Provider Directory - Aetna Medicare
Provider Directory - Aetna Medicare Provider Directory - Aetna Medicare
Aetna Medicare SM Plan (HMO) (PPO) Provider Directory This directory provides a list of Aetna Medicare SM Plan (HMO) (PPO) providers. Please refer to the Service Area Map at the back of this directory for the service area applicable to this directory. This directory is current as of 10/2009. Some plan providers may have been added or removed from the list after this directory was printed. To get the most up-to-date information about Aetna Medicare (HMO) (PPO) plan providers in your area, you can visit www.aetnamedicare.com or call our Customer Service Department at 1-800-282-5366, 8 am to 8 pm, 7 days a week. TTY/TDD users should call 1-888-760-4748.
Section 1 – Introduction This directory provides a list of Aetna Medicare (HMO) (PPO) plan providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. With the standard Aetna Medicare Health Maintenance Organization (HMO) plan you will have to choose one of our plan providers that are listed in this directory to be your Primary Care Physician (PCP). The term “PCP” will be used throughout this directory. Generally, you must get your health care coverage from your PCP. The “plan providers” listed in this directory have agreed to provide you with your health care coverage. You may go to any of our plan providers listed in this directory, however some services may require a referral. If you have been going to one plan provider, you are not required to continue going to that same provider. In some cases, you may get covered services from non-plan providers. In cases where noncontracting providers submit a bill directly you, you should not pay the bill, but submit it to Aetna Medicare for processing and determination of your financial liability, if any. Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna. You must use network providers except for urgent care or out-of area urgent care/renal dialysis. Except for those benefits described in your plan documents as directaccess benefits, or in an emergency, you will need to obtain a referral from your PCP before seeking covered non-emergency specialty or hospital care. Check your Evidence of Coverage for details. With the Aetna Medicare Open Access (HMO) plans, you are not required to choose a primary care physician (PCP) and are free to visit network providers without a referral to receive covered services. Although selecting a PCP is not required, you will benefit by receiving care from a doctor that has a deeper understanding of your health care needs and may be able to assist with important medical decisions. With the Aetna Medicare Preferred Provider Organization (PPO) Plan, you have the flexibility to choose either network providers at lower out-ofpocket costs, or out-of-network providers at a higher cost sharing level. If you select a PCP from our network, you must notify us of your selection in order to have the lower primary doctor visit copay. By having a PCP coordinate your care, you’ll also benefit by receiving care from a doctor that has a deeper understanding of your health care needs and may be able to assist with important medical decisions. Note: If you do not select a PCP, you’ll be responsible for the higher specialist copay when receiving services from a PCP. Certain healthcare services, such as hospitalization or outpatient surgery, require precertification with Aetna. This means the service must be approved by Aetna before it will be covered under the plan. Check your Evidence of Coverage for a complete list of services that require this approval. When you are to obtain services requiring precertification from a participating provider, the provider is responsible to precertify those services prior to treatment. If your plan covers out-ofnetwork benefits and you may self-refer for covered services, it is your responsibility to contact Aetna to precertify those services which require precertification. If you need emergency care, you are covered 24 hours a day, 7 days a week, anywhere in the world. Whether you are in or out of an Aetna Medicare service area, we simply ask that you follow the guidelines below when you believe you need emergency care. ■ Call the local emergency hotline (ex. 911) or go to the nearest emergency facility. If a delay would not be detrimental to your health, call your PCP. Notify your PCP as soon as possible after receiving treatment. ■ If you are admitted to an inpatient facility, you or a family member or friend on your behalf should notify your PCP or Aetna as soon as possible. If you are traveling outside of the Aetna Medicare (HMO) (PPO) plan service area, you are covered for emergency and urgently-needed care. Urgent care may be obtained from a private practice physician, a walk-in clinic, an urgent care center or an emergency facility. If, after reviewing information submitted to us www.aetnamedicare.com I
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<strong>Aetna</strong> <strong>Medicare</strong> SM Plan (HMO) (PPO)<br />
<strong>Provider</strong> <strong>Directory</strong><br />
This directory provides a list of <strong>Aetna</strong> <strong>Medicare</strong> SM Plan (HMO) (PPO) providers.<br />
Please refer to the Service Area Map at the back of this directory for the service area<br />
applicable to this directory.<br />
This directory is current as of 10/2009. Some plan providers may have been added<br />
or removed from the list after this directory was printed.<br />
To get the most up-to-date information about <strong>Aetna</strong> <strong>Medicare</strong> (HMO) (PPO) plan<br />
providers in your area, you can visit www.aetnamedicare.com or call our Customer<br />
Service Department at 1-800-282-5366, 8 am to 8 pm, 7 days a week. TTY/TDD users<br />
should call 1-888-760-4748.
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