HMO - Aetna Medicare

Follow-up Care after Emergencies
All follow-up care should be coordinated by your PCP.
Follow-up care with non-participating providers is only
covered with a referral from your PCP and prior
authorization from Aetna. Whether you were treated
inside or outside your Aetna Medicare service area, if
your plan requires referrals, you must obtain a referral
before any follow-up care can be covered. If your plan
does not require referrals you should contact Aetna at
the number on your ID card before care is received at
non-network facilities. Suture removal, cast removal,
X-rays and clinic and emergency room revisits are
some examples of follow-up care.
PPO plans: All in-network and out-of-network followup
care will be covered under the terms and
conditions of your plan.
Emergency care can always be obtained in or out of
the service area from the nearest available provider.
When in the service area HMO plan members must
use plan providers for urgent care. When out of the
service area urgent care may be obtained from the
first available provider. In addition, when out of the
service area you can obtain dialysis treatment from
any qualified dialysis provider. If HMO plan members
obtain routine care from out-of-network providers
neither Medicare nor Aetna Medicare will be
responsible for the costs.
What is the service area for Aetna
Medicare (HMO) (PPO) plan?
Please refer to the Service Area Map at the back of
this book for the counties included in this directory.
How do you find Aetna Medicare (HMO)
(PPO) plan providers in your area?
To find a plan provider near your home, look under
the plan provider section of your choice (for example,
“Primary Care Physicians”). The county and city are
listed alphabetically in each plan provider section.
If you have questions about your Aetna Medicare
HMO or PPO plan or require assistance in selecting a
PCP, please call our Member Service Department at
1-800-282-5366, 8 am to 8 pm, 7 days a week.
TTY/TDD users should call 1-888-760-4748.
Or, visit www.aetnamedicare.com.
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