Summary Plan Description

Utilization Management

Utilization management begins once an admission or procedure is precertified. Utilization management includes concurrent review of the hospitalization or services requested by the attending physician; on-going certification of services; and planning for discharge from a medical care facility and completion of medical treatment.

A case manager will monitor the patient's stay or use of other medical services and coordinate the scheduled release or an extension of the stay or extension or cessation of the use of other medical services with the patient, attending physician, and/or hospital.

If the attending physician feels that it is medically necessary for a patient to receive additional services or to extend an admission for a longer length of time than has been precertified, the attending physician must request the additional services or days.

To coordinate utilization management, your provider must contact Aetna at (888) 632-3862.