Frequently asked questions

Find answers to commonly asked questions

To change your PCP, call Member Services at 1-855-300-5528 (TDD/TTY 711). Or go log into our secure member portal and select My Online Services to change PCPs.

Aetna Better Health of Kentucky will try its best to deal with your concerns or issues quickly and bring about a result that is acceptable. You may use our grievance process or our appeal process, depending on what kind of problem you have.

There will be no change in your services or the way you are treated by Aetna Better Health of Kentucky staff or a health care provider because you file a grievance or an appeal. We will maintain your privacy and give you any help you may need to file a grievance or appeal. This includes providing you with interpreter services or help if you have vision and/or hearing problems. You may also choose someone like a relative, friend or provider to act for you.

To file a grievance or to appeal a plan action, call 1‑855‑300‑5528 (TTY users dial 711, TDD users dial 1‑800‑627‑4702), or write to:

Aetna Better Health of Kentucky
Attn: Complaint and Appeal Department
9900 Corporate Campus Drive
Suite 1000
Louisville, KY 40223
Fax: 1-855-454-5585

When you contact us, you will need to give us your name, address, telephone number and the details of the problem.

Yes. Babies born to mothers enrolled in Aetna Better Health of Kentucky should be automatically enrolled in Aetna Better Health. Please call your local Department of Community Based Services and Aetna Better Health of Kentucky at 1-855-300-5528 (TTY users dial 711; TDD users dial 1-800-627-4702.

Emergency transportation: Call 911 or the closest ambulance service.

Non‑emergency transportation: Kentucky Medicaid will pay to take some members to get medical services covered by Kentucky Medicaid. If you need a ride, you must talk to the transportation broker in your county to schedule a trip.

Please note: KCHIP III children do not get non‑emergency transportation.

Each county in Kentucky has a transportation broker. You can only use the transportation broker for a ride if you cannot use your own car or do not have one. If you cannot use your car, you have to get a note for the transportation broker that explains why you cannot use your car. If you need a ride from a transportation broker and you or someone in your household has a car, you can:

  • Get a doctor’s note that says you cannot drive
  • Get a note from your mechanic if your car does not run
  • Get a note from the boss or school official if your car is needed for someone else’s work or school
  • Get a copy of the registration if your car is junked For a list of transportation brokers and their contact information, please visit www.chfs.ky.gov/dms/ or call Kentucky Medicaid at 1‑800‑635‑2570. For more information about transportation services, call the Kentucky Transportation Cabinet at 1‑888‑941‑7433.
  • The hours of operation are Monday through Friday, 8 a.m. to 4:30 p.m. ET and Saturday 8 a.m. to 1 p.m. ET. If you need a ride, you have to call 72 hours before the time that you need the ride. If you have to cancel an appointment, call your broker as soon as possible.

Kentucky Medicaid does not cover rides to pick up prescriptions.

You should always try to go to a medical facility that is close to you. But if you need medical care from someone outside your service area, you have to get a note from your PCP. The note has to say why it is important for you to travel outside your area. (Your area is your county and the counties next to it).

Referrals

Aetna Better Health of Kentucky does not require a referral from your PCP or OB/GYN before you see another Aetna Better Health provider unless you are a Lock‑In member. Your PCP is your medical home and should coordinate your care. You should call your PCP to tell him/her you are going to the other provider. We do not require a referral for members to see in‑network

doctors for routine and preventive health care services unless you are a Lock‑In member. Lock‑In members must have a referral to see any provider except the one that they are already assigned.

Prior authorization

Aetna Better Health of Kentucky must approve some health care services and supplies before you get them. This is called prior authorization.

Aetna Better Health follows nationally recognized guidelines for the care your provider suggests. These guidelines are used to make prior authorization decisions. Some services that need prior authorization are listed below. Your provider can get the full list of services that need prior

authorization. This list may change from time to time. Call Member Services at 1‑855‑300‑5528

(TTY users dial 711, TDD users dial 1‑800‑627‑4702), Monday through Friday, 7 a.m. to 7 p.m.

ET, to request the most current list.

Prior authorization list

Your provider must check if a prior authorization is required before providing you a service. Some items that require prior authorization are:

  • All inpatient services, including psychiatric, skilled nursing facilities and rehabilitation
  • All physical health services provided in the home
  • All services administered by providers not in our network (except an emergency; care for a child in foster care; and family planning)
  • Purchase of durable medical equipment, prosthetics, enterals and supplies costing more than $500
  • Durable medical equipment rentals
  • Dental anesthesia (in an outpatient facility)
  • Transplant services, including transplant evaluation
  • Some mental health and substance use services (not emergencies)
  • Metabolic foods
  • Some vision services
  • Some dental services
  • Chiropractic visits after the first 12
  • Radiology services (CT scans, MRIs, PET Scans)
  • Cardiology services
  • Most surgical procedures
  • Pain management services

*An Aetna Better Health of Kentucky network provider may not be in the transplant network. Please work with your Aetna Better Health transplant case manager to choose a provider.