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Guidelines
Respected professional and public health organizations create clinical practice guidelines that document best practices and recommendations for care. We’ve chosen certain clinical guidelines to help our providers give members high-quality, consistent care with effective use of services and resources. These include treatment protocols for specific conditions, as well as preventive health measures.
The intention of these guidelines is to clarify standards and expectations. They should not:
- Take precedence over your responsibility to provide treatment based on the member’s needs
- Substitute as orders for treatment of a member
- Guarantee coverage or payment for the type or level of care proposed or provided
Clinical practice guidelines
Behavioral and mental health
Maternal
Physical health
Chronic Obstructive Lung Disease (COPD)
Congestive Heart Failure (CHF)
Opioids for Chronic Pain CDC Guideline
Pediatric Preventative Health Care
Clinical policy bulletins
These bulletins state our policy about the medical necessity or investigational status of medical technologies and other services to help with coverage decisions. A national review team creates the bulletins and bases them on:
- Published medical literature
- Formal technology assessments
- Structured evidence reviews
- Evidence-based consensus statements
- Expert opinions
- Evidence-based guidelines from professional and public health entities
Aetna® clinical policy bulletins
Hospice care
We work with providers to approve hospice care for members when they need end of life services and supports.