If a member cannot give authorization, Aetna accepts it from a person legally permitted to give it
If a special authorization is required but the member cannot give it, for example because the member is medically unable to, Aetna says it will accept the authorization from any person legally permitted to give it on the member’s behalf.
Supporting quotations
In the event that a special authorization is required but the member in question is unable to give the authorization (for example, if the member is medically unable to do so), we will accept the authorization from any person legally permitted to give the authorization on behalf of the member.
Qualifications & exceptions
The person must be “legally permitted” to authorize on the member’s behalf.
Not stated here
The notice does not say what proof Aetna asks for to show the person is legally permitted.
Account & Service Control · Company practice
For information about yourself, Aetna points members to the provider and says it lacks custody of medical records
For access to information about themselves, Aetna says a member should go to the provider that generated the original records, which it says are more complete than any it maintains. Aetna says it does not have custody or control of the member’s medical records. This sits alongside Section III, which lists medical history among the information Aetna collects.
Supporting quotations
If you want to access information about yourself, you should go to the provider (e.g., doctor or other caregiver) that generated the original records, which are more complete than any we maintain. We do not have custody or control of your medical records.
Qualifications & exceptions
Framed as a direction (“you should go to the provider”), not as a refusal to give access to what Aetna holds; the next card covers what Aetna will provide.
Not stated here
The notice does not reconcile “no custody or control of your medical records” with Section III’s statement that Aetna collects medical history, and does not say what medical information it keeps.
Members may request documents about information from their employer or providers; Aetna may charge a fee
A member may request documents reflecting information Aetna receives from the employer or providers when Aetna processes claims submitted for payment. In these cases Aetna may charge an administrative fee to help cover its costs, except where prohibited by law. In all other cases Aetna says it will refer the member to the applicable employer or providers.
Supporting quotations
You may also request documents reflecting information we receive from your employer or providers when we process claims submitted to us for payment. In these cases, we may charge an administrative fee to help cover our costs, except where prohibited by law. In all other cases, we will refer you to the applicable employer or providers.
Qualifications & exceptions
The fee applies to these claim-processing documents and is subject to “except where prohibited by law.”
Anything outside these documents is referred to the employer or providers.
Not stated here
The notice does not state the amount of the fee.
Account & Service Control · Procedure
Claims and encounter information is requested by phone or letter; adult dependents must co-sign
To request claims or encounter information Aetna maintains for a member and the member’s dependents, the member calls the toll-free number or writes to the HIPAA Member Rights Team at the address given earlier. The request includes the name, address, member ID or Social Security number, and date of birth of each person whose information is requested. If the request is for an adult dependent’s information, that adult dependent must co-sign the letter.
Supporting quotations
To request claims/encounter information we maintain for you and your dependents, please call our toll free customer service phone number listed in Section I or send a letter to the HIPAA Member Rights Team at the address listed above and include the name, address, member ID or Social Security number, and date of birth of each person whose information you request. If you are requesting claims/encounter information for your adult dependents, each such adult dependent must co-sign the letter.
Qualifications & exceptions
The co-signing rule is stated for requests about adult dependents.
Not stated here
The notice does not say how co-signing works for a phone request.
Account & Service Control · User right or choice
Where required by law, Aetna corrects its own records; members can request a rebuttal statement
Where required by law, Aetna says it will correct or amend the records it maintains, but not the records kept by the member’s employer, provider or other third parties. If Aetna does not agree the records are incorrect, the member can request that a rebuttal statement be added to the file.
Supporting quotations
Where required by law we will correct or amend the records we maintain (but not the records maintained by your employer, provider or other third parties). If we do not agree that the records are incorrect, you can request we add a rebuttal statement to your file.
Qualifications & exceptions
Correction is stated “where required by law” and covers only Aetna’s own records.
The rebuttal statement applies when Aetna does not agree the records are incorrect.
Not stated here
The notice does not say how to submit a correction request or how long it takes.
Account & Service Control · Procedure
Updates go to employers; members can request the notice by phone or find it on aetna.com
Aetna says updates of the notice are distributed to employers who sponsor its plans. The notice can be requested by calling the toll-free number, and is also available on Aetna’s website, www.aetna.com. Aetna adds that a short version of the notice is included in many of its general marketing communications.
Supporting quotations
Updates of this notice are distributed to employers who sponsor our plans. It can be requested by calling our toll-free customer service phone number listed in Section I, and also is available on our website, at www.aetna.com. A short version of this notice is included in many of our general marketing communications.
Qualifications & exceptions
The short version is in “many” marketing communications, not all.
Not stated here
The notice does not give a page on the website or a way to receive updates other than through employers.
Account & Service Control · Procedure
Questions about the notice go to a life and disability toll-free number
The notice invites questions about itself by phone to a toll-free customer service number, given as 1-866-825-6944 for Life and Disability. Later sections send members to this same number to ask for a special authorization form, to request claims information, and to raise a belief that the notice’s policy was violated.
Supporting quotations
If you have questions about this notice, please call our toll-free customer service number:
*Life and Disability toll free number: 1-866-825-6944
Qualifications & exceptions
The only contact route given for questions is the phone number; Section VII adds a mailing address for specific requests.
Not stated here
The notice does not give hours, an email address or a web contact form for this number.