Fill Out Your Aetna Attending Physician Statement Form

What is the purpose of the Aetna Attending Physician Statement form?

The Aetna Attending Physician Statement form serves as a comprehensive medical report that provides relevant information about a patient's health status. This form is designed to aid in the processing of insurance claims by detailing the patient's diagnosis, treatment history, and current medical condition. It includes sections for documenting important patient information, such as previous medical history, any diagnoses with corresponding ICD-9 codes, surgeries, medications, and the patient's current work capability. By filling out this form accurately, physicians help ensure that claims are appropriately evaluated and that patients receive the benefits they are entitled to.

Who is required to complete the Aetna Attending Physician Statement form?

This form must be completed by the attending physician responsible for the patient’s care. It is important for the physician to fill out every section, providing as much detail as possible. This includes the patient’s medical history, treatments received, and any limitations or capabilities that the patient may currently have. Once completed, the physician should return the form to the patient, who will then submit it to Aetna as part of their insurance documentation.

What information must be provided within this form?

Several critical pieces of information are necessary for appropriate processing. First, patient identification details, like name, Aetna ID number, birth date, and physical measurements, must be recorded. Second, the physician must specify the primary diagnosis along with any complication codes. The treatment section requires history regarding the onset of symptoms, previous treatments, surgeries, medications, and any referrals to therapy or rehabilitation programs. Finally, the physician should provide a prognosis along with any observed limitations regarding the patient’s physical or mental capabilities.

How does the Aetna Attending Physician Statement form impact an insurance claim?

The completion of this form can significantly influence the outcome of an insurance claim by providing essential documentation that supports the patient's medical condition. A thorough and accurate statement from the attending physician helps Aetna assess the claim with clarity. It can also influence decisions regarding eligibility for benefits, coverage of treatments, and, if applicable, vocational rehabilitation options. Thus, the form plays a critical role in the claims process, and accuracy is paramount to ensure that the patient's needs are met.

Filling out the Aetna Attending Physician Statement form can be complex, and it's essential to avoid common mistakes that could delay processing or compromise the accuracy of information. One frequent error involves incomplete patient information. Without providing the patient's full name, Aetna ID number, and date of birth, the processing team may face difficulties in accurately identifying the patient and linking the claim to the correct records.

Another mistake occurs when entering diagnosis codes. The form requires specific ICD-9 codes for the primary diagnosis, along with any complications and secondary conditions. Commonly, physicians may forget to include these codes or may mistakenly enter outdated ones. This can lead to misunderstandings regarding the patient's medical situation, impacting the subsequent decisions about treatment and care.

Additionally, inconsistencies in reporting treatment dates pose a significant issue. Accurate dates for when symptoms first appeared, when the patient was first treated, and the most recent treatment date are crucial. Misstating these timelines can create confusion about the progression of the patient's condition, leading to inappropriate treatment recommendations.

The frequency of visits can also be incorrectly reported. Some might list an inconsistent follow-up schedule or fail to specify if it is weekly, monthly, or otherwise. This information is vital for assessing the continuity of care. A lapse in understanding how often the patient has been seen can hinder the evaluation of their response to treatment.

Moreover, failing to provide information on current medications can have serious implications. The form requires a comprehensive list of any medications the patient is taking, including dosages and frequency. Missing this information may result in Aetna lacking crucial data needed for assessing treatment efficacy and safety.

Finally, comments about the patient's work status and any restrictions should be clearly articulated. Not specifying whether the patient is suited for vocational rehabilitation or failing to outline limitations in activities can lead to misconceptions regarding the patient's capacity to return to work. Clear communication in these areas helps ensure that all parties involved in care can make informed decisions.

The Aetna Attending Physician Statement form is often accompanied by several key documents and forms that provide further clarity about a patient's health and treatment status. Each of these documents serves a specific purpose and can be critical for accurate insurance processing and patient care.

• Medical History Report: This document outlines the patient’s past medical conditions, treatments, surgeries, and other relevant health information. It is crucial for understanding the patient’s overall health.
• Disability Claim Form: Used to request disability benefits, this form requires detailed information about the patient’s condition and how it affects their ability to work and perform daily activities.
• Work Status Update: This form provides current insights into the patient's work capabilities, detailing any restrictions or accommodations that may be necessary.
• Progress Notes: These notes are kept by the attending physician during follow-up visits. They detail the patient's recovery progress and any changes in treatment or condition.
• Request for Health Information: This form is used to obtain additional health-related information from other healthcare providers to ensure a comprehensive understanding of the patient’s medical history.
• Independent Medical Examination (IME) Report: An IME report provides an objective assessment of the patient’s medical condition by a third-party physician, often required by insurance companies for claims verification.
• Authorization for Release of Medical Information: This document allows the sharing of the patient’s medical records with insurance companies or other relevant parties, ensuring compliance with privacy regulations.

In conclusion, these accompanying forms play a vital role in the medical and insurance processes. They enhance communication and help ensure that all parties involved have the necessary information for decision-making regarding the patient's care and insurance claims. Timely completion and submission of these documents can significantly impact the efficiency of claims processing.

• Patient Health Questionnaire (PHQ): Similar to the Aetna Attending Physician Statement, the PHQ gathers comprehensive medical history and symptom details, aiding in the diagnosis and treatment planning process.

• Disability Claim Forms: These forms require detailed medical information about the claimant's health status and impairment, similar to the Aetna form. They ensure that the claims are assessed accurately based on the patient’s medical condition.

• Functional Capacity Evaluation (FCE): Like the Aetna form, the FCE assesses an individual's physical capabilities and limitations. It provides documentation on what a person can perform in terms of work-related activities.

• Workers' Compensation Medical Report: This document outlines an injured worker's medical history, current condition, and treatment plan, just as the Aetna form does for employees seeking insurance benefits.

• Insurance Policy Medical Questionnaire: This questionnaire collects essential health information from applicants. Its purpose parallels the Aetna form’s goal of evaluating the medical status of patients applying for benefits.

• Medical Treatment Plans: These documents outline the proposed medical interventions. They share a common goal with the Aetna form: to provide a clear picture of the patient's treatment journey and expected outcomes.

• Do complete the entire form thoroughly before returning it to the employee.
• Do ensure that patient information, including diagnosis and treatment details, is accurate and up to date.
• Do communicate any expected changes in the patient's condition clearly.
• Do sign and date the form using blue or black ink.

• Don’t leave any sections blank unless instructed otherwise.
• Don’t provide genetic information, as it is not allowed by law.
• Don’t include any misleading or false information, as this could lead to serious penalties.
• Don’t forget to provide your contact information for any follow-up questions.

• Misconception 1: The Aetna Attending Physician Statement form is only for patients with serious conditions.

This form applies to all types of medical conditions, not just serious ones. It is designed to gather relevant medical information regardless of the diagnosis.

• Misconception 2: Filling out this form is optional for physicians.

Completing this form is mandatory for physicians when requested. It ensures that all necessary information is provided to support the patient’s insurance claim.

• Misconception 3: The form requires extensive and unnecessary information.

Each section of the form is essential for understanding the patient's medical status and needs. This information is crucial for determining the appropriate benefits and care.

• Misconception 4: Only the primary diagnosis needs to be reported.

Both primary and any secondary diagnoses should be mentioned. This comprehensive approach provides a clearer picture of the patient’s overall health.

• Misconception 5: The form can be submitted without the physician's signature.

A physician’s signature is required for validation. This signature confirms that the information reported has been reviewed and is accurate.

• Misconception 6: Once submitted, the form can't be updated or changed.

If new information arises or corrections are necessary, modifications can be made before the review process is finalized. Communication with Aetna may allow necessary changes to be submitted.

• Misconception 7: There are no legal repercussions related to the information provided.

It is important to provide accurate information. Misrepresentation can lead to legal consequences, including fines or loss of coverage.

• Misconception 8: The patient must be present for the physician to fill out the form.

Patients do not need to be present for physicians to complete the form. Physicians can provide information based on their medical history and ongoing treatment.

• Misconception 9: The form will automatically guarantee benefits.

Filling out the form does not guarantee benefits. Aetna will review the form along with the patient's insurance policy to determine eligibility.

• Always complete the entire Aetna Attending Physician Statement form before submission.
• Clearly provide patient information, including name, Aetna ID number, and birth date.
• Ensure accurate diagnostic information by including primary diagnosis, ICD-9 codes, and any complications.
• Input subjective symptoms and objective findings to give a fuller picture of the patient's condition.
• Indicate whether the patient has any secondary conditions and provide details if applicable.
• List all treatments and medications, specifying dosages and treatment frequencies.
• Document any surgeries the patient has undergone, including dates and procedures.
• Assess and note the patient's current status and prognosis, including any expected changes.
• Consider the patient's work status and ability to participate in vocational rehabilitation.
• Sign and date the form to validate the information provided.