Resources and services
Resources for you
We want to help you be (and stay) healthy. And we want to make sure you are getting the care and service you deserve. So, in addition to your benefits, there are a few other things you need to know about your health plan.
Help is a phone call away
Not sure if you should go to the emergency department or urgent care? The Aetna Better Health Premier Plan Nurse Line can help. For answers to your questions, call Member Services at 1-866-600-2139.
If you have a medical emergency, dial 911.
Communication Methods/Language Assistance
We can give you information in another format or language. This includes enrollment materials. We have audio CD-ROM, large print or Braille. Our member materials are also available in Spanish. We offer language interpretation services, including sign language, as well as CART reporting for the hearing impaired at no cost to you. Call Member Services at 1-866-600-2139 (Aetna Better Health Premier Plan members) for more information.
ICP, FHP and MLTSS members that need language assistance after January 1, 2018 should contact their new plan. If you are not sure of your new plan, please call your care coordinator or the Illinois Client Enrollment Services at 1-877-912-8880 (TTY: 1-866-565-8576) for more information.
Your health is important
We believe in total health. The use of alcohol, some prescription medicines, or other drugs may affect your health. If you experience alcohol or drug issues or substance abuse, you may need therapy services or medicine. Behavioral health benefits cover these services.
Your plan covers many kinds of services for substance abuse. Below is a partial list of what is covered. For a more complete list, view your Summary of Benefits.
- 24-hour access to help for a crisis
- Opiate dependence medication
- Intensive outpatient rehabilitation program
- Partial hospitalization rehabilitation program
If you are in crisis, we can help. Your behavioral health crisis line is available via Member Services at 1‑866‑600-2139 (Aetna Better Health Premier Plan members), 24 hours a day, 7 days a week. TTY Relay Illinois 711. In an emergency, call 911.
If you have a medical emergency, dial 911.
Use of emergency transportation must be for emergencies only.
If you need a ride to your health care appointments or to the pharmacy to pick up your prescription on the way home from an appointment, call Member Services at 1‑866‑600-2139 (Aetna Better Health Premier Plan members).
You can call to schedule a ride Monday - Saturday from 8 a.m. - 6 p.m. Central time. Please set up a ride at least three days before your appointment.
Mileage reimbursement is available if you use your own car or get a ride from someone. You have seven days after your appointment to ask for mileage reimbursement. Call Member Services at 1‑866‑600-2139 and they will help you do this.
Would you like to have some help in planning and coordinating your health care needs at the provider level?
For many of you, getting your health care needs or your family member’s needs taken care of can be hard. This can be especially difficult when you are helping a close family member. Aetna Better Health of Illinois understands this and offers a model of care that might be right for you.
Aetna Better Health of Illinois provides a new way to deliver and coordinate your health care through providers who use Health Homes. Health Homes focus on you working with your health care team. You are the most important person on the health care team. Together with your health care team, you plan and coordinate your care.
To find out more about how to participate in a Health Home, please call Aetna Better Health of Illinois Member Services.
1‑866‑600-2139 Hearing Impaired (TTY/TDD: 711)
While we never want to think about the end of life, it is important that everyone plan for it. You should consider what kind of care you would want if you were unable to tell your wishes.
There are legal documents that you can use to give your directions in advance. These documents are advance directives. They include documents such as “living wills” or “power of attorney for health care.”
Aetna Better Health Premier Plan has policies to help you arrange advance directives so your wishes will be honored.
You have the right to give instructions about what should be done if you are not able to make medical decisions for yourself. Sometimes people become unable to make health care decisions for themselves because of accidents or serious illness. You have the right to say what you want if this happens to you.
This means that, you can:
- Fill out a written form to give someone the legal authority to make medical decisions for you if you are unable to make decisions yourself.
- Give your doctors written instructions about how to handle your medical care if you are unable to make decisions yourself.
To use an advance directive, you need to:
Get the form
If you want to have an advance directive, you can get a form from your lawyer, a social worker or some office supply stores. You can sometimes get advance directive forms from organizations that give people information about Medicare.
Fill it out and sign it
This form is a legal document. You should think about having a lawyer help you with it.
Give copies to appropriate people
Give a copy of the form to your doctor. Give another to the person you name on the form as the one to make decisions for you if you can’t.
You may want to give copies to close friends or family members as well. Be sure to keep a copy at home.
If you know ahead of time that you are going to be hospitalized, take a copy of your advance directive with you to the hospital. If you are admitted to the hospital, the staff will ask you if you have signed an advance directive form and if you have it with you.
Abuse, Neglect and Exploitation
We care about your safety, health and welfare. It is important to recognize signs of abuse, neglect and exploitation and report it. This will allow you to be safe and get the care you need.
Abuse can come in many forms such as:
- Physical abuse - Non-accidental use of force that results in bodily injury, pain or impairment. Includes but not limited to being slapped, burned, cut, bruised or improperly physically restrained.
- Verbal or emotional abuse - Includes but is not limited to name calling, intimidation, yelling and swearing. May also include ridicule, coercion, and threats.
- Sexual abuse - Any sexual behavior or intimate physical contact that occurs without your permission.
- Financial abuse - When someone uses your money without your consent. This includes improper use of guardianship or power of attorney.
Neglect - Neglect occurs when someone fails to provide or withholds the necessities of life from you. This includes food, clothing, shelter, or medical care.
Exploitation - The misuse or withholding of a member’s assets and resources (belongings and money). This includes, but is not limited to, misappropriation of assets or resources of the alleged victim by undue influence, by breach of fiduciary relationship, by fraud, deception, extortion, or in any manner contrary to law.
If you are or suspect that you are being abused, neglected or exploited please call the appropriate number below to report, prevent or stop the abuse, neglect or exploitation.
To report regarding members who are disabled adults 18 through 59 yeas of age who live in the community call the Illinois Adult Protective Services (DoA).
- 1-866-800-1409 (voice)
- 1-866-206-1329 (TTY)
To report regarding members in Nursing Facilities call the Department of Public Health Nursing Home Complaint Hotline.
To report regarding members in Supportive Living Facilities call the Supportive Living Facility Complaint Hotline.
Call member services or your care coordinator at any time to report abuse, neglect and exploitation. You can contact us 24 hours a day 7 days a week.
- 1-866-600-2139 (toll-free)
- TTY 7-1-1
It is important to us that you receive quality health care and customer service. Your satisfaction matters to us. Aetna Better Health of Illinois’ Quality Management program ensures our services meet high standards of quality and safety. We want to make sure you have:
- The care you need
- Easy access to quality medical and behavioral health care
- Help with any chronic conditions or illnesses
- Support when you need it most
- High satisfaction with your doctors and with us
If you have a problem, please call Member Services at 1-866-600-2139 (TTY: 711) 24 hours a day, 7 days a week.
Our Quality Management Program works to ensure that all of our services meet high standards of quality and safety. We aim to:
- Meet our members’ health care needs and diverse cultural and linguistic needs.
- Measure, monitor and improve the clinical care and quality of service our members get.
- Institute company‐wide initiatives to improve the safety of our members and communities.
- Improve access to health care
- Make sure we obey all the rules, whether they come from federal and state regulators or accrediting groups
We have quality programs so that you can get the care you need quickly. Some of our quality programs are:
- Surveying members and providers to measure satisfaction
- Calling members to remind them to get their care
- Educating members by sending postcards or newsletters
- Reviewing the type, amount and quality of services given to members
- Working with members who have serious health issues through case management
- Reminding providers and members about preventive health care
- Measuring standards like how long it takes for a member to get an appointment
- Monitoring phone calls to make sure your call is answered as quickly as possible and that you get correct information
- Reviewing calls and complaints from members
- Reviewing all aspects of the health plan with health plan staff, providers and members through committees
Throughout the year, we evaluate our quality programs and data trends related to how our members receive health care and preventive care services. We compare our findings to national practice guidelines. We will share this information with you in Quality Matters. You can call Member Services at 1-866-600-2139 (TTY: 711) to request a copy of our Quality Management Program and to learn more about what we're doing to improve your care.
Each year we check to see how close we are to meeting our goals. Here's what we did last year:
- We collected data on a set of clinical measures called the Healthcare Effectiveness Data and Information Set (HEDIS®). We shared the results with the National Committee for Quality Assurance (NCQA) and they make the results public. Each year, we use the results to set new goals and improve selected measures. As a result, performance has improved on many measures.
- We asked members how satisfied they are with Aetna Better Health of Illinois. We improved in rating of health plan, getting care quickly, and customer service. We met the cultural and language needs of our members.
- We surveyed members in the Case Management Program. Their satisfaction with the program is increasing.
- We reviewed access to doctors and learned that we need to improve access in Kankakee County.
Each year we like to remind you to review some important information in your member handbook. This is the handbook we sent you when you joined Aetna Better Health of Illinois.
This information helps you stay active and informed. It can help you when making health care choices for yourself. This notice gives a quick overview of what you need to know. You can learn about:
- Member rights and responsibilities
- Plans to improve quality
- Privacy and security of your health care data
- Getting the services you need to stay healthy
- Benefits questions
- How to get the care you need
- Care management
- Pharmacy services
- How to file a grievance or appeal