Selecting a Health Care Provider FAQs | Aetna

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Selecting a Health Care Provider FAQs

Choose a category below to see questions and answers about selecting a health care provider .

Coverage questions

Our trực tuyến directory can help you find :

  • Doctors (general and specialists)
  • Hospitals and urgent care centers
  • Mental health care
  • Pharmacies
  • Substance abuse treatment
  • Physical therapists
  • Dialysis centers
  • Eye exam providers
  • Medical equipment suppliers
  • Hospice care
  • Hearing discount locations
  • Much more

The simplest way to use our trực tuyến directory is through your secure thành viên account. Once you log in, you’re identified by your plan type and the system can easily find providers near you that accept your insurance .

Log in to your secure account

You also can use our public directory. It will list all of the plans we offer, and ask you to choose yours. If you’re not sure, you can search without choosing a plan by name .

If you find a provider in the public directory, we encourage you to contact the provider’s office before making an appointment, to confirm that they accept your plan .

Use our public trực tuyến provider directory

Your employer’s benefits office can give you a provider directory for your area .

You can change your PCP by through your secure thành viên account. If you would rather call us, use the number on your Aetna ID card .

Yes. Not all plans require you to choose a PCP, but if your plan allows you to choose one, you can change it whenever you want .

If your physician leaves our network, you will be asked to select another PCP.

Ask your doctor to contact our Member Services office at the toll-free number on your thành viên ID card. One of our Member Services professionals will help your physician get in touch with the appropriate network management office .

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Main FAQs

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Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

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The Applied Behavior Analysis ( ABA ) Medical Necessity Guide helps determine appropriate ( medically necessary ) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider .
Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member’s benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply .
The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered ( i. e., will be paid for by Aetna ) for a particular thành viên. The member’s benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary .
Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change .
Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the sự kiện that a thành viên disagrees with a coverage determination, thành viên may be eligible for the right to an internal appeal and / or an independent external appeal in accordance with applicable federal or state law .

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