A Guide To the Aexcel^® Network

The blue star on the results page identifies Aexcel specialists. These are doctors who meet our high standards for both clinical performance and efficiency. Going to an Aexcel specialist can lower your costs.

What does Aexcel mean?

You know what a network is, right? This is when a group of doctors agree to provide services to insurance companies' customers for less than they usually charge. Let's say you have an Aetna health insurance plan. When you go to a doctor in Aetna's network, usually you pay less than when you go to a doctor who is not in the network.

But within the Aetna network, there is a group of specialists who meet additional clinical quality and cost criteria. These specialists receive the Aexcel designation.

You can read more about the doctor evaluation process on Aetna.com. Just do a search for "Aexcel".

Keep in mind

Aexcel designation is only a guide for you for selecting a specialist. Talk with your doctor before you make a decision. All reviews have a risk of error. They cannot guarantee how your treatment will turn out.

What if my specialist does not have a blue star?

• This does not mean the specialist does not provide quality services
• We might not have enough data to evaluate this specialist
• This specialty is not one of the 12 Aexcel categories

How do we decide which specialists are in the Aexcel network?

We consider three factors:

• Volume
• Clinical performance
• Efficiency standards

First, we look at all doctors in our network who are in one of the 12 Aexcel specialties. We identify those who have managed at least 20 "episodes of care" for our members over the past three years.

What's an episode of care?
Well, it might be a hip implant or treatment for a chronic heart condition. We include all services associated with the doctor, not just office visits. The review includes inpatient, outpatient, diagnostic, laboratory and pharmacy claims for patients of these doctors.

Second, we look at clinical performance
Here are some questions we ask:

• After a hospital stay do the doctor's patients go back in the hospital within 30 days?
• How often do serious problems develop during hospital stays?
• What industry recognitions does the doctor have?
• How does the doctor keep up board certification?
• Does the doctor use electronic prescribing or electronic medical records?

We also look at efficiency. These are the areas we examine:

• The cost for services
• The number and types of services performed
• Resources used to treat the doctor's patients

Are there enough doctors for me in this network?

We work hard to make sure our Aexcel network has enough doctors to meet your needs. We may even add doctors to make sure there are enough to choose from. But we do not add doctors back if they do not meet certain performance standards.

What if my doctor's Aexcel status changes during my treatment?

This can happen. We look at doctors' performance every two years. As a result, new doctors may join the Aexcel network, others may no longer qualify. However, these doctors still remain in the broader Aetna network.

Want to check on your doctor's status? It's easy. Just go to www.aetna.com and log in to your secure Aetna Navigator^® member website.

If your doctor's status changes, it's smart to check your plan benefits.

Your plan may require that you only use Aexcel doctors. Let's say you need care from a doctor in one of the 12 Aexcel categories. If you go to a doctor who is not Aexcel you would pay much more. Or your care may not be covered at all.

Or your plan may let you see a doctor who is not Aexcel designated. But your costs may be higher than if you saw an Aexcel doctor in that same specialty.

Even if your plan does not have this benefit, you may want to consider choosing an Aexcel doctor if one is available in your area.

How can I talk to you about the Aexcel network?

We would like to hear what you have to say. Give us your feedback by taking this brief survey.

How can I file a complaint?

To obtain a review or file a complaint you can:

• Call Member Services at the phone number on your member ID card
• Submit a request in writing to the Appeals Resolution Team address shown on your Explanation of Benefits (EOB) or the Member Complaint and Appeal form
• Fill out a Complaint and Appeal Form on Navigator. Go to "Requests & Changes" and select "Forms"

Members in Metro New York may also file their complaint with the National Committee for Quality Assurance. Just send it to customersupport@ncqa.org or to NCQA Customer Support, 1100 13th Street, NW, Suite 1000, Washington, DC, 20005.

NCQA serves as an independent ratings examiner for Aetna.

Health insurance plans are offered and/or underwritten by Aetna Life Insurance Company (Aetna).

This material is for information only. The Aexcel network is only available in select locations. Aexcel is not available with HMO plans. Aexcel designation is only a guide to choosing a physician. Members should confer with their existing physicians and specialists they're selecting before making a decision. Designations have the risk of error and should not be the sole basis for selecting a doctor Health insurance plans contain exclusions and limitations. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health care services. Information is believe to be accurate as of the production date; however, it is subject to change.
Policy forms issued in OK include, GR-23 and/or GR-29/GR-29N.