Understand your benefits
We want to make sure you get the covered services you need.
Look at this information carefully. It will help you understand what is covered by your plan, and how you can find the right care when you need it.
The Medicaid plan of benefits does not require referrals for any services; however, there are services that may need prior authorization before you can get them. If you don't know if something needs approval, check with your doctor or call Member Services.
Doctors cannot bill or collect any amount from a Medicaid Member for covered Health Care Services that have been provided. This is stated in your doctor’s contract. If you receive a bill or have any questions please contact member services at the number on the back of your card.
- 1-800-306-8612 (Tarrant)
- 1-800-248-7767 (Bexar)
- 1-800-735-2989 (if deaf or hard of hearing)
The following services are available to you and your family through Aetna Better Health of Texas.
- Necessary medical care for adults and children
- Vaccines to prevent illness (immunizations)
- Chiropractic services
- Podiatry services (foot care)
- Laboratory and x-ray services
- Surgery as an outpatient (no hospital stay)
- Hospital care and outpatient care
- Maternity care and newborn care
- 24-hour nurse help line
- 24-hour emergency care from an emergency room
- Eye doctor services (includes eyeglasses and contact lenses, if medically necessary)
- Hearing services and hearing aids
- Home health agency services
- Ambulance (for emergencies only)
- Dialysis for kidney problems
- Major organ transplants
- Texas Health Steps medical and dental checkups
- Physical exam for adults, once per year
- Physical, occupational and speech therapy
- Family planning services and supplies
- HIV and sexually transmitted disease treatment
- Behavioral health services (such as counseling and treatment)
- Assistance with alcohol or drug abuse
- Diabetic supplies
- Health education classes
- Rides to medical appointments through the Medical Transportation Program
Services Not Available
The following services are not available through Aetna Better Health of Texas:
- Faith healing
- Cosmetic surgery
- Any service that is not medically necessary
Medicaid pays for most medications your primary care provider (PCP) or other doctor says you need. Your doctor will write a prescription for you to take to the drug store. Your doctor may also be able to send the prescription directly to the drug store.
To find a network pharmacy close to where you live, see the provider directories:
Medicaid STAR Tarrant Provider Directory
Or go to the 'Find a Provider' link - http://www.aetnabetterhealth.com/texas/find-provider.
If you have any questions, call Member Services at 1-800-248-7767 (Bexar) or 1-800-306-8612 (Tarrant). For members who are deaf or hard of hearing, call1-800-735-2989.
Medical Management Programs
Keeping our members healthy is very important. We offer several programs and processes for our members that are designed to help us evaluate the medical care our members need.
Care Management Program
Our Care Management Program will help you understand and control complex health conditions. Care managers can be nurses or social workers. They work with adults and children. Care managers can help you:
- Learn about your health care
- Work with your primary care provider (PCP) when medical questions come up
- Plan your care with a medical team (your PCP, family or specialists)
- Schedule rides to appointments
- Get special equipment and home health services if you need them
Children who have special medical, behavioral or educational requirements can get the help they need through the care management program. If you or your child have special health care needs, call Member Services at:
- 1-800-248-7767 (Bexar)
- 1-800-306-8612 (Tarrant)
- 1-800-735-2989 (for members that are hard of hearing)
Disease Management Program
If you have a chronic health condition, our Disease Management programs can help you stay healthy. These programs are for adults suffering from asthma, diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD) & depression.
Disease Management nurses will work with you and your doctor to help you learn about your condition and how to better care for yourself.
To learn more about our disease management programs, call Member Services at 1-800-248-7767 (Bexar), 1-800-306-8612 (Tarrant) or 1-800-735-2989 (for members that are hard of hearing).
Medicaid Transportation Benefits
If you need a ride to your doctor’s office, the Medical Transportation Program (MTP) can help. Call MTP as soon as you know your appointment date.
Please call MTP to schedule a ride at least two work days before your appointment. If you need to cancel a ride, call MTP at least one work day before your appointment. MTP can also help with money for gas for someone who drives you to an appointment. These drivers can be your family members, neighbors or other volunteers.
To learn more about MTP, or to make a reservation, call:
- 1-877-633-8747 MTP Logistics - Bexar
- 1-855-687-3255 MTP Logistics - Tarrant
Monday through Friday, from 8 a.m. until 5 p.m.
Behavioral Health Services
We want you to be healthy in body and in mind
Our health plan covers health for you as a whole person. That includes help for mental health problems like depression. You also can get help when you or someone else thinks you are drinking too much or using drugs.
You don’t need a referral
You may go to any mental health provider in our network. You don’t need to ask your doctor to refer you to someone.
You can get help anytime, day or night
If you need help right away, call our hotline. It’s open 24 hours a day, 7 days a week:
Medicaid (Tarrant): Call 1-800-306-8612; then press 1.
Medicaid (Bexar): Call 1-800-248-7767; then press 1.
Behavioral health care services include:
- Finding out what you need and making a treatment plan
- Specialist care for mental illness
- Help with drug or alcohol abuse
- Help with managing your medicines
- Help if you’re in the hospital
- Help with therapy outside the hospital
- Special outpatient services
- A care manager who organizes services for you
- Mental rehabilitation services (helping you get back on your feet)
For more information review your Member Handbook