Benefits FAQs

Call our Member Services Department.

Medicaid Member Services at 1-800-441-5501
Comprehensive Long Term Care Member Services at 1-844-645-7371
Florida Healthy Kids Member Services at 1-844-528-5815

A complaint/grievance may be filed orally or in writing at any time. To file a complaint or grievance call Member Services, Monday through Friday, 8 a.m. - 7 p.m. Eastern Time, TTY 711.

Medicaid Member Services at 1-800-441-5501
Comprehensive Long Term Care Member Services at 1-844-645-7371
Florida Healthy Kids Member Services at 1-844-528-5815 (Monday through Friday 7:30 a.m. to 7:30 p.m. Eastern)

Or, you can write to:

Aetna Better Health of Florida
Grievance & Appeals Department
261 N. University Drive
Plantation, FL 33324

Fax: 1-860-607-7894

A plan appeal is a formal request from an enrollee to seek a review of an action taken by the Managed Care Plan. A plan appeal must be filed within sixty (60) calendar days of receiving the Notice of Adverse Benefit Determination (Denial Letter). If the plan appeal is filed orally (except for an expedited appeal), it must be followed up with a written notice within ten (10) calendar days of calling in the plan appeal. A Medicaid member may file a plan appeal, or a Provider acting on the Medicaid member’s behalf with written authorization, may file a plan appeal.  To file a plan appeal call Member Services, Monday through Friday, 8 a.m. - 7 p.m. Eastern Time, TTY 711. Or, you can write to:

Aetna Better Health of Florida
Grievance & Appeals Department
261 N. University Drive
Plantation, FL 33324
Fax: 1-888-684-4928 (member) or 1-860-607-7894 (provider) 

Medicaid Member Services at 1-800-441-5501
Comprehensive Long Term Care Member Services at 1-844-645-7371
Florida Healthy Kids Member Services at 1-844-528-5815 (Monday through Friday 7:30 a.m. to 7:30 p.m. Eastern)

A Fair Hearing can be requested any time up to 120 days from the date of the Notice of Adverse Benefit, or up to 120 days after getting our decision on the member’s appeal. A Fair Hearing can be requested by calling 1-877-254-1055 or in writing to:

Agency for Health Care Administration
Medicaid Hearing Unit
P.O. Box 60127
Ft. Myers, FL 33906
1-877-254-1055 (toll-free)
1-239-338-2642 (fax)

MedicaidHearingUnit@ahca.myflorida.com

Medicaid Fair Hearing does not apply to MediKids or Florida Healthy Kids members.

Babies born to mothers in the program will be enrolled automatically in the program for up to 3 months. The 3 months starts with the month of the birth. You must enroll the baby with the Florida Department of Children and Families Services before your baby is born to make sure your baby has Medicaid. Please call the Florida Department of Children and Families at 1-866-762-2237. This is important to make sure your baby does not have a problem getting care.

Call Member Services to report an address change.

Medicaid Member Services at 1-800-441-5501
Comprehensive Long Term Care Member Services at 1-844-645-7371
Florida Healthy Kids Member Services at 1-844-528-5815

If a card is lost or stolen, please call Member Services right away.

Medicaid Member Services at 1-800-441-5501
Comprehensive Long Term Care Member Services at 1-844-645-7371
Florida Healthy Kids Member Services at 1-844-528-5815

It’s never fun to get bills in the mail. Doctor bills can be costly and scary. We have some tips for you to keep them out of your mailbox.

  • Always use a provider in the Aetna Better Health Network.
  • You may have to pay for bills from providers who are not in-network with Aetna Better Health.
  • Carry the Aetna Better Health ID card with you everywhere.
  • Be sure to show the doctor or hospital your Aetna Better Health card when you arrive or before you leave.
  • Make sure the name on the card matches what your doctor has on your file.
  • Check with the provider to make sure the spelling of your name matches your Aetna Better Health card. A wrong spelling can cause the doctor’s bill to be rejected.

If you ever get a bill, please call Member Services toll-free and we will assist you.

Medicaid Member Services at 1-800-441-5501
Comprehensive Long Term Care Member Services at 1-844-645-7371
Florida Healthy Kids Member Services at 1-844-528-5815

Medicaid Members: Medicaid Plan members don’t pay anything for covered medical items, services, or prescription drugs. Your Member Handbook has information about your covered benefits: https://www.aetnabetterhealth.com/florida/members/handbook

You may also call our Member Services department at 1-800-441-5501 for help.

 

Florida Healthy Kids Members: For Florida Healthy Kids members, some services require a copayment, a specified amount you pay to the provider when your child receives services. A copayment is sometimes called a copay. Not all services require a copayment. Preventive services, like well-child visits and routine vision screenings, are free! American Indians and Alaskan Natives who meet certain requirements do not pay any copayments. Your Member Handbook has information about your covered benefits and copays: https://www.aetnabetterhealth.com/florida/members/handbook

You may also call Member Services at 1-844-528-5815 for help.

Medicaid Members: Florida’s Agency for Healthcare Administration (AHCA) decides which benefits to cover under the Florida Medicaid Program. Decisions are based on scientific evidence of safety and effectiveness. Aetna Better Health of Florida covers all items, services, and drugs that AHCA decides to include as covered benefits.

 

Florida Healthy Kids Members: Doctors and health care companies are creating new technologies. This can be anything from a new test to a new machine. The Plan has processes on how to look and judge new devices. When we find out about new devices, we look over the new information. We may also ask experts for their views. Aetna Better Health matches the information with known standards. We base our decisions on making sure you have the right care.

How to use your benefits

The name and phone number of your doctor is on your ID card. Your doctor will help you with all of your health care.

For some care, your doctor will send you to a specialist. You must use our doctors except in an emergency.

Some doctors can’t perform some services because of religious or moral beliefs. If there's a change in the doctor's services based on moral or religious beliefs, we’ll tell you within 90 calendar days after the change. For counseling or referral services that we don’t cover because of moral or religious views, we don’t need to provide information on how and where to get it.

Family Planning
You can go to Family Planning classes or get materials. Family Planning services includes information, education, counseling, diagnostic procedures and contraceptive medication and supplies. Services are voluntary and you have full freedom of choice of methods for Family Planning to help you plan a family size or help you space the time between having children. You can go to any provider that participates with Medicaid for these services without a referral from your PCP. Family Planning services do not require prior authorization.

For some care, you need a “referral” from your doctor. A referral makes sure you see the right doctor at the right time. If you don’t get a referral when you need one, you may have to pay.

You need a referral for most specialists. You do not need one for mental health care. You do not need one for routine women’s health care or family planning. Emergency services also do not require a referral. Routine out-of-network services require prior authorization.

We will tell your doctor that you are a member. When you go to the doctor, show your card. Your name, your Primary Care Provider's (PCP) name and your doctor’s phone number are on the card.

You can see your doctor right away. Call to make an appointment. The phone number is on your card. Call if you need to cancel the appointment. If your doctor leaves our plan, you can get care from the doctor for up to 6 months if you are in an active course of treatment that is medically necessary. If you are pregnant, you can stay with your doctor until you have the baby.

Call your doctor or go to an urgent care center for minor problems. Go to the nearest hospital or call 911 for emergencies. Call your doctor and us after you go to the hospital.

Emergency care

For emergencies, go to a hospital closest to you or call 911. Call your doctor and us if you go to the hospital. You do not have to get prior authorization from the plan for emergency or post-stabilization service. If you have an emergency and you are outside of our service area, go to the closest hospital or call 911. Call your doctor and us as soon as you can.

Please remember, you should call 911 or go to the emergency room if you have serious health issues like:

  • Chest pain, shortness of breath, and other symptoms of heart attack or stroke
  • Major broken bones
  • Uncontrollable bleeding
  • Deep wounds
  • Serious burns
  • High Fever (105 degrees F)
  • Major head injury
  • Thoughts of hurting yourself or others
  • Fainting

Urgent care

Urgent care clinics are there for you and your family when you need to see a doctor and your doctor is not able to see you or the office is closed. Most urgent cares are open 24/7 and have short wait times. Health problems that can be treated in urgent cares include:

  • Common colds and flu symptoms
  • Ear pain
  • Minor cuts and scrapes
  • Sprains or strains
  • Sore throat
  • Minor burns 

It’s good to know which urgent care clinic is close to you. You can find a list of urgent care clinics in our online Provider Search or you can call Member Services. If you have trouble hearing, dial 711.

If you are having a medical emergency you should call 911. Do not try to drive yourself if you are having bad chest pain, bleeding that doesn’t stop, or if you feel like you might faint or if you cannot see well.

 

Your doctor will call the plan to get approval for some services. Your doctor will let you know which services need to be approved before you receive them. You do not have to get approval for emergency services or post-stabilization services.

Out of network services

If you need a service and we cannot provide it in our network, we will help you get these services out of network. If we approve you to go out of network, we will be sure the cost is no greater to you than in our network. Call Member Services for more information.