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Member Services Frequently Asked Questions (FAQ)
1. My doctor would like to participate in my Aetna network. Can you tell me the status of his (or her) application?
ANSWER: Ask your doctor to contact his (or her) Aetna professional service coordinator to obtain network participation status.
2. My doctor is not in my network. How can he or she apply to participate in my plan?
ANSWER: Ask your doctor to contact Aetna's Provider Service Center at 1-888 MD Aetna (632-3862). A customer service representative will help your doctor get in touch with the appropriate network management office.
3. Am I covered when I am outside my “home” service area? May I see a participating primary care physician in another area?
ANSWER: Aetna HMO, QPOS®, Elect Choice® and Managed Choice® plan members, including insured students away at school, are covered for emergency and urgent care when outside their normal "home" service area*. Emergency and urgent care may be obtained from a doctor, a walk-in clinic, an urgent care center or an emergency facility.
When you are outside your “home” service area, you will still need to coordinate your care through your primary care physician (PCP) in order to receive in-network benefits. In case of an accidental injury or life-threatening medical emergency where you are admitted to an inpatient facility, you (or someone on your behalf) should immediately notify your PCP. In other cases, your PCP should be contacted within 48 hours of the emergency.
* 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.
4. Where can I get a summary of my benefits?
ANSWER: Most employers distribute a benefits booklet directly to their employees. Contact your employer's benefits office to request this information. For some types of plans, your Aetna Navigator™ secure member website home page will allow you to view your Medical Benefits Summary and other plan documents online. You will see this option under Benefits on your home page if it is available to you.
5. What are your customer service hours?
ANSWER: 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 Aetna Voice Advantage®, our automated telephone assistant that understands natural speech or selections from your touchtone keypad and responds to your information needs in a conversational voice. During our regular business hours of 8 a.m.-6 p.m., you can ask to speak to a customer service representative for assistance with more complex questions and transactions. You may also send an e-mail message to Member Services from Aetna Navigator, which you can log in to from www.aetna.com.
6. How can I get a new ID card, change PCPs or contact Member
Services?
ANSWER:
You have two options:
a. On your secure member website. Log in to Aetna Navigator from www.aetna.com where you can:
- Order an ID card or view and print a temporary member ID from Requests & Changes
- Change a primary care physician or dentist from Requests & Changes
- Send an e-mail to Member Services using Contact Us
b. 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 Aetna Voice Advantage (AVA), our automated telephone assistant that understands natural speech or selections from your touchtone keypad and responds to your information needs in a conversational voice. Follow the menu options on AVA to:
- Order an ID card
- Change a primary care physician or dentist.
During our regular business hours of 8 a.m.-6 p.m., you can opt to speak to a customer service representative.
7. How do I change my name or address?
ANSWER: In general, we look to your employer to regularly provide member and covered dependent eligibility information. You may contact Member Services by telephone, in writing, or by sending an e-mail to Member Services from Aetna Navigator's Contact Us to change your address. However, we encourage members to contact their employer with name or address changes to ensure that eligibility information supplied by the employer does not override the member-requested update.
8. How will I be affected if my primary care physician (PCP) leaves the network?
ANSWER: 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 using DocFind®,** 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. As part of Aetna's ongoing commitment to quality, our PCPs are re-credentialed approximately every two years.
** Availability varies by service area.
9. How do I find information on continuing my health insurance after I
leave my company?
ANSWER: Contact your prior employer's benefits office and tell them you're interested in purchasing a COBRA policy. According to federal law, your company must make you aware of your options for purchasing this coverage.
10. I am a new Aetna member and needed to go to the doctor before I received my ID card, so the doctor required that I pay for the service. Where do I send the claim and how do I get reimbursed?
ANSWER:
If you have received your medical ID card, submit your claim along with a completed "Medical Benefits Request Form" (which you can find on the secure member website Forms Library) to the address printed on your card. Be sure to include your member ID number which appears on the card. Also, be sure that your payment to the doctor is clearly indicated on the bill.
If you do not have an ID card yet, log in to your secure member website and view your Temporary Member Identification for the necessary address and member ID number.
If you do not have Internet access, contact your employer's benefits office to obtain a Medical Benefits Request Form, the mailing address for submitting it and/or your Member Services toll-free telephone number.
11. How can I get information about Alternative Health Care Programs?
ANSWER: The Alternative Health Care Programs from Aetna offer you
access to reduced rates on alternative therapies and products, including visits to designated acupuncturists, chiropractors, massage therapists and nutritional counselors.
Participants can also save on vitamins, herbal supplements, books and many other health-related products, such as aromatherapy, foot care and natural body care.
12. How can I get information regarding discounts that are offered to Aetna Members at health clubs and gyms?
ANSWER: Go to the Members & Consumers page on www.aetna.com and select Products & Programs, Health & Wellness, and then Fitness. You will find information on the discount Fitness Program, including a link to a directory of participating health club locations, as well as general fitness information on Aetna InteliHealth®, our consumer health information website.
13. How can I cover my newborn from birth?
ANSWER: 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/her date of birth. To continue coverage beyond this initial 31-day period, the eligible child must be enrolled within 31 days of birth and any applicable premium must be paid. Special provisions may apply to legally adopted child or a child for whom an individual is a court appointed legal guardian. Eligibility provisions may vary by state law and the plan of benefits elected by your employer. Refer to your Certificate of Coverage for details.
14. How do I add or delete family members?
ANSWER: Members may add or delete family members at open enrollment through their employer. In addition, we will generally accept enrollments for eligible members within 31 days of their eligibility date due to the following events, provided that documentation is submitted to us:
- A marriage or divorce of the employee
- The death of the employee's spouse or a dependent
- The birth, proposed adoption, or adoption of a child of the employee
- The termination or commencement of employment of the employee's spouse
- The switching from part-time to full-time employment status or from full-time to part-time status by the employee or employee's spouse
- The taking of an unpaid leave of absence of the employee or employee's spouse
- The significant change in health coverage of employee or spouse attributable to spouse's employment
15. How do I obtain coverage for my newly adopted child?
ANSWER: 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.
16. How often are your online doctor and hospital directories updated?
ANSWER:
For the most up-to-date information, members can access DocFind, our online directory of doctors and hospitals, on the Internet at www.aetna.com. DocFind is refreshed/updated three times a week.
Log in to Aetna Navigator from www.aetna.com and your plan information and home zip code will be pre-filled for you on DocFind.
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