Disease Management

We want to help you be as healthy as possible

Our Disease Management Program is designed to help you manage illnesses and chronic diseases. We mail you detailed materials to help you manage your condition.

If you need more education, you will be signed up for complex case management. Complex case management includes a personal care plan with exact goals. Our nurses provide you with instructions and help in getting through the system. They can help you get transportation and can talk with your doctor. The goals rate your progress with getting better. Your case is closed when the goals are met.

 

Utilization Management (UM) is the process Aetna Better Health of Kentucky of Kentucky uses to make sure members receive the right care at the right place and at the right time.

The Aetna Better Health of Kentucky of Kentucky UM program ensures that members receive quality services that are medically necessary.

  • We look at the care you get based on:
    • Your covered benefits and;
    • If the service is medically necessary
  • We do not reward any providers or staff for denying coverage or services
  • We do not give money to any providers or staff to make decisions that keep you from getting the right care.

If you call after hours, you can leave a message and someone will call you the next business day.  Aetna Better Health of Kentucky of employees make clinical decisions regarding health care based on the most appropriate care, service available and existence of benefit coverage. Aetna Better Health of Kentucky does not reward providers or other employees for any denials of service. Aetna Better Health of Kentucky does not encourage nor reward clinical decisions that result in decreases or under use of services.

Our staff is here to help you. We will tell you our name, what we do and that we are with Aetna Better Health of Kentucky of Kentucky when you call us, so you know whom you are speaking with. The office hours are 7:00 a.m. to 7:00 p.m. Eastern Time, Monday through Friday for any UM questions.

If you have any questions about a UM process or a UM issue, please call Member Services, toll free, at 1-855-300-5528 (TTY 711). Free interpreter services are available for all languages.

Aetna Better Health of Kentucky does not use incentives to encourage barriers to care and service. Aetna Better Health of Kentucky prohibits any employee or representative of Aetna Better Health of Kentucky from making decisions regarding hiring, promoting, or termination of providers or other individuals based upon the likelihood or perceived likelihood that the individual or group will support or tend to support the denial of benefits.

You are signed up for the disease management program when you have a lasting condition. You can sign up or close the case whenever you want. We offer disease management to our members with the following conditions:

  • ›Asthma
  • ›Congestive Heart Failure (CHF)
  • ›Diabetes
  • ›Chronic Obstructive Pulmonary Disease (COPD)
  • ›Chronic Renal Failure
  • ›Coronary Artery Disease (CAD)
  • ›Depression

If you would like more information, contact Member Services toll free at 1-855-300-5528 Monday through Friday, 7 a.m. to 7 p.m., ET (TTY 711).