(HMO) (PPO) - Aetna Medicare

If you are traveling outside of the Aetna Medicare
(HMO) (PPO) plan service area, you are covered for
emergency and urgently needed care. Urgent care
may be obtained from a private practice physician, a
walk-in clinic, an urgent care center or an emergency
facility. If, after reviewing information submitted to us
by the provider that supplied care, the nature of the
urgent or emergency problem does not qualify for
coverage, it may be necessary to provide us with
additional information.
Follow-up care after emergencies
All follow-up care should be coordinated by your PCP.
Follow-up care with nonparticipating 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 the Aetna
Medicare (HMO) (PPO) plan?
The county in our service area is listed below.
Individual and Employer Group Service Area
County:
See Service Area Maps at the front of this directory for
product detail.
Richmond
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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