Member rights: Member services FAQs

My doctor would like to participate in my Aetna network. Can you tell me the status of his (or her) application?
Ask your doctor to contact his (or her) Aetna professional service coordinator to obtain network participation status.

My doctor is not in my Aetna network. How can he or she apply to participate in my plan? 
Ask your doctor to contact Aetna's Provider Service Center at 1-888 MD Aetna (1-888-632-3862). A Member Services representative will help your doctor get in touch with the appropriate network management office.

Am I covered when I am outside my “home” service area? May I see a participating Primary Care Physician (PCP) in another area? 
Many Aetna plans do cover emergency and urgent care when you are outside your normal “home” service area.* These include Aetna HMO, QPOS®, Elect Choice® and Managed Choice® plans. In addition, these plans also provide coverage for insured students who are away from home at school. You can seek emergency and urgent care from a doctor, a walk-in clinic, an urgent care center or an emergency facility.

When outside your “home” service area, you should still coordinate care through your PCP. This way, you can be sure to receive in-network benefits. If you are admitted to a hospital because of an injury or life-threatening medical emergency, you (or someone acting for you) should immediately notify your PCP. In other cases, you should contact your PCP within 48 hours after receiving emergency care.

Where can I get a summary of my benefits? 
Most employers will give you a benefits booklet, which includes a summary of your benefits. You should contact your employer’s benefits office to request this information. For some plans, your Aetna Navigator® secure member website will allow you to view a medical benefits summary and other plan documents online. You can find these materials listed under Benefits on your Aetna Navigator home page (if this option is available to you). If you have an individual (Aetna AdvantageTM) policy, please call Member Services. Our Member Services representatives can have a benefits summary sent to you.

What are your Member Services hours? 
You may call the toll-free Member Services number on your member ID card 24 hours a day, 7 days a week. All calls are answered by the Aetna Voice Advantage® system. This is an automated telephone assistant that recognizes natural speech, or selections from your touchtone keypad, and responds to you in a conversational voice. During regular business hours, you can ask to speak with a Member Services representative. See all the ways you can contact us.

How can I get a new ID card, change PCPs or contact Member Services?
You have two ways:

  • Go to your secure member website. Log in to Aetna Navigator from www.aetna.com so that you can: 
    • Order an ID card, or view and print a temporary member ID (through Requests & Changes)
    • Change your primary care physician or dentist (through Requests & Changes)
    • Send an e-mail to Member Services (through Contact Us) 
  • By telephone. Call the toll-free Member Services number on your member ID card 24 hours a day, 7 days a week. All calls are answered by the Aetna Voice Advantage system (AVA). This is an automated telephone assistant that recognizes natural speech, or selections from your touch-tone keypad, and responds to you in a conversational voice. Just follow the menu options on AVA to: 
    • Order an ID card 
    • Change your primary care physician or dentist

During regular business hours, you can ask to speak with a Member Services representative.

How do I change my name or address? 
In general, we rely on your employer to provide us with changes to your name or address. You should give any changes of name or address to your employer, who will then send this information to us.

How will I be affected if my Primary Care Physician (PCP) leaves the network? 
If your doctor leaves the network, you will be asked to select another Aetna participating provider. You can find a new PCP who participates in your network on your secure member website by our online directory of doctors and hospitals. All of our PCPs must pass stringent credentialing requirements so that only doctors who meet our standards participate in our networks.

How do I find information on continuing my health insurance after I leave my company? 
Contact your prior employer's benefits office and tell them you're interested in purchasing a COBRA policy. According to federal law, companies that employ more than 20 employees must make you aware of your options for purchasing this coverage.

I am a new Aetna member. Before receiving my ID card, I needed to go to the doctor. My doctor then required that I pay for this service. Where should I send my claim for reimbursement?
If you have received your medical ID card, you can submit this claim (along with a completed Medical Benefits Request Form) to the address printed on your card. Note: You will find the Medical Benefits Request Form in the Forms Library at Aetna Navigator. Please include your member ID number, which appears on your card, and a copy of your doctor’s bill. Be sure that your payment to the doctor is clearly indicated on this bill.

If you do not have an ID card yet, just log in to Aetna Navigator to view your Temporary Member Identification. You can use this information to submit your claim for reimbursement.
If you do not have Internet access, please contact your employer’s benefits office. Your employer can give you a Medical Benefits Request Form, along with the mailing address to submit this form and/or your Member Services toll-free telephone number.

How can I get information regarding discounts that are offered to Aetna Members? 
Go to our discounts page to learn more about discounts that may be offered to Aetna Members.

How can I cover my newborn from birth?
You should contact your employer’s benefits department for instructions and an enrollment change form. In general, an eligible newborn child is covered for 31 days from his or her date of birth. To continue coverage beyond this initial period, a child must be enrolled within 31 days of birth and any applicable premium must be paid. Special provisions may apply to a legally adopted child or a child for whom you are legal guardian. Eligibility provisions may vary by state, as well as the plan of benefits chosen by your employer. Please refer to your Certificate of Coverage or other plan documents for more details.

How do I add or delete family members?
You may add or delete family members during the annual open enrollment period with your employer. In addition, we will generally accept enrollments for newly eligible members within 31 days after the following events (with proper documentation submitted to us): 

  • An employee’s marriage or divorce
  • Death of an employee’s spouse or dependent
  • The birth, proposed adoption or adoption of a child by an employee
  • Beginning or ending of employment by an employee’s spouse
  • A change in full-time or part-time employment status by an employee or an employee’s spouse 
  • Unpaid leave of absence taken by an employee or an employee’s spouse
  • Significant change in the health coverage of an employee or an employee’s spouse (when caused by a spouse’s employment).

How do I obtain coverage for my newly adopted child? 
Special provisions may apply to legally adopted child or a child for whom an individual is a court appointed legal guardian. However, we must receive the request to enroll adopted children within 31 days of the birth or adoption. Eligibility provisions may vary by state law and the plan of benefits elected by your employer. Refer to your plan documents for details.

How often are Aetna’s online doctor and hospital directories updated? 
We update our online directory of doctors and hospitals six times a week. Log in to Aetna Navigator from Aetna.com and you can access the secure DocFind tool where your plan information and home zip code will be prefilled for you.

* If you are enrolled in an Open Choice® PPO, you do not need a referral to see a participating doctor when outside your home network.
** Availability varies by service area.

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