In CA : Some hospitals and other providers do not provide one or more of the following services that may be covered under your policy and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you become a policyholder or select a network provider. Call your prospective doctor or clinic, or call Member Services using the number of the back of your ID card to ensure that you can obtain the health care services that you need.

A paper directory is also available at no cost to members and members of the public.

To request a print directory:

• You can call us at the toll-free number on your ID card.
• Visit Member Services and log in by choosing Contact Us to complete a request, or
• Request a copy in writing at:
     Aetna
     PO Box 14079
     Lexington, KY 40512- 4079

• You can call us at 800-445-5299,
• Visit Member Services to complete a request, or
• Request a copy in writing at:
     Aetna
     PO Box 14079
     Lexington, KY 40512- 4079
  

If eligible health services are not available from a network provider, we will arrange for you to get the services from an out-of-network provider. Your claim will be paid at the network provider cost sharing level. This means you will pay the in-network copayments and coinsurance and the cost will apply to your in-network deductible (if any) and in-network maximum out-of-pocket limit.

To receive the highest level of benefits under the plan, you may be required to get an authorization or referral from your PCP before you can see a provider (for e.g. a network specialist). A ''referral'' is a written request for you to see another doctor. Some doctors can send the referral right to your specialist for you.

• Title VI of the Civil Rights Act of 1964
• Age Discrimination Act of 1975
• Americans with Disabilities Act of 1990
• Section 504 of the Rehabilitation Act of 1973
• Laws that apply to those who receive federal funds
• All other laws that protect your rights to receive health care

In Connecticut :

To get the highest level of benefits under the plan, you may need an authorization or referral from your Primary Care Physician (PCP) before you can see a specialist. A "referral" is a written request for you to see another doctor. Some doctors can send the referral right to your specialist for you. Want to find out if you need a referral? Just check your plan documents, the member website, or call Member Services at the number on the back of your ID card.

In Delaware :

To request a print directory:
Aetna Members:

• You can call us at the toll-free number on your ID card.
• Visit Member Services and log in by choosing Contact Us to complete a request, or
• Request a copy in writing at:
     Aetna
     PO Box 981106
     El Paso, TX 79998-1106

• You can call us at 800-445-5299,
• Visit Member Services to complete a request, or
• Request a copy in writing at:
     Aetna
     PO Box 981106
     El Paso, TX 79998-1106
  

In Georgia :

To report inaccurate provider information, please complete the linked form http://www.aetna.com/docfind/data_correction.html or call 1-800-445-5299.

Please note that certain benefit plans require a referral or authorization before a particular type of provider may be seen.

To request a print directory:
Aetna Members:

• You can call us at the toll-free number on your ID card.
• Visit Member Services and log in by choosing Contact Us to complete a request, or
• Request a copy in writing at:
     Aetna
     PO Box 14079
     Lexington, KY 40512- 4079

• You can call us at 800-445-5299,
• Visit Member Services to complete a request, or
• Request a copy in writing at:
     Aetna
     PO Box 14079
     Lexington, KY 40512- 4079
  

In Massachusetts : , all primary care physicians and specialists are reimbursed on a fee schedule unless otherwise noted.
Definitions for compensation methodologies:

• Capitation: Provider receives a fixed, age/sex-adjusted, periodic prepayment based upon the members in a Provider's panel. Primary Care Physicians also receive a Quality Enhancement payment for maintaining open panels.
• Fee Schedule:Provider is paid a fee for each service rendered as billed by Provider.
• Discount from Charges: Provider receives an agreed upon percentage discount from the Provider's billed charges for services rendered.
• Per Diem: Provider receives a fixed payment per day of service. Payment amount may depend upon services provided and length of stay.
• Case Rate: Provider receives a fixed payment for providing services to a member based upon the diagnosis of the patient.

Massachusetts hospitals are reimbursed based upon a combination of payment methodologies including Per Diems, Case Rates, Fee Schedules, Discount From Charges, Capitation.

In Ohio :
When a referral is needed from your primary care provider As an Aetna Open Choice plan member, you never need a referral (a written request for you to see another doctor) from your regular doctor to see a specialist. You also do not need to select a primary care provider (PCP), but we encourage you to do so to help you navigate the health care system. With Aetna Managed Choice plans, you may choose a doctor in our network with or without a PCP referral. You may also choose to visit an out-of-network doctor. We cover the cost of care based on your choices. With Aetna Elect Choice plans, you are required to get a referral from your PCP before you can see a specialist. A “referral” is a written request for you to see another doctor. Some doctors can send the referral right to your specialist for you. There’s no paper involved! Talk to your doctor to understand why you need to see a specialist. And remember to always get the referral before you receive the care.

Just because a facility is participating in your network does not mean that all providers at that facility are in your network. An in-network participating facility may allow services to be provided by providers that are not in-network. Some examples may include anesthesiologists, radiologists and laboratories. For more information on how your plan will reimburse these providers, contact Member Services.

Some plans include a tiered provider network called Savings Plus. In these plans, members pay different levels of copayments, coinsurance, deductibles depending on the tier of the provider delivering a covered service or supply. Note that some services require a referral or authorization. In these plans, doctors displayed as "Best Results for Your Plan” or “Maximum Savings are in-network Tier 1 doctors. These doctors are covered at the highest level under your plan. Doctors displayed as "All Other” or “Standard Savings” are in -network Tier 2 doctors. These doctors participate with your plan but are not covered at the highest level.

In Oregon :
A provider’s network participation status may change. A provider that has been participating in your network may leave and no longer participate in your network. Because of this, please consult the last available and updated provider directory to check whether a provider continues to participate in your network. If the provider is not shown as a participating provider for your network in the last available and updated provider directory, your out-of-pocket expenses and financial liability could increase if you see this provider. If you are in an active course of treatment by a provider, a limited exception to this rule may apply in certain cases. This exception is called “transition of care coverage.” Contact the Member Services number on the back of your ID card for more information.

Source of Directory Information
The information included in the on-line directory is accurate as of the date posted to the web. The information contained in this directory is provided to Aetna from the providers, or the providers’ representatives, for publication. DocFind is updated 6 days per week, excluding holidays, Sundays, or interruptions due to system maintenance, upgrades or unplanned outages.

Network Criteria
Aetna has established a standardized approach to the selection, credentialing and retention of participating practitioners and providers. Practitioner and provider selection is guided by Aetna’s participation criteria. The participation criteria include business criteria, and professional, competence and conduct criteria.

In Texas : for members covered under Aetna Open Access® (HMO) or Aetna Choice® POS, PCP means physician (primary care). To view a listing of counties in Aetna Life Insurance Company’s service area(s) and whether they meet state network adequacy rules, click here.

For Utah members covered under Aetna HMO, Aetna Choice® POS, Aetna Health Network Only^SM, and Aetna Health Network Option^SM:

You may be entitled to coverage for health care services from the following non-participating providers if you live or reside within 30 paved road miles of the listed providers, or if you live or reside in closer proximity to the listed providers than to Aetna participating providers:

• Halchita Clinic, San Juan County, Utah

If you have questions concerning your rights to see a provider on this list, you may contact Customer Service at the number located on the ID card. If we do not resolve your problem, you may contact the Office of Consumer Health Assistance in the Utah Insurance Department toll free at 1-866-350-6242.

In Washington :
When a referral is needed from your primary care provider
As an Aetna Open Choice and Aetna Whole Health Open Choice plan member, you never need a referral (a written request for you to see another doctor) from your regular doctor to see a specialist. You also do not need to select a primary care provider (PCP), but we encourage you to do so to help you navigate the health care system.

With Aetna Managed Choice plans, you may choose a doctor in our network with or without a PCP referral. You may also choose to visit an out-of-network doctor. We cover the cost of care based on your choices. With Aetna Elect Choice plans, you are required to get a referral from your PCP before you can see a specialist. A “referral” is a written request for you to see another doctor. Some doctors can send the referral right to your specialist for you. There’s no paper involved! Talk to your doctor to understand why you need to see a specialist. And remember to always get the referral before you receive the care.

Help for those who speak another language
If you need help in another language ask an English speaking family member or friend to contact your doctor or medical facility. Ask if multi-lingual employees are on staff. If not, you can also ask if they provide over-the-phone interpretation through a service like the AT&T Language Line. These types of services can provide interpretation for up to 170 languages. If this is a service offered by your doctor or medical facility, they’ll connect you to the number associated with their practice and ask for an interpreter that speaks your native language. A member of the practice will remain on the line to answer your questions through the interpreter. This directory is also available in other languages at no cost to you.

Handicapped accessibility
Health care providers participating in the Aetna network are required to have all areas physically accessible to all members, including but not limited to the office entrance, parking, and bathroom facilities.