Where You Can Go for Care
As a member of Texas Health Aetna, your options and cost for care vary based on where you go and also where your doctor refers you to go. Find out what you need to know about who you can see and what facilities you can go to for care.
- Texas Health Aetna Anytime MD: download the app for Texas Health Aetna Anytime MD, enter your insurance information when you set up your profile, and get your visit for free!
- Network Doctors: You are enrolled in a plan with a narrow network made up of a select, local group of primary care doctors and specialists in the Dallas-Fort Worth area in Texas Health Aetna’s Open Access EPO Plus network. Make sure to check that your doctor is a network doctor.
- Network Hospitals: You have enrolled in a plan with a narrow network made up of a select, local group of hospitals in the Dallas-Fort Worth area in Texas Health Aetna’s Open Access EPO Plus network. Make sure to check that your facility is an in-network facility.
- Out-of-Network: You will pay the full cost of services for any care you receive from a doctor or hospital that is not in network.
VERY IMPORTANT TIPS
- Procedures: When your doctor refers you for a procedure (such as an x-ray, outpatient surgery, or a test of some kind like an MRI) you can save dollars by checking with Texas Health Aetna before your appointment to see how the place the doctor recommended is covered by your medical plan and how the plan will pay for the procedure.
- Lab Work: Did your doctor tell you that you need to get lab work done? Your covered network labs are LabCorp and Quest Labs. How to find a doctor or facility in the Texas Health Aetna Open Access EPO Plus network, which has grown since last enrollment:
- Visit www.texashealthaetna.com
- Select “Click here to find a doctor” under the Find a Doctor section
- Enter your home location (zip, city, county, or state) and click “Search”
- Under Select a Plan, choose “Employer Plan — Open Access EPO Plus” as your plan and click “Continue”
To get the most up to date information, please contact Texas Health Aetna member services at 1-877-698-4754 prompt 1. Specifically ask about doctors or facilities for the Texas Health Aetna network called “Open Access EPO Plus”, NOT just the Aetna network.
- Check your hospital bill: When you go to a hospital for a procedure (such as surgery or childbirth), you may receive services from hospital-based physicians that you are not aware you have received. For example, if you have an MRI, you typically will not meet the radiologist who interprets the results. For most patients with insurance, charges are often considered out-of-network for services provided by radiologists, anesthesiologists, pathologists and emergency physicians. Under all our medical plan options, when you use an in-network hospital, Texas Health saves you money by covering hospital-based physician services as in-network. Because most plans do not offer this same advantage, these claims are often processed incorrectly. When you receive your explanation of benefits from your medical carrier, you should carefully check your hospital charges to be sure you are not being charged out-of-network rates for these services. If you believe your bill is inaccurate, call Texas Health Aetna and ask for a review of the claim.