How to use your benefits

Direct access to care

You can go to any in-network provider without a referral. Some services may require prior authorization. If you prefer, you can choose a women's health specialist to be your PCP.

You can get the following services from out-of-network providers without referral or approval from Aetna Better Health:

  • ›Emergency services
  • ›Family planning
  • ›Treatment for sexually transmitted diseases (STDs)

If you have a chronic or severe illness like HIV or AIDS, we encourage you to talk with your primary care provider (PCP) about your care.

Your primary care provider (PCP)

A primary care provider (PCP) takes care of most general health care needs. This person is usually a doctor, but can be a physician assistant or a nurse practitioner. You can choose the PCP you’d like to see for your well care checkups. This also is where you’ll go first for medical problems. Your PCP will become your medical home. A medical home keeps all your records together in one place. This helps make sure you get the right medical care when you need it.

Get to know your PCP. It helps ensure that you get medical care from someone who knows you and from someone who you feel comfortable with.  If you have a new PCP, call your PCP and make an appointment, even if you are not sick. You can get to know each other. Your PCP will learn about your health condition to prevent or detect future illness.

Your PCP will help keep you well by:

  • ›Teaching you how to stay healthy
  • ›Treating a health problem before it becomes serious
  • ›Keeping your immunizations (shots) up to date
  • ›Providing care when you are sick

You can get care 24 hours a day, 7 days a week. This includes holidays and weekends.

Don’t forget, your PCP’s phone number is on your Aetna Better Health Member ID card.  If you need care after your PCP’s office closes, call the office to find out how to get care after hours. There will be an answering service. If it’s not an emergency, leave a message. Someone will call you back. Please allow time for them to answer. You can change your PCP at any time by calling us at 1-855-300-5528 (TTY: 711 or TDD: 1-800-627-4702). There‘s no limit to how many times you can change your PCP.

If you need our free Provider Directory, call Member Services and we will mail one to you. You can always search online for a provider.

24-Hour Nurse Line

If you can’t reach your PCP or the doctor on call, call our 24-Hour Nurse Line at 1-855-620-3924 (TTY: 711).