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Payer-to-payer health info

Sharing your health info: What you need to know

How to share your health info

 

You can share your health info between two health plans. To do this, we need your approval to send or receive your health info.

 

There are two ways to share your health info:

 

  • If you want Aetna® to get your health info from another health plan, log in to your member website to start.

  • If you want another health plan to get your health info from Aetna, contact your other health plan.

 

Important points

  • Aetna will send the health info we have from the last 5 years.
  • Aetna will also send info we’ve received from other health plans.
  • You can share your health info with your health care team.

Who can use this service?

 

You can use this service if you’re a current or former member (within the last 5 years) of:

 

  • A health plan managed by the federal government (Medicare, Medicaid, health insurance that individuals or families can buy on their own, etc.)
  • A health plan mandated by state law (certain health plans through an employer)

Benefits of sharing your health info with us

 

Sharing your health info with your health care team can make your treatment plan more personal and complete. This helps you: 

 

  • Make sure you get screenings, exams or vaccines on time
  • Manage chronic illnesses better
  • Avoid repeat tests
  • Prevent harmful drug interactions
  • Have current test results handy

Types of health info Aetna® shares

Aetna plans will send certain clinical info in members’ records with a date of service on or after January 1, 2016. We may also share health info related to sensitive conditions.

  • Clinical info includes:

     

    • Vital signs
    • Height
    • Weight
    • Smoking status
    • Medications
    • Lab results
    • Conditions
    • Procedures
    • Immunizations

  • Condition info includes:

     

    • Chronic diseases
    • Contagious diseases
    • Alcohol/drug use disorders
    • HIV/AIDS
    • Sexually transmitted diseases
    • Genetic marker info
    • Mental health info

Need help? Here’s how to share your health info.

  • To send your health info to Aetna

    To share your health info from another health plan with us, follow these steps:

     

    • Step 1: Get your member ID card from your other health plan. If you don’t have it, contact your other health plan.
    • Step 2: Have your log-in info (username and password) for your Aetna member website. If you don’t have one, create an account.

     

    Need to check the status of the info exchange? Log in to your member website. 

  • To send your health info to another health plan

    To send your health info from Aetna to another health plan, here are the steps:

     

    • Step 1: Contact your other health plan. Find out how their payer-to-payer info exchange process works. You may need to visit their website or call them. Have your Aetna ID card and member info ready.
    • Step 2: Aetna will send some info.
      We’ll send all required clinical info we have as part of your record for eligible health plans. This includes health info we’ve received from other health plans through the payer-to-payer info exchange, if it applies. We will not send your claims or provider/facility info.

  • To check your health info sharing request

    To check the health plans that are sending or receiving your health info through Aetna, here’s what to do:

     

    Go to the “Manage who can view your data” section on the Aetna member website.

Frequently asked questions

  • You decide whether Aetna will receive your health info from another plan. You also control whether we send your health info to another plan. If you don’t want Aetna to send or receive your health info, don’t start a payer-to-payer health info exchange.

  • Certain health plans must offer features that let current and former members (up to 5 years after leaving Aetna), to provide consent to:

     

    • Receive their health info from other health plans
    • Send their health info to other health plans

     

    These plans include:

     

    • Certain health plans managed by the federal government (Medicare, Medicaid and health insurance that individuals or families can buy on their own, etc.)
    • Health plans mandated by state law

     

    Not sure if you’re eligible? Call us at the number on your member ID card to speak with our Member Services team.

  • If you tell Aetna to send your health info to another health plan, Aetna will send required clinical info from the last five years. In some cases, Aetna may also send info from before this date. Aetna will also share any health info it has received about you from another health plan through the payer-to-payer health info exchange.

     

    The health info Aetna sends may not include your full medical history. This health info isn’t a substitute for your complete medical history.

  • We only use or share your health info through the payer-to-payer health info exchange at your request. Aetna treats personal health info as confidential. We protect your privacy based on federal and state laws, as well as our own privacy policies. 

     

    For more details on how we use and share your info to manage your benefits, and your rights, review our Notice of Privacy Practices.

  • Once you tell us to share your health info with another health plan, Aetna does not oversee how that health plan may use or share your info. To understand how another health plan may handle your health info, contact that health plan.

  • There’s no charge for the info exchange or for Aetna to keep the info we receive from another health plan.

  • Call the number on your Aetna member ID card for help.

  • Call the number on your Aetna ID card to reach our Member Services team.

  • You only need to log in with your current member log-in.

  • You may direct Aetna to receive your health info from any health plan that covered you in the last five years. If you need info from multiple health plans, you’ll need to make a request for each plan.

  • Members aged 14 and older in an eligible plan can direct Aetna to share their health info using their member website.

     

    For members aged 13 and under, a guardian or authorized representative can create an account for them.

  • The info needed to verify your identity and consent is different among health plans. Be sure to have your ID card from the other health plan, as Aetna may request info to match you to your records.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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