The Covered Services Matrix English / Spanish shows what services Aetna Better Health of Louisiana covers. Look at your benefits closely. It'll help you understand what is covered by your plan, what is not and how you can get the right care when you need it.
You have access to services like doctor’s visits, lab testing, X-rays and much more. These benefits and programs help you live a healthier life. Your benefits also include preventive care and help for serious health concerns. These may be chronic diseases or mental health issues. We also can connect you with resources in your community for extra help.
Some services need prior approval before you can get them, this is called prior authorization. All decisions are based on:
- whether the service is needed (medical necessity)
- whether the service is likely to be helpful (clinical appropriateness)
- if you have coverage
Check with your Primary Care Provider (PCP) or you can call Enrollee Services at 1-855-242-0802, TTY 711.
We do not reward providers for denying, limiting or delaying coverage of health care services. We also do not give monetary incentives to our staff to make medical necessity decisions that provide less health care coverage or services.
As an Aetna Better Health enrollees you do not have any copays. You do not pay anything to get services we cover. If a provider bills you, do not pay it and call us right away.
Medicaid covered services
There are some services that are covered by Medicaid but not by Aetna Better Health of Louisiana. Since these services are not covered by our Plan, you don’t have to use our network providers to obtain these services.
Extra benefits for our enrollees
Adult preventive care
Our program offers gift cards as incentives for wellness screenings, including:
- STI Screening — Chlamydia screening (16-24 years old) - $10 gift card
- Women’s mammogram — $15 gift card a two years
- Diabetes HbA1C Tests (A1C) — $10 gift card once per calendar year
- Cervical cancer screen—$15 gift card once every three to five years
- Colonoscopy (members aged 50 and over)—$25 gift card for initial colonoscopy
- Flu Vaccinations for adult members 18-64 years old—$5 gift card
To claim your reward just call 1-855-242-0802, TTY 711
Asthma Condition Management Program
Enrollees can enroll in the Asthma Condition Management program. Enrollees are identified for participation through use of a spreadsheet that lists enrollees identified as filling rescuer inhalers 10 times in 6 months. A letter is mailed to the enrollee's provider informing the provider of our Asthma Condition Management program.
Once you are enrolled in the program, the following incentives are available:
- A $15 gift card for follow-up with a PCP visit after an ED episode
- A $15 gift card annually for completing an asthma assessment with their PCP
- An in-home environmental assessment for members diagnosed with asthma
To claim your reward just call 1-855-242-0802, TTY 711
Dental care for adults
We will offer an exam and cleaning twice a year as well as a bitewing X-rays annually to adult enrollees. PLUS, effective December 1, 2015, every year we will cover $500 in fillings and extractions.
Only available to adult enrollees aged 21 and over who do not have dental coverage through another source.
Extended Enrollee Services hours
Enrollee Services has toll free extended hours available 24 hours a day, 7 days a week. You can always reach us at 1-855-242-0502, TTY 711.
$25 per month over-the-counter medicine and products
Free over-the-counter products
Aetna Better Health of Louisiana offers each household $25 worth per month of certain over-the-counter (OTC) drugs and supplies mailed right to your home. You can place an order online, by phone, by mail, or by fax. You will need your enrollees ID number to place an order.
- Ordering online: Visit online then enter your Aetna Better Health of Louisiana ID number to get started.
- Ordering by phone: Call 1-888-628-2770 from 8 a.m. to 4 p.m., Monday through Friday.
- Ordering by mail: Follow the instructions to complete the order form. Mail it to the address listed on the form.
- Ordering by fax: Follow the instructions to complete the order form. Fax completed for to 1-866-682-6733.
With the Aetna Better Health application, you can get on demand access to the tools you need to stay healthy. Find a doctor, request a enrollee ID card or change your Primary Care Physician (PCP) at any time, from anywhere. It’s easy. Just download the app to your mobile device or tablet.
Mobile app features:
• Find a provider
• Request your Enrollee ID card
• Change your PCP
• View your claims and prescriptions
• Message Enrollee Services for questions or support
• Update your phone number, address and other important enrollee details
To get the mobile app, you can download it from Apple’s App Store or Google’s Play Store. Search for Aetna Better Health to locate the app. It is free to download and to use. This application is available on certain devices and operating systems (OS).
Promise program for pregnant enrollees
Our Promise Program encourages pregnant enrollees to make early and frequent prenatal and post-natal visits. The program will include case management, text4babySM, and Promise program rewards. Dedicated Case Managers educate pregnant members about local community programs. Participants will receive personalized text4baby messages during pregnancy and after the baby is born to remind them of appointments and provide education on topics such as the baby’s growth, development, nutrition, well-child visits, and immunizations. The Promise Program will also provide coverage of long-acting contraception.
You can earn Promise rewards before and after your baby is born:
- You’ll earn your first $25 gift card when you visit your doctor within the first 6 weeks of pregnancy. If you are a new enrollee, you must visit your doctor within 42 days of enrolling with our plan.
- Each prenatal visit after your first visit, you’ll earn a $10 gift card when you visit your doctor.
- You’ll earn a $50 gift card when you complete your postpartum visit. This visit must be within 21 to 56 days after your baby is born.
- You will also learn about family planning or long-acting contraceptive.
- Free circumcision for newborn boys.
- Sign up for Text4babyTM – this free text service sends you health tips and reminders throughout your pregnancy.
In addition, you can earn a special Promise reward gift* for seeing your doctor regularly during your pregnancy. The more visits you complete, the bigger the reward you can earn.
* You must claim your Promise reward gift within one year of the birth of your baby.
To claim your Promise reward, just call 1-855-242-0802, TTY 711, after your baby is born. You can earn one Promise reward gift per birth.
Access to a nurse is available at 1-855-242-0802, 24-hours a day, 7 days a week to answer your health care questions. The nurse line does not take the place of your PCP. But, if it’s late at night or you can’t reach your PCP, the nurses can help you decide what to do. The nurses can also give you helpful hints on how to help you feel better and stay healthy.
Stop smoking help
Enrollees aged 18 and older who smoke are screened for inclusion in the program. This includes assessing the enrollee's readiness to change through using Motivational Interviewing techniques. The program includes telephonic health coaching and continued contact to assess the enrollee's tobacco use status. We also provide smoking cessation medications for six months:
- Bupropion and Bupropion SR
- Nicotine gum, lozenges, and patches, which can be accessed over-the-counter
- Nicotrol® cartridge
- Nicotrol nasal spray
Enrollees under 18 years old may enroll with written consent from their parent or guardian.
Ted E. Bear, M.D., Kids Club
In addition to the Ted E. Bear, M.D., program, we will offer a weight management program for children and adolescents. These young enrollees will be able to request assistance from Case Managers for help with weight management; they are enrolled in Integrated Care Management for any other issues.
Participants will receive incentives for enrolling and participating in the program. After enrolling, each enrollee will receive a pedometer, water bottle or exercise bands (for members 12 and over). Participants can then receive gift cards in graduated amounts as they meet the goals that they set when they enrolled.
- Upon completion of the first goal, they will receive a $15 gift card.
- Annual wellness check (Birth-21 years old) — $20 gift card
- Completion of the second goal will earn a $25 gift card.
- When the third goal is completed, the enrollee will receive a $30 gift card.
To earn the incentives the enrollee must also have confirmed attendance at four weight management assessments and four nutritional consultations.
Teladoc - a doctor is only a video chat away
As another added benefit, we now provide you with year-round 24/7 access to doctors and pediatricians by video chat. Teladoc consults are available at no cost to you.
Teladoc does not replace your primary care provider (PCP). It is just another choice for quality care when your PCP is not available. Through a secure video consult, you can meet with a U.S. board certified doctor, licensed in your state, who can treat many conditions like:
- Sinus problems
- Cold and flu symptoms
- Respiratory infections
- Ear infections and more
3 easy steps
- Set up an account - Go to www.teladoc.com and click on “Set up account”
- Log in and complete “My Medical History” tab
- Request a consult, available 24 hours a day, 7 days a week
If you have any questions call 1-800-Teladoc (835-2362) 24/7.
Unlimited primary doctor visits for all adults
Adults have an unlimited visits to a their primary care provider.
Vision care for adults
Adult enrollees aged 21 and over will receive a free annual refraction and $100 toward eyewear (frames, glass lenses, or contact lenses).
Enrollees may also receive a $10 gift card as an annual incentive for accessing an adult wellness screen for a diabetic dilated eye exam.
We will cover a retinopathy screening for enrollees with sickle cell.