines T, et al.","Care will take the appropriate measures to abide by the ERO determination.","The cost of whole blood and blood products replacement to a blood bank.","This includes room and board and other institutional care.","ERISA and according to other federal and state laws that apply.","Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis.","Schedule of Covered Services are made by the Plan.","Visit your secure member website and sign in to your account.","Needles and syringes, except for those used for selfadministration of an injectable drug.","It never involves muscles other than those innervated by the facial nerve.","COBRA continuation coverage is contingent upon the timely election of COBRA continuation coverage and the receipt of any required contribution that is due.","Physicians should keep in mind that they may become liable for the lack of adequate staff coverage or the misbehavior of other physicians if they acquiesce in the misbehavior.","Dysport over placebo, but this was not significant.","None, these terms mean the same thing and are used interchangeably.","Currently, no consensus exists regarding the management of a parotid sialocele.","You or your provider should call Aetna for approval to continue any care.","Fully insured California HMO members and fully insured Connecticut PPO members receiving coverage for drugs added to the precertification list continue to have coverage.","Care work when you live outside of Texas in an areawhere Aetna does not have a network?","When does COBRA coverage end?","First Coast Service Options has added a new article addressing billing and coding procedures that complement the LCD for Biofeedback.","Patients without prior use of botulinum toxin should be started with a lower initial dose, with subsequent dosing adjusted based on individual response.","If so, provide risk factors.","Network providers will submit the claims directly to Aetna for you.","Participation in the Universitysponsored Student Health Insurance Plan can be waived onlineonce the student has registered for classes.","Although evidence for a dose response effect was not statistically significant, there was a clear trend towards greater efficacy and duration of effect with higher doses of Dysport.","You must complete your enrollment information and send it to us within days after the adoption or the date the child was placed for adoption.","If we paid claims for your past coverage, we will want the money back.","The intent was to better understand the mixed results that these studies have provided.","Custodial Care is not a covered service.","Beneficiaries already face almost insurmountable odds when appealing claims denials.","Charges associated with services provided to a surrogate.","Medicare has the following parts: Part A is insurance that helps pay for inpatient Hospital facility charges, Skilled Nursing Facility charges, Hospice care and some home healthcare services.","Each insurance company defines its own step therapy requirements.","Rarely, people can experience eyelid drooping or muscle weakness in areas further away from the injection site.","The violation wasfor a good cause or beyond our control.","Medical care and support services provided to a terminally ill person and his or her family under arrangements with a Hospice Care Agency as a part of a Hospice Care Program.","When infusion therapy services and supplies are provided in your home, they will not count toward any applicable home health care limits.","How does my prescriber submit a completed Prior Authorization form to Navitus?","Remind your doctor to check your plan to make sure you get maximum coverage.","And they need to be delivered quickly.","These are services which are not solely related to your care and may include: Sitter or companion services for either you or other family members.","VFSS before the treatment.","You can respond to this information before we tell you what our final decision is.","Aetna participating providers and members in applicable plan designs.","Nasr MW, Jabbour SF, Sidaoui JA, et al.","Covered according to the type of benefit and the place where the ervice is received.","Plan Participants may enroll in Medicare on the SSA website at ssa.","They are not beyond any limits in the schedule of benefits.","Each insurer has sole financial responsibility for its own products.","MD Anderson Dysphagia Inventory.","Texas Christian University administrative fee.","Childers MK, Wilson DJ, Gnatz SM, et al.","Zesiewicz TA, Elble RJ, Louis ED, et al.","This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.","Examples are endometriosis surgery or, for men, varicocele surgery.","Make sure they include your member ID number, date of birth and mailing address on the fax cover sheet.","You will pay the cost sharing specific to eligible health services for diagnostic testing.","The patient must be treated by a Psychiatrist at least once per week.","Covered by Medicare, Aetna will estimate the portion of the claim that Medicare would have paid.","Gabriel A, Champaneria MC, Maxwell GP.","This applies to Aetna.","This is part of your total obligation but will not apply to your maximum coinsurance limit.","Trosch RM, Adler CH, Pappert EJ.","Each case will be reviewed and considered on its own merits.","You enroll under a group Medicare plan that we offer and your coverage ends under that plan In addition, coverage for your domestic partner will end on the earlier of: The date thisplannolongerallowscoverage fordomestic partnersorcivilunionpartners.","All claims should be filed promptly.","Note to pharmacies: Inform the member that the medication requires prior authorization by Navitus.","Has the patient responded to a trial of botulinum toxin that has enabled ADLs or communication?","May require periodic medical review.","You or your provider may request a review of the preauthorizationdecision.","No specific recommendations can be made regarding the choice of instrumented guiding technique, except that US appears to be more effective than ES for spastic equinus in adults with stroke.","They included RCTS of any use of botulinum toxin treatment for strabismus.","If you enter domestic partnership, you can enroll your domestic partner on your plan.","They are used to treat complex and chronic conditions like cancer, multiple sclerosis, and rheumatoid arthritis.","Some types of clinical evidence include findings of government agencies, medical associations, national commissions, peer reviewed journals, authoritative summaries and opinions of clinical experts in various medical specialties.","Applications and forms for healthcare professionals and their patients.","Cantarella G, Berlusconi A, Mele V, et al.","If you suffer from chronic migraine headaches and have tried several treatments already, you may want to ask your doctor about Botox.","If your plan includes enhanced drug benefits, look for the Enhanced Drug Benefit Category in the following pages to determine which drugs are covered.","Internet access to reliable health information, tools and resources.","Snow V, Weiss K, Wall EM, et al.","This applies whether or not a claim is made for such benefits.","It noted that further studies on injection methodology including the use of electromyographic guidance, ultrasonography, and electrical stimulation are needed to optimize treatment technique.","Rehabilitative services provided for longterm, chronic medical conditions, except as provided for herein.","Participating Providers do not.","If you have questions about this section, see the How to contact us for help section.","If it has been in effect the longest, back to the original Effective Date of Coverage under the employer group, whether or not the insurance company has changed over the course of Coverage.","Botox therapy for ischemic digits.","You may want someone to speak with us more often.","Eligible Health Services The health care services and supplies and Prescription drugs listed in the Eligible Health Services under your Plan section and not carved out or limited in the exceptions section or in the Schedule of Benefits.","In the event of a disagreement between two Plans, the gender rule applies.","How do I request an exception to the Aetna Medicare formulary?","An appropriately licensed hospital that has not contracted to participate in an Aetna Network.","Your cognitive deficits are caused by neurologic impairment due to trauma, stroke, or encephalopathy.","Botox Cosmetic at approved doses.","Chuang YC, Chancellor MB.","See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage.","If a service cannot be provided to you Sometimes things happen that are outside of our control.","TRS will tell you in advance of the fees it will charge.","Health Resources and Services Administration guidelines for children and adolescents When these recommendations and guidelines are updated, they will apply to this plan.","Obtaining prescription drugs from multiple pharmacies through use of the same prescription order.","Treatment and prognosis of adolescent idiopathic scoliosis.","It contains only a partial, general description of plan benefits or programs and does not constitute a contract.","To obtain preauthorization, call Member Services at the tollfree number on your IDcard.","Each visit of up to four hours by an RN or an LVN.","The authors concluded that BTX injection into the vocal folds provided temporary relief of symptoms in airway obstruction in adult patients with BVFMI.","Bills should be submitted in the foreign currency.","Both studies with high risk of bias had several key limitations.","Contact Express Scripts directly.","Longer or shorter length of coverage If none of the above rules determine the order of payment, the plan that has covered the person longer is primary.","Aetna sites are provided for your convenience only.","If this is a continuation therapy, specify how long the patient has been on this medication.","This website works best when Javascript is enabled in your Internet browser.","Psychiatric or courtrdered evaluations or therapy when related to judicial or administrative proceedings or orders, when employer requested or when required for school.","When used to treat voice tremor, botulinum toxin A may cause breathiness, hoarseness, and swallowing difficulties.","Keep a Good Migraine Diary.","Guerts I, Hendrix V, Blaauw I et al.","Skilled Nursing Facilities also include rehabilitation Hospitals, and portions of a rehabilitation Hospitaland a Hospital designated for skilled or rehabilitation services.","You have the right to third party review conducted by an independent external review organization.","Call your insurance company before you receive your health care services or prescription.","Reversal of a voluntarysterilization.","Any dermatological services that are primarily for cosmetic purposes.","Any service performed by a person without any medical or paramedical training.","This article is for informational purposes only and should not be taken as medical advice.","This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract.","Services must be Medically Necessary and provided by a Behavioral Health Provider with the appropriate license or credentials.","If this is completed on time, you have enrolled in COBRA.","One potential treatment for depression utilizes botulinum toxins.","Limits column tells you if our plan has any special requirements for coverage of your drug.","The authors noted that further study of Botox prophylactic treatment of CDH appears warranted.","This is called an appeal.","They stated that a comparative study randomizing both techniques of injection using standard toxin dose is needed to validate these preliminary findings.","There you can add or remove your prescriptions.","In addition, it can improve early gastric emptying, decrease respiratory complications, shorten hospital stay, and reduce late bile reflux.","Hospitalafter a cesarean delivery.","That includes information we need to recover any payments from your other health plans.","Please enter valid email.","Kung nagsasalita ka ng Tagalog, maaari kanggumamit ng mga serbisyo ng tulong sa wika nang walang bayad.","In addition, both of the studies were short term, with no comparisons to other treatments for back pain.","Talk to a Specialist Pharmacist.","Certain infused medications may be covered under the outpatient prescription drugsection.","Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis.","CI will be calculated for continuous outcomes.","Botulinum toxin type B for cervical dystonia.","Rescission means you lose coverage going forward and going backward.","The facility must also provide, or have an agreement with a hospital in the area to provide, any required medical services.","Appeals and file claims.","Other health coverage updates contact information Youshould contactusifyouhave anychangestoyourothercoverage.","How long you continue getting them will depend on how you respond to treatment.","None of the trials was independently funded.","Botulinum toxin assessment, intervention and aftercare for pediatric and adult drooling: international consensus statement.","Prosthetic devices that are nondurable, such as support garments, ed hose, obst or compression stockings, clothing and like items.","See the Breast feeding durable medical equipmentsection of the certificate of coveragefor limitations on breast pump and supplies.","All services and supplies must be furnished by the facility, including drugs and medicines prescribed by a physician for the treatment of the mental disorder.","Haase J, Schwaag S, et al.","There were no complications associated with the use of the neurotoxin.","Examples are: Routine patient care such as changing dressings, periodic turning and positioning in bed.","Select a state below to update coverage details.","These are drugs that are taken regularly for chronic conditions like diabetes or asthma.","Chronic complications of spinal cord injury and disease.","The primary efficacy end point was not met.","The additional examinations confirmed the isolated muscle hypertrophy.","Replacing the Broken Medicare Physician Payment Formula: At What Cost for People with Medicare?","They excluded participants with unilateral or compensatory contralateral masseter hypertrophy resulting from head and neck radiotherapy.","Most cases resolve after conservative therapy consisting of repeated aspiration and pressure dressing.","Services related to the diagnosis and treatment of abnormalities of the breast.","Document the medical necessity of services, particularly if they could be perceived as elective or cosmetic.","See the schedule of benefits and the Exclusions and Glossary sections for specific information.","You can access the form online.","If you receive payment from Aetna, it will be your responsibility to settle your account with your provider.","This was a case study; and the clinical benefit of botulinum toxin, if any, is confounded by the multiple therapies used in this patient.","Medical supplies used by you during your inpatient stay.","Units divided among effected muscles.","The services of blood donors, apheresis or plasmapheresis For autologous blood donations, only administration and processing expenses are covered Breasts Services and supplies given by a provider for breast reduction or gynecomastia.","There were no date or language restrictions in the electronic searches for trials.","Dodick DW, Turkel CC, Degryse RE, et al.","Care work when you travel in the United States?","BTX injection, and identified patient characteristics or CP muscle histologic features that predict efficacy of BTX injection.","When a Network physician or hospital is providing the medical service, then that provider is responsible for making the call.","This is the case unless we tell you otherwise when you receive the precertification decision.","Click on the following locations to find a GP clinic in your state or territory.","This site has its own login.","When the Other health care Coverage applies, you will pay the Other health care cost share.","Whether an alternate therapy or course of treatment has failed or is not appropriate.","Coverednewborns, an initial Hospitalcheckup.","IM in the medial rectus muscle.","Treatment is being requested to enhance function or allow additional therapeutic modalities to be employed.","Hascoet J, Manunta A, Brochard C, et al French Referral Network of Spina Bifida.","How do you enroll in COBRA?","If you are denied a medical exception based on the above processes, you may have the right to a thirdparty review by an independent external review organization.","Get the best ways to save on your prescriptions delivered to your inbox.","Coveragefor medical expenses incurred.","The representative can tell you the date your coverage will end.","See the Exclusions section and the schedule of benefits for specific plan details.","This includes lessons in sign language.","Aetna provides certain management services on behalf its affiliates.","The provision of blood to the hospital, other than blood derived clotting factors Any related services including processing, storage or replacement expenses The services of blood donors, apheresis or plasmapheresis For autologous blood donations, only administration and processing expenses are covered.","Does the member have distant metastatic disease identified on bone scan and computed tomography?","Diet pills, diet programs, weight reduction therapy, services, tests, examinations or supplies.","Disponible \u00fanicamente en ingl\u00e9s.","The authors concluded that further studies should address the possible value of multiple injections with extended observation periods, dose optimization, and whether duration of headache history and number of previous treatments are predictors of patient response.","Coverage will be subject to any sex, age, medical condition, family history, and frequency guidelines in the recommendations of the United States Preventive Services Task Force.","Information may need to be submitted describing the use and setting of the drug to make the determination.","Presence of Morbid Obesity.","EFNS guideline on the drug treatment of migraine revised report of an EFNS task force.","American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis.","The types of services offered will vary by the provider and location of the clinic.","These types of drugs may include, but are not limited to, drugs that are injected, infused, inhaled or taken by mouth.","Those efforts are designed to keep health care costs under control for everyone.","Urinary tract infections and urinary retention were the most common adverse effects in this population.","For example, it could show what drugs started requiring coverage reviews like precertification, step therapy or quantity limits.","At inclusion, there was no significant difference between groups whichever variable was considered.","Boston University Page Insulin pumps or tubing or other ancillary equipment and supplies for insulin pumps except as specifically provided in the Eligible health services under your plan abetic equipment, supplies and education section.","Our Pharmacy and Therapeutics Committee meets regularly to review new drugs and new information about current drugs.","Benefits will be paid as soon as the necessary proof to support the claim is received.","Another advantage of botulinum A toxin is that it is minimally invasive compared to other therapies.","Note, however, that your Coveragemay not be cancelled or nonrenewed simply because of your participation in a qualified cancer trial as defined by Illinois law.","Moghaddam M, et al.","Botulinum toxin A and chronic low back pain.","They can also speak with us on your behalf.","Your specialist will send any details and test results to your GP, and they will communicate regularly about your care and any treatments, medications or procedures you require.","Details about the process to appeal your claim and initiate an external review will be described below.","The chart below shows the different types of claims and how much time we have to tell you about our decision.","TRS may use or disclose your protected health information to support health plan administration functions.","Ceiling effects in GMFM and PEDI may have reduced responsiveness.","PM on the Coverage End Date indicated.","Any election made on behalf of a dependent will be binding on that dependent.","Aetna Medicare PDP Plans.","Not health services are covered.","Services and related expenses for personal blood storage, unless associated with a scheduled Surgeryforyou.","How can you extend coverage when getting inpatient care when coverage ends?","The date your Employer determines your approved FMLA leave is terminated.","You must pay any applicable cost share for eligible health services to which the deductible does not apply.","But sometimes your plan will pay the entire expense; and sometimes you will.","Graham, HK, et al.","It can fill your prescription specialty medicine.","However, despite a high rate of return symptoms after BTA injection, repeat BTA injection has been shown to be effective.","The treatment must be supervised by a psychiatric physician.","The recognized charge depends on the geographic area where you receive the service or supply.","Remember, prior authorization is not a guarantee of payment.","Botulinum toxin B treatment in children with spastic movement disorders: A pilot study.","If the employee or covered person takes no action to recover any money from any source, the employee or covered person agrees to allow the Plan to initiate its own direct action to enforce its subrogation or other rights of recovery.","Generally, to be eligible for an independent external review, you must exhaust the internal claim review process described above, unless your pharmacyis urgent.","You are about to leave the Harvard Pilgrim website and connect to another website.","Besides, changing paradigms may occur with the advent of optogenetics and a better understanding of epigenetic regulation.","This cosmetic services exclusion does not apply to surgery afteran accidental injury when performed as soon as medically feasible.","Garuti G, Rao F, Ribuffo V et al.","Replacement partsor repairsfor a hearing aid.","Gallien P, Reymann JM, Amarenco G, et al.","Prior authorization does not guarantee your insurance company will cover the entire cost of authorized services.","We mayimmediatelyendyour coverage ifyoucommitfraudorintentionallymisrepresentedamaterial fact when you applied for or obtained coverage.","For payer specific policies, please reference the payer specific websites.","Botulinum toxin has been studied as a treatment for flexion contractures.","Aetna may require proof of the continuation of the disability.","You can generally keep your coverage without paying a penalty if you decide to enroll in Medicare prescription drug coverage later.","Physician; charges for lost or stolen items, such as Durable Medical Equipment or injectable medications; services or supplies for which no charge is made or for which no payment would have been made absent this Coverage.","Aetna for any purpose.","Please enable Cookies and reload the page.","The simple fact is that with one or two patients giving different responses, this would have been declared a negative trial.","Required clinical information must be completed precertification requests.","This process is automatic.","Accurate coding decreases your denial rates.","Or which drugs no longer do.","An advanceclaim review The advance claim review gives you an idea of what we might pay for services before you receive them.","If you know any urologists attending the Summit for the first time, please share the link with them and encourage their participation.","Comparison of botulinum neurotoxin preparations for the treatment of cervical dystonia.","What types of doctors can be a primary care physician?","Medicare card in order to obtain the correct premium reduction.","We encourage providers submit precertification requests least two weeks beforethe scheduled services.","Family members can lose coverage for many reasons, such as growing up and leaving home.","Medically Cecessary for eligible participants.","Here is more detail about those benefits.","Child of content above.","MEDICALLY NECESSARY SERVICE OR SUPPLY.","Exercise or fitness equipment or other equipment used to promote health or wellness.","The results of treatment with oral medication were not satisfactory.","Necesita su ID de usuario?","Interest of botulinum toxin.","The investigators noted that none of the study subjects developed neutralizing antibodies.","Botulinum toxin A for the treatment of refractory chronic anal fissures and internal anal sphincter achalasia in pediatric patients.","Attenuation of isolated pyloric pressure waves in gastroparesis in response to botulinum toxin injection: A case report.","Secure provider website available through aetna.","The insurance referral must be initiated by a PCP with a reason for the visit, as well as their best guess as to how many appointments will be required to treat a condition.","Bigger practices have enough staff to help fight on your behalf, and get the prior authorizations.","They stated that nevertheless, a RCT should be done to confirm these results and rule out the effect of potential spontaneous improvement of neurological injury.","Will my GP still be involved in my care?","Equipment for environmental control, such as air conditioners, furnaces or heaters, air filters or purifiers, humidifiers or dehumidifiers.","More stringent state requirements may supersede these requirements.","Reports: Annual statistical information is reported to a national procedure registry and to Aetna.","Even if you do not send TRS a written statement explaining why you disagree with the denial, you can ask that protected health information that you wanted changed.","Aetna has selected Caremark as the prescription management and mail delivery service for our members.","The page includes detailed information and links to CMS forms.","It is recommended that appropriate instruments to decompress the orbit be accessible.","There have also been reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes.","TRS will consider your request but is not required to agree to it.","TRS may disclose protected health information to a coroner or medical examiner for purpose of identifying a deceased person, determining a cause of death, or for the coroner or medical examiner to perform other duties authorized by law.","Patient Global Impression of Improvement.","Physician GAC did not reach significance.","Pavone V, Testa G, Restivo DA, et al.","The authors concluded that Dysport resulted in a significant reduction in muscle tone, limb pain and dependence on walking aids.","Genital exam in men.","When you enter the Armed Forces of any country, we will refund any unearned pro rata premium to the policyholder.","ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you.","Member Servicesby calling the tollfree number on your ID cardin the How to contact us for help sectionor by logging onto the Aetna website atwww.","BTA has been suggested as a treatment for this condition, but there is little supporting literature to this effect.","Services of another physician for the administration of a local anesthetic.","When an insurance company denies for a missing referral, it is important to find out if they will accept one received after the fact.","Treatment with injections of type A botulinum toxin was conducted in association with a splint and relaxation.","Morbid Obesity surgical services received from any Provider not designated by the Plan as a Bariatric Surgery Center of Excellence.","On the other hand, there is insufficient data to ascertain the effectiveness of botulinum neurotoxin in patients with phonic tics.","ACA guidelines when prescribed by a prescriber and the prescription issubmittedtothe pharmacistfor processing.","PRECERTIFICATION REQUIREDCoverage may be provided if all medical criteria are met.","Services and supplies that are providedduring your stay in a Skilled Nursing Facility.","Si ou pale yon l\u00f2t lang ki pa Angl\u00e8, wap jwenn s\u00e8vis asistans pou lang gratis ki disponib.","You can ask us to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition.","We are stronger together.","Care determine my premium?","Teeth are sound natural teeth.","If it does, the nurse authorizes the request and the health plan will cover the service.","Is necessary for the health of the mother or unborn child.","See the Eligible health services under the plan Outpatient prescription drugs section.","Benecke R, Jost WH, Kanovsky P, et al.","Aetna website at banneraetna.","If there are no such rooms, Aetna will calculate the rate based on the rate most commonly charged by similar institutions in the same geographic area.","Prior Approval in which a long litany of questions must be answered to determine if the insurance company will allow the medication that the physician wants to prescribe to be allowed.","BOTOX CDH Study Group.","Adverse events after botulinum A toxin injection for neurogenic voiding disorders.","TRS communicates with you could put you in physical danger.","ATENCI\u00d3N: si habla espa\u00f1ol, tiene a su disposici\u00f3n servicios gratuitos de asistencia ling\u00fc\u00edstica.","State or other applicable law, to act on behalf of an enrollee or other party involved in the grievance or appeal.","Injuries that occur during medicaltreatmentsare not considered accidental injuries, even if unplanned or unexpected.","For certain kinds of drugs, you can use Aetna Rx Home Delivery services.","The authors concluded that objective reduction of pelvic floor spasm reduces some types of pelvic pain.","What do health plans cover?","Please talk to your doctor to find out if a generic is right for you.","Plan Participants eligible for Medicare.","We review them for their safety, effectiveness and current use in therapy.","Your surgery correctsan accidental injury.","Efficacy of botulinum toxin A for the treatment of bladder pain syndrome: A systematic review.","You do not need a referral.","Elstner KE, Read JW, Jacombs ASW, et al.","Lee DH, Jin SP, Cho S, et al.","Care is administered by the Aetna Service Center in San Antonio, Texas.","Grip strength was not statistically significantly different between groups at any time.","The extraction of a third molar tooth does not qualify.","This includes Room and Board for rest cures, adult day care and convalescent care.","These investigators reviewed the current evidence pertaining to Botox use in the head and neck.","Tocontradicts TRS laws and rules, the TRS laws and rules control.","Any confinement for which the ember is not legally obligated to pay.","All Appeals must be accompanied by all documentation supporting the request for reconsideration.","Specific conditions Autism spectrum disorder Autism spectrum disorder is defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.","Allowable Amount do not apply.","Arch Phys Med Rehabil.","All patients had vascular studies to rule out occlusive disease.","The network pharmacy will take care of claim submission.","Emergency Services, the Recognized charge is the Negotiated charge for Providerwith whom we have a direct contract but are not network Providers.","It does not matter what caused the condition or the duration of the condition.","Physician, other health professional, Hospital, Skilled Nursing Facility, Home Health Care agency or other entity or person licensed or certified under applicable state and federal law to provide health care services to you.","Difference Between an HMO and a PPO?","However, we recognize that many members do not want to receive unsolicited marketing materials unrelated to their health, disability and life benefits.","Aetna Aetna Life Insurance Company, an affiliate, or a third party vendor under contract with Aetna.","AHRQ Comparative Effectiveness Reviews.","Year Service Credit Requirement at the time of retirement.","Insulin pumps or tubing or other ancillary equipment and supplies for insulin pumps.","In the temporalis muscle, bruxism events did not differ between groups or among times.","How long will it take to get an ERO decision?","In addition, the new policy requires drugs to be purchased through the BCBS of Tennessee Preferred Specialty Pharmacy Network, or the Providers will not receive payment.","Vizitoni faqen ton\u00eb n\u00eb internet ose merrni n\u00eb telefon numrin e telefonit n\u00eb kart\u00ebn tuaj identifikuese t\u00eb an\u00ebtarit.","CVS Caremark at If a new medication has been prescribed for you to take immediately, please ask your doctor to issue two prescriptions.","Botox injections are considered to be safe and effective for preventing migraines and lowering the severity of migraine attacks.","Please be aware that there are edits to ensure safety and to comply with exclusions of coverage that are required for all commercial books of business in all states.","Coverage and to assist you in enrolling or changing the benefits you have selected.","The Medical Director must be a Psychiatrist.","Acceptable written evidence of a delegation of authority may include, among others, a power of attorney, a court order, or a hospital form signed by the enrollee.","State of New York Department of Insurance.","Thus, diagnosis is crucial before undertaking botulinum toxin type A injections.","All charges associated with: Surrogacy for you or the surrogate.","Emerging treatments for neuropathic pain.","You have received an adverse determination If our claim decision is one for which you can seek external review, we will say that in the notice of adverse benefit determination or final adverse benefit determination we send you.","Friedenberg FK, Palit A, Parkman HP, et al.","Hospitalconfinement for the convenience of the patient or because adequate arrangements are not available at home.","If a claim is submitted to an insurance payer without the authorization or referral that they require, it will be denied.","TRS may disclose your protected health information to its business associates so that they can perform the services that TRS has asked them to do.","CPP and standardized evaluation of participants are lacking across the literature.","For example, cosmetic surgery generally is not an allowable expense under this plan.","Your plan will cover this cost once per pregnancy.","Including plans specific templates.","Botox can improve symptoms and gastric emptying in patients with diabetic gastroparesis.","To keep your newborn covered, we must receive your completed enrollment information within days of birth.","Skilled Nursing Care that cannot be met at a lower level of care.","Ask your doctor to consider prescribing drugs that are on the Aetna Pharmacy Plan Drug List.","There were clinically statistically significant paired differences in the change in average voided volume, urinary frequency and episodes of incontinence between active treatment and placebo.","What are you looking for?","See Continuation of coverage for other reasons in the Special coverage options after your coverage ends section for more information.","Get accurate measurements from that.","Dispensed by a mail order pharmathat includes prescription drugs that cannot be shipped by mail due to state or federal laws or regulations, or when the plan considers shipment through the mail to be unsafe.","You have the right to a full and fair impartial review of your claim.","Boston University Page coinsurance listed in the schedule of benefits below reflects the plan coinsurance percentage.","You can call to check the status of a request.","Effect of intrathecal baclofen, botulinum toxin type A and a rehabilitation programme on locomotor function after spinal cord injury: A case report.","BTA injection prior to complex abdominal hernia repair was a safe procedure that causes flaccid relaxation, elongation and thinning of the lateral abdominal muscles and decrease in hernia defect.","It relaxes the bladder muscle, increasing its storage capacity and reducing incontinence.","Delays of several years before diagnosis are common, and symptoms are often confused with muscle tension dysphonia.","An example of a significant life change would be loss of health coverage under another health plan.","They searched Medline, Embase, Cochrane, Scopus, Ebsco, LILACS, and BVS.","BOTOX are reasonable and reflect current practice.","What types of services and supplies require precertification?","You must request the correction or Your letter must tell TRS what you think is wrong and why you think it is wrong.","Aetna Pharmacy Management administers, but does not offer, insure or otherwise underwrite the prescription drug benefits portion of your health plan and has no financial responsibility therefor.","Illnessor Injuryand premature birth.","This includes tubal ligation, hysterectomy and vasectomy only if obtained as a form of voluntary sterilization.","Botox has been shown to reduce muscle tone and increase range of movement in upper extremity spasticity or in spastic foot drop after stroke.","Hospitalafter a vaginal delivery.","This bill awaits subcommittee consideration.","Botulinum toxin in the treatment of cricopharyngeal dysphagia.","CVS Caremark cards will be issued under the name of the retiree or surviving spouse.","This content is owned by the AAFP.","Hospice care agency An agency or organization licensed, certified or otherwise authorized by applicable state and federal laws to provide hospice care.","Medicare Summary Notice to the Plan Participant.","Charges that would not be made if you did not have coverage under the plan Treatment of infertility Allchargesassociatedwiththe treatmentofinfertility, exceptasdescribed under the Eligible health services under your plan Treatment of infertility Basic infertility section.","They also searched reference lists of relevant articles and contacted investigators to identify additional published and unpublished studies.","Morbid Obesity will be certificationis required.","Perhaps the physician does not have the skills or resources needed to continue the case.","If the prescriber does not respond within a designated time frame, the request will be denied.","Please refer to the Clinical Policy Bulletin at www.","We can speak with that person during that call.","Some insurance companies require an active referral on file when a patient comes in for a surgical procedure or testing.","Alternative health care Services and supplies given by a provider for alternative health care.","TRS will attempt to gain your personal authorization when possible before making Certain Uses and Disclosures Requiring an Opportunity to Agree or to Object.","Thus, the understanding of potential treatment effects was diluted.","Recommended dose varies based on the size of the muscle affected, the intensity of the spasm, and the number of muscles affected.","Diagnostic lab work includes lab services, pathology and other tests when performed from a licensed lab.","ERO and the cost the external review.","Aetna provides certain management services to these entities.","Many patients report significant pain and discomfort with the tissue expansion process.","They attempted to contact researchers who are active in this field for information about further published or unpublished studies.","At our expense, we have the right to have a physician of our choice examine you.","IA therapies were discussed.","However, CGIC was significantly higher than PGIC.","Botulinum toxin for treatment of glandular hypersecretory disorders.","Nonmedicalcosts of an egg or sperm donor.","We do not provide care or guarantee access to health services.","Patients experiencing adequate paralysis of the target muscle that require subsequent injections should receive a dose comparable to the initial dose.","You can find a network pharmacy online or by phone.","If an earlier discharge is recommended, Eligible Health ervicesinclude an inhome nurse visit.","Complex imaging for preoperative testing covered under this benefit.","CMS definition of an appointed representative.","These researchers devised a clinical assessment score for PMS diagnosis and developed a treatment strategy.","Coordination of Benefits If a Plan Participant enrolled in the program is entitled to primary benefits under another group Plan, the amount of benefits payable under the program may be reduced.","For an urgent admission Call before you are scheduled to be admitted.","Chiropractic therapy that is preventive in nature.","This request is made by the provider rendering the procedure.","All pain scores trended to zero over time.","Results of studies of botulinum toxin for lateral epicondylitis have had mixed results.","Which Hospitals Have the Best Maternity Centers in Texas?","Network Covered Medical Expenses incurred by the covered family members in excess of a single deductible.","Please enter your email address.","Immunizations related to work Immunization agents Implantable drugs and associated devices except as specifically provided in the Eligible health services under your plan Outpatient prescription drugs sections.","Treatment of infertility Basic infertility services Inpatient and outpatient care basic infertility Covered according to the type of benefit and the place where the service is received.","Botulinum toxin causes temporary paralysis of muscle and may be an effective local treatment that improves asthma control.","Plast Reconstr Aesthet Surg.","Plan first calculates what the benefit would have been for the claim if there was no other Plan involved.","TRS is not a medical provider and does not directly participate in decisions about what kind of health treatment you should receive.","In comparison with oral splint, botulinum toxins are equally effective on bruxism.","Botulinum toxin as an adjunct to motor learning therapy and surgery for obstetrical brachial plexus injury.","We must receive your completed enrollment information from you within days of the event or the date on which you no longer hathe other coverage mentioned above.","American Academy of Neurology.","Management of strabismus with botulinum A toxin.","To look at the full Plan description, which is contained in the Certificate of Coverage issued to you, go to www.","Charges for services or supplies that are prohibited by federal, state or local law.","And if it takes place in a facility, the facility must meet any applicable licensing standards established by the jurisdiction in which it is located.","United States for diagnosis, care or treatment.","Conversations with CVS Caremark Specialist Pharmacists are private, which means that you can feel comfortable asking even personal and sensitive questions about your medications.","Care provides for two mandated levels of appeal to Aetna, with the option to thereafter seek a voluntary external review for claims that qualify.","Shaw L, Rodgers H, Price C, et al.","For a list of participating health care professionals who specialize in obstetrics or gynecology, contact your Employer or, if you are a current member, your Aetna contact number on the back of your ID card.","Bariatric Surgery Centers of Excellence.","This amount is based on your pharmacy plan design.","This form will also update your information on the online provider directory.","If precertificationdetermines that the stay or outpatient services and supplies are not covered benefits, the notification will explain why and how you can appeal our decision.","Preventive treatment in migraine and the new US guidelines.","Doctor, Urgent Care or ER?","Ask your employer when benefits for your domestic partner will begin.","Understanding each of these processes and how to determine what is required by the insurance is key to avoiding lost revenue and negatively impacting patients financially.","Your dental coverage may end while you or your dependent ain the midle of treatment.","He or she can consider this before writing a prescription.","If the submitted form contains complete information, it will be compared to the criteria for use.","It ends when he or she leaves after one Day Care or one Night Care treatment.","Plan Year in which the charge was incurred.","The Aetna unique number will be different from the CVS Caremark unique number.","Maternity care delivered by Physicians, such as doulas.","The drug must be injected into the bladder using cystoscopy, which may require general anesthesia.","It is not a nursing home or mainly a place for rest, for the aged, for drug addicts or for alcoholics.","Shim SR, Cho YJ, Shin IS, Kim JH.","Dosing in initial and sequential treatment sessions should be tailored to the individual patient based on head and neck position, localization of pain, muscle hypertrophy, patient response, and adverse event history.","Certificate of Coverage or Summary Plan Description.","Residential Treatment Facility by applicable state and deral laws to provide for Substance Use Disorders residential treatment programs.","Ochoa Vargas DC, Garc\u00eda Perd\u00f3mo HA.","Immunizations for unexpected mass immunizations directed at or ordered by public health officials for general population groups.","Private or special nursing services.","Karamfilov T, Konrad H, Karte K, et al.","Your doctor will work with you to see how long you should continue getting treatments and may recommend that you keep taking other medications until you see an improvement.","New prospects in the treatment of traumatic and postoperative parotid fistulas with type A botulinum toxin.","Nothing hissection shall prluthe prescribing provider from prescribing anothdrug overed by the plan that mecallyopriate for the rolnor shall anything his section be construed to prohibit generdrug bstitutis.","Data relating to the aim were extracted.","This is not the case and is precisely where the predetermination of benefits come into play, in addition to understanding reimbursement policies set up by payers themselves.","Speech function is the ability to express thoughts, speak words and form sentences.","Removed place of service information indicating the place as outpatient.","Home health care Eligible health services include home health care services provided by a home health agency in the home, but only when all of the following criteria are met: You are homebound.","If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount.","Treatment of bruxism in individuals with developmental disabilities: A systematic review.","If this occurs, you will be provided information about the breach and how you can mitigate any harm as a result of the breach.","Here are the steps to get an advance claim review: Ask your dental provider to write down a full description of the treatment you need.","These investigators stated that they could not recommend Botox for widespread use in the treatment of delayed gastric emptying until more data are available.","General exam for assessment of edema and neurologic abnormalities.","Cochrane systematic evidence review found that botulinum toxin may have a role in certain types of shoulder pain.","Visit Clinical Policy Bulletins and our online provider directoryi.","Lo KK, Aycock JK.","Authorized Representative for consideration of an Adverse Benefit Determination.","It also may exclude any backdated adjustments made by CMS.","Irvine, CA: Allergan, Inc.","COBRA, as afterplan that covers the person other than under such right of continuation.","Aetnaplan and your providerstops being in our network However, in some cases, you may be able to keep going to your current providerto complete a treatment or to have treatment that was already scheduled.","Reasonable and customary charges for each service are determined from claims from a large number of the same types of providers within a geographic region.","You can choose someone to do all of the above.","Botulinum toxin A for the treatment of chronic neck pain.","Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair.","Homemaker or caretaker services.","Not all benefits plans are offered in all service areas.","Some patients injected for cosmetic purposes develop neutralizing antibodies.","Botulinum toxin for treatment of cocontractions related to obstetrical brachial plexopathy.","Proprietary Signature affirms that information given on this form is true and accurate and reflects office notes.","They were extensively questioned and examined for any evidence of side effects or recurrence.","Botulinum toxin A for sialorrhea associated with neurological disorders: Evaluation of the relationship between effect of treatment and the number of glands treated.","Independent Health has updated prior authorization criteria for the prostate cancer drug Nubeqa.","Note: A Student Health Service referral is required for followuptreatment, including outpatient services.","How do I find a medical specialist?","Preferred generic drugs cost less.","Substance abuse This is a physical or psychological dependency, or both, on a controlled substance or alcohol agent.","What is cost sharing?","To help this process move quickly, please alert your doctor to expect our call.","Subjects had asthma resistant to optimized treatment and abnormal vocal cord movement.","Improving how we communicate updates We regularly review and adjust our clinical payment and coding policies.","Botulinum toxin treatment of myofascial pain: A critical review of the literature.","Then you fill out and send a prescription drugrefund form to us, including all itemized pharmacyreceipts.","What is the Aetna Medicare Comprehensive Formulary?","When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by our plan.","Furthermore, the letter encourages CMS to broaden its bench of clinical and measurement experts and includes recommendations regarding the new testing requirements to allow for a feasible timeline for testing reliability and validity of measures.","The patient is usually responsible for obtaining the original referral from their doctor.","Watching or protecting you.","Moore AP, Wood GD.","Dev Med Child Neurol.","Segment snippet included twice.","Call your doctor when you have medical questions or concerns.","The authors suggested that by temporarily weakening some of the power of medial rotation, afferent signals to the brain are reduced and cortical recruitment for the injured nerves is improve.","Managing Editor and Chief Encouragement Officer.","Shuhendler AJ, Lee S, Siu M, et al.","Benzodiazepines can also be used.","Drug List or MO.","FMLA leave, the dependent will be eligible for the continued coverage on the same terms as would be applicable if you were actively at work, not on an approved FMLA leave.","Covered Medical Expenses for health care services or supplies that are furnished by a Network provider or for emergency NETWORK HOSPITAL.","The reduction may be to the extent that the total payment provided by all Plans does not exceed the total allowable expense incurred for the service.","When we say Medicare, we mean the health insurance provided by Title XVIII of the Social Security Act, as amended.","Filled prior to the effective date or after the end date of coverage under this plan.","The part of the EOB that indicates that a portion, if any, of a claim is denied coverage is your notice of a claim denial.","Dependent coverage requires an additional premium.","Appeal process, you may request an external review of the final internal benefit determination.","They may even be able to provide you with a copy of the guidelines if the licensing agreement allows it.","Ragona R, Lauria G, et al.","It also covers buying a new DME item to replace one that was damaged due to normal wear and tear, if it would be cheaper than repairing it or renting a similar item.","Cervical cancer screening for sexually active woman.","Maintenance of the house.","You are now being directed to the Apple.","Remember to visit the website on your member ID card.","This should be in your enrollment kit.","This type of medicine is used regularly, to treat conditions like arthritis, asthma, diabetes or high cholesterol.","Whether or not for psychological or emotional reasons.","The network provider isresponsible for obtaining precertification.","You must continue to pay your Medicare Part B premium.","Biglan AW, May M, Bowers RA.","Severe primary axillary hyperhidrosis that is inadequately managed with topical agents.","Continuous facial myokymia in multiple sclerosis: Treatment with botulinum toxin.","By law, TRS must follow the privacy practices that are described in the most current privacy notice.","Legislature or agencies of the state or federal government, including, but not limited to health oversight agencies, for activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, civil, administrative, or criminal proceedings or actions, or other activities.","Limitations include things like maximum age, visits, days, hours, admissions and other limits.","These are drugs that are taken regularly for chronic conditions like arthritis, diabetes or asthma.","If the request is denied, you and your doctor will be notified.","CERTIFICATION REQUIRMENTS SCHEDULE OF COVERED SERVICESVI.","No significant side effects were seen.","COBRA continuation coverage retroactively if you are determined to be ineligible.","Singh JA, Fitzgerald PM.","Your surgery isneededtoimprove asignificantfunctionalimpairmentofabody part.","They stated that this finding opened the door to further clinical research.","Mental Disorder not otherwise specified.","The upper border of the cricoid cartilage was identified and the CM localized using a standard EMG.","Covered according to the type of benefit and the place where the service is received Covered according to the type of benefit d the place where the service is received.","Network, the participant is responsible for these charges.","Vizite sitw\u00e8b nou an oswa rele nan nimewo telef\u00f2n ki sou kat idantifikasyon manm ou an.","Inform us of any changes It is important that you inform us of any changes that might affect your benefit status.","Evidencebased items that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force; ande comprehensive guidelines supported by the Health Resources and Services dministration.","Practice guideline update summary: botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, dult spasticity, and headache: eport of the guideline development subcommittee of the American Academy of Neurology.","MS or spinal cord injury.","We may recommend moving a drug to a different coverage level.","As an Aetna Better Health provider, you need to prescribe medically necessary therapy or medications for a member.","Employer determines your approved FMLA leave is terminated or the date of the event for which the continuation is available.","Moreover, they stated that a prospective study is needed to evaluate whether this treatment can prevent aspiration pneumonia in neurologically impaired children.","Moreover, they noted that the short duration of action will presumably limit the use to patients who have experienced tachyphylaxis with Botox.","Not all plans are offered in all service areas and not all plans include all services listed.","You might also see this referred to as our formulary.","Certain Prescription drugs are Eligible Health Services under the medical Plan when they are given to you by your doctor or health care facility and not obtained at a pharmacy.","This includes descending by a parachute, wingsuit or any other similar device.","Expert Opin Biol Ther.","Nieto JF, et al.","Prescription medication written by a dentist or Physician r the purpose of treating a dental condition; dental care delivered during the treatment of accidental Injury to sound natural teeth that is not related to the accidental Injury.","So patients who belong to the same HMO but work for different companies may have different benefits.","Botulinum toxin for the treatment of excessive gingival display: A systematic review.","And if needed: Direct observation of urine loss by using cough stress test with full bladder; an estimation of post void residual volume; or urinalysis.","Ann Phys Rehabil Med.","Nem \u00f6t tn internet td\u00eb ke y\u00ef cl aku\u00ebn ctmec bi\u00e4k kak anyuth duyic.","Join a Migraine Community.","Sexual deviations and disorders except for gender identity disorders.","Habilitation therapy services sections and the schedule of benefits.","CD, proper assessment of neck motion and selection of relevant muscles and dosing must be met.","These quantity limits help your prescriber andpharmacist check that your prescription drug isusedcorrectlyand safely.","See in the eneral information sectionfor additional guidance.","Services provided bya person who ordinarily resides in your home or is in your immediate family.","Brien CF, Truong DD, et al.","The information you receive for that service is your proof of loss.","These drugs may be injected, infused or taken by mouth.","Kannafu websitti keenya illala hookan telefoona waarraqa miseensa irra jirran bilbilla.","The difference between complaint and an appeal complaint You may not be happy about provider or an operational issue, and you may want to complain.","Wong SM, Hui AC, Tong PY, et al.","Visits to the emergency room for services that are otherwise not Coveredunder the Plan.","Patients had periodic dental examinations to monitor for changes in dentition and oral mucosa.","This booklet will be revised prior to that date.","For an updated formulary, please contact us.","Evidence Centre Critical Appraisal.","Videofluoroscopy showed impairment of the UES opening, residue in pyriform sinuses, and aspiration in all cases.","During their review the insurance company may decide a generic or another lower cost alternative may work equally well in treating your medical condition.","Contact your Plan Administrator for the name, address, and telephone number of the party responsible for administering your COBRA continuation coverage.","BTX and placebo injections.","Prior Authorization in traditional Medicare.","They are based on the specific service given to you.","CDC or other nationally recognized entities whose role it is to establish eligibility guidelines and recommend preventive guidelines.","Curr Treat Options Gastroenterol.","If we find out that you do not meet this eligibility requirement, we are onlyrequired to refund any premium contribution minus any claims that we have paid.","If the quicker medical exception is approved, coverage will be providedfor the entire time you have an urgent situation.","However, for patients with a severe underlying condition this may not be a feasible option.","If you are unhappy with your prior authorization decision, you or your doctor can ask for a review of the decision.","Cervical Dystonia to reduce the severity of abnormal head position and neck pain associated with Cervical Dystonia.","Eligible Health Servicesfor Medically Necessary vision services required for the diagnosis and treatment of diseases of, or injuries to, the eye.","Unlimited Acquired brain injury Covered according to the type of benefit and the place where the service is received.","Blue Cross and Blue Shield of North Carolina.","Therapeutic efficacy and safety of botulinum toxin type A in trigeminal neuralgia: A systematic review.","Botox in selected patients with diabetic gastroparesis.","For example, physician care isan eligible health service but physician care for cosmetic surgery isnever covered.","Is your medical practice ready?","Formulary Exclusions, Precertification, and Quantity Limit Lists are subject to change.","Medicare covers skilled care to maintain or slow decline as well as to improve.","Predetermiations: Why and when?","How can we help?","Dummies has always stood for taking on complex concepts and making them easy to understand.","Greenwood Village, Colo: Thomson Micromedex.","You or your provider may request a review of the precertification decision.","Committee is an external advisory body of clinical professionals from across the United States.","What is Aetna Specialty Pharmacy?","Units of one product can not be converted into units of another product.","However, the pathology is poorly understood and difficult to diagnose.","You can also see if there are alternatives that cost less.","Ask us to reach out to your doctor.","This schedule replaces any schedule of benefits previously in use.","Sialorrhea in cerebral palsy.","Pharmacologic interventions for treating phantom limb pain.","Akosa is assistant professor of clinical family medicine at the Indiana University School of Medicine and associate medical director of Advantage Health Solutions Inc.","GYN on contraceptive methods.","The trick in clinical management is to use it intelligently and to know when and when not to use it.","There is insufficient evidence to support the use of botulinum toxin for treatment of constipation.","The chart below shows a timetable view of the different types of claims and how much time we have to tell you about our decision.","ID card in the How to contact us for helpsection.","They stated that additional studies with larger numbers of participants are needed to confirm these results.","Appeal through an external review process.","Paid according to the type of drug per the schedule of benefits, above Maximums: Coverage will be subject to any sex, age, medical condition, family history, and frequency guidelines in the recommendations of the United States Preventive Services Task Force.","Moreover, they stated that further study will help determine the optimum dose and frequency of injection to prevent recurrence of symptoms.","Proprietary Was there failure with baclofen AND at least ONE other formulary muscle relaxant such as dantrolene?","Ekbom DC, Garrett CG, Yung KC, et al.","Skilled Nursing Facility A facility specifically licensed as a Skilled Nursing Facility by applicable state and federal laws to provide Skilled Nursing care.","Request the Formulary First.","This cbe done by metabolic or other means determined by a physician or a nurse practitioner working within the scope of their license.","Storage of eggs, embryos or sperm.","Language services can be provided by calling the number on your member ID card.","When should I consider Botox for my migraines?","They stated that further research is very likely to have an important impact on the estimate of effect and the confidence in it.","They performed a qualitative analysis due to lack of data.","Degener Neurol Neuromuscul Dis.","Botulinum toxin type A therapy for blepharospasm.","The search strategy and studies selection were performed using the PICOS method according to the PRISMA statement.","Conrin L, Karp BI, Alter K, et al.","Hand weakness, which is dose dependent and transient, is a frequent adverse effect.","If both parents have the same birthday, the Plan that has provided Coverage longer is the primary Plan.","Current evidence is insufficient to guide choice of other therapies including sacral neuromodulation, instillation of oxybutynin, and injections of botulinum toxin.","Care follows all applicable state and federal laws, including mandates regarding diabetic care and treatment.","Expert Opin Drug Saf.","Orthodontics Root canal treatment Removal of soft tissue impactions Removal of bony impacted teeth Alveolectomy Augmentation and vestibuloplasty treatment of periodontal disease False teeth Dental implants This exclusion does not include bone fractures, removal of tumors, and odontogenic cysts.","Therefore, they concluded that there is no evidence of a benefit from botulinum toxin injection in the treatment of chronic tennis elbow.","We need receive requests for precertification before you provideservices.","This is for adults who have an inadequate response to or are intolerant of an anticholinergic medication.","The remaining measures in the urology measure set are general measures.","Ask your employer if you have any questions about the group policy.","Care may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing.","However, if the referral is not made correctly, the liability of the referring physician may increase.","Eligible health servicesunder your plan Ambulance service section.","Your outpatient prescription drug plan is based on the drugs in the drug guide.","CVS Caremark would not pay any ecausehaveother coverage.","Our flexible health insurance solutions can help your clients to lower costs, improve employee health and productivity, and more.","It appears that botulinum toxin A produces benefits which are sustained beyond the period for which the toxin is recognized to be active.","Plan, you are encouraged to utilize one to assist you in coordinating your care.","Youshould select a PCP for your covered dependent if they are a minor or cannot choose a PCP on theirown.","Coverageis not excluded for thtreatment of nail fungus for embers who have metabolic peripheral vascular disease or diabetes.","You will continue to pay copayments or coinsurance, if any, for eligible health services after you meet your deductible.","IC, with a slightly larger PVR.","The authors noted that more investigation is clearly needed.","Employee or Member The Plan that covers the Plan Participant as an active employee or member is primary: Over the Plan that covers the Plan Participant as a Dependent.","You can also get more information about the restrictions applied to specific covered drugs by visiting our Website.","Minimum Creditable Coverage standards set by the Commonwealth Health Insurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship.","This list is subject to change.","The authors stated that randomized, controlled, prospective studies are needed to address these issues and to define the true benefits of Botox injections in patients with ischemic digits.","If you need assistance finding this information, call the number on the back of your ID card.","Trigonal injection had no therapeutic effect on symptom or urodynamic improvement.","One year follow up of a randomized pilot study.","Eligible health services under your plan Preventive care and wellnesssection, including preventive services for obesity screening and weight management interventions.","Hawlik AE, Freudenmann RW, Pinkhardt EH, et al.","Outcomes measured included pain rating, digit color and appearance, transcutaneous oxygen saturation, and healing of chronic ulcers.","You can appeal to us verbally or in writing.","You may want to take this guide with you when you see your doctor to talk about what is covered under your plan.","Many commonly prescribed drugs are listed in this guide.","You pay the pharmacy directly for the cost of the prescription.","Key terms Here are some key terms we use in this section.","Side effects of the use of botulinum toxin for treatment of benign essential blepharospasm and hemifacial spasm.","Your plan pays foits share of the expense for eligible health services only if the general requirements are met.","Relearn skills so you can significantly regain your ability to perform the activities of daily living on your own.","Baxter M, Uddin N, Raghav S, et al.","Tier Commercial Member Guidewww.","Botulinum toxin type A as an adjunct to the surgical treatment of the medial rotation deformity of the shoulder in birth injuries of the brachial plexus.","Request ID cards, view claims, estimate costs for care, and much more.","Camilleri M, Parkman HP, Shafi MA, et al; American College of Gastroenterology.","Gobets D, Beckerman H, de Groot V, et al.","Gracies JM, Bayle N, Goldberg S, Simpson DM.","Blepharospasm is a focal dystonia involving the orbicularis oculi muscles and other periocular muscles, including the procerus and corrugator muscles.","We will only use a statement during a dispute if it is shared with you and your beneficiary, or the person making the claim.","Curr Pain Headache Rep.","London, UK: Haymarket Media, Inc.","Int J Oral Maxillofac Surg.","If you would like to learn more about specialty medications and services, visit www.","No studies provided evidence relating to a trajectory of care.","You can refer to the General provisions other things you should know section for more information on rescissions.","Want to see options for a different location?","Salivary gland tumors: Treatment of locoregional disease.","Find more information about notificationand coverage determinationsrequire precertification when Aetna Innovation Health is the secondary payer.","Pursue arbitration, litigation or other type of administrative proceeding.","First Coast Service Options has added a new article addressing billing and coding procedures that complement the LCD for Prostatic Urethral Lift.","In some cases, your insurance company will ask for more information from your doctor in order to make a decision.","Cochrane DB Syst Rev.","Member Services number on your ID card or visit our Internet site at www.","Contact Customer Service if you have questions about other services.","All languages were included as long as they met the inclusion criteria.","Preventive screening and counseling services Eligible health services include screening and counseling by your health professional for some conditions.","Home Plan before deciding whether or not to proceed with impatient services that have been denied certification, even if the member has agreed to pay.","The IRO will notify you in writing that it has received the request for an external review.","If deemed denied and you have the right to appeal the claim.","For language services, please call the number on your member ID card and request an operator.","Services and supplies furnished to a person mainly to assist him or her in the activities of daily living, such as bathing, toileting, feeding, personal grooming, dressing, or getting in or out of bed or a chair.","Mental health treatment Coverage provided under the same terms, conditions as any other illness.","Clinical doses expressed in units are not comparable from one botulinum toxin product to the next.","Eligible health services under your plan Preventive care and wellness section, including preventive services for obesity screening and weight management interventions.","Guide, Formulary Exclusions, Precertification, Quantity Limit and Step Therapy Lists are subject to change.","Specialty prescription drugs Drugs that are included on the list of specialty prescription drugs as covered under your outpatient prescription drug benefit.","They included published and unpublished randomized controlled trials without language restrictions.","As to coverage for prescription lenses in a policy year, this benefit will cover either prescription lenses for eyeglass frames or prescription contact lenses, but not both.","Int J Pediatr Otorhinolaryngol.","PH, van den Hoogen FJA, van Limbeek J, Gabreels FJ, van Hulst K, Rotteveel JJ.","Ting Anh, ch\u00fang t\u00f4i c\u00f3 dch vng\u00f4n ngn ph\u00ed.","Referrals must be made so that the patient is assured of the availability of ongoing care.","Your Planonly covers the same type of DME that Medicare covers.","New Zealand J Physiother.","TRS or a If you request copies of your protected health information, TRS can charge you a fee for each page copied, for the labor involved in compiling and be mailed to you.","Psychiatrist Psychiatrist generally provides evaluation and treatment of mental, emotional, or behavioral disorders.","Empower yourself as a patient, and learn how to get the most out of your benefits.","The Botox group reported improvement in gastric emptying; however, this was not superior to placebo.","Laparoscopic ventral hernia repair.","If our claim decision is one that allows youto ask for an external review, we will say that in the notice of adverse benefit determination we sendyou.","See the Specific therapies and tests section.","The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention?","Botulinum toxin products are not interchangeable.","Aetna at the telephone number listed on your ID card.","Appeal process must be followed before you may seek an external review, except for urgent care situations.","Added Inrebic to the policy.","Strabismus, retrobulbar hemorrhages sufficient to compromise retinal circulation have occurred.","Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions.","Changes will be effective for all of your protected health information that TRS maintains.","Dodick DW, et al.","Coverage will not be continued beyond the first to occur of: The date you are required to make any contribution and you fail to do so.","Comparative Effectiveness Review No.","To access this form, visit www.","Maintaining the highest ethical standards in the workplace depends on each individual.","Fully insured Texas and Louisiana members continue be covered for drugs added the precertificationlist accordingtheircurrent plan design until their renewal date Fully insured California HMO members and fullyinsured Connecticutmembers covered for drugs added the precertification list continue have coverage.","You or your dependents may have to pay for such coverage.","The information on this site is not intended as a substitute for professional medical training.","Ann Otol Rhinol Laryngol.","If possible, call your physicianbut only if a delay will not harm your health.","Existing drugs are removed from the market.","Some policies are different for professional services than for facility services.","Refractory idiopathic urge urinary incontinence and botulinum A injection.","For details on the guidelines and the current list of covered tobacco cessation prescription drugs and OTC drugs, contact Member Servicesby logging onto your Aetna secure website at www.","The prior authorization process gives your health insurance company a chance to review how necessary a certain medication may be in treating your medical condition.","Botulinum toxin: New treatment for temporomandibular disorders.","Botulinum toxin A for muscle spasm of various anatomic origins: A review of the clinical effectiveness.","Aetna determines the category of Appeal and will send you written notification regarding the category of Appeal, your Appeal rights and information regarding how to initiate an Appeal.","Be aware that not all insurance verification tools or software include this information, especially for ASCs.","How does the prescriber begin the Prior Authorization process?","Cricopharyngeal dysfunction is one of the major findings in these patients.","Adjunctive services such as medication monitoring Care is delivered according to accepted medical practice for the condition of the person.","Surgeryreconstruction of the other breast to produce a symmetrical appearance.","UI; amount and type of perineal pads or protective devices; previous treatments for UI and effects on UI; and expectations of treatment.","Eligible health services under your plan Other services section and the Preventive care and wellness section, including preventive services for obesity screening and weight management interventions.","These types of drugs may be injected, infused or taken by mouth.","Below are changes to the drug list that will also affect members currently taking a drug: New generic drugs.","CERTIFICATION REQUIREMENTS LIMITATIONS use your own eggs.","This can always be updated later at the request of the specialist.","Dependent enrollment applications will not be accepted after the enrollment deadline, unless there is a significant life change that directly affects their insurance coverage.","Botulinum toxin for the treatment of gastroparesis: A preliminary report.","If possible, call your physicianbut only if delay will not harm your health.","Aetna selects facilities with experience and a history of successful clinical outcomes.","The chart below lists who is responsible for giving the notice, the type of notice they are required to give and when.","PMS and an optimum treatment strategy was proposed.","You cancall Member Services at the tollfree number on the back of your ID card for information on continuity of care.","BTX injections did not influence effectiveness.","Provider that has contracted with Aetna to offer these services.","New to Migraine Again?","The authors concluded that botulinum toxin reduced treated tic frequency and the urge associated with the treated tic.","The incidence of AEs attributable to IA therapies across clinical trials in knee OA was very low, and barely reached significance when compared to the incidence of AEs in the comparator group.","Coverage and services Your coverage can change Your coverage is defined by the group policy.","Message frequency varies, but you may receive up to one message per week during Open Enrollment.","This may include a determination by us as to whether the service is Medically Necessary and eligible for Coverage.","Visit Clinical Policy Bulletins our online provider directory.","Boyd RN, Hays RM.","They are: The Eligible Health Service is Medically Necessary.","When making your appointment, confirm your provider is a network vision location for pediatric vision services.","Botulinum toxins can reduce spasticity, improve function, and reduce the amount of needed assistance.","Transportation by Ambulancebecause you did not have any other form of transportation.","Proven coverage solutions that support your total health and wellness.","Most documents are in PDF format to make them easy to download and print.","Pharmacologic management of acute attacks of migraine and prevention of migraine headache.","Clinical manifestations and initial management of infants with bladder exstrophy.","Preparation of special diets andsupervision of medication that is usually selfadministered regardless of who orders the services.","Services outside the home or to help meet personal, family or domestic needs.","Treatment of weak, strained, flat, unstable or unbalanced feet, fallen arches, or chronic foot strain.","These terms have the meanings given by regulations and other official actions and publications of the FDA and Department of Health and Human Services.","Aetna for your coverage.","If coverage is not authorized, you may be responsible for the full cost.","Aetna for the same service by other similar providers.","In some cases, our plan requires you to first try certain drugs to treat your medical condition, before we will cover another drug for that condition.","Referral For plans that require one, this is a written or electronic authorization made by your PCP to direct you to network provider for medically necessary services and supplies.","Comprehensive preventive clinics or spas.","At the time you request the leave, you must agree to make any contributions required by your Employer to continue coverage.","Here are some basics.","Coverage for the purchase of breast pump equipment is limited to one item of equipment for the same or similar purpose.","Para acceder a los servicios de idiomas sin costo, llame al n\u00famero que figura en su tarjeta de identificaci\u00f3n.","In practice, this duty does not help the emergency room physician or the patient if the neurosurgeon refuses to come in.","The authors concluded that the proposed evaluation score may facilitate PMS diagnosis and treatment standardization.","Mental Disorders and Substance Use Disorder under the laws of the jurisdiction where the individual practices.","Overall, both participants and clinicians reported an improvement of subjective clinical status.","The primary plan must pay benefits in accordance with its policy terms.","Mental disorders are often connected to significant distress or disability in social, work or other important activities.","Care participants who are eligible for Medicare.","Service at BEFORE the procedure or service is performed.","Botulinum toxin type A was found to be a safe and useful treatment option for vasospastic digital ischemia.","Your plan will cover either buying or renting the item, dependingon which we think is more cost efficient.","CVS Caremark at The prescription drugs that you get through the CVS Caremark Pharmacy, as well as those purchased from a participating retail pharmacy, are checked for potential drug interactions.","Botox as a treatment for diabetic gastroparesis is warranted.","Chemotherapy Eligible health services for chemotherapy depend on where treatment is received.","Services, supplies and drugs received outside of the United States Nonemergency services, outpatient prescription drugs or supplies received outside of the United States.","However, TRS may disclose your protected health information for treatment purposes.","Please note that all services ordered or rendered to Medicare beneficiaries must be signed.","Carefully designed prospective studies are needed to ascertain the safety and effectiveness of botulinum toxin in pain disorders.","Eligible dependent children can be covered only if the surviving spouse elects coverage.","Directory The list of network providers for your plan.","You may each select a different PCP.","Botulinum toxin B: A review of its therapeutic potential in the management of cervical dystonia.","You may put child of your spouse, domestic partner on your plan.","Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice.","Thean initiate an external review.","Surgical, hormone replacement therapy, and counseling treatment Covered according to the type of benefit and the place where the service is received.","Aetna is the brand name for insurance products issued by the subsidiary insurance companies controlled by Aetna, Inc.","The safety and efficacy of botulinum toxin type B in the treatment of patients with cervical dystonia: Summary of three controlled clinical trials.","These may include asthenia, generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties.","How do I request an exception to the Aetna Medicare Formulary?","Genetic Information Information about genes, gene products and inherited characteristics that may derive from an individual or a family member.","Plan Participants without enough earned work credits have the option to enroll in Medicare Part A and pay a monthly premium contribution.","Continue health care coverage for yourself, your spouse, or your dependents if there is a loss of coverage under the Plan as a result of a qualifying event.","Medically Necessary; take home drugs; charges forservices or supplies provided before or after your Effective Date of Coverage.","Success was defined as independence on gastrostomy for patients who previously were dependent on gastrostomy and improvement in disability rating scale score after BTX injections.","CERTIFICATION REQUIREMENTS LIMITATIONS used to transfer oocytes or sperm to the Coveredrecipient.","Reduction in pain was estimated by VAS bladder pain score.","Recurrence rates after complex ventral hernia repair remain high, and increase with each failed attempt.","Lindern JJ, Niederhagen B, Appel T, et al.","Pediatric comprehensive low vision evaluations Performed by a legally qualified ophthalmologistoptometrist, therapeutic optometrist, or any other providers acting within the scope of their license Covered according to the type of benefit and the place where the service is received.","Mus saib peb lub website los yog hu rau tus xov tooj nyob rau saum koj tus kheej daim npav tswv cuab.","Services related to the prevention of breastcancer and its early detection.","The authors concluded that Dysport injection appears to be a safe and effective procedure with only by minor, and transit adverse events.","You can call them with questions anytime, any day of the year.","Service Area The geographic area where network Providerfor this Plan are located.","This helps our employees and managers keep up with skills, expand their knowledge, and work better together.","Important note: Refer to the Vision care section in the certificate of coverage for the explanation of these vision care supplies.","Our plan covers both brand name drugs and generic drugs.","Contact your state insurance department for further information about your rights with respect to a health insurance issuer.","Applied behavioral analysis will be subject to the same cost sharing requirements as other, outpatient services provided by a behavioral health provider for the treatment of autism spectrum disorder.","Migraine Again will advocate on your behalf if we know who you are and how many people have the same coverage issue.","The AAN concluded that botulinum neurotoxin is probably safe and effective for the treatment of DSD in patients with spinal cord injury and should be considered for use in these patients.","International guidelines recommend a combination of BTX injections and physiotherapy.","Other medications also STEP THERAPYYou must try one or more similar, lower cost medications before the plan Step Therapy is used for certain medications prescribed to treat New prescriptions are subject to Step Therapy.","Note to existing members: This formulary has changed since last year.","Aetna is pleased to now offer Medicare Advantage plans.","ATTENTION: If you speak English, language assistanceservices, free of charge, are available to you.","Deductibles, and referral requirements, if any, as outlined in your Plan documents.","Some contracts state that the Allowed Amount is the lesser of billed or the contracted fee.","Help with walking, grooming, bathing, dressing, getting in or out of bed, going to the bathroom, eating or preparing foods.","Telemedicine A consultation between you and a providwho is performing a clinical medical or behavioral health service.","Medicare Prescription Drug Plan.","Replacement items, including, but not limited to, replacement batteries, tires, and light bulbs.","Preventive breast cancer genetic counseling provided by a genetic counselor to interpret the test results and evaluate treatment.","Personal comfort orconvenience items or services such as television, telephone, barber or beauty service, guest service and similar incidental services and supplies.","Deductible applies to each visit to an emergency room which does not result in an inpatient admission.","This limits the generalizability of the findings.","The effectiveness of this approach needs to be validated by further investigation.","It has not been proven to be an effective treatment for complex regional pain syndrome or occipital neuralgia.","Vargas H, Galati LT, Parnes SM.","These posters are required by federal and state law to be posted for the benefit of employees so that they can have a better understanding of their rights.","Health benefits and health insurance plans contain exclusions and limitations.","How can you extend coverage for hearing services and supplies when coverage ends?","Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the Coverederson involved.","Care retiree premiums are based on three factors: level of coverage selected, years of TRS creditable service, and eligibility for Medicare.","Chuang YC, Smith CP, Somogyi GT, Chancellor MB.","Any other information you would like to have considered in your appeal to Aetna.","You maput a foster child on your plan when you have obtainlegal responsibility as foster parent.","This includes both Medicare and Medicaid plans.","The pharmacy can give the member a five day supply.","Annual Urology Advocacy Summit is almost full!","Read the complete policy.","Patients suffered from chronic ischemic hand pain.","Treatment of interstitial cystitis.","CPT codes are not required by every plan, but are required by some.","Services provided by a school district.","This individual deductible applies separately to you and each covered dependent.","Legal notices, state and federal posters, and documents relevant to benefits for employees at the University of Rochester.","The amount of BTX and the injection sites can be tailored to meet individual patient needs.","Fees or costs associated with services that are primarily exercise.","Rehabilitative services whose primary goal is to return you to a specific occupation or job, such as workhardening oworkconditioning programs.","Want to use this article elsewhere?","Contact your Plan Administrator for assistance in obtaining a certificate of creditable coverage.","BTX prior to elective repair of recurrent abdominal hernias.","First bite syndrome: Incidence, risk factors, treatment, and outcomes.","Data for individual studies were reported, and pooled data were analyzed if appropriate.","Botulinum toxin A, adjunctive therapy for refractory headaches associated with pericranial muscle tension.","Uses of botulinum toxin injection in medicine today.","Anal fissure: medical management.","BTA into the parotid gland.","Aetna Rx Home Delivery.","Expenses incurred for treatment of alcoholism or drug abuse will be Covered Medical Expenses only as provided above.","In unapproved uses and approved indications, cases of spread of effect have been reported at doses comparable to those used to treat Cervical Dystonia and spasticity and at lower doses.","Summary of Product Characteristics.","Injections were administered into the dorsomedial part and on both sides into the ventrolateral parts of the muscle.","Electrophysiologic evidence of piriformis syndrome.","Botulinum toxin in the treatment of diffuse esophageal spasm.","Precertificationis required before beginning each treatment program.","In most cases these scenarios happen due to continuity of care or a provider with the required skill set is not contracted with the insurance plan a patient may have.","All doses of Dysport studied showed a significant reduction from baseline of muscle tone compared with placebo.","Sometimes you do not have to complete the two level appeals process before you may take other actions.","There is little evidence to support the use of botulinum toxin for tinnitus.","Botulinum toxin is being investigated as a treatment for depression.","This includes but is not limited to aromatherapy, naturopathic medicine, herbal remedies, homeopathy, energy medicine, Christian faithhealing medicine, Ayurvedic medicine, yoga, hypnotherapy, and traditional Chinese medicine.","If you must fill a prescription in either situation, we will reimburse you as shown in the table below.","While many people improve with just one treatment cycle, some may require more.","This coverage will be provided in consultation with the attending physician and the patient, and will be provided in accordance with the plan design, limitations, copays, deductibles, and referral requirements, if any, as outlined in your plan documents.","And we will directly pay the network provider for what the plan owes.","Prescription drugs and may receive or pay additional amounts from or to third parties underpri guarantees.","Adverse Benefit Determination Categories of Appeal There are two separate categories of Appeals: medical and administrative.","Members must meet all of the Coverage criteria in order to be eligible for these benefits.","For example, ask how many prescriptions or visits will be approved.","Use of botulinum toxin type B for migraine and tension headaches.","The therapy consists of local injections of botulinum A toxin in the affected skin.","Alternative therapies, such assleep therapies.","And a nurse or pharmacist should monitor you during your treatment.","Quantity limits help your doctor and pharmacist make sure that you use your drug correctly and safely.","Dysport against placebo and trials that used Botox against placebo showed no significant differences between Dysport and Botox in terms of benefits or adverse events.","We will provide you with any new or additional information that we used or that was developed by us to review your claim.","Not all health services are covered.","Your condition is unstable, and requires medical supervision and rapid transport.","Clinical manifestations include increased blinking and spasms of involuntary eye closure.","Strabismus is the condition of misalignment of the eyes.","SCI will need treatment to control it.","Probably one of the trickiest parts of any physician practice administratively is understanding and effectively navigating insurance prior authorization requirements.","Medicare Part A benefits based on the work history of a current, former or deceased spouse.","Ischiorectal fossa abscess after pelvic floor injection of botulinum toxin.","Message and data rates may apply.","Shah SK, Liang MK.","This also could include tubal ligation andsterilization implants.","Guide, Formulary Exclusions, Precertification, and Quantity Limit Lists are subject to change.","Experimental or nvestigational Infertility treatment as determined by the American Society for oductive Medicine.","The contracted Allowed Amount is usually less than the billed amount.","Replacing the neuroleptic drug with substitute drugs may help some individuals.","FDA approved and are used to treat the same conditions.","Cosmetic Services, drugs or supplies that are primarily intended to alter, improve or enhance your appearance.","If a member elects to proceed with an inpatient admission that the Home Plan has denied certification, can the member be billed?","The letter urges BCBS to reconsider their decision is attached.","Spinal manipulation Eligible health services include spinal manipulation to correct muscular or skeletal problem, but only if your provider establishes or approves treatment plan that details the treatment, and specifies frequency and duration.","Eligible health services under your plan, Autism Spectrum Disorder Educational services Examples of those services are: Any service or supply for education, training or retraining services or testing.","Preventive chiropractic services, including, but not limited to, longterm or periodic manipulation of bones or joints, massage therapy, or holistic or alternative medicine.","Restructured list of indications, previously applicable for all botulinum toxins, into subsections for treatment with Botox, Dysport, Xeomin, and Myobloc.","This treatment reduces the number hospitalizations for enterocolitis and can be effective in improving symptoms in some patients, however it is difficult to predict which patients will respond.","Nardini L, Manfredini D, Salamone M, et al.","In Maryland, by Aetna Health Inc.","The Evaluation of the clinical effects of Botulinum Toxin on Nocturnal Bruxism.","The program provides a full spectrum of support and services to terminally ill participants and their families, including nurse case management support, online tools and information.","The dental care services are not a Covered Benefit.","Care and any applicable deductibles, coinsurance amounts, and copayment amounts.","We define them in the Glossary section.","The notice will tell you why your coverage is ending.","Arch Otolaryngol Head Neck Surg.","Disclaimer: The materials contained on this website are provided for informational purposes only and do not constitute legal or other professional advice on any subject matter.","Major bruxism was assessed by premature dental wearing.","Select a Health Plan.","You are responsible for the entire expense of cancelled or missed appointments.","After a single injection, all parents reported improvement in function.","An appointment is good for one year from the date that you and your representative sign an Appointment of Representative form.","Sorry, that email address is invalid.","By following the tips provided in this article, you can reduce the time you spend on utilization management and get back to your most important job: caring for patients.","The therapeutic protocol was described; it allowed simple management of these complications and use of smaller doses than those described in the literature for treatment of sialoceles.","What the plan pays and what you pay section, and your schedule of benefits Claim information in the When you disagree laim decisions and appeal procedures section How to contact us for help We are here to answer your questions.","Where your schedule of benefits fits in You are responsible for paying your part of the cost sharing.","If approved this would lower the amount you must pay for your drug.","Your doctor can fax in the prescription.","Care provides coverage for many of your health care needs, including prescription drugs and more.","How can I relieve my back pain?","No serious adverse events were attributable to Botox.","You or a covered dependent become entitled to benefits under Medicare.","EFFECTIVE DATE OF COVERAGE.","Medicare fraud occurring among HHAs providing services to Medicare beneficiaries.","Medicare or exploring other coverage, our plans offer flexible options to fit all needs and lifestyles.","How much does Botox for migraines cost?","Notice of No Lifetime Limit and Enrollment Opportunity You do not have a lifetime limit on the dollar value of benefits under your group health Plan.","High versus low concentration botulinum toxin A for benign essential blepharospasm: Does dilution make a difference?","Harvard Pilgrim Health Care, Inc.","You may also call the number on your ID card for help in finding dentist.","In addition, it has been shown to improve patient quality of life.","Truong D, Comella C, Fernandez HH, Ondo WG; Dysport Benign Essential Blepharospasm Study Group.","Treatment is empiric and is aimed at minimizing pain while maximizing function.","This is done under a coverage management program.","What is the evidence for botulinum toxin for migraine?","You will be given an Express Scripts telephone number that you should give to your doctor.","Adverse events were similar between the groups.","Ask your health plans what guidelines they use.","Many health plans do not cover services such as employment, sports, immigration and insurance physicals.","Plan the day before the date of the qualifying event that causes the loss of coverage for that individual.","This typically occurs following stroke, brain injury, SCI, multiple sclerosis and other disabling neurological diseases and cerebral palsy.","These are the types of drugs that may be injected, infused or taken by mouth.","Botox and Dysport made comparison with previous studies difficult.","Health Questionnaire were the secondary outcome measures.","Do you need help?","You may be responsible for the unpaid balance of the bills.","Standard LOS for: Vaginaldeliveriesisthreedaysfewer Cesareansectionfivedaysfewer Contact Aetna Pharmacy Management for precertification of oral medications not this list.","Enrollment in our plans depends on contract renewal.","Custodial care Servicesandsuppliesmainlyintendedtohelpmeetyour activitiesofdailyliving orotherpersonal needs.","Aetna and CVS Caremark Mail Service Pharmacy are part of the CVS Health family of companies.","Another example of health care operations perform its administrative activities.","Some drugs on the Aetna Drug List may be subject to manufacturer rebates.","Reconstructive surgery and supplies section This cosmetic services exclusion does not apply to surgery after an accidental injury when performed as soon as medically feasible.","Aetna has updated its selected treatments for neurogenic bladder commercial medical policy.","Breast cancer chemoprevention counseling.","Choose how you would like to enroll in an Aetna Medicare plan.","Allowable expense means: A health care expense that any of your health plans cover to any degree.","What types of medications typically need approval?","CVS Caremark Specialist Pharmacist.","Botulinum toxin A for various pain syndromes: A review of the clinical effectiveness.","Please note that if your prescription drug benefits plan changes, the information herein may no longer apply.","If you purchase DME, that purchase is only eligible for Coverageif you need it for longterm use.","Deductible provisions The deductible may not apply to certain eligible health services.","Aetna, it will be your responsibility to settle your account with your provider.","Your browser sent a request that this server could not understand.","Neurobloc European Cervical Dystonia Study Group.","Generic alternatives are not the same as generic equivalents.","Any service or supply for education, training or retraining services or testing.","Your coverage for the service or supply will continue until you receive a final appeal decision from us or an external review organization if the situation is eligible for external review.","Diagnostic lab work Eligible health services inclde diagnostic lab services, and pathology and other tests, but only when you get them from a licensed lab.","The condition may be a form of muscular dystonia that could contribute to asthma resistant to optimized treatments.","Generally accepted standards of medical and dental practice and The views of physicians and dentists practicing in the relevant clinical areas We use commercial software to administer some of these policies.","You will find details on preauthorizationrequirements in the Medical necessity and preauthorizationrequirementssection.","If there is a difference between this Benefit Summary and the Certificate of Coverage, the Certificate will control.","Kelly EA, Koszewski IJ, Jaradeh SS, et al.","Precertification for all members with plans applicable this precertification list unless services are emergent.","You may also ask us to send you a copy.","Pharmaceutical companies and device manufacturers also lobby hard to get their therapies covered by Payers, but they are seen as profiteers.","Changes in secondary outcome measures were also not statistically significant.","Outpatient contraceptive drugs and devices not approved by the FDA; reversal of a voluntary sterilization.","Milieu therapy, biofeedback, behavior modification, sensitivity training, hypnosis, electrohypnosis, electro sleeptherapy or electronarcosis.","Network providerprovider listed in the directory for your plan.","Does health insurance cover chiropractic care?","Precertification is one way that we can help you and your doctor find safe, appropriate drugs and keep costs down.","All pharmacological interventions are adjunctive to a program of physical intervention and there is a good evidence base for this in relation to BTX treatment.","Curr Sports Med Rep.","Botulinum toxin type B in piriformis syndrome.","In unclear cases, or in patients with temporary problems, no good method other than swallowing training, bougienage, and tube feeding are available.","Hu GC, Chuang YC, Liu JP, et al.","In subcondylar fractures, most surgeons are conscious of facial nerve injury; however, they usually pay little attention to the parotid duct injury.","Jeffe JS, Sulman CG.","Clinical pharmacists and medical doctors at the insurance company are trained in reviewing prior authorizations.","Moreover, they stated that further detailed quantification of advancement gains and morbidity from this technique is needed, both with and without prior administration of BTX to facilitate closure.","Paradoxical use of frontalis muscle and the possible role of botulinum a toxin in permanent motor relearning.","What is therapeutic duplication?","Then mail it to us with a completed order form.","HDHP, Standard and High Option plan members.","We will let you know if we need more information to make a decision.","The published results must clearly demonstrate either a survival or quality of life enhancement standard treatment for that particular cancer.","We will pay for that exam.","Treatment of postparotidectomy salivary fistula with botulinum toxin.","The use of botulinum toxin for the treatment of temporomandibular disorders: Preliminary findings.","Baumann L, Slezinger A, Halem M, et al.","Doctor of Dental Science or Doctor of Dental performs.","Botox was as effective as amitriptyline for the prophylactic treatment of chronic daily migraines.","Precertification is the process of collecting information before inpatient admissions and select ambulatory procedures and services.","FDA approved as prophylactic treatment option for adult chronic migraine sufferers.","For details, contact your physician or Member Services by logging onto your Aetna secure website at www.","Acting fast in these situations is critical.","Charges associated with your care when using a gestational carrier including egg retrieval and culture and fertilization of your eggs that will be transferred into a gestational carrier.","Motor vehicle accidents Services and supplies given by a provider for injuries sustained from a motor vehicle accident but only when benefits are payable under other valid and collectible insurance.","Network vision claims and pharmacy expenses typically must be filed by the member.","See the Medical necessity and precertification requirements section for more information.","Park AJ, Paraiso MF.","You are now leaving our Medicare website.","Surgery; orthodontic correction of tooth alignment or malocclusion; dental related oral Surgical services to correct an overbite or under bite.","Please see the Medicare section of this page.","PCP in his or her office.","Appeals of adverse benefit determinations You can appeal our adverse benefit determination.","Units is considered not medically necessary.","We may add or remove drugs from the Preferred Drug List for certain reasons.","This includes but is not limited to aromatherapy, naturopathic medicine, herbal remedies, homeopathy, energy medicine, Ayurvedic medicine, yoga, hypnotherapy, and traditional Chinese medicine.","Medication Guide to help patients understand the risks and benefits of botulinum toxin products.","Br J Plast Surg.","If precertification determinesthat the stay or services and supplies are not covered benefits, we will explain why and how our decision can be appealed.","Shall not: Cancel, limit or refuse to issue or renew a policy or plan Deny or limit coverage of a claim Apply additional cost sharing to a person because of race, color, national origin, sex, age, or disability.","Tudor KI, Sakakibara R, Panicker JN.","Eligible health services include the expense of renting or buying DME and accessories you need tooperate the item from a DME supplier.","All hernias were surgically reduced with mesh with no early recurrence.","Ask your employer when benefits for your adopted child will begin.","Ghei M, Maraj BH, Miller R, et al.","Why would we end coverage?","The notice will also tell you about your rights to receive additional information that may be relevant to the appeal.","CPP without endometriosis and whether pain relief is due simply to the placebo effect.","Orthopedic surgery or neurosurgery may be an option for selected patients with intractable spasticity.","Enhance other forms communication to make up for hearing loss or devices that simulate speech.","Intentional deception If we learn that you defrauded us or you intentionally misrepresented material facts, we can take actions that can have serious effects on your coverage.","Generally, generic drugs cost less than brand name drugs.","While they have access to Student Health Services, students in the School of Public Health, the Division of Graduate Medical Sciences, the School of Medicine and the Goldman School of Dental Medicine do not have a referral requirement.","We also have policies addressing circumstances in which members are unable to give consent.","Why do some drugs require prior authorization or precertification?","Wissel J, Bensmail D, Ferreira JJ, et al; TOWER study investigators.","How can I get more information about a Prior Authorization?","FMLA leave, continue Health Expense Benefits for you and your eligible dependents.","Health and Governance Operations Committee members.","Hyman N, Barnes M, Bhakta B, et al.","If you are successful, the court may order the person you have sued to pay these costs and fees.","Pharmacists are also available around the clock CVS Caremark and TRS regularly review formulary options to look for ways to control costs while preserving individual choice and access to clinically effective drugs.","If so, there may be a limit for how long after the date of service the referral can be received.","You canaccess the list of specialty prescription drugs.","Lists are subject to change.","Airway mucus function and dysfunction.","BTA for the treatment of obesity is not well known since results in literature are discrepant.","UI on their socialization.","If the Fair Health database becomes unavailable, we have the right to substitute a different database that we believe is comparable.","The date the coverage involved discontinues as to your eligible class.","Plan for the period of coverageloss of coverage has not occurred.","As defined in accordance with FDA regulations.","Two review authors independently screened the search results.","Garza I, Schwedt TJ.","Chou R, Atlas SJ, Stanos SP, Rosenquist RW.","Care participant will Eye Exams and Treatmentcoveragein the same manner as for any other illness.","Coverage is not provided for any services received before coverage starts or after coverage ends.","Single port component separation: Endoscopic external oblique release for complex ventral hernia repair.","Lists will continue to have those medications covered for as long as the treating physician prescribes them, provided the drug is medically necessary and more medically beneficial than other covered drugs.","United States and its territories.","FDA approves Botox to treat chronic migraine.","Navitus by phone or fax of an urgent request submission.","The efficacy of botulinum toxin A in the treatment of spasticity in ambulant children with cerebral palsy: A structured review.","Learn what to send us for reimbursement.","Botulinum toxin type A injection for achalasia and anal fissure.","No Is member at high surgical risk or is unwilling to undergo surgical myotomy or pneumatic dilation?","When informing physicians of a denial of services, health plans are required to state the exact reason for the denial and provide an opportunity for the physician to discuss the denial with the reviewer.","TRS also may disclose, as authorized by law, protected health information to funeral directors so that they may carry out their duties.","Committee includes licensed pharmacists and doctors, including those who are currently in practice and others who are Aetna employees.","Aetna will review and process the request for the extended stay and notify you and your Physician of an approval or denial.","Thesrescription drugs are not normally covered in a Medicare Prescription Drug Plan.","The external reviewer will review the request to determine whether it qualifies for expedited review.","Spinal cord injury and use of botulinum toxin in reducing spasticity.","If you speak a language other than English, free language assistance services are available.","Biglan AW, Burnstine RA, Rogers GL, Saunders RA.","Once the initial COBRA payment is made, COBRA contributions are due on month for which a COBRA contribution is required.","American Gastroenterological Association medical position statement: Diagnosis and treatment of gastroparesis.","COBRA continuation coverage, which is a temporary extension of coverage under the Plan to your spouse or your dependent children who are covered under the Plan when they would otherwise lose the group health coverage.","These are limited to only one purchase per pregnancy in any year where a covered female would not qualify for the purchase of new pump.","This call will focus on the upcoming Annual Urology Advocacy Summit.","If you need help, just call us.","Review your plan documents or call the number on your health plan ID card for more information about the treatments, services, and supplies that require prior authorization under your specific plan.","MRI results about denervative process.","Why do some drugs have quantity limits?","Care covers medical expenses at the Allowed Amount.","Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug.","ACG clinical guideline: management of benign anorectal disorders.","Your doctor may require you to schedule a visit before he or she will write you a new prescription.","This booklet contains the most current information regarding changes for the Plan Year.","Marques RE, Duarte GS, Rodrigues FB, et al.","Approach to the patient with myalgia.","STANDARDIZED PRIOR AUTHORIZATION REQUEST FORM REFERENCE GUIDEThe Standardized Prior Authorization Request Form is not intended to replace payer specific prior authorization procedures, policies and documentation requirements.","Sedano MJ, Trejo JM, Macarron JL, et al.","If you have any questions about our coverage of mastectomies and reconstructive surgery, please contact the Member Services number on your ID card.","If you are denied access to your protected health information, you may request that the denial be reviewed, TRS will choose a licensed health care professional to review your request and the denial.","Fluid leakage outside the cyst was noted where the skin was thin.","Zwart JA, Bovim G, Sand T, et al.","Medicare beneficiaries who need home health services.","Coordination of Benefits provision, including determining which plan is primary and which is secondary, you may call the Member Services telephone number shown on your ID card.","Contact the Arizona Department of Insurance to request an investigation of complaint or appeal.","Haapaniemi JJ, Laurikainen EA, Pulkkinen J, Marttila RJ.","The exact provisions, including definitions, governingthis insurance are contained in the Certificate of Coverage issued to you and may be viewed online at www.","Cognitive rehabilitation associated with physical rehabilitation, but only when: Your cognitive deficits are caused by neurologic impairment due to trauma, stroke, r encephalopathy.","If you have questions about getting MANAGING YOUR PRESCRIPTIONS ONLINEYou can set up a secure, online account to manage your prescriptions.","What is a Referral?","Some of these services require prior authorization.","If you need prior authorization, ask about the specifics.","The Planwill also cover transportation and lodgingexpenses for thepatient and one immediate familymember or support person prior to the transplanand forup to one year following the transplan.","Once we have received all the information we need, we will review your dental providerplan.","Care participant whose coverage is terminated may continue coverage.","Annual Benefit Choice Options booklet.","The Plan covers only those health services and supplies that are deemed Medically Necessary by the Plan and not excluded under the exclusions and limitations section of this Plan Document.","The objective was to critically review the studies to see if they are appropriately designed, conducted, and interpreted to provide guidance in the management of MPS.","Caremark webpage, linked below.","Check your plan documents to see how much you must pay for urgent care services.","Who can influence what gets covered by insurance companies?","Transplants and other specialized procedures are performed with a certain frequency.","This information is not a complete description of benefits.","Please seek medical advice before starting, changing or terminating any medical treatment.","We are not responsible.","You or your provider may request a review of the precertificationdecision.","Units of any other botulinum toxin products assessed with any other specific assay method.","Botulinum toxin type A in the treatment of lower limb spasticity in cerebral palsy.","Therefore, she was also treated with bilateral injections of BTX type A into the flexor digitorum brevis muscles.","RCTs are needed to translate these findings into better clinical outcome and better quality of life for TN patients.","An open formulary means your plan covers most prescription drugs.","Home health aide services are provided under the supervision of registered nurse.","Other services How you get an emergency prescription filled Where your schedule of benefits fits in What precertification requirementsapply How can I request a medical exception Prescribing units Some prescription drugsmay not be covered or coverage may be limited.","In Florida, by Aetna Health Inc.","However, if you receive these services while inpatient in a hospital, then you will pay the applicable Hospital care coinsurance.","Some BCBS Plans may allow their members to be held financially responsible when certification is denied and a member elects services and agrees to be financially responsible.","We will review that claim for payment to the provider or to you as appropriate.","If preauthorizationdetermines that the stay or outpatient services and supplies are not covered benefits, the notification will explain why and how you can appeal our decision.","The services or supplies are provided by one or more dental providers to treat a dental condition.","Provider who gives you the care.","Care may continue his or her own coverage but may not cover a spouse upon remarriage.","Bruxism symptoms were investigated using questionnaires.","An Aetna representative will advise you on the appeal procedures.","We may make other changes that affect members currently taking a drug.","The authors concluded that botulinum toxin injections are effective on bruxism and are safe to use.","Diplopia after botulinum toxin injection for facial rejuvenation is a rare and transient complication that is related to chemodenervation of adjacent muscle groups.","Care at least four weeks in advance of your trip.","These are nonmedically necessary surgeries performed during the same procedure as a medically necessary surgery.","Do I need a referral to see a specialist on an HMO Plan?","Among studies addressing treatment effects, little evidence demonstrated the effectiveness of surgical approaches.","This notice explains how, when, and why TRS uses and discloses your protected health information.","Aetna, an affiliate, or a third party vendor, may receive under a rebate arrangement between Aetna, an affiliate or a third party vendor and a drug manufacturer for any Prescription drug, including Prescription drugs on the Preferred drug guide.","BTX reduces the frequency of headache days, reduces acute headache pain medication, or has any impact on functioning in comparison with saline.","Prescription drug marketed with a specific brand name by the company that manufactures it, usually by the company which develops and patents it.","American Gastroenterological Association medical position statement: Diagnosis and care of patients with anal fissure.","New indications for botulinum toxin in rheumatology.","The following services or supplies: A replacement of: A hearing aid that is lost, stolen or broken.","In the last decade botulinum A toxin has become established as a therapy for individuals with bothersome Frey syndrome.","It will give you more information on coverage levels for maternity care under this plan.","Frykman PK, Short SS.","Be supervised at all times by a psychiatrist who is responsible for coordinating patient care and is at the facility on a regular basis.","And when you may still be able to continue coverage.","You may change your PCP at any time.","Following Surgery, the patient has agreed to participate in a multidisciplinary program that will provide guidance on diet, physical activity, and behavior and social support.","COBRA continuation coverage for your spouse or dependent children will automatically terminate before the end of this The Plan terminates.","MPS, excluding MPS in neck and head muscles.","Precertification is required for maternity and newborn confinements that exceed the standard LOS.","The authors concluded that OAB and associated symptoms are common.","It maintains a complete medical record on each patient.","Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients.","The referral must be acceptable to all three parties involved: the referring physician, the receiving physician, and the patient.","The exact relationship of these events to the botulinum toxin injection has not been established.","Family Deducti le Limit is a family deductible limit is the maximum amount of deductible that all family members combined must pay during year.","Hemifacial spasm is characterized by involuntary synchronous spasms of one side of the face, usually beginning around the eye.","Coveragefor children shall be granted immediately with respect to a newly born child from the moment of birth but is subject to eligibility requirements and other policy limitations.","Botulinum toxin type A therapy for cervical dystonia.","Plan terms that do not involve any use of medical judgment.","This includes Pap smears.","Coverage does not include the offic visit for the fitting of prescription contact lenses.","This includes care that assists embers in the activities of daily living, like walking, getting in and out of bed, bathing, and dressingfeeding and using the toilet.","In many cases, oral medications alone do not adequately control spasticity or the patient cannot tolerate the side effects.","Illness, Injury or disease.","This notice generally explains COBRA continuation coverage, when it may become available to your family and what you need to do to protect the right to receive it.","Please remember this is not a complete list of drugs covered under your plan.","CM spasm, is present.","ID cards, providers, and more.","Hyperhidrosis: review of recent advances and new therapeutic options for primary hyperhidrosis.","The author concluded that the available evidence is insufficient to guide clinical practice.","See the How to contact us for help section todetermine if coverage is under the outpatient prescription drug section or thsection.","Tell us about you.","Your PCP will provide your routine care, and send you to other providers when you need specialized care.","The court will decide who should pay court costs and legal fees.","Other side effects can include some neck pain and muscle weakness where the medication was injected.","Charges made for Day Care or Night Care treatment are considered to be inpatient facility charges.","Certain services or diagnostic or screening procedures determined by the Planto be inappropriate for the delivery to, or screening of, an entire population or subpopulation.","The Medicare Supplement Insurance plans are insured by Aetna Health and Life insurance Company, Aetna Life Insurance Company, American Continental Insurance Company or Continental Life Insurance Company of Brentwood, Tennessee, all Aetna Companies.","They stated that BTX is a safe and effective treatment for FBS.","You will be reimbursed for the drug cost plus a dispensing fee.","Your benefits may be reduced, or the Plan may not pay any benefits.","They are based on the specific service given toyou.","Treatment of overactive bladder in women.","Be an informed wisely.","You should show your ID card to the network pharmacy every time you get a prescription filled.","Botox Has member remained symptomatic despite surgical myotomy or pneumatic dilation?","The descriptions have been alphabetized for quick reference.","They interfere with neuromuscular transmission, temporarily paralyzing the affected muscle.","Submit legible documentation clearly stating the reason for the requested service.","Aetna customer service will not provide this application.","Spasticity following spinal cord injury.","MEDICARE COORDINATION OF BENEFITS CLAIM FILINGXI.","Anycontraceptivmethods thatarenot approved by the FDA.","Euro Ann Otolaryngol Head Neck Diseases.","Unauthorized services will not be reimbursed.","Adding new dependents Special times you can join the plan Who is eligible Your employer decides and tells us who is eligible for health care coverage.","For example, some brand name medications are very costly.","Should You Stop Drinking Alcohol to Lose Weight?","The authors concluded that improved characterization of the targeted condition, intervention, and population in CPP research was necessary to inform treatment choices for this commonly reported entity.","Long H, Liao Z, Wang Y, et al.","Your coverage typically ends when you leave your job.","Continuation of coverage for other reasons To request an extension of coverage, just call the number on your ID card.","Sitter or companion services.","Where do you sweat excessively?","Spasticity treatment with botulinum toxins.","Qualified Beneficiary Shall have the meaning set forth in COBRA.","In multiple sclerosis, Botox can relieve contractions of thigh adductors that interfere with sitting, positioning, cleaning, and urethral catheterization.","Phys Med Rehabil Clin N Am.","Frederiksen A, Kasch H, et al.","CERTIFICATION REQUIREMENTS LIMITATIONS Services Administration.","Botulinum toxin type A therapy for hemifacial spasm.","Pain, fatigue, nausea, and other symptoms sometimes persist.","If the prescription is for home delivery, Express Scripts will make three doctor, and will let you and your doctor know its decision.","Provider participation may change without notice.","Has the member had an orchiectomy?","Weissler JM, Lanni MA, Tecce MG, et al.","Rowe FJ, Noonan CP.","What happens to your dependents if you die?","How does Navitus decide which prescription drugs should require Prior Authorization?","Most do, however, pay for routine physicals for health maintenance.","Als u een andere taal spreekt dan Engels, is er gratis taalondersteuning beschikbaar.","Predeterminations are not always required by the insurance company, yet they are often times recommended.","You may log onto the TRS website www.","Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review.","Uniformed Services Employment and Reemployment Rights Act; or services received as a result of war or any act of war, whether declared or undeclared or caused during service in the armed forces of any country.","Fetal cord blood harvesting and storage.","FBS treated with BTX and reviewed the current literature on available treatment modalities for this difficult to treat syndrome.","Your coverage tier can be reduced or dependents dropped at any time by covered under this Program both as a retiree and as a dependent, or as a dependent of more than one retiree.","Select dose based on muscles affected, severity of muscle spasticity, prior response and adverse reaction history following treatment with botulinum toxins.","If the directory is materially inaccurate, you may be entitled to have an outnetwork claim paid atthe innetwork level of benefits.","Botulinum toxin in headache treatment: The end of the road?","Botulinum toxin A for migraine headache: A review of the clinical effectiveness.","Treatment was intended to supplement, not replace, other desirable treatment modalities.","Append a slash to it.","This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment.","All procedures require a call to the insurance company until you gain experience in recognizing what requires an authorization.","Capture supporting clinical documentation.","Eligible Health Services under the Plan is set forth in this Plan Document.","How do Botox injections help treat migraines?","If your request for an external review is approved, Aetna will assign an accredited ERO to conduct the review.","There are two options for payment of claims.","Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology.","Physicianwith the consent of the mother, discharges the mother or newborn earlier.","Select your browser settings menu to enable Javascript.","Botox injection surgery was performed for patients in the study group.","The management of spasticity is physical and all pharmacological interventions are adjunctive to that.","The need for assistance with bathing, toileting, feeding, personal grooming, dressing or getting in and out of a bed or chair.","Kaffenberger TM, Mandal R, Schaitkin BM, Hirsch BE.","Use our provider directory to \ufb01nd doctors, hospitals and other health care professionals who accept your plan.","Our plans are designed to deliver more personal, a\ufb00ordable and e\ufb00ective health care right in your community.","Web site to inquire about and make certification requests.","The requested URL was rejected.","If you marry, ou can put your spouse on your plan.","Network provider is used, the participant will be responsible for any expenses exceeding the Allowable Amount.","Other adverse events were very mild, although lagophthalmos and dry eyes occurred in some patients, but none manifested any corneal complications.","You will have enough time to file an appeal.","Emergency Services do not include poststabilization services.","During this continuation period, you are still responsible for your share of the costs, such as copaymentscoinsurance and deductibles that apply to the service or supply.","Committee meets regularly to review new drugs and new information about drugs that are already on the market.","Repair or replacement of prostheses, prosthetic devices or PA due to misuse or loss.","Dysport for treating hip adductor spasticity in patients with multiple sclerosis.","We are primary We pay your claims as if there is no Medicare coverage.","Fanucci E, Masala S, Sodani G, et al.","It also stated that while a few patients in one Class II study suggested that botulinum neurotoxin may be effective for lower extremity dystonia, the data are inadequate to provide a recommendation.","You can withdraw or change your request at TRS may deny your request to inspect and copy your protected health information in certain limited circumstances.","The secondary plan pays after the primary plan.","If the criteria are not met, a coverage review will be required.","Kwanchuay P, Petchnumsin T, Yiemsiri P, et al.","Care Standard plan year will be extended to Dec.","Here are some reasons why we may make changes to the Preferred Drug List.","Benjamin Lowentritt testified in support of the bill.","Most experts would submit that a washout period after the crossover may have been appropriate.","SCI, as this is the gold standard to treat focal spasticity.","Caso voc\u00ea seja falante de um idioma diferente do ingl\u00eas, servi\u00e7os gratuitos de assist\u00eancia a idiomas est\u00e3o dispon\u00edveis.","Both Botox and Myobloc are neurotoxins produced by fermentation of the bacterium Clostridium botulinum.","Dental related oral surgical services to correct an overbite or underbite.","RCTs are needed to confirm the findings of this analysis.","External reviews are not available for decisions relating to eligibility.","Brashear A, Lew MF, Dykstra DD, et al.","Am J Sports Med.","Care work if my Network doctor terminates while I am All Network providers are required to continue to provide services to patients under certain circumstances for a period of time after the contract between the provider and Aetna has been terminated.","Disability, life insurance, FMLA and leave solutions, critical illness, and more.","Strabismus can be horizontal, vertical, or torsional.","Aetna will then subtract that amount from the total charge and adjudicate the claim for an eligible secondary reimbursement.","Botulinum toxin for masseter hypertrophy.","Double the above values on mobile.","Links to outside sites are provided for your convenience only.","In our health Plans, participating Network Providerare also required to give you access to your medical records within a reasonable amount of time after you make a request.","Report of the Quality Standards Subcommittee of the American Academy of Neurology.","American Association for Pediatric Ophthalmology and Strabismus.","Michela F, Decavelb P, Toussirotc E, et al.","What Is Medicare Supplement Insurance?","Your primary care physician will refer you to a participating specialist or a health care service provider if he or she cannot personally provide the care you need.","No one cares more about your health than you do, even your doctor and their office staff.","This website was developed by the New Hampshire Insurance Department and the University of New Hampshire Mobile Development team and is maintained by the Department in cooperation with Human Services Research Institute.","No participants in the Dysport group converted from negative to positive antibodies after treatment.","Our rate may also exclude other payments that CMS may make directly to hospitals or other providers.","Proprietary Enzyme replacement drugs, cont.","Pediatric Lower Limb Spasticity: Select dose based on the affected muscle, severity of spasticity, and treatment history with botulinum toxins.","How claim is paid Your claim will be paid at the network provider cost sharing level.","These events were exceptionally serious.","Clinical guideline: Management of gastroparesis.","You are now leaving www.","The clinicians engaged in botulinum toxin injections for facial rejuvenation or blepharospasm, should be aware of the possible complications, and inform the patients about the risk of developing double vision.","PCPto oversee your care.","Explore a variety of legal documents and resources related to benefits packages.","Dependents not previously enrolled in the Plan cannot elect to begin coverage under COBRA.","That are considered oral dental preparations and fluoride rinses, except pediatric fluoride tablets or drops as specified on the preferred drug guide.","Xeomin has not been studied in the pediatric age group and is therefore not recommended in pediatric patients.","Custodial Care Services and supplies mainly intended to help meet your activities of daily living or other personal needs.","Sleep studies provided within the home.","Utilization Management clinical criteria through CHPConnect.","Pelvic exam in women to assess skin condition, genital atrophy, pelvic organ prolapse, pelvic masses, paravaginal muscle tone and any other abnormalities.","Plan The State of Illinois Employee Quality Health Plan.","However, few RCTs mean that data are limited with respect to candidate suitability, treatment dosages, frequency and duration of treatment.","IHcapacitatedand the other is to be completed by the participant.","Please refer to your State of Illinois Benefits Handbook for more information regarding your eligibility requirements, leaves of absence, continuation and conversion rights and termination of Coverage.","Doppler scanning was performed on most patients to measure blood flow.","One patient showed no response to triceps injections.","Glader L, Delsing C, Hughes A et al.","In a retrospective case review, these investigators documented their experience using this treatment method for FBS.","Reduction or elimination of exclusionary periods of coverage for preexisting conditions under your group health plan, if you have creditable coverage from another plan.","Plan document for additional information.","That are considered oral dental preparations and fluoride rinses, except pediatric fluoride tablets or drops s specified on the preferred drug guide.","Ear molds, and other equipment intended to improve hearing, except asotherwise provided hereinhearing aid evaluation, except as otherwise provided hereinhearing aid repair, reconditioning, supplies or batteries; digital and programmablehearing devices; hearing therapy and related diagnostic hearing tests.","Liu HT, Tsai SK, Kao MC, Hu JS.","This website is not intended for residents of New Mexico.","Limitations, copayments, and restrictions may apply.","Currently, BTA is the most widely used agent for intradermal injection.","Requirement Deadline Submit a claim You should notify and request claim form from us.","This includes estate planning and the drafting of a will.","Requesting and obtaining an SPA will allow for your provider to be reimbursed at a higher rate for services rendered.","Your reasons for making the appeal Any other information you would like us to consider Another person may submit an appeal for you, including a provider.","Text HELP for help.","If you are: Primary plan Secondary plan Covered under the plan as an employee, retired employee or dependent The plan covering you as an employee or retired employee.","Nonmedically necessary ambulance transports Armed Forces Services and supplies received from a provider as a result of an injury sustained, or sickness contracted, while in the service of the Armed Forces of any country.","Medicare prescription drug plan.","Acupuncture was the sole complementary and alternative medicine treatment, among reflexology and hypnosis, with early evidence of benefit.","If you obtain Medicare after you enrolled in this student plan, your health coverage under this plan will not end.","Cognitive therapy is typically utilized in addition to a pharmacological intervention.","In pediatric patients treated for lower limb spasticity, upper respiratory tract infection was not reported with an incidence greater than placebo.","When you have an inpatient stay in a facility, we will tell you, your physician and the facility about your precertified length of stay.","Under certain circumstances, we or your employer or the law may change your plan.","This concept is not the easiest to understand.","For purposes of this definition, utism is considered a related condition.","Author disclosure: nothing to disclose.","New and emerging prophylactic agents for migraine.","Recommendations of the Canadian Hyperhidrosis Advisory Committee.","Aetna does not provide care or guarantee access to health services.","Andrews J, Yunker A, Reynolds WS, et al.","Faria J, Harb J, Hilton A, et al.","Please type your last name.","Health plans consider utilization management important for quality assurance and cost control, which explains why they usually focus their efforts on inpatient admissions, orthopedic procedures, potential cosmetic procedures, alternative and complementary medical services, and expensive imaging studies.","Annals Phys Rehab Med.","Institutional care which is forthe primary purpose of controlling or changing your environment.","This exclusion does not apply to hospice counseling services by a social worker or family counselor for individual and family counseling.","Urgent condition An Iness or Injury that requires prompt medical attention but is not an Emergency Medical Condition.","The amount you pay depends on the drug your doctor prescribes.","An urgent admission: You, your physician or the facility will need to call before you are scheduled to be admitted.","Side effects were generally similar in the two treatment groups; only blurred vision and weakness occurred significantly more often with Dysport.","Any additional information you submit to the IRO will also be sent back to CVS Caremark for reconsideration.","Please try again later.","Botulinum toxin had a poorer response than surgery in a trial of patients requiring treatment for horizontal strabismus in the absence of binocular vision.","We cover each of the methods identified by the FDA at no cost share.","If you change from a Medicare Advantage plan that includes prescription drug coverage to a Medicare prescription drug plan, this will disenroll you from your Medicare Advantage plan.","If the Appeal involves a medical judgment, it will be reviewed and considered by a qualified healthcare professional.","AEs, and the time and indications for repeat injection would be promising.","The overall complication rate was minimal, although many patients complained of transient worsening of dysphagia after CP BTX injection.","First things first some notes on how we use words.","Llame al n\u00famero que figura en su tarjeta de identificaci\u00f3n.","Functional opliteal artery entrapment syndrome: Poorly understood and frequently missed?","The pathogenesis and management of achalasia: current status and future directions.","This may include interviews of the individual, family, or others.","Enteral nutrition; blood products.","One fatal case of anaphylaxis has been reported in which lidocaine was used as the diluent, and consequently the causal agent cannot be reliably determined.","The primary outcome was the paired difference in change in average voided volumes.","Patients have the right to refuse referral without relieving their attending physicians of responsibility.","When should the prior authorization process begin?","Referral or Prior Authorization: Knowing the Difference Matters!","Mail order pharmacy A pharmacy where Prescription drugs are legally dispensed by mail or other carrier.","BTX to their lateral oblique muscles to facilitate defect closure.","Call the number on your ID card.","For example, TRS may disclose your protected health information if your doctor asks that TRS disclose the information to another doctor to help in your treatment.","BTX in the CM of patients who did not show upper esophageal sphincter passage in a swallowing study in spite of maximal swallowing rehabilitation.","Select dose based on the affected muscle, severity of spasticity, and treatment history with botulinum toxins.","Some reasons why they can change include: New drugs are approved.","Fees, costs or similar services associated with services that are primarily exercise.","Any charges for the administration or injection of prescription drugs or injectable insulin and other injectable drugs covered by us.","Cranial caps and helmets, except for certain diagnoses.","Drug coverage continues for these California members as long as the drug is appropriately prescribed and considered safe and effective treatment for the medical condition.","It is likely to continue indefinitely.","The amount a network Provider has agreed to accept for rendering services or providing Prescription drugs or supplies to members of your Plan.","There are many rules and regulations a provider must follow based on payer guidelines.","Each prescription islimited to a maximum day supply.","Examples include, but are not limited to, membership fees for health clubs, fitness centers, weight loss centers or clinics, or home exercise equipment.","Pelvic floor tension myalgia is a diagnosis of exclusion.","Important note: Any visits that exceed the lactation counseling services maximum are covered under the Physicians and other health professionals section.","We have the right to apply Aetna reimbursement policies.","You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take.","Depending upon your plan, our home delivery service may save you money.","You can request expedited delivery for an additional charge.","If you obtain Medicare after you enroled in this student plan, your health coverage under this plan will not end.","If you use the CVS Caremark Pharmacy, your doctor will be contacted directly.","That person is called an authorized representative.","To learn more see the Who the plan covers section.","Aetna before you receive Coverage certain services.","Ke clkc yekc kuny n\u00eb nmba de abac tn\u00eb ID kard du ku.","What is a course of dental treatment?","The limits above may be extended only if we and the policyholder agree in writing to extend them.","Study injections were preceded by an injection of local anesthetic to numb the area and ensure accuracy localizing the scar neuroma.","You can appeal by sending a written appeal to the address on the notice of adverse benefit determination.","Be careful to keep complete records of the expenses of each person.","Get a Headache after Exercise?","Appeal Process rolled members may utilize an internal Appeal process which may be followed by an external review, if needed.","To register and receive alerts, you will need your prescription drug ID card and a recent prescription number.","Fadeyi MO, Adams QM.","Strabismus repair is considered cosmetic in adults with uncorrected congenital strabismus and no binocular fusion.","Please select a Health Plan.","Dependent coverage will continue as long as the monthly payment is made and the dependent remains eligible.","There was no evidence from RCTs to allow the authors to draw definitive conclusions on the optimal treatment intervals and doses, usefulness of guidance techniques for injection, the impact on QOL, or the duration of treatment effect.","You are also responsible for costs not covered under this plan.","BTX into affected parotid glands, focusing on areas of greatest first bite pain.","The authors concluded that local botulinum toxin injection proved to be an effective alternative treatment to invasive procedures for patients with isolated dysfunction of the UES, and also for patients with more complex deglutition problems combined with aspiration.","Youare responsible forall amounts above what is eligible for coverage.","Object ertain Disclosures that TRS is Required to Make ertain Uses and Disclosures of Genetic Information that Cannot Be Made ertain Uses and Disclosures of Protected Health Information that Will ther Uses And Disclosures Require Your Prior Written Authorization.","They hoped to publish the outcomes as their cohort size increased, but at present this remained an unproven intervention.","CD patients treated with EMG guidance experienced a significantly more pain at the injection site but a significantly lower adverse event occurrence rate of dysphagia when compared to CD patients treated with palpation guidance only.","Askiv, muaj cov kev pab cuam txhais lus dawb pub rau koj.","Lacy BE, Zayat EN, Crowell MD, Schuster MM.","Botox injection for voiding disorders are rare but they can be very disabling for patients with spinal cord injury.","What is Aetna Rx Home Delivery?","No adverse effect was reported.","Network Providerduring your stay in a network Hospital.","Botulinum toxin B reduces sialorrhea in Parkinsonism.","As result, you need to replace or add teeth to your denture or bridge.","You cannot limit the uses and disclosures that TRS is legally required to make.","GYN How do you choose your PCP?","It has policies established by a professional group associated with the agency or organization.","You pay the lowest cost for drugs in this level.","Youhave specialrightsifwe rescindyour coverage.","The difference is that generics may be a different color, shape or size.","And the generic versions cost less.","The process for external review will depend on whether the peal is an administrative Appeal or medical Appeal.","Unfortunately, if the carrier does not allow this, the claim must be adjusted off, as it was the responsibility of the provider to obtain the authorization.","Corneal pathology improved in all cases.","Brin MF, Lew MF, Adler CH, et al.","Hoogerwerf WA, Pasricha PJ.","Standard therapies have not been effective or are not appropriate.","Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc.","Counseling Marriage, religious, family, career, social adjustment, pastoral, or financial counseling.","Check to see if your plan includes our home delivery pharmacy service.","Predetermination approval is not a guarantee of claims payment.","It may be different from your Aetna secure member site login.","ELIGIBILITY REQUIREMENTS, LEAVES OF ABSENCE, CONTINUATIONRIGHTS AND TERMINATION OF COVERAGE IV.","This includes special education, remedial education, wilderness treatment program, job training and job hardening programs; services provided by a school district.","In accordance with generally accepted standards of medical practice.","Then look under the category name for your drug.","The sole indication for treating spasticity is when it is causing harm and interferes with active or passive functioning.","Important note: if the provider bills less than the amount calculated using the method above, the recognized charge is what the provider bills.","Other potential conservative treatments are wearing splints and muscle relaxant drugs.","SUPPLYCRITERIA AND COVERAGEPROVIDEDPRECERTIFICATIONREQUIREMENTS LIMITATIONSAbortionhe expenses of obtaining an abortion, induced miscarriage or induced premature birth are not Eligible Health Servicesunless, in the opinion of Physician, such procedures are necessary for the preservation of the life of the woman seeking such treatment.","If possible, contactyour Physicianin the event you receive Urgent Care.","The representative will work with you to process your disenrollment.","For information regarding Prescription drug plan referto your Prescriptionbenefit manager policies.","No other person including your employer or provider can do this.","CMS establishes for those medications.","As to Prescription drug Coverage when Prescription drugs are obtained from a network pharmacye amount Aetna has established for each Prescription drug obtained from a network pharmacy under this Plan.","Generic drugs may have unfamiliar names, but they are safe and effective.","Botox has been shown to improve gait patterns in patients with cerebral palsy with progressive dynamic equinovarus or equinovalgus foot deformities.","Management and prognosis of cerebral palsy.","ID card as soon as reasonably possible, but no later than the final authorized day.","ID card each time you get health care from a provider to help them bill us correctly andhelp us better process their claims.","If a service is being denied by most health plans, you may have a systems problem such as improper coding practices.","HIPAA that compromises the security or privacy of your protected health information.","How you get an emergency prescription filled You may not have access to a network pharmacy in an emergency or urgent care situation.","They are not listed in the Exclusions section.","Botulinum toxin for shoulder pain.","Routine care of a newborn provided by a Pediatrician while in the Hospital, including circumcision.","In case of medical emergency When you experience an emergency medicalconditionyou should go to the nearest emergency room.","ID and a recent prescription number.","However, the documentation in the medical records must show the precise amount of the drug administered and the amount discarded.","Treating providers are solely responsible for medical advice and treatment of members.","Botulinum toxin is effective and safe for palatal tremor: A report of five cases and a review of the literature.","This Policy Year Deductible and the Prescribed Medicine Expense Deductible do not apply towards satisfying each other.","Management therefore aimed at the development of a formal treatment plan is important to document the intended outcomes, which should be written and agreed upon with the patient.","It is proposed that such treatment may reduce the volume of the muscle without the same degree of potential functional consequences resulting from surgical myotomy.","CH\u00da \u00dd: N\u1ebfu b\u1ea1n n\u00f3i Ti\u1ebfng Vit, c\u00f3 c\u00e1c d\u1ecbch v\u1ee5 h\u1ed7 tr\u1ee3 ng\u00f4nng\u1eefmi\u1ec5n ph\u00edd\u00e0nh chob\u1ea1n.","Ask your employer when benefits for your foster child will begin.","Um Schprooch Services zu griege mitaus Koscht, ruff die Nummer uff dei ID Kaart.","If confirmed this would be the first preventive medication indicated specifically for chronic migraine.","The schedule of benefits lists how much the plan pays and how much you pay for each type of health care service.","Aetna Service Center at you have other insurance coverage.","Our updates include information on state advocacy in Maryland to support prostate cancer screening legislation as well as our joint congressional meetings with appropriations staff on appropriations funding for bladder cancer.","How much will COBRA coverage cost?","Please choose a state.","If you have a question or need help finding or completing a document, our contact page will point you in the right direction.","You and your dental provider can then decide how to proceed.","Medical Appealalso pertain to retroactive cancellations or discontinuations of Coverage, unless the cancellation or discontinuation relates to a failure to pay required premiums or contributions.","The review also found a strong association of placebo with improvement in headaches over time.","You may need to refrigerate them.","Provider for the Department.","GP addressed to a particular type of medical specialist.","AT A PARTICIPATICG RETAIL PHARMACY When you purchase your medications at a participating retail pharmacy, simply present your prescription drug ID card and pay the applicable amount.","Head and neck muscle spasm after radiotherapy.","Although oral medications do a fair job of controlling spasticity in most patients, some patients will need additional forms of treatment.","Details about the process to appeal your claim and initiate an external review will described below.","Google Chrome, Mozilla Firefox, Microsoft Edge, Safari or Opera.","CERTIFICATION REQUIREMENTS LIMITATIONS You have not had a voluntary sterilizationwithout surgical reversal, or you had a successful surgical reversal of the voluntary sterilization.","If you misuse yourcard we may end your coverage.","Your plan will cover the services you get in an individual or group setting.","Shah SN, Hornyak J, Urquhart AG.","Botulinum toxin type A for prophylactic treatment of chronic migraine.","Acesse nosso site ou ligue para o n\u00famero de telefone presente em seu cart\u00e3o de identifica\u00e7\u00e3o de membros.","There is some question whether Botox treatments are as good as or better than conventional therapy, pneumatic dilation, or myotomy.","Vision care supplies We provide vision eyewear coverage that can help pay for prescription eyeglassesor prescription contact lenses.","This Negotiated charge may reflect amounts Aetna has agreed to pay directly to the network pharmacy or to a third party vendor for the Prescription drug, and may include an additional service or risk charge set by Aetna.","Although these provide useful descriptive information, clarification is needed to ascertain the effective use of botulinum toxin as an independent treatment modality.","Committee can make recommendations to change the tier level of a drug or to place it on our Formulary Exclusions List, designating it as a drug that is no longer covered.","Medicare allowable rates except as specified below, these are the rates CMS establishes for services and supplies provided to Medicare enrollees.","Since coverage will not be authorized without it, beginning the prior authorization process early is important.","Eligible Healthervices also include formula and low proteinmodified food products ordered by a Physicianfor the treatment of phenylketonuria or an inherited disease of amino and organic acids.","Before Open Enrollment, look at the companies and get a copy of their Formulary, which tells you which medications and procedures are covered.","We may immediately remove a brand name drug on our Drug List if we are replacing it with a new generic drug that will appear on the same or lower cost sharing tier and with the same or fewer restrictions.","Spastic hemiplegia, such as due to stroke or brain injury.","What is the Aetna Preferred Drug List?","The dentures, bridges or other prosthetic items are needed to replace one or more natural teeth.","See the How to contact us for help section fordetails.","The patient would then receive a referral number which would be required for submitting the claim.","Others have four tiers, three tiers or two tiers.","How can I find help for Behavioral Health or Substance Use Disorder needs?","Each drug is grouped as a generic, a brand or a specialty drug.","Besides prescription drugs, what else requires prior authorization under my plan?","As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted.","The medical record must substantiate the medical need for PTNS with documentation of duration of symptoms and unsuccessful treatments for OAB as outlined in the LCD.","Your pharmacy plan may not have all the coverage levels listed above so check your plan documents to see how much you will pay.","But sometimes those services are not covered at all or are covered only up to a limit.","Botulinum toxin type A injection into the iliopsoas muscule.","Gupta P, Rao SS.","If you need to be hospitalized, ask how many days you will be allowed to stay.","The investigators noted that there is no effective treatment for this relentless disorder, except for temporary relief of dystonia and pain, with local botulinum toxin injections.","Aetna or an affiliate.","Moreover, endoscopic myotomy was found to have a higher success rate compared to open myotomy.","Skilled nursing facilityfacility specifically licensed as a illed nursing facility by applicable state and federal laws to provide skilled nursing care.","Sialocele formation is a frequent and untoward complication owing to extravasation of saliva into the surgical defect, which delays healing, creates fistulas, and produces painful facial swelling.","Injury Physical damage, independent of disease or bodily infirmity, done to a person or part of their body.","We do not disclose personal information for these marketing purposes unless the member consents.","Eligible health services include habilitation therapy services your physician prescribes.","The response in patients depended on the severity of the deformity and the degree of contracture.","Please note that if your prescription drug benefits plan changes, the information here may no longer apply.","Care Plan Design Summary Effective Sept.","Exertional pain and muscle strength were monitored, based on the Medical Research Council score.","The authors concluded that BTX therapy was an effective treatment for persistent sialocele.","When you request a formulary, tiering or utilization restriction exception you should submit a statement from your prescriber or physician supporting your request.","Botulinum toxin is being investigated as a treatment for dyspareunia.","Disorders of facial motor function.","If you do not intend to leave our site, close this message.","If you go to an emergency room for what is not an emergency medical condition, the plan may not cover your expenses.","It is usually the date you legally become a foster parent or the first day of the month following this event.","Singer BJ, Silbert BI, Silbert PL, Singer KP.","CVS Specialty to get your specialty medications.","Are rebates available for medical specialist appointments?","We will only cover this treatment if physician or behavioralhealth provider ordersitaspart ofa treatmentplan.","It reviews available information concerning safety, effectiveness and current use in therapy.","Recommendations on the use of botulinum toxin in the treatment of lower urinary tract disorders and pelvic floor dysfunctions: A European consensus report.","We list examples of those in the Exclusions section.","Such right does not affect any other right of recovery the Plan may have with respect to such overpayment.","Coverage at an network benefit level for outnetwork provider or facility unless services are emergent.","However, there is insufficient evidence to support the effectiveness of this approach.","Many physicians have had to hire additional staff just to handle the extensive paperwork process put into effect by the payers.","When you accept coverage under this group policy, you agree to let your providers share your informationwithus.","Ezzeddine D, Jit R, Katz N, et al.","Aetna has sole responsibility for its products and services.","American Academy for Cerebral Palsy and Developmental Medicine Care Pathways.","If the submitted form does not have all of the needed information, the prescriber will be contacted to provide the information.","This is regardless of the existence of other medical conditions.","Dental provider Any individual legally qualified to provide dental services or supplies.","If you have a change of address, or are on leave of absence, contact your employing agency GIR.","But sometimes we pay only some of the claim.","Care would have paid if there were no other coverage.","No definitive serious adverse event reports of distant spread of toxin effect have been associated with Botox for blepharospasm or for strabismus at approved doses.","Therefore, the referring physician will need to contact the insurance company to see if a retroactive referral is possible.","Your Plancovers the exams recommended by the Health Resources and Services Administration.","You can ask that TRS limit how it uses and discloses your protected health information.","For example, for certain drugs, our plan limits the amount of the drug that we will cover.","Disagreements We know that people smetimes see things differently.","If we determine we need more data for a particular service or supply, we may base rates on a wider geographic area such as an entire state.","Rectal exam to assess perineal sensation, resting and active sphincter tone, fecal impaction, presence of masses and in men, the consistency and contour of the prostate.","Insurance or the ERO will: Consider appropriate credible information that you sent Follow our contractual documents and your plan of benefits We will stand by the decision that the ERO makes, unless we can show conflict of interest, bias or fraud.","Essential palatal myoclonus: A rare cause of objective tinnitus.","Your plan may include supplemental coverage for some drugs during the Coverage Gap stage of the plan.","Botox were injected into the pyloric sphincter.","This term does not include conditions that you cannot attribute to a mentaldisorder that are a focus of attention or treatment oan addiction to nicotine products, food or caffeine intoxication.","Care program may be discontinued.","Make sure your doctor includes your member ID number, your date of birth and your mailing address on the fax cover sheet.","You may receive a bill for the difference between the amount billed by the provider and the amount paid by this plan.","Schneider I, Thumfart WF, Pototschnig C, Eckel HE.","Primary closure of challenging hernias is often prohibited by severe lateral retraction and tension of the abdominal wall musculature.","Outpatient prescription drugs Deductible waiver Waiver for risk reducing breast cancer prescription drugs The prescription drug cost share will not apply to risk reducing breast cancer prescription drugs when obtained at a network pharmacy.","Outpatient diagnostic testing section.","This article summarized the present knowledge on the treatment of diffuse esophageal spasm with a special emphasis on botulinum toxin injection.","Surgical management and postoperative outcome of children with bladder exstrophy.","Electronic submission of precertification requests and inquiries is preferred.","To the extent permitted by law, we use and disclose personal information as provided above without member consent.","Then you fill out and send a prescription drug refund form to us, including all itemized pharmacy receipts.","Have more questions about your pharmacy benefits?","RN on duty or on call.","Visiti il nostro sito web oppure chiami il numero di telefono presente sul Suo tesserino identificativo.","The plan may request additional information or clarification, if needed, to evaluate requests.","An urgent admission is a hospital admission by a physician due to the onset of or change in an illness, the diagnosis of an illness, or an injury.","Instructions for submitting the request to Aetna are on the form.","Medically Necessary; planned home deliveries; doulas.","Its spectrum as a potential treatment for neuropathic pain has grown.","Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.","Although its mechanism is unknown, Botox yielded a distinct improvement in perfusion and reduction in pain in patients failing conservative management.","In a systematic review, these investigators evaluated the existing studies on the effectiveness of myotomy, dilatation, and BTX injection in the management of cricopharyngeal dysphagia.","Routine eye exams are not covered.","RCTs of botulinum toxin for treating MPS need to be conducted before firm conclusions on its effectiveness and safety can be drawn.","You must send us notice and proof as soon as reasonably possible.","Strabismus, or for Chronic Migraine at the labeled doses have been reported.","Any statement made is considered a representation and not a warranty.","This is a Continuity of Care requirement.","Individuals whose Coverage ended by reason of reaching a lifetime limit under the Plan are eligible to enroll in the Plan.","Noridian has added a new article addressing billing and coding procedures that complement the LCD for Circulating Tumor Cell Marker Assays.","Aetna Health Insurance Company of New York, Aetna Health Assurance Pennsylvania Inc.","Effect of Botulinum Toxin in the Treatment of Drooling: A Controlled Clinical Trial.","Provider Manual for our notification and referral policies.","Vision care services and supplies Pediatric vision care services and supplies Your plan does not over vision care services and supplies, except as described in the Eligible health services under your plan Other services section.","Prior authorization is usually required if you need a complex treatment or prescription.","Pichon Riviere A, Augustovski F, Garcia Marti S, et al.","Botulinum toxin B is not an effective treatment of refractory overactive bladder.","All State Employees Group Insurance Program Plan Participants who are receiving regular dialysis treatments or who have had a kidney transplant on the basis of ESRD are required to apply for Medicare benefits.","Sometimes you can get a faster external review decision.","Institutional care which is for the primary purpose of controlling or changing your environment.","In certain cases, you or your prescriber can request a medical exception to the precertification, step therapy or quantity limits requirements.","Are there any restrictions on my coverage?","You are responsible for paying for the discounted goods or services.","This includes information regarding carrier status and information derived from laboratory tests that identify mutations in specific genes or chromosomes, physical medical examinations, family histories and direct analysis of genes or chromosomes.","The clinical trial takes place at an NCIdesignated cancer center or takes place at more than one institution.","Just call the number on your ID card.","There were no differences between groups regarding withdrawals due to AEs.","Gourcerol G, Benard C, Melchior C, et al.","Precertification requests are to be made in advance of a scheduled inpatient admission.","Residential services must be certifiedprior to admission to receive Networkor Networkbenefits.","Eligible health services include the counseling services to help you prevent or reduce sexually transmitted infections.","Policy Year: Policy Number: www.","The trial conforms to standards of the NCI or other, applicable federal organization.","Cost effectiveness of botulinum toxins for the treatment of depression: Preliminary observations.","Your requested has been submitted successfully.","Check your Prescription Drug Schedule of Cost Sharing to find out if you have coverage for these drugs.","All stages of reconstruction of the breast on which a mastectomy has been performed; Surge and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and eatment of physical complications of all stages of mastectomy, including lymphedemas.","The patient must be treated by a psychiatrist at least once per week.","Ann Chir Plast Esthet.","Care must be determined to be Medically Necessary.","ATTENTION: If you speak English, language assistance services, free of charge, are available to you.","Services that facilitate the continuum of care beyond the initial neurological insult through rehabilitation and community reintegration.","It does not include institutions that primarily provide for the care and treatment of Mental Disorders or Substance Use Disorders.","These are dispensed through a pharmacy to Participan.","Patients treated with botulinum toxin A had a higher subjective improvement in their perception of treatment efficacy than the placebo subjects.","Foot or shoe inserts and other Coveredorthotic devices.","But, we have the right to change orend the arrangementsatanytime.","Specialist office visits section.","Examples include examinations to get or keep job, or examinations required under labor agreement or other contract.","To promote safe and effective drug therapy, certain covered medications may have quantity restrictions.","Care does not qualify for external review.","Safety edits are a type of drug coverage review that applies to a limited list of drugs with the highest potential for abuse and harm to the member.","Care will be aware of your Medicare enrollment.","How to get started with Aetna Specialty Pharmacy Ordering your prescription through Aetna Specialty Pharmacy is easy.","What are alternative healthcare services?","Birthday refers only to the month and day in a calendar year, not the year in which the person was born.","Aetna and your provider stops being in our network However, in some cases, you may be able to keep going to your current provider tocomplete a treatment or to have treatment that was already scheduled.","Traumatic brain injury medical treatment guidelines.","Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages.","Successful treatment strategies have now been developed and there is good evidence of treatment effectiveness.","All enrollments will be handled directly through Aetna Student Health.","All patients in both groups had successful epicardial fat pad injections without complications.","Two new families with hereditary essential chin myoclonus: Clinical features, neurophysiological findings and treatment.","This means that you will need to get approval from us before you fill your prescriptions.","Quality of life and treatment satisfaction measures suggest such improvements can be important to women.","You can ask us to waive coverage restrictions or limits on your drug.","Tension headache: Botulinum toxin paralysis of temporal muscles.","BTA injections to the lateral abdominal wall muscles prior to elective complex ventral hernia repair.","The prescription drug cost share will apply to prescription drugs that have a generic equivalent or biosimilar or generic alternative available within the same therapeutic drug class obtained at a network pharmacy unless you receive a medical exception.","Xing ST, Wang D, Wen XH, et al.","Santamato A, Panza F, Ranieri M, et al.","Mathew NT, Frishberg BM, Gawel M, et al.","Sportsrelated services designed to affect performance or physical conditioning programs such as athletic training, bodybuilding, exercise fitness, flexibility and diversion.","Emergency services and urgent care A separate hospital emergency room or urgent care cost share will apply for each visit to an emergency room or an urgent care provider.","The Plan is available for Texas Christian University students.","COCHRANE DB SYST REV.","What is step therapy?","Aetna must notify you in writing of the results of this preliminary review within one business day after completing the review.","Care premium charts located on the TRS website at www.","Educational or vocational therapy, schools or services designed to retrain you for employment.","Please indicate your gender.","Dental work due to an injury or accident, including surgery and orthodontic treatment needed to remove, repair, replace, restore, or reposition natural teeth damaged, lost or removed or other body tissues of the mouth fractured or cut.","Brin MF, Lyons KE, Doucette J, et al.","If an electric breast pump was purchased within the previous three year period, the purchase of another electric breast pump will not be covered until a three year period has elapsed since the last purchase.","Daele D, Finnegan E, Rodnitzky R et al.","Your employer has days to send youa COBRA election notice.","Plan features and availability may vary by service area.","Plan Year The period during which the total amount of yearly benefits is calculated.","For many people, migraine symptoms are so severe that they can interfere with normal life.","Added Vesicare and removed Tovlaz as examples of applicable anticholinergic medications.","For details on the guidelines and the current list of covered tobacco cessation prescription drugs and OTC drugs, see the How to contact us for help section.","Confidentiality Notice Aetna considers personal information to be confidential and has policies and procedures in place to protect it against unlawful use and disclosure.","For the best experience on Cigna.","For more information see the What the plan pays and what you pay section, and see the schedule of benefits.","IM in any one muscle.","If, for any reason, a person is enrolled in an inappropriate level of coverage, coverage will be adjusted as provided in this Booklet.","Authorization guidelines are among some of the most murky and confusing guidelines of them all.","Mobile menu for the website.","Claims Administrator Aetna Life Insurance Company Coinsurance The percentage amount you must pay above the specified benefit payable as a condition of the receipt of certain services as provided in this Plan.","Santo C, et al.","Failure preclude the Plan from exercising its rights to subrogation or obtaining full Therecoverycoveredrecoverymedical expenses paid by the Plan.","We did not follow ll of the claim determination and appeal requirements of the State Federal Department of Health and Human Services.","FDA at no cost share.","Charges for services or supplies ordered by, or care rendered to you by, family member or relative or someone who ordinarily resides with you in your home.","Prescribed by or in consultation with an oncologist.","All mental health treatment coverage is provided under the same terms and conditions as any other illness.","It is an estimate.","Applied behavior analysis is an educational service that is the process of applying interventions: That systematically change behavior, and That are responsible for observable improvements in behavior.","Care Customer Service line at www.","Know the levels of appeal available for each health plan and the time frame for each level.","The Plan is required to offer to your spouse and your dependent children who are enrolled under the Plan the right to temporarily continue group health coverage if the coverage would cease upon the occurrence of certain qualifying events.","The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat.","Wald A, Bharucha AE, Cosman BC, Whitehead WE.","Examples of these are: The provision of blood to the Hospital, other than blood derived clotting factors.","Waseem Z, Boulias C, Gordon A, et al.","It mainly provides a program for diagnosis, evaluation, and Effective Treatment of alcoholism or drug abuse.","Other rules do not apply If none of the above rules apply, the plans share expenses equally.","Unfortunately, no randomized control studies have been documented, and based on a Cochrane Review of the literature, no conclusions can be made on its efficacy.","See the Important note below for how this affects your policy or plan.","Ates F, Vaezi MF.","Aetna is the brand name used for products and services provided by Allina Health and Aetna Insurance Company.","Botox are probably more suitable.","Dysport in patients with idiopathic blepharospasm or hemifacial spasm.","Coinsurance amounts are set forth in the Schedule of Benefits.","Drug coverage continues for these Connecticut members as long as the drug is medically necessary and more medically beneficial than other covered drugs The prescribing provider must respond requests for more information.","Because of differing sensitivity to Botox, the injection protocol and dosage must be established for every patient on an individual basis.","Prior authorization gives the clinical staff at an insurance company the chance to review treatment protocol, available health care providers, and contribute to the course of treatment.","Your provider must call us or send us a Request for External Review Form.","Drift snippet included twice.","Aetna may communicate directly with the Plan Participant or the Provider of services regarding any additional information that may be needed to process a claim.","Members receive the support of this team throughout the entire course of therapy.","The copay tiers for covered prescription medications are listed below.","This initial payment must cover the period from the termination date of coverage to the date of the COBRA election.","COBRACan you add a dependent to your COBRA coverage?","Aetna Specialty Pharmacy offers specialized care for patients with complex chronic conditions.","Refer to the appropriate precertification list for a list of the specific benefits plans to which precertification applies.","This field is for validation purposes and should be left unchanged.","Paying for eligible health servicessharing the expense Generally, your plan and you will share the expense of your eligibe health services when you meet the general requirements for paying.","This does not include a plan established by a government for its own employees or their dependents or Medicaid.","Is it an authorization or a precertification?","See the Adding new dependents section for more information.","They considered a diagnosis of MPS to be based on the identification of trigger points in the taut band through palpation of sensitive nodules, local twitch response and specific patterns of referred pain associated with each trigger point.","Botulinum toxin type A for chronic pain and pelvic floor spasm in women: A randomized controlled trial.","Prescription drugs may be Covered parately through your pharmacy Coverage.","This change may not be considered a material change in all states.","No RCTs were identified evaluating dental implant therapy.","Following the request, the physician may simply write a script for treatment that references a specific doctor, such as a specialist.","Your Planwill cover either buying or renting the item, depending on which we think is more cost efficient.","If you learn that our plan does not cover your drg, you have two options: You can ask Member Services for a list of similar drugs that are covered by our plan.","The State of Illinois does not coordinate benefits with the following: Private individual insurance Plans.","Hans Arora, former AUA Holtgrewe Fellow and current AUA Delegate to the AMA.","BTX injections in the setting of ventral hernia, and demonstrated an opportunity to leverage this product for use in abdominal wall reconstruction.","You may add a new dependent during a period of COBRA coverage.","Legislature or agencies of the state or federal government, including, but not limited to health oversight agencies for activities authorized by law, such as audits; investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities.","It may be intermittent or constant and may occur with near fixation, distance fixation, or both.","Care program and get your medication on the same day.","Pelvic floor pressures were measured by vaginal manometry.","Federal law requires that TRS provide you with this notice about its privacy practices and its legal duties regarding your protected health information.","What is the purpose of the Prior Authorization process?","Study populations likely vary widely, and studies may be reporting effects from treating symptoms rather than a diagnosed condition.","Aetna member portal has changed to the new Aetna Health portal.","Sometimes patients are referred to our providers and we are not contacted with their insurance plan.","Hall RA, Moore AP.","Care as surviving You are eligible to elect coverage as a surviving spouse of a retiree if you retiree was eligible for, or would have been eligible for, coverage under this program.","If you believe the network is inadequate, you may file a complaint with the Texas Department of Insurance.","Typically, these services or procedures would not have been proven to be of value when applied to a large population or subpopulation.","Patients also completed a standardized quality of life questionnaire on incontinence and a VAS on the impact of bladder problems on daily life activities, and underwent urodynamic assessment, including pressure flow studies.","What is prior authorization?","Refer to your schedule of benefits for this information.","We have grouped them as Type A, B and C, and orthodontic treatment services in the schedule of benefits.","FAIR Health changes these rates periodically.","TRS will tell you that the information has been added or corrected.","Each patient is started with a standard dose.","The rules below are applied in sequence.","How is the Preferred Drug List developed?","Important note: See the Outpatient prescription drugs, Other services section for more information on other prescription drug coverage under this plan.","Personalized botulinum toxin type A therapy for cervical dystonia based on kinematic guidance.","This is a limitation.","Services by volunteers or persons who do not regularly charge for their services.","Instruct patients to contact their physician if they experience difficulty in voiding as catheterization may be required.","Network Allowable Amounts, and coinsurance percentages.","Certificate of Coverage issued to Texas Christian University, and may be viewed online atwww.","It does not inspire confidence, especially as this is the only randomised controlled trial for this intervention in this indication and the quality of reporting allows for the possibility of bias, as well as it being financed by the manufacturer.","You may be eligible for an expedited external review if your treating physician believes that a delay in decision making during your external review might maximum function.","Whenwe learnofthe mistake, we may make a fair change in premium contribution or in your coverage.","The effect was to be measured by the return of efficacy of conservative treatment in halting curve progression.","The old information may remain in your record.","TRS to correct or add the information.","Ovulation induction with menotropins, intrauterine insemination and any related services, products or procedures.","For urology, this prior authorization and purchase requirement would affect drugs such as Lupron, Trelsar, Eligard, Zoladex, Vantas, Firmagon, Provenge, Botox, Jevtana, Testopel, Xgeva, Xiaflex, and Zometa.","Per visit or admission Deductibles do not apply towards satisfyingthe Policy Year Deductible.","Jankovic J, Schwartz K, Clemence W, et al.","Prog Neuropsychopharmacol Biol Psychiatry.","Botulinum toxin: An endoscopic approach for treating fecal incontinence.","These are things such as natural disasters, epidemics, fire and riots.","Every year, in January and July, we typically updatetheprecertificationlist.","They often need special storage and handling.","Eligible health services include formula and low protein modified food products ordered by a physician for the treatment of phenylketonuria or an inherited disease of amino and organic acids.","Additional Deductible Deducbles that are in addition to the annual Plan Deductible.","What is Prior Authorization and How Does the Process Work?","Randomized trials were included.","This includes hearing aid batteriesand auxiliary equipment.","Botulinum toxin injections for new onset bilateral vocal fold motion impairment in adults.","You should get precertification within the timeframes listed below.","CGS Administrators has added a new article addressing billing and coding procedures that complement the LCD for Botulinum Toxins.","Paid according to the type of drug per the schedule of benefits, above Maximums Coverage will be subject to any sex, age, medical condition, family history, and frequency guidelines in the recommendations of the United States Preventive Services Task Force.","This program is designed to help arrange covered care for organ and tissue transplants including heart, lung, liver, kidney, pancreas, peripheral stem cell and bone marrow transplants.","ATENCI\u00d3N: si habla espa\u00f1ol, tiene a su disposici\u00f3n serviciosgratuitos de asistencia ling\u00fc\u00edstica.","Ifyour Employergrantsyou an approved FMLA leave for a period in excess of the period required by FMLA, any continuation of coverage during that excess period will be subject to prior written agreement between Aetna and your Employer.","This information can also be found at the www.","This guide provides helpful information on the Aetna Preferred Drug List and your pharmacy benefit plan.","Any outpatient disposable supply or device.","Formulary management; litigation proceedings; transfer of policies or contracts to and from other insurers, HMOs and third party administrators; underwriting activities; and due diligence activities in connection with the purchase or sale of some or all of our business.","Atvered person is legally obligated to pay.","How will I find out if my Prior Authorization request is approved or denied?","These prescriptions may be available only at certain pharmacies.","Low protein modified food products do not include foods that are naturally low in protein.","For any drug, which due to its characteristics as determined by us must typically be administered or supervised by a qualified provider or licensed certified health professional in an outpatient setting.","CH\u00da \u00dd: N\u1ebfu b\u1ea1n n\u00f3i Ti\u1ebfng Vit, c\u00f3 c\u00e1c d\u1ecbch v\u1ee5 h\u1ed7 tr\u1ee3 ng\u00f4n ng\u1eef mi\u1ec5n ph\u00ed d\u00e0nh cho b\u1ea1n.","These researchers examined if BTX injection affects the frequency and duration of respiratory infections including aspiration pneumonia and hospitalizations in neurologically impaired children.","Treatment of essential tremor: Report of the Quality Standards subcommittee of the American Academy of Neurology.","What pharmacy benefits plan do I have?","It describes all recognized mental disorders.","The policy would allow us to adjust payment for multiple endoscopy procedures in the same family when billed by the same surgeon or assistant surgeon on the same date of service for the same member.","Penney SE, Bruce IA, Saeed SR.","It includes Surgerya healthy breast to make it even with the reconstructed breast, treatment of physical complications of all stages of the mastectomy, including lymphedema, and prostheses.","Botox as a preventive therapy for migraine has revealed mixed results.","Please review this notice carefully.","Experimental Procedures Determination Policy.","After the amount paid for eligible health services reaches your family deductible, this plan will begin to pay for eligible health services for the rest of the year.","As part of this coverage, we will cover certain early intensive behavioral interventions, such as applied behavior analysis.","Xtandi for a Covered Use.","Important note: The lactation counseling services maximum will be covered for the duration of breastfeeding.","The use of botulinum toxin for the treatment of temporomandibular disorder.","Employer determines the approved FMLA leave is terminated.","An EOB is sent to the Plan Participant to verify the benefit determination.","BTX into the pectoralis muscle on one side versus placebo on the contralateral side during immediate tissue expander reconstruction after bilateral mastectomy.","This information must be included on every page of correspondence.","Important note: The advance claim review is not a guarantee of coverage payment.","Preventive care immunizations: Subject to any age limits provided for in the comprehensive guidelines supported by Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.","If TRS extends its response time, TRS will tell you in writing the reasons for the delay and the date by which TRS will provide the list.","Eur J Med Res.","Blue Cross NC members.","TRS may use or disclose protected health information, provided that TRS informs you in advance of the use or disclosure and you have an opportunity to agree to or prohibit or restrict the use or disclosure of your protected health information.","Bustamante F, Brunaldi VO, Bernardo WM, et al.","Preferred brand drugs will have a higher cost.","If the COBRA election is untimely or the COBRA payments are not received when due, the elected COBRA continuation coverage will terminate permanently, retroactive to the Yourdependent children COBRA coverage may not be reinstated in such an event.","Elstner KE, Jacombs AS, Read JW, et al.","If you do not enroll when you first qualify for health benefits, you may have to wait until the next annual enrollment period to join.","System Pharmacists; Updated periodically.","PCP fails to ask us for precertification.","Helps you get and pay for a lot of but not all health care services.","Surgical treatment was reported in patients with very severe symptoms refractory to pharmacologic treatment.","Important note: Coverage does not include the office visit for the fitting of prescription contact lenses.","Medicare as Part D drugs, and your copay may differ depending upon the tier at which the drug resides.","This section addresses the medical necessity and precertification requirements.","If you have questions about our plan, please contact us.","Botulinum Toxin A in bruxers.","Few subjects discontinued due to adverse events.","Thiincludes room and board for rest cures, adult day care and convalescent care.","Genetic testing and counseling done to detect genetic abnormalities in the absence of either significant symptoms of or risks for the genetic disease in question.","Botulinum toxin A in the treatment of upper and lower limb spasticity: A systematic review of randomized controlled trials.","You may submit an appeal if Aetna gives notice of an adverse benefit termination.","AUA Public Policy Council that may benefit your Section members.","What is a referral?","Drug treatments for spasticity.","Recent studies of subjects with chronic migraine appear to have positive results.","The plan tells you how we will work through our differences.","If you have any questions about our Coverage of mastectomies and reconstructive Surgery, please contact Aetna Member Services number on your ID card.","Reimbursement If you recover expenses for an Illness or Injury that due to the negligence of a third party, Aetna has the right to first reimbursement for all benefits we paid.","Before we extend coverage, we may ask that your child get a physical exam.","You are now leaving the Aetna Medicare website.","So it might be helpful to ask your GP to recommend a few options for you.","Unlike other movement disorders, this can continue during sleep.","Wolters Kluwer Health, St.","Surrogacy for you or the surrogate.","Botox approved for urinary incontinence; overactive bladder in MS.","Skilled nursing facility Eligible health services include inpatient skilled nursing facility care.","Coverage does not include custodial, nursing, rest, or extended care facilities, and facilities operated exclusively for the treatment of the aged, drug addicts or alcoholics, whether or not such facilities are operated as a separate institution by a hospital.","Aetna is proud to be part of the CVS Health family.","ALL initial authorization criteria for all approvable conditions other than chronic migraine prophylaxis.","This includes hearing aid batteries, amplifiers, and auxiliary equipment Enhance other forms of communication to make up for hearing loss or devices that simulate speech.","FDA as having the same active ingredient as the brand name drug.","When this is the primary plan, we will pay your claims first as if the other plan does not exist.","Coverage for your dependents will generally become effective on the date your coverage becomes effective if, by then, you have requested dependent coverage.","This will only apply when benefits are available or payable under any workers compensation or occupational disease Act or law, regardless of whether a claim was filed for such benefits.","Lee BJ, Lee JC, Lee YO, et al.","You can ask for your request to be expedited.","Sometimes, this plan is the primary plan, which means that the plan pays benefits before Medicare pays benefits.","An evaluation of the interrelationships between the nervous system and other bodily organs and behavior.","Your PCP We encourage you to access eligible health services through a PCPThey will provide you with primary care.","You and your PCP will work together to maintain your health, and your PCP will be able to provide or coordinate most of your health care needs.","The authors concluded that the safety of IA therapies can be improved by applying simple measures designed to prevent AEs.","See Adding new dependents and Special times you can join the plan for more information.","Your doctor will start the prior authorization process.","The dental condition is diagnosed by your dental provider after they have examined you.","Dummies helps everyone be more knowledgeable and confident in applying what they know.","It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan.","Once COBRA continuation coverage terminates for any reason, it cannot be reinstated.","Semirivate Room and Boardor specialty units, such as intensive care and coronary care.","Some services, such as chiropractic care and bariatric surgery, are supplemental benefits included only in the health plans of employers who purchased them in addition to basic health care coverage.","Marriage, religious, family, career, social adjustment, pastoral, or financial counseling.","While this Plan Design and Benefit Summary document will tell you about some of the important features of the Plan, other features may be important to you and some may further limit what the Plan will pay.","The terms hypertropia and hypotropia are used to describe vertical misalignment.","Treatment is provided under the direction of a physician.","Zhang DZ, Liu XY, Xiao WL, Xu YX.","There is insufficient evidence for the use of botulinum toxin in motor or phonic tics.","Chronic exertional compartment syndrome.","Waldfogel JM, Nesbit SA, Dy SM, et al.","Rationale: Promote appropriate utilization and dosing of Nubeqa for its FDA approved indication.","However, repeated injection may provide better sustained results with no additional morbidities.","Fill out this form below and mail it to us.","Find practitioners near you and book your next appointment online.","Moericke R, Mackey S, Wang C, et al.","BTX could decrease pain associated with tissue expanders.","Hey all you underarm heavy sweaters!","This may be because the language is still under official review for approval.","You are responsible for paying any remaining coinsurance.","Generally, Medicare Part D requires a monthly premium contribution.","Strabismus: The dose is based on prism diopter correction or previous response to treatment with BOTOX.","Drug coverage continues for these Connecticut members as long as the drug is medically necessary and more medically beneficial than other covered drugs.","However, some insurance payers require referrals to be more formal than a script.","Evidencebased guideline update: Pharmacologic treatment for episodic migraine prevention in adults.","Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.","Plast Surg Hand Surg.","We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex.","Consistent with the standards set forth in policy issues involving clinical judgment.","If the provider bills you for an amount above your cost share, you are not responsible for paying that amount.","See the Eligible health services under your policy Diabetic equipment, supplies and education section for covered equipment and supplies.","Baumann LS, Helam ML.","Deductible The amount you pay for Eligible Health Services per Plan Year before your Plan starts to pay as listed in the Schedule of Benefits.","What are quantity limits?","An CVS Caremark Specialist Pharmacist may even call you or your doctor to help make sure your medications will work safely together.","If you have terminated State service and are continuing Coverage under COBRA, contact the MBSC Service Center.","The certificate of coverage contains acomplete description of the preauthorizationprogram.","Treatment of morton neuroma with botulinum toxin A: A pilot study.","This bill makes it easier for a project to obtain a certificate of need when that project will be located in an area in which one provider or group of providers controls a majority of the market for similar medical service.","Piriformis syndrome: Anatomic considerations, a new injection technique, and a review of the literature.","Spasticity may be general, regional or localized.","Please consult with your administrator.","This prescription drug has a Part B versus Part D administrative prior authorization requirement.","Certain Uses and Disclosures of Protected Health Information that Will Not Be Made.","Mental health care in lieu of detention or correctional placement or that is required to be treated in a public facility.","For the BOTOX Migraine Clinical Research Group.","Plan, have a duty to do so prudently and in your interest and that of other plan participants and beneficiaries.","HCPCS code must describe the service performed.","The authors concluded that BTX seems to be an effective treatment for focal spasticity and for reducing disability in persons with SCI.","Plan has been advised of the responsibility, that Plan is primary payer over the Plan of the other parent.","You will receive notice when necessary.","Vaezi MF, Pandolfino JE, Vela MF.","They may be needed for a claim.","Network providers will submit a claim directly to Aetna.","When will coverage end for any dependents?","Choose Your Doctor Carefully.","Mail your new prescription to Aetna Rx Home Delivery with a completed order form.","See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage.","More Details If You.","Botulinum toxin type b for the treatment of a sialocele after parotidectomy.","Fernandez HH, Lannon MC, Trieschmann ME, Friedman JH.","Searching the Medicare coverage database.","Notification is dataentry process.","Medically Necessary, Medical Necessity.","Limit coverage of prescriptions to a specific number of units in a defined amount of time.","Render slideshow if info advacned items contain one.","Diagnostic testing is not covered under the preventive care benefit.","The plan covering you as a dependent.","These investigators selected RCTs comparing botulinum toxin with placebo or active treatment in people with shoulder pain.","Plan will not: adjust premium or contribution amounts on the basis of Genetic Information; request or require an individual or a family member of such individual to undergo a genetic test; or request, require or purchase Genetic Information for underwriting purposes.","Note: Chronic pain isdefined as pain that persists longer than the amount oftime normally expected for healing.","In addition, the authors found that parotid major ducts were enveloped by the deep lobe and extensive dissection during the subcondylar fracture reduction may cause parotid major duct injury.","If your insurance plan requires a prior authorization on a treatment that the doctor believes in medically necessary, he or she needs to support that claim to get you coverage.","Sequelae of mild traumatic brain injury.","This is problematic since the condition is chronic and a single treatment modality is unlikely to fully resolve symptoms for most women.","Eligible health services include the services and supplies provided by a physician or behavioral health provider for the diagnosis and treatment of autism spectrum disorder.","With the increasing demand for aesthetics, these silicone implants were not only used in breast augmentation surgery but also in breast reconstruction after mastectomy.","September is facing barriers from insurers.","Any other services that a person without medical or paramedical training could be trained to perform.","You and your doctor can talk about these medical services and decide if they are right for you.","ID number, full address, phone number, date of birth, and gender.","However, they stated that further RCTs are needed.","The letter will describe your right to submit additional information for consideration to the IRO.","Injury to the parotid duct is often unavoidable when surgically treating buccal SCC because of the intimate anatomic relation among the buccal mucosa, Stensen duct, and parotid gland.","All Other Uses And Disclosures Require Your Prior Written Authorization.","Information is subject to change.","The measurement, fitting or adjustment, or polishing of eyeglasses or contact lenses.","We already told you about the many health care services and supplies that are eligible for coverage under your plan in the Eligible health services under your plan section.","Effect of botulinum toxin injection on nocturnal bruxism: A randomized controlled trial.","Over the Plan that covers the Plan Participant under COBRA.","If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card.","It will be on the date your Declaration of Domestic Partnership is filed or the first day of the month following the qualifying event date.","Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.","Complete the claim form.","The lowest recommended starting dose should be used.","Br J Oral Maxillofac Surg.","Ambulance A vehicle staffed by medical personnel and equipped to transport an ill or injured person.","Please rate the following statement.","Individually, authorizations and referrals can have a major impact on reimbursement from an insurance payer.","This committee includes licensed pharmacists and doctors.","It is often difficult to achieve negative margins and preserve the integrity of the parotid duct.","The authors concluded that botulinum toxin A is a simple method of treatment of bruxism, without side effects and appreciated by patients.","Three Tier means you could pay three different amounts, depending on the drug you take.","The FDA emphasized that the potency units are specific to each botulinum toxin product, and the doses or units of biological activity can not be compared or converted from one product to any other botulinum toxin product.","Health care providers usually initiate the prior authorization request from your insurance company for you.","Standard LOS for vaginal deliveries is a total of three days or less; standard LOS for Cesarean section is a total of five days or less.","When appropriate, your doctor may decide to prescribe, or allow substitution with, a generic drug.","Benefit payment Written proof must be provided for all benefits.","There is emerging evidence that injection of the pylorus with botulinum toxin may be an alternative to pyloroplasty or pyloromyotomy for esophagogastrectomy.","Efficacy of botulinum toxin in treating myofascial pain in bruxers: A controlled placebo pilot study.","ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verf\u00fcgung.","SCHEDULE OF COVEREDSERVICES OR SUPPLIES WHEN DETERMINED TO BE MEDICALLY NECESSARYSERVICE OR SUPPLYCRITERIA AND COVERAGEPROVIDEDPRECERTIFICATIONREQUIREMENTS LIMITATIONSadvantage in clinical trials; iv.","The list of drugs requiring precertification, quantity limits or step therapy is subject to change.","How to use this guide Your guide includes a list of commonly used drugs covered on your pharmacy plan.","Read the reviews and add your own.","However, when there is a more diffuse neurological disorder present the results of surgery are more disappointing.","Your hysician orders them.","Author analysis was then compared and full papers for appropriate studies were obtained.","Get themostvalueoutofyour benefits: We have online tools to help decide whether to get care and, if so, where.","CMS and who have elected and enrolled in Coverage under the Plan through submission of an enrollment form.","The preferred product is Xeomin.","For a current listing f the prescription drugs and medical injectable drugs that require preauthorization, contact Member Servicesby calling the tollfree number on your ID cardin the How to contact us for help sectionor by logging onto the Aetna website atwww.","Aetna has the sole and discretionary authority to interpret the Plan and to determine all questions arising in the administration, interpretation and application of the Plan provisions.","This material is for information only and is not an offer or invitation to contract.","For example, these could be visit, day or dollar limits.","Tocoverage reviews and prior authorization, please call CVS Caremark at For some medications, you must obtain approval through a coverage review before the medication can be covered under your plan.","Stoppa repair were used.","Botulinum toxin type B vs.","They stated that a larger series of patients is needed to confirm these preliminary results.","This bill clarifies that only hospitals licensed by the Department of Health are subject to certificate of need requirements.","You are then Theif there were no other coverage.","Your insurance company will contact you with the results to let you know if your drug coverage has been approved or denied, or if they need more information.","Little carryover was noted in the second arm placebo and the placebo data from both arms were included in analysis.","Does health insurance cover preventive services?","Clinical Policy Code Lookup.","MR, Hirtz D, Aisen M, et al.","You will receive an email notification when new information is available.","We are responsible for the cost of sending this information to the ERO and the cost of the external review.","Wenn Sie eine andere Sprache als Englisch sprechen, stehen Ihnen kostenlose Sprachdienste zur Verf\u00fcgung.","Requests for precertification and notification must be received before rendering services.","Use Aetna Specialty Pharmacy to get this medicine sent right to your mailbox.","Participating Provider Providerwho has entered into a direct or indirect written agreement with the claims administrator to provide health services to Participants.","The process must keep the physiological risk to the patient at a minimum.","Complete remission is rare.","Bone Joint Surg Am.","Updates to the tier status of individual medications happens Drug exclusions from the formulary will occur once per year and will typically go into effect on Jan.","When you have received a service from an eligible provider, you will be charged.","How is the formulary developed?","Major adverse events were not reported.","Do not assume anything.","You have the right to extend coverage for your dependent child beyond the plan age limits.","However, these researchers stated that to draw a valid conclusion, a further investigation with a larger sample size is needed.","BTX injection in the treatment of gummy smiles and the importance of targeting the levator labii superioris alaeque nasi muscle, studies differed in the type and the dose of toxin administered and the technique adopted.","Network services or supplies.","Specialty drugs treat complex, chronic conditions.","Apostolidis A, Dasgupta P, Denys P, et al; European Consensus Panel.","Such a trial is published in a peer reviewed medical journal.","Physician A skilled health care professional trained and licensed to practice medicine under the laws of the state where they practice; specifically, doctors of medicine or osteopathy.","If you are pregnant, an urgent claim also includes a situation that can cause serious risk to the health of your unborn baby.","The following Schedule of Covered Services sets forth the health care services and supplies that are Eligible Health Services under this Plan.","For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first.","Care work when you travel outside of the United States?","The denial will say why your request was denied and explain your right to send TRS a written tell you how to complain to TRS or the Secretary of the Department of Health and Human Services.","If we make such a change, you or your prescriber can ask us to make an exception and continue to cover the brand name drug for you.","Schedule of Covered Services Description of Eligible Health Services.","Primary plan The primary plan pays your claims as if there is no other health plan involved.","These requirements and limits may include: Prior Authorization: Our plan requires you or your physician to get prior authorization for certain drugs.","Giannantoni A, Conte A, Proietti S, et al.","Hospice care Supportive care given to people in the final phase of a terminal illness with a focus on comfort and quality of life, rather than cure.","Interventions designed to alleviate or decrease abnormal physiological responses of the nervous system due to behavioral or emotional factors.","Special rules apply for adult children and children of civil union partners.","Care retirees, surviving spouses and surviving dependent children will receive two cards, one from Aetna for medical expense and one from CVS Caremark for pharmacy expenses.","Your employment ends because of a military leave of absence.","Or you can go to Aetna.","DNA testing for women Radiological services, lab and other tests given in connection with the exam.","Any coverage being continued for a dependent will not be continued beyond the date it would otherwise terminate.","What precertification requirements apply Why do some drugs need ecertification?","Any other type of coverage for persons in a group.","This content conforms to AAFP CME criteria.","From your insurer of what it will pay for the services.","Your plan covers many kinds of health care services and supplies, such as physician care and hospital stays.","The authors concluded that botulinum toxin A infiltrations are a safe and useful treatment for patients with severe bruxism.","Further, TRS may disclose protected health information to organizations that handle organ, eye, or tissue donation and transplantation.","For example, Aetna companies cannot make payments for health care or other claims or services if it violates a financial sanction regulation.","Third Party Claim and Code Review Program As of March you may see new claims edits.","How does the prior authorization process work?","The University of Rochester is committed to maintaining the highest ethical standards in the workplace and ensuring compliance with state and federal laws concerning employment.","Stidham KR, Solomon PH, Roberson JB.","COORDINATION OF BENEFITS IX.","The request processes as quickly as possible once all required information is together.","Nonsurgical interventional therapies for low back pain: A review of the evidence for an American Pain Society clinical practice guideline.","The information you will be accessing is provided by another organization or vendor.","Insured Employers actually have the most influence in this battle, because we are suffering and we and are employers are paying the insurance bill.","When a Plan Participant has medical services rendered by a Provider who has opted out of the Medicare program, a private contract is usually signed explaining that the Plan Participant is responsible for the cost of the medical services rendered.","See policy for criteria.","You are enrolled in the Aetna Commercial Three Tier Open Formulary for fully insured plans.","Bone Marrow Transplants for Breast Cancer Bone Marrow Transplants for Breast Cancer Covered according to the type of benefit and the place where the service is received.","We will provide a written notification to you and your physician of the precertification decision, where required by state law.","You are now leaving BOTOXMedical.","Contact CVS Caremark to order medication, check the status of an order, review the tier status of medications, generic drugs, medication costs, and obtain a prescription drug card.","This article therefore dealt with the principles of management of spasticity and treatment with BTX.","Attach supporting documentation when submitting.","Aetna and its affiliates provide certain management services for Innovation Health.","It must be delivered quickly.","Overview of abdominal wall hernias in adults.","FMLA leave is deemed terminated by your Employer, you may, on the date of such termination, be eligible for Continuation Under Federal Law on the same terms as though your employment terminated, other than for gross misconduct, on such date.","Generic prescription druggeneric drug prescription drug with the same dosage, safety, strength, quality, performance and intended use as the brand name product.","We are responsible to you for what our employees and other agents do.","Fishman LM, Zybert PA.","Authorization For Release of Protected Health Informationwww.","Reconstituted DYSPORT is intended for intramuscular injection only.","This is called continuity of care.","Sialorrhea in patients with ALS: Current treatment options.","There is no coverage for the cost of subsequent eyeglasses or contact lenses.","Precertification is required when Aetna or Innovation Health is secondary payer.","ZYDELIG X X LDZYKADIA X \u5a00\u5954I\u4700\u4120If your doctor supplies or administers your drug, they may continue to do so.","Botulinum toxin type A as a migraine preventive treatment.","This is a plan that provides for care and treatment of a disease or injury.","Why use the SHOP Marketplace?","Assistance with Your Questions If you have any questions about your Plan, you should contact the Plan Administrator.","Botulinum toxin in the treatment of primary chronic headache disorders.","If you have a chronic health condition, your GP may be able to manage this most of the time and refer you to a specialist, only if your condition worsens.","Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates.","Care Plan provisions and no other representations, expressed or implied, will prevail over the information contained therein.","Qualitative findings were also considered to help demonstrate valuable themes across the literature.","Having knowledgeable support staff in the area of preservice is crucial to any organization.","Hall RA, Smith CT, et al.","Moreover, the author concluded that further studies are needed.","Rehabilitative services provided for longterm, chronic medical conditions.","If you leave us during the annual election period, your last day of coverage is usually Dec.","Surgery Center A facility specifically licensed as a freestanding ambulatory surgical facility by applicable state and federal laws to provide outpatient Surgery Services.","However, both of these studies were small and from a single investigator, raising questions about the generalization of the findings.","In addition, if you are receiving extra help to pay for your prescriptions, you will not get any extra help to pay for these drugs.","Surgery center A facility specifically licensed as a freestanding ambulatory surgical facility by applicable state and federal laws to provide outpatient surgery services.","Botulinum toxin to improve results in cleft lip repair.","Family deductible You pay for network eligible health services each year before the plan begins to pay.","Use and mechanism of botulinum toxin in overactive bladder treatment.","Consistent with applicable federal and state laws, TRS may disclose your protected health or the public, such as disclosures to prevent disease, help with product recalls, report adverse reactions to medications, or report suspected abuse, neglect or domestic violence.","Hospital care Eligible health services include inpatient and outpatient hospital care.","Charge for services actually provided.","Rehabilitative services whose primary goal is to maintain your current level of function, as opposed to improving your functional status.","Krymchantowski AV, Bigal ME, Moreira PF.","What is the effectiveness of botulinum toxin A in the reduction of upper limb spasticity in children with cerebral palsy?","The exact provisions, including definitions, governing this surance are contained in the Certificate of Coverage issued to you and may be viewed online at www.","Hobson DE, Gladish DF.","Silberstein SD, Stark SR, Lucas SM, et al.","Intractable orbicularis myokymia: Treatment alternatives.","It meets any licensing standards set by the jurisdiction in which it is located.","Repairing DME due to normal wear and tear.","Aetna Health app from the App Store or on Google Play.","The third party service provider is responsible for the goods or services they deliver.","That are ordered by a dentist or prescribed by an oral surgeon in relation to the removal of teeth, or prescription drugs for the treatment of a dental condition unless dental benefits are provided under the plan.","VS Caremark Specialist Pharmacist may even call you or your doctorto help make sure your medications will work safely together.","Patient has had bilateral orchiectomy.","Kalra HK, Magoon EH.","Carriers have broader guidelines for emergency surgeries versus elective, scheduled encounters.","Overall, the evidence base is extremely limited and no definitive statements regarding treatment efficacy can be made.","It fills prescriptions for maintenance medicine.","See current summary plan description and historical communication references.","Those policies may further reduce the Recognized charge.","Supplies and services are covered only if they are medically necessary.","MENTAL OR NERVOUS DISORDER OR CONDITION TREATMENT FACILITY.","The formulary can change throughout the year.","Medicare makes its coverage guidelines available on its Web site.","Cordivari C, Misra VP, Catania S, Lees AJ.","Court order You can put child you are responsible for under qualified medical support order or court order on your plan.","Schurch and Corcos noted that Botox appears to be a reasonable alternative to surgery in the management of intractable OAB in children.","This decision is called the final adverse benefit determination.","Botulinum toxin injections for adults with overactive bladder syndrome.","Intravesical instillation therapy has basically not changed during the last few years, although some studies have disconfirmed some regimens.","Management of chronic constipation.","See the Special coverage options after your coverage ends section for more information.","Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes.","To look at the full Plan description, which is contained in he Certificate of Coverage issued to you, go to www.","In most cases, chemotherapy is covered as outpatient care.","For domestic partnership, you should provide your employer completed and signed Declaration of Termination of Domestic Partnership.","When appropriate, your doctor may decide to prescribe a generic drug or allow the pharmacist to substitute a generic drug.","Holland S, Silberstein SD, Freitag F, et al.","Generally, your GP will be able to recommend a specialist for you based on your individual circumstances and preferences.","Revised criterion for Botox for chronic anal fissures regarding trial and failure of nitroglycerin ointment, etc.","The authors stated that any future studies should be powered to account for the significant placebo response while exploring higher doses without unmasking controls.","Financial or legal counseling, including estate lanning or drafting of a will.","The authors concluded that although a placebo effect cannot be ruled out, local injection of BTX may be an effective treatment for intractable asthma associated with abnormal vocal cord movement.","If you overpaid, your account will be credited.","If there is a court decree that states that the parents shall share joint is responsible for the health care expenses of the children, the order of a oveapply.","Each No is one step closer to Yes.","Soares A, Andriolo RB, Atallah AN, da Silva EM.","You can access the list of ecialty prescription drugs.","The authors concluded that botulinum toxin appears relatively safe and effective in treating cervical dystonia and chronic facial pain associated with masticatory hyperactivity.","Get a new prescription from your doctor.","Care advise all Plan participants and covered dependents of their rights to continue health coverage that would otherwise cease under certain circumstances.","You can ask us to cover a drug even if it is not on our formulary.","Several rules apply to the dental benefits.","Hyperhidrosis treated by botulinum A exotoxin.","They will give you more information on coverage levels for maternity care under this plan.","If the original bills are in a foreign language, you should obtain an English translation of the services rendered, if possible.","Two review authors selected the studies, assessed the risk of bias using the Cochrane Back Review Group criteria, and extracted the data using standardized forms.","Eligible Health Service when required.","However, the benefits of the drugs used may be marginal compared with placebo yet the costs associated with their use continue to increase.","This drug may be covered under Medicare Part B or D depending upon the circumstances.","The authors concluded that this approach appears to be safe; but randomized trials are needed.","Search autocomplete is currently not responding.","For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative.","Tsai CP, Chiu MC, Yen DJ, et al.","They will also deny or approve the procedure based on several factors.","It has been shown in European studies to be a safe and effective treatment for cervical dystonia.","The eligible health services are those listed in the pediatric dental care section of the schedule of benefits.","These items are usually included in the cost of other services and are not billed separately.","Thus, the current symptomatic therapy remains unsatisfactory.","PREEMPT Chronic Migraine Study Group.","Access to a pharmacist and nurse specially trained in your condition.","Providerdiscuss the treatment if a review will be applied.","This includes behavioral health services that are not primarily aimed at the treatment of illness, injury, restoration of physiological functions or that do not have a physiological or organic basis.","TRS may use or disclose your information to prepare a bill for medical services to you or another person or company responsible for paying the bill.","Preliminary results of suburothelial injection of botulinum a toxin in the treatment of chronic interstitial cystitis.","Coverage under this Plan in accordance with its terms and conditions.","At present, the effects of botulinum toxin and its use for pain relief remain controversial.","Any exception granted is based upon an individual, case by case decision, and will not apply to other members.","Urgent appeal requests may be oral or written.","United States Preventive Services Task Force.","Heise CO, Gon\u00e7alves LR, Barbosa ER, Gherpelli JL.","Botulinum toxin type A with subpectoral breast implants.","Aetna cards will be issued in the name of the retiree or surviving spouse with the name of all individuals listed.","You have the right to request that your protected health information not be disclosed to TRS if you have paid for the service received in full.","Physical examination revealed a bilateral hypertrophy of the masticatory muscles, predominantly affecting the right temporalis and the left masseter.","This applieswhether or not claim is made forsuch benefits.","The network pharmacy will submit your claim.","You cannot receive these medications through mail order.","Eyeglasses, contact lenses, and other equipment intended to improve vision.","The patient must be bed or stretcher bound.","An institution specifically licensed as a residential treatment facility by applicable state and federal laws to provide for substance abuse residential treatment programs.","An independent clinical reviewer associated with the ERO, who possesses appropriate expertise in the area in question, will review all of the information and documents you have submitted in support of your appeal.","Pringsheim T, Davenport W, Mackie G, et al.","This date is based on the date the roviderterminated their participation with Aetna How claim is paid Your claim will be paid at not less than the negotiated charge during the transitional period.","Your doctor should have an answering service if you call after the office closes.","The established drug names of the botulinum products have been changed to emphasize the differing dose to potency ratios of these products.","You are now being directed to the CVS Health site.","Retail pharmacy A community pharmacy that dispenses outpatient Prescription drugs at retail prices.","These investigators concluded that although the primary efficacy end point was not met, all groups responded to treatment.","Care will always be primary.","If you have questions, see the How to contact us for help section.","This guide provides helpful information about your pharmacy benefits plan.","Home Plan will be financially responsible for any covered services not paid and the member will be held harmless.","Once you have reached the deductible, this plan will begin to pay for eligible health services for the rest of the year.","See the Glossary section for what these termsmean.","HOME HEALTH CARE PLAN.","Remember, only you and your covered dependents can use your member ID card.","You are not Coveredfor the following: Outpatient services that are considered to be Experimental or Investigational.","If it is a verbal order, it must promptly be put in writing by the Network pharmacy.","Urological applications of botulinum toxins.","These prescription drugs are not normally covered in a Medicare Prescription Drug Plan.","You, someone who represents you or your prescriber can contact us.","The Minor test confirmed a significant improvement.","If the covered student does not obtain a referral from Student Health Services, no benefits will be payable.","CPP and reported similar effectiveness among active agents.","Facility payment will be based on the Aetna contracted rate.","Health Resources and Services Administration.","Care program may be changed with the approval of the TRS Board of Trustees.","Filing deadlines for managed care Plans, including behavioral health services offered under the managed care Plan may be different.","In patients with congenital strabismus who have compromised or absent binocular vision, treatment is cosmetic as ocular realignment is not capable of restoring binocular vision.","Kanovsk\u00fd P, Slawek J, Denes Z, et al.","If there is a balance due, an invoice will be included with your prescription order.","Physician for the administration of a local anesthetic.","United Kingdom and United States botulinum neurotoxin A formulations.","How claim is paid Your claim will be paid at not less than the negotiated charge during the transitional period.","OR DRUG ABUSE TREATMENT FACILITY.","International members are excluded.","BTA and control group.","In all these cases, the provider may require you to pay the entire charge.","Aetna quote for your clients.","Care Customer Service at ID card.","This exception does not apply to Preventive care and wellness benefits.","Dystonia in corticobasal degeneration.","During the past decade, BTX has been found to be of therapeutic value in the treatment of a variety of neurological disorders associated with inappropriate muscular contractions such as torticollis and spasmodic dysphonia.","There is still no comprehensive understanding of the underlying biologic processes responsible for diabetic neuropathic pain.","An addiction to a controlled substance or cannabis that is used in violation of law.","When you are discharged When you no longer need inpatient care When you become covered by another health benefits plan \u018c\u018cWhat exceptions are there for dental work completed after your coverage ends?","Myobloc may be effective in patients with cervical dystonia who have developed antibodies to or who have not responded to Botox.","It will only complicate matters down the road.","See bullets below for more information on changes that affect members currently taking the drug.","Also, there is currently no consistent evidence or strong evidence to allow drawing conclusions on the effectiveness of botulinum neurotoxin in chronic daily headache.","With this type of pharmacy, you can get this medicine sent right to your home.","Arzul L, Corre P, Khonsari RH, Asymmetric hypertrophy of the masticatory muscles.","Please tell us who you are in the hyperhidrosis community.","Want to learn more about the drug coverage for your plan?","This is the quickest way receive an authorization for services requiring precertification.","Depending upon your plan, mail order may save you money.","Eligible health services under your plan Outpatient prescription drugs section Packaged in unit dose form.","Special coverage options after your coverage ends section.","Specifics depend on your plan.","Evidence was insufficient to comment on relief of pain after hysterectomy.","The study was small, and most subjects were women.","Payment is made without regard to the possibility that another plan may cover some expenses.","Formulary Exclusions List A list of Prescription drugs not Covered under the Plan.","EMG was useful in distinguishing between muscle contraction and underlying contractures and to determine the dosage of BTX.","Subject to any age limits provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.","They considered eligible only RCTs enrolling obese patients comparing BTA versus saline injections.","Because thousands of drugs are included in your pharmacy benefits plan, we only list the most commonly prescribed ones.","Important note: You may qualify for a medical exception if your provider determines that the contraceptives covered standardly as preventive are not medically appropriate.","Besuchen Sie unsere Website oder rufen Sie die Telefonnummer auf Ihrem Mitgliederausweis an.","TRS reserves the right to change its privacy practices and the terms of this notice at any time.","Please select a Request Type.","If the provider is contracted and participating in a network, the Allowed Amount is determined by the contract.","Or it could be a situation in which you need care to avoid severe pain.","Specializedtechniques andcharacterizationsare not eligible.","Get immediate access, anytime, anywhere.","The spouse of an active member or retiree at the A medical prognosis of six months or less to live.","Medicare Part A ineligibility.","Hearing therapy and relateddiagnostic hearing tests.","Almansa C, Hinder RA, Smith CD, Achem SR.","Solish N, Bertucci V, Dansereau A, et al.","It includes compensation, health care plans, tuition benefits, retirement plans, and so much more.","You can call Member Services at the tollfree number on the back of your ID card for information on continuity of care.","They treat the same condition as the step therapy drug.","Charges that satisfy your Part B deductible will be applied in the order received.","By using the website, you agree to our use of cookies to analyze website traffic and improve your experience on our website.","Prostheses and treatment for physical complications at all stages of the mastectomy, including lymph edemas.","Service Center in San Antonio, Texas.","See below for information about how to request an exception.","Fahy JV, Dickey BF.","BTX abdominal CT measured changes in abdominal wall muscle thickness and length.","The authors concluded that physicians need to be aware of this possible complication, consider alternate injection techniques and antiseptic preparation before injection.","What is an insurance referral and why is it needed?","BTX required to achieve response, the number of injections per patient, and complications were reported.","You are leaving Harvard Pilgrim.","Biopsy specimens of the CP muscle were evaluated in the subset of patients with CP BTX injection who proceeded to myotomy, with results of neuropathic, myopathic, and mixed histologic subtypes.","HIV screening and counseling for sexually active woman.","Medical necessity precertification requirements section.","If concomitant neuromuscular disorders, such as myasthenia gravis and certain myopathies exist, Botox may be harmful.","Or, your doctor may prescribe a different but equally effective medication.","The care, filling, removal or replacement of teeth.","Initial results have demonstrated that this therapy results in the suppression of sweating and causes no significant side effects.","Medical specialty drugs Effective March we will enhance our daily unit limit claim edits for medical specialty drugs.","You must generally use network pharmacies to use your prescription drug benefit.","The Plan will notify your spouse or dependent coverageavaila le.","Services and supplies not Medically Necessary, as determined by Aetna, for the diagnosis, care, or treatment of the disease or injury involved.","This section will help you navigate the health care system when you need care.","You will need to provide us with the required clinical documentation.","See the ligible health services under your plan Hospital and other facility care section.","Cricopharyngeal dysfunction: A systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy.","In addition to hosting the Migraine Again Podcast and producing the Migraine World Summit, Paula is a frequent speaker at industry, health care and public policy events.","Investigational or suitable mainly for research purposes It is the subject of a phase I, phase II or the Eerimental or research arm of a phase III clinical trial.","Other types of medications are dangerous when combined with others you may already be taking, others are very addictive, etc.","University Student Health Insurance Plan is underwritten by Aetna Life Insurance Company.","Outpatient radiation therapy Outpatient radiation therapy Covered according to the type of benefit and the place where the service is received.","TRS will send you the denial in writing.","Bruch JM, Kamani DV.","There are several types of exceptions that you can ask us to make.","We will provide this information at no cost to you before we give you a decision at your last available level of appeal.","Dependent coverage will start: On your effective date, if you enrolled them at that time.","Management of ventral hernias.","Health plans are required to inform their members of services that are excluded and, therefore, not covered; however, not all members read this information until they receive a denial letter from their health plan.","Tremor, myoclonus, focal dystonias, and tics.","Funeral arrangements; pastoral, financial or legal counseling; estateplanning or drafting of a will; homemaker or caretaker services that may includetransportation, maintenance of the house and sitter or companion services.","After your referral, your GP will continue to work together with your specialist on an ongoing basis.","Repeat injections for hyperhidrosis should be administered when the clinical effect of a previous injection diminishes.","Botox with those of amitriptyline on the treatment of chronic daily migraines.","Neither Providers nor Plan Participants are allowed to bill Medicare.","Eligible for Medicare If you or a dependent have Medicare coverage, the rule above may be reversed.","You should send the bill to theaddress listed on the back of your ID card, and we will resolve any payment dispute with the provider over that amount.","Spontaneous resolution of muscle contraction could occur in the first months following surgery.","Botulinum toxin for the treatment of major depressive disorder.","Your pharmacy will be alerted when a prescription is subject to Step Therapy.","Failure to enroll or remain enrolled in Medicare when Medicare is determined to be the primary payer will result in a reduction of eligible benefit payments.","Aetna will calculate the rate based on the rate most commonly charged by similarinstitutions in the same geographic area.","Your plan may not cover certain drugs such as infertility, erectile dysfunction, weight loss and smoking cessation.","There is limited evidence for the use of botulinum toxin in chronic pelvic pain.","Provide, at all times, psychiatric social work and nursing services.","All patients had significant benefit to pain, with accompanying muscle relaxation, and palmar infection, when present, was eradicated.","Copies of recommended immunization schedules are available upon request.","Methods of abdominal wall expansion for repair of incisional herniae: A systematic review.","This includes routine vision and hearing screenings given as part of the exam.","Over the Plan that covers the Plan Participant as a laid off employee or Retiree.","Botulinum toxin type A versus botulinum toxin type B for cervical dystonia.","Deductible You have to meet your deductible before this plan pays for benefits.","This amount is determined by the specific biological activity, the relationship between the biological activity and the amount of botulinum neurotoxin contained in the preparation.","BTA injection for anterior knee pain and to elaborate the possible mechanisms underpinning pain and symptom relief.","Some drugs require step therapy.","Allina Health and Aetna, will offer, underwrite or administer health insurance plans.","This is an exclusion.","Many insurance companies require an authorization for certain procedures.","The therapy is coordinated with us as part of a treatment plan intended to restore previous cognitive function.","Aetna deem the care not Medically Necessary, you can still receive the care, but the Plan will not pay for it.","Local spasticity can be treated with BTX injections.","University of Rochester policy no.","Physicians also usually learn about the excluded benefits when they receive the denial letter after the services have been provided.","Allergy injections are not considered immunizations.","Mild differences between products have been inconsistently reported mainly for IA HA.","Committee creates guidelines to promote effective prescription drug use for each prior authorization drug.","Botulinum toxin injection should be reserved for patients with cricopharyngeal dysfunction who are not candidates for surgery or endoscopic balloon dilation and should only be performed in centers of expertise.","Value Prescription drugs A group of medications determined by the Plan that may be available at a reduced Coinsurance and are noted on the Preferred drug guide.","CP muscle under EMG control.","Be sure to have your CVS Caremark ID number and a recent prescription number handy.","They excluded studies with MPS of the neck and head from this review, as they have already been assessed in existing systematic reviews.","The following are updates in your Section.","Federcivil rilaws andoes not diriminude oreat ple differently ban their racolor, nationorigisex, agdisability.","The emergency room physician must care for the patient until appropriate specialty care becomes available.","This material is provided for informational purposes only.","How to request precertifications and prior authorizations for patients.","For more information on how to fill your prescriptions, please review your Prescription Drug Schedule of Cost Sharing.","Botulinum toxin A for upper and lower limb spasticity: A systematic review.","Allina Health and Aetna Insurance Company is an affiliate of Aetna.","Packaged in unit dose form.","Medicare Part B requires a monthly premium contribution.","An authorization is a confirmation that the approved procedure can go forward with certain criteria having been met.","Precertification means that you or your doctor need to get approval from the plan before certain drugs will be covered.","What you can expect to pay With your pharmacy plan, the amount you pay depends on the drug your doctor prescribes.","Thereavaila leservicesunless a patient is transported to the nearest facility equipped and staffed to treat the condition.","Care, the true facts will be used to determine the coverage in force, if any.","These limits are designed to help promote appropriate and efficient drug use and enhance patient safety.","You enroll by sending in an application and paying the premium.","NOTE: Some Plans not Covered by state law may follow the gender rule for Dependent children.","Appeal process has not been exhausted.","Revised criterion for Botox and Dysport for focal spasticity or equinus gait due to Cerebral Palsy regarding occupational therapy care to include physical care.","Medical review coverage determinations made for items on the precert list are utilization review decisions.","La informaci\u00f3n a la que acceder\u00e1 es proporcionada por otra organizaci\u00f3n o proveedor.","The authors concluded that the success rate of myotomy was significantly higher than the success rate of BTX injections in cricopharyngeal dysfunction.","This has been done to reduce outreach for additional clinical documentation.","Medicare and bill the patient directly for any services provided that would normally be covered by Medicare.","In situations where a claim is not filed by the Provider, the member must file the claim within a specific period of time.","The purchase of donor embryos, donor oocytes or donor sperm.","Patients with a history of aspiration pneumonia, amyotrophic lateral sclerosis, salivary gland or duct malformation, and gastroesophageal reflux disease were excluded.","Functional Oral Intake Scale.","However, they typically cost less.","BTX A for the treatment of muscle spasticity by SCI.","If both parents have the same birthday, the coveredthose of a plan that covered the other parent for a shorter period of time.","Important note when you pay all section.","They appear in the Eligible health services under your plan section.","Updated the references access dates.","This term does not include conditions that you cannot attribute to a Mental Disorder that are a focus of attention or treatment or an addiction to nicotine products, food or caffeine intoxication.","Requiring prior approval for every prospective home health recipient will effectively delay and deny home health coverage for countless Medicare beneficiaries, often when they are most medically vulnerable.","An agency or organization that meets the appropriate licensing authority to provide skilled nursing services and other therapeutic services.","It does include actions that you take in selfdefense as long as they are not against people who are trying to restore law and order.","HMO paid for a service for one patient it will do the same for all patients.","CVS Caremark will automatically notify the You or your doctor may start the process by calling CVS Caremark CVS Caremark will contact your doctor to request more information than appears on the prescription.","Wu C, Xue F, Chang W, et al.","Those records will be proof that certain insurers are denying coverage for migraine treatments repeatedly.","If so, provide documentation.","Attending to the physical characteristics of muscle shortening is the basis of spasticity management.","The member is not responsible for the copay.","What are Botox treatments like?","Bezoek onze website of bel naar het telefoonnummer op uw lidkaart.","To go to school, camp, or sporting event, or to join in sport or other recreational activity.","Should you have feedback regarding your experience, please provide it in the Web Feedback online form.","Care Program is designed uniquely for retired Texas public school employees.","No recommendation of the United States Preventive Service Task Force shall serve to reduce the mammogram benefits required by Illinois law.","ATENCI\u00d3N: Si habla espa\u00f1ol, tiene a su disposici\u00f3n servicios gratuitos de asistencia ling\u00fc\u00edstica.","Applied behavior analysis requires precertification by Aetna.","Thus, says the AUA, adding a urology specific measure increases meaningful participation in both a specialty measure set and MIPS in general for those who care for urologic patients.","Or you can call the number on your ID card.","Practice Parameter: Therapies for essential tremor.","Care participation without enrolling through COBRA.","Treatment of children with cerebral palsy during the early years when functional skills in walking are being developed improves the outcome and may help to avoid surgery for contracture and bony torsion.","FDA for a particular indication.","Providers or does not obtain the required referrals, the managed care health Plan is not required to pay.","Care work when there is other coverage?","TMJ and CMJ treatment Covered according to the type of benefit and the place where the service is received.","Which of the folowing is the patient being treated for?","Visite nuestro sitio web o llame al n\u00famero de tel\u00e9fono que figura en su tarjeta de identificaci\u00f3n de miembro.","These studies have all been unblinded with small numbers of patients from single centers and have observed mild improvements in gastric emptying and modest reductions in symptoms for several months.","The services or supplies provided to Participant for which Plan Sponsor will make payment, as described in the document.","ALCOHOLISM OR DRUG ABUSE EFFECTIVE TREATMENT.","Many referrals do not require an authorization number.","You need to show your ID card to the pharmacy when you get a prescription filled.","Eligible Healthervices for fertility preservation are paid on the same basis as other ART services benefits for individuals who are nfertile.","December regarding endoscopy payments.","Information is believed to be accurate as of the production date; however, it is subject to change.","Subconjunctival botulinum toxin injection.","Summit participants Ruchika Talwar, Mei Tuong, and Vikas Bhatt will be discussing their past advocacy experiences.","Effective date of coverage Your coverage will begin after we have received your completed enrollment form.","Bethesda, MD: ASHP; updated periodically.","This document may have amendments or riders too.","Services and associated expenses related to the performance of autopsies.","The amount of time that we have to tell you about our decision on a claim depends on the type of claim.","Coinsurance is calculated before any rebates are subtracted.","Authorization, also known as precertification, is a process of reviewing certain medical, surgical or behavioral health services to ensure medical necessity and appropriateness of care prior to services being rendered.","All insurance policies and group benefit plans contain exclusions and limitations.","POS plans also require you to get a referral from your primary care doctor in order to see a specialist.","Studies were searched in published databases and no published literature from inception to the present day.","Benign asymmetric hypertrophy of the masticatory muscles promoted by bruxism was diagnosed.","Talk to your doctor about which preventive exams are right for you.","Boston University Page Educational services Examples of these services are: Any service or supply for education, training or retraining services or testing.","Zebryk P, Puszczewicz MJ.","Then we explain how your plan works so you can get the most out of your coverage.","Network hospital or physician will be considered at the participating Network Allowed Amount and coinsurance.","Mazlout H, Kamoun Gargouri H, Triki W, et al.","This Clinical Policy Bulletin may be updated and therefore is subject to change.","ERO to consider during its review.","Specified that requests will be reviewed on a case by case basis.","Added Rozlytrek to the policy.","It is important to note that a prior authorization is not a promise to pay on the claim.","However, coverage for emergency medical costs are subject to the terms of your health plan.","You can find the form on your secure member website.","Use of rimabotulinum toxin for focal hypertonicity management in children with cerebral palsy with nonresponse to onabotulinum toxin.","There were no reported complications related to the use of BTX.","Home Health Care visits and Private Duty Nursing shifts will be covered in any one Plan year.","Boston University Page Artificial organs Any device that would perform the function of a body organ.","Electrolysis of face and neck Covered according to the type of benefit and the place where the service is received.","All trademarks, brands, logos and copyright images are property of their respective owners and rights holders and are used solely to represent the products of these rights holders.","The request is badly formed.","If your precertified services are approved, the approval is valid for days as long as you remain enrolled in plan.","Aetna Rx Home Delivery You can have maintenance drugs sent right to your home or anywhere else you choose with Aetna Rx Home Delivery pharmacy.","Only service actually credited in TRS or ERS on or before Aug.","Services related to alternative or nutritional treatments for cancer.","Preventive care and wellness This section describes the eligible health services and supplies available under your plan when you are well.","However, the retiree and all dependents must be enrolled in the same coverage level.","For more information about the Complaints and Appeals Procedure or External Review processes, you may call the Member Services telephone number shown on your ID card.","Documentation must be available upon request of the contractor.","Care Standard Plan Participants Plan Year: Sept.","In: BMJ Clinical Evidence.","The quantity limits and step therapy drug coverage review programs are not available in all service areas.","Replacement items, such as batteries, tires and light bulbs.","BTX treatment are merited.","Insurance companies are required to offer at least one level of appeal.","Government Employees Health Association, Inc.","Stay in a facility for treatment for dementias or amnesia without a behavioral urbance that necessitates mental health treatment.","The drugs on the Preferred Drug List, Formulary Exclusions, Precertification, Quantity Limit and Step Therapy Lists are subject to change.","However, whether this translates into functional improvement has yet to be substantiated.","Waiver for contraceptives The prescription drug cost share will not apply to female contraceptive methods when obtained at network pharmacy.","Simpson DM, Blitzer A, Brashear A, et al.","Patients cannot suppress the movements.","The planthat pays after the primary plan is the secondary plan.","Where can I find more Preferred Drug List information?","Furthermore, the assessment stated that there is insufficient evidence to recommend an optimum technique for muscle localization at the time of injection.","Enroll in an Aetna Medicare plan by mail.","Health benefits and health irance plans ctain excluions and itions.","Medicare Part B, you should purchase it.","You can have your claim reviewed internally and at the same time through the external review process.","Migraine in adults: Preventive pharmacologic treatments.","Evers S, Afra J, Frese A, et al.","Aetna is a unique partnership with a refreshing new approach to health care.","We also explain what you can do if you think we got it wrong.","Bakheit AM, Thilmann AF, Ward AB, et al.","SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.","You could not reasonably get the services and supplies needed from a network Provider.","Services must be medically necessary and provided by a behavioral health provider with the appropriate license orcredentials.","The review also includes a determination of whether the service being requested is a covered benefit under your benefit plan.","Prosthetic device means: A medical device which replaces all or part of an internal body organ or an external body part lost or impaired as the result of disease, congenital defect or injury This includes ostomy supplies.","Where can I find GP clinics?","Decisions regarding medical necessity are guided by current guidelines viewed at www.","Daytime and nighttime urinary frequency, and urinary incontinence episodes were recorded.","This means any other plan of health expense coverage Group insurance.","Youandyour dependentsfailtomake the necessarypaymentsontime.","Results from the present study supported the efficacy of botulinum toxin A to reduce myofascial pain symptoms in bruxers, and provided pilot data which need to be confirmed by further research using larger samples.","Select behavioral interventions were associated with symptom improvements comparable to medications.","Ihde SK, Konstantinovic VS.","Treatment of upper eyelid retraction associated with thyroid eye disease with subconjunctival botulinum toxin injection.","If the health care service is not covered by any of the plans, it is not an allowable expense.","Documentation of medically significant complications of sialorrhea, such as chronic skin maceration or infections that cannot be controlled with topical treatments or hygiene.","Aetna may receive rebates from certain drug manufacturers.","We will tell you when we make that decision.","Glossary Any capitalized terms listed in this Section shall have the meaning set forth below whenever the capitalized term is used in this document.","Sign up to view injection technique videos, anatomy lectures, and other helpful education for professionals.","West Virginia or Wisconsin, do not complete an authorization form.","See the Eligible health services under your plan and Exclusions sections plus the schedule of benefits.","Failure to precertify your eligible health services when required will result in the following benefit penalties: benefit penalty will be applied separately to each type of eligible health services.","How do I know if they are covered?","Evaluation of botulinum toxin A in treatment of tinnitus.","Surgeries that alter or improve physical appearance but do not correct or materially improve a physiological function and are not Medically Necessary for the prompt repair of accidental Injury or Illness or to improve the function of a congenital anomaly.","We might also move a drug from one coverage tier to another.","Any miss could result in a devastating financial burden on the patient as well as the provider.","See the Eligible health services under your plan Hospital and other facility care section.","Providers: Click the authorization form you need to download it.","To help us get paid back, you are agreeing to provide us with any requested: Information or assistance Documentation This provision applies whether or not the third party admits liability.","The Formulary is available for review in Participating Provider offices or by contacting the claims administrator.","Your prescription drug cost share will apply after those two programs have been exhausted.","Your outpatient prescription drug plan also covers related services and supplies needed to administer covered devices.","National Institute of Neurological Disorders and Stroke.","Medicinal and injection therapies for mechanical neck disorders.","Melville JC, Stackowicz DJ, Jundt JS, Shum JW.","Neurology, only comparable with levodopa.","Use of an operating recovery roomsincluding anesthesia.","AUGS disclaims liability for actions or consequences related to any of the information provided.","Successful treatment with Botox facilitated motor relearning and cessation of muscle contraction.","Or you can go right to www.","How to contact us for help We are here to answer your questions.","Hayton MJ, Santini AJ, Hughes PJ, et al.","This will be done at all reasonable times while certification or a claim for benefits is pending or under review.","Aetna Better Health Premier Plan MMAI, All Right Reserved.","Learn more about how Botox treats migraines, its potential side effects, and costs.","Your medical plan may continue to cover your drug.","The crossing may occur predominantly with one eye or may alternate between eyes.","Sometimes, this plan is the secondary plan, and pays benefits after Medicare or after an amount that Medicare would have paid if you were covered.","Here are the qualifying events that trigger COBRA continuation, who is eligible for continuation and how long coverage can be continued.","Zoons E, Dijkgraaf M, Dijk J et al.","Looking for a practitioner?","You may want to take this guide with you when you see your doctor to talk about what is covered under your plan and what you can expect to pay for your medicine.","Study designs included controlled and uncontrolled studies.","Naver H, Swartling C, Aquilonius SM.","The initial electric breast pump is broken and no longer covered under a warranty Breast pump supplies and accessories Eligible health servies include breast pump supplies and accessories.","Among patients not using CIC at baseline, those with multiple sclerosis were more likely to require CIC post injection than those with spinal cord injury.","Price AE, Ditaranto P, Yaylali I, et al.","Aetna Request for approval You need to complete a Transition of Coverage Request form and send it to us.","This includes a postdelivery checkup within six weeks.","However, Vancouver Scar Scale assessments were similar between groups.","Any additional treatment programs will be paid according to the tier of drug per the schedule of benefits, above.","Ophthal Plast Reconstr Surg.","The authors concluded that the findings of this pilot study showed that botulinum toxin type A significantly reduced diabetic neuropathic pain and transiently improved sleep quality.","Botulinum toxin type B for treatment of axillar hyperhidrosis.","Units and placebo than nondiabetics.","TRS may disclose your protected health information to the executor or administrator of your estate.","The AUA will keep you apprised of advocacy opportunities to promote this initiative.","Please consult the Full Prescribing Information for complete details for recommended dose adjustments.","The lists above are subject to change.","For any drug, which due to its characteristics, as determined by us, must typically be administered or supervised by a qualified Provideror licensed certified health professional in an outpatient setting.","Ruiz C, et al.","For information on how to select a primary care provider, and for a list of the participating primary care providers, contact your Employer or, if you are a currentmember, your Aetna contactnumber on the backof your IDcard.","London, UK: BMJ Publishing Group Ltd.","This was based on a single Class II study.","Rehabilitative services whose primary goal is to return you to a specific occupation or job, such as workhardening or workconditioning programs.","It also includes surgery on a healthy breast to make it even with the reconstructed breast, treatment of physical complications of all stages of the mastectomy, including lymphedema, and prostheses.","Felony Services and supplies that you receive as a result of an injury due to your commission of a felony.","You must make Youcontact you.","It also includthe accessories and supplies needed to operate the item.","Covered services must be Medically Necessary and provided by a licensed doctor.","The authors concluded that further analysis is needed to examine factors contributing to analgesic response.","Federal civil rights laws and does not discriminate or excludepeople on the basis of race, color, national origin, age, disability, or sex.","Sorry, No result found.","This exception does not apply to epo Provera and other injectable drugs used for contraception.","Other health care can include care given by a Provider who does not fall into any of the categories in the Provider directory.","Your outpatient Prescriptiondrug lanalso covers related services and supplies needed to administer Eligible Health Servicedevices.","How your deductible works This schedule of benefits shows the deductible amounts that apply to your plan.","CP muscle in patients with neurological dysphagia caused by alteration in the UES opening and with preserved pharyngeal contraction.","Medically Necessary pain medication and pain therapy related to the treatment of breast cancer.","There is an exception.","Payers that do not require precertification and what this means for providers.","Sialorrhea: Anatomy, Pathophysiology and treatment with emphasis on the role of botulinum toxins.","PRCRP and into the CDMRP.","You or your dependent did not enroll in this plan before because: You were covered by another health plan, and now that other coverage has ended.","OF CONTENTSTHE SERS FORMULARYPRESCRIPTION FILLSCONTACT INFORMATIONAetna Choice POS II and Aetna Traditional Choice plans www.","Hu Y, Guan X, Fan L, et al.","This notice describes how medical information about you may be used and disclosed and how you can get access to this information.","CERTIFICATION REQUIREMENTS LIMITATIONS You have exhausted the comprehensive Infertilityservices benefits or have a clinical need to move on to ART procedures based on our clinical policy bulletin.","Therapeutic duplication means that two or more drugs of the same type are prescribed at the same time.","The second document is the schedule of benefits.","Care Customer Service at www.","Options include oral medication, intrathecal baclofen, botulinum toxin, and nerve blocks.","CVS Caremark for more information on which pharmacies have chosen to participate in the network.","If we approve the request, we will notify your doctor.","Health Technology Inquiry Service.","One patient without relief of symptoms had bilateral cricoarytenoid joint fixation.","If you do not intend to leave our site, please click Close.","These investigators provided a systematic review of the literature regarding BTX in the treatment of major depression.","These services are usually provided after your discharge from a hospital or if you are homebound.","Please tell us where you sweat so we can help you and others.","Furthermore, there are not robust clinical trials that demonstrated the safety and efficacy of botulinum toxin injection for the treatment of mastectomy scars.","Slotema CW, van Harten PN, Bruggeman R, Hoek HW.","Medicare is likely to cover your services.","If it is not a network vision location, you will have to pay for the eyewear and submit a claim form for reimbursement.","Risk of bias analysis was done using the Cochrane risk of bias tool.","The covered student must contact Boston University Student Health Services before receiving any medical care.","You can view a sample list of exclusions by clicking on the download link below.","American Academy of Family Physicians.","Overall, results from the clinical trials are mixed.","Once you have met your deductible, we will start sharing the cost when you get eligible health services.","In the event that any claim is made that any part of this subrogation and right of recovery provision is terms, the Claims Administrator shall have the sole authority and discretion to resolve all disputes regarding the interpretation of this provision.","This plan has limits for some covered benefits.","Administration costs related to the procurement, processing and storage of blood from a person you designate as a donor.","You and we will interpret it according to these laws.","If there are no such rooms, the semiprivate room rate will be the rate most commonly charged by similar institutions in the same geographic area.","Any ear or hearing performed by physician who is not certified as an otolaryngologist or otologist.","How can request edical exception?","Abd A, et al.","Efficacy and safety of botulinum toxin in treatment of anismus: A systematic review.","You do not need to do anything to get privacy protection for your health information.","NJ, PA, SC, MD, DE, DC, NC, VA and WV, you may now be affected by a Medicare demonstration program.","Please be aware of how current health care reform guidelines may impact you.","Drugs can be withdrawn from the market or may become available without a prescription.","Your prescriber may request a medical exception and submit the exception to us.","Do you have questions?","After repeated use of high doses, antibodies can develop in some individuals, making further treatment ineffective indefinitely.","For certain drugs, our plan limits the amount of the drug that we will cover.","Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy.","Outpatient Prescription Drugs For information pertaining to your behavioral health, dental or outpatient Prescription drug benefits, please contact your respective Plan administrator for more information.","The studies were individually critiqued, and an overall assessment and commentary was made of the studies in the field as a whole.","Travel or transportation expenses, even if prescribed by a Provider, except as specifically provided for herein.","If a medical exception is approved, you only need to pay the copay after the deductible.","Moreover, the authors stated that further studies are needed before botulinum toxin type A can be proposed as treatment for men with PD.","We will also cover associated donor medical expenses, established by us, as a prerequisite to donation.","See the schedule of benefits Precertification benefit reduction section.","In uncontrolled studies, there are individuals who continue to respond to treatment despite the presence of neutralizing antibodies.","The person performing this review will not be the same one who denied your initial request.","Your plan covers the exams recommendby the Health Resources and Services Administration.","Diplopia following subcutaneous injections of botulinum toxin for cosmetic or medical use.","You need to send your application and pay the premium.","All claims should be reported promptly.","Botulinum toxin has been investigated for use in restless legs syndrome; however, there is insufficient evidence to support its use for this indication.","The effective date of this revision is based on date of service.","Proprietary Immunologic agents, cont.","Controlling costs, improving employee health, and personalized service are just a few of the ways we can help your organization thrive.","Radiological services, laboratory testing and diagnostic services.","Kasyan and Manning studies.","Covered according to the type of benefit and the placewhere the service is received.","Your plan Medicare Note regarding ESRD: If you were already eligible for Medicare due to age and then became eligible due to ESRD, Medicare will remain your primary plan and this plan will be secondary.","When we do the advance claim review, we will look at other procedures, services or courses of dental treatment for your dental condition.","Breast reconstruction Surgeryfollowing a ically Necessary mastectomy.","Botulinum toxin treatment of urethral and bladder dysfunction.","Because these treatments can be expensive, you should search for coupons or savings plans that are available to help lower the cost.","Plan will end and cannot be reinstated under COBRA.","WPS has added a new article addressing billing and coding procedures that complement the LCD for Decipher Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease.","Your PCP will coordinate your medical care or may provide treatment.","They stated that the findings of this controlled study supported the use of botulinum toxin injection as an effective treatment for nocturnal bruxism.","You will find the requirement to use a network provider and any exceptions in the Who provides the care section.","Botulinum toxin treatment of objective tinnitus because of essential palatal tremor: A systematic review.","The authors concluded that the majority of published literature on the use of botulinum toxin in the treatment of strabismus consists of retrospective studies, cohort studies or case reviews.","Who at my insurance company will be reviewing my prior authorization?","For example, a skin tag excision without documentation of pain, bleeding, irritation or other evidence of medical necessity could easily result in a denial.","Maria G, Cassetta E, Gui D, et al.","Mental Disorders are often connected to significant distress or disability in social, work or other important activities.","The main outcomes measured were pain reduction and healing of digital ulcers.","Some reasons why it can change include: New drugs are approved.","Coordination of Benefits provision is contained in the Policy issued to Boston University, and may be viewed online at www.","The authors concluded that these findings suggested that botulinum toxin injection reduced the number of bruxism events, most likely mediated its effect through a decrease in muscle activity rather than the central nervous system.","Or that it be placed on our Formulary Exclusions List and no longer be covered.","Get inside intel, research results, event invites!","The right to bring a legal action may be limited by sovereign immunity.","Botulinum toxin A for the treatment of delayed gastric emptying.","How do I get a referral?","General information section for additional guidance.","Previous studies have demonstrated that patients undergoing BTA injection demonstrate improvement in symptoms of gustatory sweating and flushing.","Dodick DW, Mauskop A, Elkind AH, et al.","If a device is not available for a certain method, you may obtain certain devices for that method at no cost share.","Limits prescription coverage to a specific number of units over a specific amount of time What if I need a drug that requires an exception to the precertification, step therapy or quantity limits requirements?","Radiological services when performed from a licensed lab.","Bromer MQ, Friedenberg F, Miller LS, et al.","You can find out about exclusions the Exclusions section and about limitations in the schedule of benefits.","FBS usually lasts less than a minute, it is disabling for afflicted individuals and leads to a fear of oral intake.","Please select primary task.","We will send the request and all the required information to the director to start the process.","The primary plan pays first.","Youmust complete your enrollmentinformationandsendittous withindays after the date the child is placed with you.","UES opening and with pharyngeal contraction.","P\u00ebr sh\u00ebrbime p\u00ebrkthimi falas p\u00ebr ju, telefononi n\u00eb numrin q\u00eb gjendet n\u00eb kart\u00ebn tuaj t\u00eb identitetit.","Botulinum toxin type A with or without needle electromyographic guidance in patients with cervical dystonia.","Botulinum toxin A is effective in treating trismus associated with postradiation myokymia and muscle spasm.","If so, provide dosage form.","HMO, or the state board of medical examiners.","This does not apply if you are donating the organ to a spouse, domestic partner, civil union partner, child, brother, sister, or parent.","Botulinum toxin type A for theprevention of headaches in adults with chronic migraine.","Two patients reported mild weakness following both placebo and botulinum toxin A injections.","The precertification process is one of the reasons physicians and patients are so dissatisfied with HMOs, which use this strategy more often than other managed care organizations in an effort to contain costs.","Level of evidence was determined using the modified Sackett scale.","Care terminate my coverage?","Transportation Services or supplies provided to a minor or dependent adult when a family member or caregiver is not present Hospice care Funeral arrangements.","For more information see the schedule of benefits.","Dystonia, often accompanied by painful rigidity and fixed contractures, is one of the most disabling features of CBD.","Applications of botulinum toxin in neurology.","Symptoms are usually bilateral, synchronous, and symmetric, but may be asymmetric.","Aetna Rx Home Delivery refers to Aetna Rx Home Delivery, LLC, a subsidiary of Aetna Inc.","Keep in mind that you are responsible for costs not covered under this plan.","You will be responsible for the unpaid balance of the bills.","You are leaving Aetna Medicare for Caremark.","In the case of an urgent appeal for coverage involving urgent care, you afterreceipt of your appeal request.","Linkov G et al.","TRS will follow your instructions.","The drug Nubeqa was added to the prior authorization list.","Treatment programs, services or supplies havingto do with the cessation of tobacco usage or nicotine habits or addictions.","Plan may be divided up between the employee or covered person and their attorney if applicable.","Hamagara inumero iri kuri karangamuntu kawe.","Olsson JE, Behrin HC, Forssman B, et al.","On the date your coverage ends, we will refund to your employer any prepayments for periods after the date your coverage ended.","The process also allows your health insurance company to review your prescriptions, looking for any potentially dangerous drug interactions that your doctor may have been unaware of when prescribing.","Required Medical Information: Diagnosis for which Xtandi is being used.","These researchers noted that Botox is a potential candidate for the management of neurogenic urinary incontinence.","Santo C, Borges A, et al.","Eligible health services under your plan Treatment of infertility section Injectables: Any chargesfor the administration or injection of prescription drugs or injectable insulin and other injectable drugs covered by us.","If we do, we can require the person we paid you or your provider to return what we paid.","Alcohol in combination with drugs This can be done by metabolic or other means determined by a Physician, or a nurse practitioner working within the scope of their license.","Ask your doctor to consider prescribing drugs that are on the Preferred Drug List.","You need to provide either your email address or mobile phone number.","This section tells you how and why coverage ends.","Hospice care program A program prescribed by a physician or other health professional toprovide hospice care and support to a person with a terminal illness and their families.","Type A services The reimbursement percentage, copayment, deductible or no charge amount, for services rendered by a noncontracting dental provider will be reimbursed the same s a contracting dental provider.","You can use an authorized representative at any level of appeal.","In general, small case series of only a few patients were not included unless they made a relevant point and there were no available randomized studies or larger studies.","Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.","Kranz G, Sycha T, Voller B, et al.","Some people have health coverage under more than one health plan.","These pharmacists can help identify potential health risks, such as side effects and unsafe drug interactions.","Ask your employer when benefits for your stepchild will begin.","BECAUSE THESE STANDARDS MAY CHANGE, REVIEW YOUR HEALTH PLAN MATERIAL EACH YEAR TO DETERMINE WHETHER YOUR PLAN MEETS THE LATESTSTANDARDS.","The most common adverse reactions reported by patients being treated for chronic migraine were neck pain and headache.","The bill may include serviceswhy you received those services.","Dental implants Organ removal Services and supplies given by a provider to remove an organ from your body for the purpose of donating or selling the organ except as described in the Eligible health services under your plan section.","Some of these patients had risk factors including cardiovascular disease.","Better for Yeast Infections?","You may select a PCP from the Network of Providers.","We may also encourage and incent you in connection with participation in a wellness or health improvement program.","However, there is currently insufficient scientific evidence of the effectiveness of botulinum toxin in the treatment of back pain.","Any related services including processing, storage or replacement expenses.","For example, cannot pay for eligible health services if it violates financial sanction regulation.","Aetna is the brand name for Aetna Life Insurance Company and its affiliated companies.","Specialty medicine often needs special storage and handling.","Tardive dyskinesia: Prevention and treatment.","Or we may make changes based on new clinical guidelines.","Tardive Dyskinesia Information Page.","If you are not present or able to agree to these disclosures of your protected health information, then TRS may, using our professional judgment, determine whether the disclosure is in your best interest.","Maternity and related newborn care Eligible health services include prenatal and postpartum care and obstetrical services.","PCP is responsible for obtaining any necessary precertification before you get the care.","Brandenburg JE, Krach LE, Gormley ME Jr.","Naumann M, So Y, Argoff CE, et al.","For people who have tried other migraine treatments without success, or who have had side effects from those treatments, Botox may be a good option.","South San Francisco, CA: Solstice Neurosciences, Inc.","Innovation Health Insurance Company and Innovation Health Plan, Inc.","However, few studies have been designed to avoid many of the pitfalls associated with a trial of botulinum toxin treatment of trigger points.","UTIs during treatment should only be considered when the benefit is likely to outweigh the potential risk.","Physical exams to diagnose or evaluate a medical condition are not routine physicals.","Over the counter foot orthotics.","Aetna provides certain administrative services for Allina Health and Aetna.","These services may be available in your home or inpatient setting."]