Get the free aetna growth hormone precertification form

Pediatric Growth Hormone Injectable Medication Precertification Request Aetna Precertification Notification 503 Sunport Lane Orlando FL 32809 Phone 1-866-503-0857 FAX 1-888-267-3277 Page 1 of 2 Please return Pages 1 and 2 for precertification of medications. Please indicate Start of treatment Start date / Continuation of therapy Date of last treatment Precertification Requested By Phone A. PATIENT INFORMATION First Name Fax Last Name Address City Home Phone State Work Phone DOB Allergies B....

How to fill out aetna growth hormone precertification

How to fill out Aetna growth hormone precertification:

1. Obtain the necessary precertification form from Aetna or download it from their website.
2. Fill in the patient's personal information, including their name, date of birth, and Aetna member ID number.
3. Provide details about the healthcare provider prescribing the growth hormone, such as their name, address, and National Provider Identifier (NPI).
4. Clearly state the diagnosis or medical condition for which the growth hormone is being prescribed.
5. Include the specific growth hormone medication being requested, along with the dosage and frequency of administration.
6. Attach any supporting medical documentation, such as lab results or diagnostic tests, that justify the need for growth hormone therapy.
7. If applicable, indicate any previous treatments or medications that have been tried and failed to achieve the desired medical outcome.
8. Sign and date the precertification form, and ensure that the healthcare provider also signs and provides their contact information.
9. Submit the completed precertification form to Aetna via fax, mail, or online portal, following their specific submission guidelines.

Who needs Aetna growth hormone precertification:

1. Patients who have been prescribed growth hormone therapy by their healthcare provider.
2. Individuals who have Aetna insurance coverage and are seeking reimbursement for the cost of growth hormone medication.
3. Those who are uncertain whether their specific medical condition or diagnosis qualifies for coverage of growth hormone therapy and require confirmation from Aetna through the precertification process.

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