Scene 1: Get the most from your health care dollars
We know you and your family are feeling the crunch of rising health care costs; most people are. But the truth is, you have a lot of choice when it comes to selecting your health care providers and facilities.
Did you know that the cost of the same service or procedure can vary widely from specialist to specialist? How about from facility to facility? That’s right – same service, same care, same quality – different price. Unfortunately, this difference can result in higher costs for you.
The key to getting the most from your health benefits is simply doing what you would for any other big life decision – your homework. By looking at your options for care and choosing wisely, you can eliminate the risk of overpaying AND feel good about the quality of care you receive. And that is where your informed choices really pay off.
You’re in luck because Aetna makes this easy. As an Aetna member, you have a set of tools to help you compare your options while still maximizing your health care benefits.
To find out how to get the most from your health care dollars, use the control panel on the screen to navigate through this guide. Watch the whole video or jump directly to the section that interests you.
Scene 2: Your provider network
You’ve probably heard the term “in network” before. This is the group of doctors, hospitals and other facilities that Aetna has negotiated rates with to help you keep your costs down. These providers are called “in network.”
Believe it or not, the hospitals and doctors in Aetna’s network have very different rates, even in the same local area. That’s why it’s so important to do your homework, use the tools, and find the right provider that suits your needs and your budget.
Within Aetna’s general network, there may be certain hospitals, specialists and other facilities in your area that have been put into a “special group” if they meet certain criteria, such as quality and efficiency. If you choose a provider from this special group, you can pay a lower portion of your medical costs. It all depends on your particular health plan. And more importantly, it depends on YOU.
The thing to remember is that it’s YOUR CHOICE. That means it’s up to YOU to decide where to get care.
To help you choose wisely, Aetna has useful online tools — and helpful people — that can help you make the right choice for YOU. We’re always here to answer your questions. To learn more, choose your next chapter!
Scene 3: Providers who make the grade
Will I still get the quality care I deserve … even if I’m paying less for care?
The answer is: definitely, yes!
When we evaluate the Aetna network and decide which providers to put into the “special group,” we use recognized standards for clinical quality, along with Aetna standards for efficiency. For the clinical quality, we consider factors, such as:
- Treatments that have been proven to show positive results, according to medical standards
- Lower hospital readmission rates
- Fewer reported complications
- Technology usage
- Industry certification
- And more
Remember, you have a choice of doctors to see when you seek care. And, you also have a say in what facility you use, too – like hospitals, freestanding medical facilities, urgent care clinics, labs and more. It’s all about deciding what is best for YOU.
We’ve done a lot of the homework for you and, hopefully, that makes your choice a little easier.
“You should confer with your physicians and specialists before making a decision.”
Scene 4: You have the power to pay less
At Aetna, we want to help you make the most of your benefits. And, give you access to a network of quality providers and facilities that also operate efficiently, so you can get the care you need without paying more than you have to. Plus real-time information is available anytime, anywhere to help you make spending decisions that work best for you and your budget.
So, now that a huge part of the legwork is done, the rest is up to you.
Get online. Register on Aetna Navigator® and get to know the easy-to-use online health care tools that are out there for you. Understanding your situation can help you stay ahead of the game.
Take control. Before you see a doctor or schedule a procedure, be prepared with questions about your condition and your care options, so you get the most out of each visit.
Check your options. Choose the doctors and facilities that meet your needs and your budget. For example, there may be a 30 percent to 50 percent cost difference between different providers. It makes sense to check it out before you make an appointment.
Finally, take care of yourself! Because the healthier you are, the less you’ll spend on health care. This is the best way you can make your health care dollars go further.
To start, visit Aetna Navigator and check out Aetna’s online tools to find providers, estimate costs and more.
Scene 5: Questions to ask your doctor
Your doctor took an oath to “prescribe regimens for the good” of his or her patients. But, let’s face it, the Hippocratic Oath never mentions health insurance coverage.
Your doctor is probably in many different health care networks. That’s why it’s so important to discuss procedures, referrals and facilities with him or her.
To help you find the right match for you, there are several questions you should ask, including:
- Can your doctor recommend more than one option for a specialist, hospital or lab, so you can compare costs and see which ones meet your care needs and budget?
- Can the procedure be performed at an outpatient facility or surgical center rather than at a hospital?
- Is surgery the only answer?
- If prescribing medication, is there a generic drug available?
It’s okay to talk to your doctor about your health care plan and YOUR preferences. It’s your health. And it’s your money! Together, you can decide on a regimen you both are comfortable with.
Scene 6: Questions to ask yourself
You can make the most of your health care dollars by continuing to make smart health care decisions—some before you even see a doctor.
You simply have to ask yourself the right questions.
First of all, if it’s an emergency, don’t ask. JUST GO!
But in non-emergency situations, here are a few questions you should ask before you seek help.
“Can an over-the-counter medicine help?” Your doctor may be the greatest on the planet. But there’s still no cure for the common cold.
If it’s after hours, “Is there an urgent care or walk-in clinic in the neighborhood?” Urgent care centers offer quality care—often for less money, less waiting and fewer hassles than going to an ER.
“Is my doctor the right person to see?” After all, you wouldn’t go to your family doctor for a toothache. Who would be the right doctor or specialist for your symptoms?
“Am I covered?”
The answers can be easy to find when you’re an Aetna member. Any time of day. Any day of the week. Check out the resources on Aetna Navigator.
“Questions? Call Aetna’s Informed Health Line 24/7/365.”
Scene 7: Tools and resources within Aetna Navigator
There are advantages to being a member in an Aetna health plan.
As a member, you have access to plenty of tools and easy-to-understand information to help you make wise decisions about your health care options.
To make the most of your health plan, take a few minutes to get to know the tools and resources available to you as an Aetna plan member.
- Start with Aetna Navigator, your easy-to-use, secure online resource for your benefits and health information. Here, you can take care of business while you take care of your health, all in one place. With Aetna Navigator, you can:
- Look up a claim
- Find a doctor
- Get a cost estimate for your next doctor visit or scheduled procedure
- Take a health assessment
- View and print your member ID information
Inside Aetna Navigator, you’ll find:
- The DocFind® tool is your one stop to find Aetna providers in your local area, including doctors, specialists, hospitals, labs, urgent care centers and more.
- Cost of Care tools, like Member Payment Estimator, that help you learn how much you’ll pay before you go to that appointment.
- Ask Ann, your virtual personal assistant, can help answer all kinds of questions.
- And much more
The idea is to provide you with the information you need to make a great decision, and feel good about it.
It’s easy to get more from your health care plan and make smart financial decisions – when you take just a little time to prepare yourself
To get started, register at the Aetna Navigator log-in page.
Scene 8: Aetna Mobile
When you live your life on the go, shouldn’t your information go with you? With Aetna Mobile, it does. That’s because Aetna Mobile lets you take care of the things that help you take care of your health, right from your smart phone. We’re talking about:
- Looking up a claim
- Finding a doctor, hospital or other facility in your network
- Viewing your coverage and benefits
- Viewing your ID card information
- Checking drug prices
- And more
All you need to do is go to Aetna.com from your smartphone. Or if you have an iPhone or Android powered phone, you can download the Aetna Mobile app. It couldn’t be easier than that. So no matter where you are, you can count on Aetna to be there if you need care. And that’s a good feeling.
Scene 9: DocFind
Selecting a doctor and other health care providers is an important part of taking care of your health. DocFind, our online directory, makes it easy. You can use DocFind on your computer and your smartphone. DocFind locates providers by using criteria that’s most important to you … and best suited to your needs.
For example, you can search for a provider online by:
- And more
And DocFind is not just searching for doctors. You can look up facilities like hospitals, urgent care centers, labs and more to see if they are in your network and find out other information.
Just one search can tell you things like which plan the provider accepts, are they accepting new patients, and if the provider has met special standards for quality and efficiency.
You can even view maps and driving directions!
With DocFind at your fingertips, you get great facts at a glance … and peace of mind in your care choice.
The best way to use DocFind is to log in to Aetna Navigator and click “Find a doctor, pharmacy or facility.” That way, you’ll be able to use all the DocFind features and get the latest information.
We keep our DocFind database up to date because things are always changing. So it’s helpful to check DocFind each and every time you need a provider.
Scene 10: Member Payment Estimator
At Aetna, we want to give you all the tools you need to make an informed choice. And when it comes to understanding costs, you’ll find the Member Payment Estimator very handy!
Member Payment Estimator automatically uses your benefits plan to let you know what your out-of-pocket expenses will be—before you go to the doctor or get a procedure!
It's one of the best ways to avoid surprises when it comes to your health care bills.
And it couldn’t be easier. You don’t have to know a thing about medical coding to use Member Payment Estimator. This convenient online tool walks you through everything to tell you:
- Your cost for a procedure or service, like an office visit
- Deductible and coinsurance payments—what you’re expected to pay out of pocket
Use Member Payment Estimator before you make an appointment to compare costs between providers. You may be surprised to find a wide range of costs, even for providers in the same specialty and same geographic area. So to make sure you’re not paying more than you have to for the same care, it’s best to know and compare before you go. You can end up saving hundreds of dollars.
To use Member Payment Estimator, simply log in to your Aetna Navigator secure member website to get started!
Scene 11: Ask Ann
We’d like to take this opportunity to introduce to you, Ann, your very own personal guide to your Aetna benefits. Ann is stationed right on Aetna Navigator, and she’s always available to answer your questions.
Simply type your question, and Ann will respond. You can ask Ann just about anything – like questions about your benefits, claims, where to find doctors near you and much more. You can even ask her to recommend ways you can save on out-of-pocket health costs. She’s always friendly, and she never takes a day off.
The next time you log in and visit Aetna Navigator, stop by and have a chat with Ann.
Scene 12: Your health plan and provider network
You’ve already made a smart decision by choosing Aetna. And we’re here to help you get the most for your health care dollars.
Start with your health plan. It provides coverage for all kinds of care, such as doctor visits, tests, procedures, hospital stays and more. Aetna pays a significant part of these costs, and you pay the rest. Just how much you pay depends on your particular health plan.
Then there’s your network. This is the group of doctors, specialists, hospitals, labs and other facilities in your local area that have negotiated special rates with Aetna to help keep your costs down. Sometimes, your plan has a special network of doctors and hospitals or other facilities who meet criteria such as quality and efficiency, and by using them, you pay even less out of pocket.
So what does all this mean? The doctors, hospitals and facilities you choose matter. Choose wisely and you can stretch your health care dollars even further.
Scene 13: Aexcel Network
Looking for a certain specialist but don’t know where to start? Look for the Aexcel® “blue star” to help you make important decisions about your care.
The Aexcel blue star says a lot about a doctor. It says he or she meets certain standards for clinical quality — standards established by leading medical associations and industry organizations. The doctor also meets Aetna’s standards for efficiency.
It says these doctors use technology and tools that speed your recovery and keep costs down.
More important, it says you’ll get the quality care you deserve … AND pay less out-of-pocket costs.
The Aexcel blue star is available for 12 types of specialists — from cardiologists to Ob/Gyns and more. Look for it and feel good about feeling better!
Scene 14: Institutes of Quality
Sometimes having surgery is the best choice for your health. Hip and knee replacement, heart surgery and gastric bypass have become more common, but all surgery carries some level of risk. So it’s important to look for facilities that are known for quality care.
As an Aetna member, you have a special network of hospitals and other facilities that specialize in certain procedures — cardiac (for the heart), orthopedic (for the joints and spine) and bariatric (for weight loss). We call these facilities our Institutes of Quality (or IOQ for short). And there’s a good reason for that.
Facilities earn IOQ status for showing a high level of quality for certain cardiac, orthopedic or bariatric procedures. We measure many factors like the level of care patients receive, how often patients return to the hospital after surgery, and more. The goal is to help you make a smooth recovery, so you can get back to living your life.
Besides quality care, the amount that you pay out of pocket for your procedure may be less at an IOQ. How much you’ll pay depends on your particular health plan.
If surgery could be in your future, here are some ways to put your mind at ease:
- Visit www.aetna.com and log on to Aetna Navigator® - that’s your secure member website.
- Click the link to “Find a Doctor, Pharmacy or Facility” – Look for facilities listed as an Institute of Quality and specialists who have privileges at these hospitals.
- It’s also makes sense to check Member Payment Estimator. You can find out how much you’ll pay even before you step into the doctor’s office or schedule a procedure
With over 600 Institutes of Quality nationwide, getting the quality care you deserve has never been easier.
© 2013 Aetna Inc. Health Insurance Plans are offered an/or underwritten by Aetna Life Insurance Company (Aetna).
This material is for information only. Health insurance plans contain exclusions and limitations. Aexcel is not available with HMO plans. Aexcel designation is only a guide to choosing a physician. Members should confer with their existing physicians before making a decision. Designations have the risk of error and should not be the sole basis for selecting a doctor. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Incentive rewards may be taxable to you. You may wish to consult with a tax advisor as to the proper tax treatment of the incentive award. The Personal Health Record is offered by Aetna Life Insurance Company and should not be used as the sole source of information about the member's medical history. Information is believed to be accurate as of the production date; however, it is subject to change. Policy forms issued in OK include: GR-23 and/or GR-29/GR-29N. For more information about Aetna plans, refer to www.aetna.com.