Claire Dawson
Finding an in-network hospital under the Aetna health plan can help you save money. In-network providers, such as doctors, hospitals, and surgical centers, have negotiated rates with Aetna, which are often much lower than their regular fees. To find an in-network hospital, Aetna members can log in to their accounts and use the provider search directory to find hospitals that accept their specific plan. Non-members can choose the type of plan they are interested in and search for hospitals that accept it. This can be done by entering a name, ZIP code, condition, procedure, or specialty in the search box.
| Characteristics | Values |
|---|---|
| Who can find in-network hospitals? | Aetna members and non-members |
| What do members need to do? | Log in to find doctors, dentists, hospitals and other providers that accept their plan |
| What do non-members need to do? | Choose the type of plan they're interested in and search for health care providers that accept it |
| What is the benefit of staying in-network? | It is more cost-effective |
| What are some drawbacks of going out-of-network? | You need to pay the full cost of any care you receive, out-of-pocket costs are usually higher, and you have to take care of precertification yourself |
| How can members find in-network hospitals? | Use the provider search online directory, enter a name, ZIP code, condition, procedure or specialty in the search box |
| How can non-members find in-network hospitals? | Choose the type of plan they're interested in and search for health care providers that accept it |
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What You'll Learn
Log in to find in-network hospitals
If you are an Aetna member, you can log in to your secure account to find doctors, dentists, hospitals, and other providers that accept your plan. You can also download the Aetna Health app from the App Store or Google Play.
If you are a non-member, you can choose the type of plan you are interested in and search for healthcare providers that accept it.
Staying within your network is the easiest way to save money on healthcare. If you go out of network, your out-of-pocket costs are usually higher. Your Aetna health benefits or insurance plan may pay part of the doctor's bill, but it pays less than it would if you got care from a network doctor. Some plans only cover out-of-network care in an emergency. Additionally, an out-of-network doctor can bill you for anything over the amount that Aetna recognizes or allows, which is called "balance billing." A network doctor has agreed not to do that.
If you need assistance in finding an in-network provider, you can call the Aetna Member Services department. In rare circumstances, an out-of-network provider may be the only option in your area for certain services. In these instances, a Case Specific Rate Negotiation (CSRN) process may be available to you upon review.
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Search the online directory
To find in-network hospitals for Aetna, you can search the online directory. This is a simple process and can be done in a few steps. Firstly, log in to your Aetna account. Once you are logged in, you can search for doctors, dentists, hospitals, and other providers that accept your plan. You can also search for healthcare providers that accept a specific plan if you are a non-member.
The online directory is a useful tool that allows you to find in-network doctors, hospitals, and pharmacies. You can search by entering a name, ZIP code, condition, procedure, or specialty. The search will provide you with maps, directions, and other helpful information.
Staying in-network is a smart way to save money. Aetna negotiates rates with providers so that you pay less. Out-of-network doctors can charge higher rates and are not limited by the amount that Aetna recognizes or allows, which can result in "balance billing", where you are billed for the difference. Out-of-network care is usually more expensive and may not be covered by your plan unless it is an emergency.
You can also request a printed directory by contacting member services through the Contact Us page.
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Ask your doctor for a referral
If you're an Aetna member, asking your doctor for a referral to an in-network hospital is a great way to ensure you receive high-quality, cost-effective care. Here's why:
- Cost Savings: Staying within the Aetna network can result in significant cost savings for you. Out-of-network doctors can charge higher rates, and your Aetna plan may cover less of those costs, leading to higher out-of-pocket expenses. By staying in-network, you avoid "balance billing," where an out-of-network doctor can bill you for any amount above what Aetna recognizes or allows.
- Precertification: If you need a procedure that requires precertification, a network doctor will handle the process for you. This saves you time and the hassle of extra paperwork.
- Quality Assurance: Doctors in the Aetna network have been designated as Aetna Smart Compare® providers, indicating that they consistently deliver high-quality, effective care. This means you can trust that your doctor has been vetted and provides excellent care.
- Doctor's Expertise: Your doctor will be familiar with your medical history and needs. They can refer you to specialists or hospitals within the Aetna network that align with your specific healthcare requirements, ensuring you receive the most appropriate care.
- Streamlined Billing: In-network hospitals have agreed to recognized rates with Aetna, so you won't be surprised by unexpected charges. This simplifies the billing process and gives you peace of mind about your financial obligations.
- Emergency Coverage: In case of an emergency, you're covered no matter where you are, even outside of your immediate network. However, for non-emergency situations, staying in-network ensures that your doctor visits and treatments are covered as expected.
By asking your doctor for a referral to an in-network hospital, you can be confident that you're receiving the best care at the best price. Remember to log in to your Aetna account to verify that the referred hospital is within your network before proceeding with treatment.
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Compare costs
The costs of healthcare services can vary significantly depending on whether you visit an in-network or out-of-network hospital. Aetna has negotiated rates with in-network providers, which means you will receive services at a reduced rate. These rates are usually much lower than what the providers would charge if you weren't an Aetna member.
When you visit an in-network hospital, you only need to pay your coinsurance or copay along with your deductible. On the other hand, if you visit an out-of-network hospital, you may be responsible for the full cost of the services received. Some Aetna plans do not offer any out-of-network benefits, meaning you will have to pay the entire bill yourself unless it is an emergency. Even for plans that do cover out-of-network care, you will typically pay more than if you had stayed within the network.
To compare costs, you can use the Member Payment Estimator tool on the Aetna website. This tool allows you to find costs for procedures, doctor's office visits, lab tests, and surgeries before you go. It uses your plan details, including your deductible and coinsurance, to provide personalized estimates. The estimator also helps you find the most affordable options in your area and within your network.
Additionally, it is important to understand your benefit plan, as it determines your coverage. Some plans may exclude coverage for services that Aetna considers medically necessary. The Applied Behavior Analysis (ABA) Medical Necessity Guide can help you understand the medically necessary levels and types of care for behavioral health conditions. However, it is not a guarantee of coverage, and you should consult your benefit plan for specific details.
Furthermore, for dental coverage, members should review the Dental Clinical Policy Bulletins (DCPBs) with their providers to understand Aetna's policies. Under certain plans, Aetna may authorize coverage only for a less costly covered service, provided certain terms are met.
By utilizing the Member Payment Estimator, understanding your benefit plan, and being mindful of the potential costs of out-of-network care, you can make informed decisions to compare and manage your healthcare expenses effectively.
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Understand precertification
Precertification is a process that occurs before inpatient admissions and certain ambulatory procedures and services. It is a utilization review process that determines whether a requested service, procedure, prescription drug, or medical device meets the company's clinical criteria for coverage. In other words, it ensures that any care received is backed by the latest medical evidence and is appropriate for the patient's personal medical needs.
Aetna provides precertification for procedures and services on the Aetna Participating Provider Precertification List, the Aetna Behavioral Health Precertification List, and procedures and services that require precertification under the terms of a member's plan. Additionally, it covers organization determinations requested by a Medicare Advantage member, appointed representative, or physician for a coverage decision.
To request precertification, healthcare providers can submit a request electronically, through the secure provider website, or by phone using the number on the member's ID card. It's important to note that precertification does not guarantee payment of care or services, and coverage decisions are made on a case-by-case basis.
If a member disagrees with a coverage determination, they have the right to appeal the decision and request an independent external review. Under certain circumstances, a physician may also request a peer-to-peer review to discuss a medical necessity precertification determination.
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Frequently asked questions
You can use the provider search online directory to find hospitals that participate in the Aetna network. You can search by entering a name, ZIP code, condition, procedure, or specialty. Alternatively, Aetna members can log in to find in-network hospitals that accept their plan.
Staying in-network is a smart way to save money. Out-of-network doctors set their own rates, which are usually higher than the amount your Aetna plan "recognizes" or "allows".
If you go out-of-network, you will have to pay the full cost of any care you receive. Your Aetna plan may pay part of the bill, but it will be less than if you got care from an in-network hospital.
You can check your member website to search the provider directory. You can also ask the hospital directly what the charge will be, and this will help you determine whether they are out-of-network.
