Aetna hmo what is covered

Be involved in deciding on the kind of care you do or do not want. Input and feedback. Have your health care professional's help when you have to make decisions about the need for services, and if you are involved in a complaint process. Suggest changes in the plan's policies and services, including our Member Rights and Responsibilities policy. Choose a primary care physician from the plan's network and form an ongoing patient-physician relationship.

Help your health care professional make decisions about your health care. Follow instructions. Read and understand your plan and benefits. Know your copayments and what services are covered and what services are not covered. Follow the directions and advice you and your health care professionals have agreed upon. See the specialists your primary care physician refers you to. Make sure you have the correct authorization for certain services, including inpatient hospitalization and out-of-network treatment.

Show your member ID card to health care professionals before getting care from them. Pay the copayments required by your plan. Promptly follow your plan's complaint procedures if you believe you need to submit a complaint.

Treat doctors and all providers, their staff, and the staff of the plan with respect. Not be involved in dishonest activity directed to the plan or any health care professional. Tell your health care professionals if you do not understand the treatment you receive and speak up if you do not understand how to care for your illness. Tell a health care professional promptly when you have unexpected problems or symptoms. Consult with your primary care physician for referrals to non-emergency covered specialist care or hospital care.

Understand that network doctors and other health care professionals who care for you are not employees of Aetna and that Aetna does not control them.

Call Aetna's Member Services department about your plan if you do not understand how to use your benefits. Give correct and complete information to doctors and other health care professionals who care for you. Tell Aetna about other medical insurance coverage that you or your family members may have. Ask your treating doctor about all treatment options, and how the doctor is paid by Aetna. You may have additional rights and responsibilities depending upon any state laws applicable to your plan.

Myron is a year-old book editor in Philadelphia. He and his longtime boyfriend, Joseph, who maintain separate homes, love to travel. With that in mind, he switches to an HDHP. The HSA helps pay his medical bills. Myron is feeling confident that he and Joseph will soon be planning their next trip. Ready to test out your newfound knowledge? Take our quiz , and see how you do! Links to various non-Aetna sites are provided for your convenience only.

Aetna Inc. The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message. Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan.

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