Transcription of Aetna Accident Plan Benefits Request
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Aetna Accident Plan Benefits Request
Internal Use Aetna Accident plan Benefits Request Category Code VPCF. Office Key Code 039. Please call our Customer Service Center at 1-888-772-9682 between 8:00 AM and 6:00 PM if you have any questions about Benefits or how to file your claim, or if you wish to appeal a decision. The completion of this form does not guarantee payment. A. Instructions for filling out this form 1. Please check the box(es) that best describes your claim: Check Check Check Covered Benefit Box Covered Benefit Box Covered Benefit Box Dislocations Pain Management *Accidental Death Closed Reduction (Epidural Anesthesia). Dislocations . Accidental Dismemberment Paralysis Open Reduction Physician's Office or Urgent Accident Follow-up Emergency Room Care Center Prosthetic Device/Artificial Ground Ambulance Eye Injury Limb Air Ambulance Fractures - Closed Reduction Rehabilitation Unit - Daily Appliances (for mobility) Fractures - Open Reduction Ruptured Disc Blood/Plasma/Platelets Hospital Stay Admission Surgery (with repair).
Aetna Accident Plan Benefits Request Internal Use Category Code . VPCF . Office Key Code . 039 . Please call our Customer Service Center at 1-888-772-9682 between 8:00 AM and 6:00 PM if …
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