Aetna Clinical Policy Bulletin: Dorsal Column Stimulation

At Aetna, we strive to provide our members with access to quality healthcare services while ensuring that care is rendered in a responsible and cost-effective manner. This clinical policy bulletin outlines our utilization review process for dorsal column stimulation (DCS), a treatment option used to address certain behavioral health conditions.

Precertification: What It Means

It's essential to clarify that precertification, as defined by Texas law, does not imply payment or guarantee of coverage for fully insured HMO and PPO members. Instead, it refers to the utilization review process we use to determine whether a requested service, procedure, prescription drug, or medical device meets our company's clinical criteria for coverage.

Medical Necessity Determinations

Our medical necessity determinations are made on a case-by-case basis, considering individual circumstances and treatment plans. While our ABA Medical Necessity Guide provides guidance on appropriate levels and types of care for patients with behavioral health conditions, it does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment.

Member Rights

As an Aetna member, you have the right to dispute a coverage determination through our internal appeal process or seek an independent external review in accordance with applicable federal or state law. It's essential to consult your benefit plan to understand any exclusions or limitations that may apply to DCS services or supplies.

In conclusion, our clinical policy bulletin on dorsal column stimulation outlines the utilization review process and medical necessity determinations we use to ensure responsible and cost-effective care for our members. By understanding these guidelines, you can better navigate your healthcare options and make informed decisions about your treatment plan. If you have any questions or concerns, please discuss them with your treating provider.

Aetna clinical policy bulletin dorsal column stimulation