Directory - Aetna Medicare

What to Do Outside Your Aetna GoldenChoice Plan Service AreaMembers are covered for emergency and urgentlyneeded care. Urgent care may be obtained from aprivate practice physician, a walk-in clinic, an urgentcare center or an emergency facility. Certainconditions, such as severe vomiting, earaches, sorethroats or fever, are considered "urgent care" outsideyour Aetna Golden Choice Plan service area and arecovered in any of the above settings.If, after reviewing information submitted to us by theprovider that supplied care, the nature of the urgentor emergency problem does not qualify for coverage,it may be necessary to provide us with additionalinformation. We will send you an Emergency RoomNotification Report to complete, or a Member Servicesrepresentative can take this information by telephone.Follow-up Care after EmergenciesAll in-network and out-of-network follow-up care willbe covered under the terms and conditions of yourplan.How Aetna Compensates Your ProviderAll the physicians in the directory are independentpracticing physicians that are neither employed norexclusively contracted with Aetna. Individual physiciansare in the network by either directly contracting withAetna and/or affiliating with a group or organizationthat contracts with us.Physicians, hospitals and other providers in ournetwork are compensated in various ways for theservices covered under your plan.■ Per individual service or case (fee for service atcontracted rates).■ Per hospital day (per diem contracted rates).Non-network providers providing covered services arereimbursed by referring to the Original Medicareapproved amount and determining the allowable fee.You are encouraged to ask your physicians and otherproviders how they are compensated for their services.XXIV