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Type of Providers Physicians and Medical Professionals Primary Care Physicians are physicians who coordinate your health care and may refer you to specialists as needed (depending on the plan you participate in.) This category includes: Internal Medicine, Pediatrics, Family Practice, General Practice, and in some states, OB/GYN. Specialists provide a variety of specific services. They include cardiologists, dermatologists, podiatrists, etc. Psychiatrists, Psychologists, Therapists, etc. provide mental health benefits. Other types of services that may be found in this category: Marriage/ Family Therapy; Social Workers; Counselors. Behavioral Health Providers provide mental health benefits. Other types of services that may be found in this category: Marriage/Family Therapy; Social Workers; Counselors; Substance Abuse Professionals; Employee Assistance Professionals (EAP). Natural Therapy Professionals ("Professionals") include non-traditional types of Professionals, such as acupuncturists, chiropractors, massage therapists and nutritional counselors. Members have access to the services provided by these Professionals, which may be covered by the member's health benefit plan. Dentists Primary Care Dentists: A primary care dentist is a general dentist who a member must select; the primary care dentist is responsible for the diagnosis, treatment, management and overall coordination of services to meet patients' routine dental care needs, the primary care dentist will help coordinate the member referral when necessary. Some services provided by a primary care dentist are routine exams and cleanings, fillings and simple extractions. Specialists include Endodontists, Orthodontists, Oral Surgeons, Pedodontists, Periodontists and Prosthodontists Providers with this symbol If planning to visit a dentist participating in a plan with the PPO II network, confirm your plan includes that network. Medical Facilities Medical Hospitals provide emergency and non-emergency services, both in and out patient. Mental Health Facilities specialize in the treatment of behavioral/mental health issues. The information contained herein is provided for information purposes only. Your behavioral health benefits plan may require that you call a behavioral health toll-free number to receive pre-certification and/or avoid a reduction in benefits. For additional information on the specific requirements of your benefits plan please refer to your benefits plan booklet or call the toll-free number listed on your member ID card. If your plan requires, please be sure to call the toll-free number listed on your member ID card prior to seeking care. Substance Abuse Facilities specialize in the treatment of addiction issues. The information contained herein is provided for information purposes only. Your behavioral health benefits plan may require that you call a behavioral health toll-free number to receive pre-certification and/or avoid a reduction in benefits. For additional information on the specific requirements of your benefits plan please refer to your benefits plan booklet or call the toll-free number listed on your member ID card. If your plan requires, please be sure to call the toll-free number listed on your member ID card prior to seeking care. Ambulatory Surgicenters are stand-alone facilities, not associated or affiliated with a hospital outpatient facility, that provides surgical services for members not requiring inpatient hospitalization services. Urgent Care Facilities can be accessed for conditions or services that are non-preventive or non-routine, and needed in order to prevent the serious deterioration of a member's health following an unforeseen illness, injury or condition. Walk in Clinics typically consist of Nurse Practitioners and/or Physician Assistants and have a physician on call during all hours of operation. Walk in Clinics are designed to treat ailments such as strep throat, pink eye, and seasonal allergies as well as offer a limited list of vaccines such as tetanus, hepatitis and pneumonia. Walk in Clinics are not designed to be an alternative for primary care providers. They were designed to offer a quick alternative for common ailments with no appointment necessary. Other Facilities--Lab, X-Ray, etc. . . are services accessed through facilities and vendors. They include: Durable Medical Equipment, Home Health Care Agencies, MRIs, Radiology Centers, and Rehabilitation Services. Durable Medical Equipment National Durable Medical Equipment Providers: Durable Medical Equipment (DME) Providers that have met extensive performance criteria and offer high quality comprehensive services which may include oxygen, wheelchairs, soft goods and highly specialized items. Typically, these providers can provide service across the country in most geographic locations. Nationally contracted providers offer 1-800 numbers in order to assist the member/patient with Durable Medical Equipment needs. They will deliver/ship the equipment within 24 hours of receiving a request. Local Durable Medical Equipment Providers: Durable Medical Equipment (DME) Providers that have limited locations and/or services that are contained within a specific geographical location. These providers are available to service your DME needs and may supply similar products as the National DME Providers. They can be located using the zip code search feature in DOCFIND. Institutes of Excellence™ Transplant Facilities: Hospitals that have met extensive quality and credentialing criteria have been selected by Aetna to participate in our Institutes of Excellence network for transplant and transplant related services. These facilities have been contracted on a transplant specific basis and facilities are considered participating only for the transplant type listed in this directory. To be considered in-network for coverage for transplant related services, including evaluation, transplant, and follow-up care, you must utilize an Institutes of Excellence participating facility that has been specifically contracted by Aetna for your transplant type. Services must be preauthorized with Aetna for coverage to be effective. Any facility that is not specified as an Institutes of Excellence network facility is considered non-participating or non-preferred for transplant related services, even if they are considered participating for other types of services. Facilities are listed in the Institutes of Excellence section of this directory by transplant type and by State. Pediatric Congenital Heart Surgery Facilities: Hospitals that have met enhanced credentialing criteria have been selected by Aetna to participate in our Institutes of Excellence network for pediatric congenital heart surgery services. Aetna requires that these services be preauthorized. The listed facilities have premier pediatric congenital heart surgery programs but you may access any Aetna participating pediatric congenital heart surgery provider in order to receive any applicable preferred level of benefits. Refer to your plan of benefits for details. Facilities are listed in this section of the directory by state. Institutes® of Quality Bariatric Surgery Facilities: Facilities that have met Aetna's designation requirements for clinical quality, access and cost efficiency for bariatric services have been selected by to participate in our Institutes of Quality® for Bariatric Surgery. Bariatric services must be preauthorized with us for coverage to be effective. This is in accordance with our Clinical Policy Bulletins (CPBs). You can find these CPBs in the Health Coverage Information section on our public website, on www.aetna.com (our public website) for both members and providers. Bariatric surgery is not a covered benefit under all plans, and the Bariatric Network is not available for all plans. Please check your benefits plan for details. Facilities are listed in this section of the directory by region. Eye Care Locations Aetna Vision Preferred Provider Locations provide services for routine eye examinations, eyeglasses and contact lenses. This category includes ophthalmologists, optometrists, and opticians. Providers participate in the Aetna network through an agreement with EyeMed Vision Care, LLC and/or its affiliates (EyeMed). These providers are not credentialed by Aetna, but are subject to the credentialing requirements of EyeMed. If you should have any questions, contact 1-877-9-SEE-AETNA. To find a provider for services other than routine exams or eyewear, please select your Medical plan and choose either Ophthalmology or Optometry as the provider specialty. Vision Discount Program Locations offer discounts on eye examinations, eyeglasses and contact lenses through the Vision Discount Program. This program is available to Aetna health and dental plan members. No referral from a primary care physician is required for the Vision Discount Program. Pharmacy Locations Pharmacy: Locate the closest participating pharmacy to you. Specialty Pharmacies: The Specialty Pharmacy Network is a network of participating specialty pharmacies that serves the injectable and other specialty medication needs of Aetna members with certain high-cost, high-risk chronic health conditions. Hearing Services Locations Hearing Services: Hearing discount program locations offer discounts on hearing exams, services and hearing aids. The program is available to all members. You do not need a referral from a primary care physician. However, if your benefits plan covers hearing exams and hearing aids, consult your directory of health care professionals or log on to DocFind for a list of participating audiologists. Your out-of-pocket expenses could be lower if you use a participating audiologist. |
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may participate with Aetna through an agreement that Aetna has with a vendor. The provider may not be directly contracted with Aetna, and, consequently, not credentialed by Aetna. Providers available through these vendors are only subject to the credentialing requirements, if any, of the vendor. If you should have any questions, contact Aetna Member Services.