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FAQs

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Is my doctor in the network?

To see if your doctor is in our network, click a plan link below.

  • HMO Plan
  • Open Access Plan
  • QCHP/CDHP Plan

For step-by-step instructions, click on a plan below.

  • HMO Plan (PDF)
  • Open Access Plan (PDF)
  • QCHP/CDHP Plan (PDF)
Do I need to take action in an Aetna health benefits plan?

Click for details of enrollment.

What if I lose my Aetna member ID card and have an appointment the same day?

You can print your ID card from your secure Aetna member website.

  • Log in or register to your secure Aetna member website
  • Look under “Request & Changes”
  • Select “ID card”
  • Print your ID card

You can also display a digital copy of your Aetna ID card through the Aetna Health app.

Find what you need — wherever, whenever — with Aetna Health app. Download the app from your app store, or text AETNA to 90156 for a link.*

 

*Data and messaging rates may apply.
How can I find out if my doctor submitted my claim?
  • Go to your secure Aetna member website and log in or register. The claims tab shows a quick view of the most recent claims on file. Each claim line includes the date of service, patient and provider name.
  • Click on the “details” link to access the Claim Details screen View more information about the selected claim. There is also a link to search for other claims on file.
Where can I find information about pharmacy benefits?

CVS/caremark administers the pharmacy benefits for the Aetna OAP and QCHP Plans. For more information on the CVS/caremark pharmacy benefits, visit www.caremark.com or call 1-877-232-8128.

Aetna HMO Plans

To find information about your pharmacy benefits for the Aetna HMO Plans, including a list of covered drugs on the formulary, click on the button below.

Pharmacy benefits for HMO

2024 Aetna Pharmacy Drug Guide 

What is an urgent care center?

Urgent care centers are a great option for when you need prompt medical treatment for non emergency care.*

Urgent care centers can treat common problems like sprains, animal bites, ear and throat pain and more. They offer convenient hours, including extended evening, weekend and holiday hours. You just walk right in — no appointments needed.

To find an urgent care center near you, log in to your Aetna member website.

If you have questions before you go, call our 24-Hour Nurse Line at 1-800-556-1555. While only your doctor can diagnose, prescribe or give medical advice, our nurses can provide information on a variety of health topics.

 

*It isn't always easy figuring out what's a non-emergency versus an emergency. So if you have any doubt, play it safe and head to your local ER or call 911.
What is preauthorization or precertification?

Preauthorization or precertification* is an important process. It is approval a person gets for care before receiving the care. This helps people know if the care is covered by a health plan. People should check with their plan to see what kind of service needs this approval.

This can also be called: 

  • Authorization
  • Certification
  • Prior authorization

List of services (PDF)

 
*In Texas, this approval is known as pre-service utilization review and is not verification as defined by Texas law.
My doctor is not in the network. How do I submit a claim?

Please visit the Find a Form page on Aetna.com and click on "Medical, dental & vision claim forms". There, you can download a claim form and find instructions for submitting a claim.

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