Resources and services
Resources for you
We want to help you be (and stay) healthy. And we want to make sure you are getting the care and service you deserve. So, in addition to your benefits, there are a few other things you need to know about your health plan.
Help is a phone call away
Not sure if you should go to the emergency department or urgent care? The Aetna Better Health Premier Plan MMAI Nurse Line can help. For answers to your questions, call Member Services at 1-866-600-2139 (TTY: 711).
If you have a medical emergency, dial 911.
Communication Methods/Language Assistance
We can give you information in another format or language. This includes enrollment materials. We have audio CD-ROM, large print or Braille. Our member materials are also available in Spanish. We offer language interpretation services, including sign language, as well as CART reporting for the hearing impaired at no cost to you. Call Member Services at 1-866-600-2139 (TTY: 711) for more information.
Your health is important
We believe in total health. The use of alcohol, some prescription medicines, or other drugs may affect your health. If you experience alcohol or drug issues or substance abuse, you may need therapy services or medicine. Behavioral health benefits cover these services.
Your plan covers many kinds of services for substance abuse. Below is a partial list of what is covered. For a more complete list, view your Summary of Benefits.
- 24-hour access to help for a crisis
- Opiate dependence medication
- Intensive outpatient rehabilitation program
- Partial hospitalization rehabilitation program
If you are in crisis, we can help. Your behavioral health crisis line is available via Member Services at 1‑866‑600-2139 (TTY: 711), 24 hours a day, 7 days a week. In an emergency, call 911.
If you have a medical emergency, dial 911.
Use of emergency transportation must be for emergencies only.
If you need a ride to your health care appointments or to the pharmacy to pick up your prescription on the way home from an appointment, call Member Services at 1‑866‑600-2139 (TTY: 711).
You can call to schedule a ride Monday - Saturday from 8 a.m. - 6 p.m. Central time. Please set up a ride at least three days before your appointment.
Mileage reimbursement is available if you use your own car or get a ride from someone. You have seven days after your appointment to ask for mileage reimbursement. Call Member Services at 1‑866‑600-2139 (TTY: 711) and they will help you do this.
Would you like to have some help in planning and coordinating your health care needs at the provider level?
For many of you, getting your health care needs or your family member’s needs taken care of can be hard. This can be especially difficult when you are helping a close family member. Aetna Better Health Premier Plan MMAI understands this and offers a model of care that might be right for you.
Aetna Better Health Premier Plan MMAI provides a new way to deliver and coordinate your health care through providers who use Health Homes. Health Homes focus on you working with your health care team. You are the most important person on the health care team. Together with your health care team, you plan and coordinate your care.
To find out more about how to participate in a Health Home, please call Aetna Better Health Premier Plan MMAI Member Services.
1‑866‑600-2139 Hearing Impaired (TTY: 711)
While we never want to think about the end of life, it is important that everyone plan for it. You should consider what kind of care you would want if you were unable to tell your wishes.
There are legal documents that you can use to give your directions in advance. These documents are advance directives. They include documents such as “living wills” or “power of attorney for health care.”
Aetna Better Health Premier Plan MMAI has policies to help you arrange advance directives so your wishes will be honored.
You have the right to give instructions about what should be done if you are not able to make medical decisions for yourself. Sometimes people become unable to make health care decisions for themselves because of accidents or serious illness. You have the right to say what you want if this happens to you.
This means that, you can:
- Fill out a written form to give someone the legal authority to make medical decisions for you if you are unable to make decisions yourself.
- Give your doctors written instructions about how to handle your medical care if you are unable to make decisions yourself.
To use an advance directive, you need to:
Get the form
If you want to have an advance directive, you can get a form from your lawyer, a social worker or some office supply stores. You can sometimes get advance directive forms from organizations that give people information about Medicare.
Fill it out and sign it
This form is a legal document. You should think about having a lawyer help you with it.
Give copies to appropriate people
Give a copy of the form to your doctor. Give another to the person you name on the form as the one to make decisions for you if you can’t.
You may want to give copies to close friends or family members as well. Be sure to keep a copy at home.
If you know ahead of time that you are going to be hospitalized, take a copy of your advance directive with you to the hospital. If you are admitted to the hospital, the staff will ask you if you have signed an advance directive form and if you have it with you.
Abuse, Neglect and Exploitation
We care about your safety, health and welfare. It is important to recognize signs of abuse, neglect and exploitation and report it. This will allow you to be safe and get the care you need.
Abuse can come in many forms such as:
- Physical abuse - Non-accidental use of force that results in bodily injury, pain or impairment. Includes but not limited to being slapped, burned, cut, bruised or improperly physically restrained.
- Verbal or emotional abuse - Includes but is not limited to name calling, intimidation, yelling and swearing. May also include ridicule, coercion, and threats.
- Sexual abuse - Any sexual behavior or intimate physical contact that occurs without your permission.
- Financial abuse - When someone uses your money without your consent. This includes improper use of guardianship or power of attorney.
Neglect - Neglect occurs when someone fails to provide or withholds the necessities of life from you. This includes food, clothing, shelter, or medical care.
Exploitation - The misuse or withholding of a member’s assets and resources (belongings and money). This includes, but is not limited to, misappropriation of assets or resources of the alleged victim by undue influence, by breach of fiduciary relationship, by fraud, deception, extortion, or in any manner contrary to law.
If you are or suspect that you are being abused, neglected or exploited please call the appropriate number below to report, prevent or stop the abuse, neglect or exploitation.
To report regarding members who are disabled adults 18 through 59 yeas of age who live in the community call the Illinois Adult Protective Services (DoA).
- 1-866-800-1409 (voice)
- 1-866-206-1329 (TTY)
To report regarding members in Nursing Facilities call the Department of Public Health Nursing Home Complaint Hotline.
To report regarding members in Supportive Living Facilities call the Supportive Living Facility Complaint Hotline.
Call member services or your care coordinator at any time to report abuse, neglect and exploitation. You can contact us 24 hours a day 7 days a week.
- 1-866-600-2139 (toll-free)
- TTY 7-1-1
It is important to us that you receive quality health care and customer service. Your satisfaction matters to us. Aetna Better Health Premier Plan MMAI Quality Management program ensures our services meet high standards of quality and safety. We want to make sure you have:
- The care you need
- Easy access to quality medical and behavioral health care
- Help with any chronic conditions or illnesses
- Support when you need it most
- High satisfaction with your doctors and with us
If you have a problem, please call Member Services at 1-866-600-2139 (TTY: 711), 24 hours a day, 7 days a week.
Our Quality Management Program works to ensure that all of our services meet high standards of quality and safety. We aim to:
- Meet our members’ health care needs and diverse cultural and linguistic needs.
- Measure, monitor and improve the clinical care and quality of service our members get.
- Institute company‐wide initiatives to improve the safety of our members and communities.
- Improve access to health care
- Make sure we obey all the rules, whether they come from federal and state regulators or accrediting groups
We have quality programs so that you can get the care you need quickly. Some of our quality programs are:
- Surveying members and providers to measure satisfaction
- Calling members to remind them to get their care
- Educating members by sending postcards or newsletters
- Reviewing the type, amount and quality of services given to members
- Working with members who have serious health issues through case management
- Reminding providers and members about preventive health care
- Measuring standards like how long it takes for a member to get an appointment
- Monitoring phone calls to make sure your call is answered as quickly as possible and that you get correct information
- Reviewing calls and complaints from members
- Reviewing all aspects of the health plan with health plan staff, providers and members through committees
Throughout the year, we evaluate our quality programs and data trends related to how our members receive health care and preventive care services. We compare our findings to national practice guidelines. We will share this information with you in Quality Matters. You can call Member Services at 1-866-600-2139 (TTY: 711) to request a copy of our Quality Management Program and to learn more about what we're doing to improve your care.
Each year we check to see how close we are to meeting our goals. Here's what we did last year:
- We collected data on a set of clinical measures called the Healthcare Effectiveness Data and Information Set (HEDIS®). We shared the results with the National Committee for Quality Assurance (NCQA) and they make the results public. Each year, we use the results to set new goals and improve selected measures. As a result, performance has improved on many measures.
- We asked members how satisfied they are with Aetna Better Health of Illinois. We improved in rating of health plan, getting care quickly, and customer service. We met the cultural and language needs of our members.
- We surveyed members in the Case Management Program. Their satisfaction with the program is increasing.
- We reviewed access to doctors and learned that we need to improve access in Kankakee County.
Each year we like to remind you to review some important information in your member handbook. This is the handbook we sent you when you joined Aetna Better Health Premier Plan MMAI.
This information helps you stay active and informed. It can help you when making health care choices for yourself. This notice gives a quick overview of what you need to know. You can learn about:
- Member rights and responsibilities
- Plans to improve quality
- Privacy and security of your health care data
- Getting the services you need to stay healthy
- Benefits questions
- How to get the care you need
- Care management
- Pharmacy services
- How to file a grievance or appeal
Recommended Screening and Services
What does that mean?
Annual Adult preventive for all members
It is important to see your provider at least once a year for a well visit, this is also known as your yearly physical. During this time your provider will make sure that all your health needs are well managed. They will also make recommendations on screenings that you should complete to make sure that you continue to have good quality of life. During this visit your provider may complete some recommended screenings that are discussed below.
Care for Older Adults:
Adult members 66 years of age and older should have an adult well visit once a year. During this visit the provider should complete the following screenings or services:
Advanced Care Planning
End of life matters can be difficult to discuss. Sharing your wishes in case of an emergency or unexpected event can help make things easier for your loved ones and make sure that your own wishes are respected and observed. Talk to your provider about your treatment preferences. It’s best to put your wishes in writing. Examples of advance care planning documents include an advance directive, living will, or surrogate decision maker.
Be sure to take a list of your medications or bring your medication bottles with you to your next doctor’s appointment. This way, your provider will know all the medications that you take. This can help prevent medication errors or duplications.
Functional Status Assessment
Tell your doctor if you’re having trouble moving around or doing daily activities. There are many services and equipment that can help you manage your activities of daily living better.
Be sure to tell your doctor if you have any pain, even if you are used to it. Try rating your pain on a scale of 1-10 to help your doctor understand. This will help your provider understand your overall well-being and help direct your care.
Follow Up after Hospitalization for a Mental Health Diagnosis
If you have a hospital stay for a mental health condition, be sure to see your mental health provider within 7 days of hospital discharge. This will help you be successful in your discharge plan and in your road to recovery after being in the hospital.
Follow-Up After Emergency Department Visit for Members With Multiple High-Risk Conditions
After an emergency department visit, it is recommended that you follow up with your primary care provider within 7 days of your ER visit. Your provider will work with you to help you manage your conditions that resulted in an emergency department visit.
Initiation and Engagement in Drug and Alcohol Treatment
Your plan covers treatment for Alcohol and Drug Abuse. Call member services or your case manager to learn more. Starting a treatment as soon as possible once you have been diagnosed with alcohol or drug abuse will help you get on the road to recovery. Recovery takes time. If you are receiving treatment for Alcohol or Drug Abuse, continue to go to all scheduled appointments.
Controlling Blood Pressure
If you have hypertension, also known as high blood pressure, it is important to keep your blood pressure reading under 140/90. Keeping your blood pressure under 140/90 will reduce your risk of developing complications from your condition. It is important to see your provider regularly and that your provider checks your blood pressure with each visit.
Breast Cancer Screening
It is recommended that women between the ages of 50-74 have a breast cancer screening every two years. Regular screening mammograms can help find breast cancer in its earlier stages. Finding cancer earlier means you can get the care you need sooner and increase your chances of successfully treating breast cancer.
It is recommended that members between the ages of 50 and 75 have a screening for colorectal cancer. It can take a long time for colorectal cancer to be discoverable. To prevent late stages of this cancer it is important to have your colorectal screenings done regularly. If discovered early, there are many additional treatment options. Discovering any form of cancer early has benefits of getting the right treatments which means that you may have many treatment options. Talk to your provider about any of the following tests within the recommended time frames:
- Fecal Occult Blood Test every year. This test uses a sample of your stool and checks for hidden blood.
- Flexible sigmoidoscopy within 5 years.
- Colonoscopy within 10 years
- CT colonography within 5 years
- FIT-DNA, within 3 years, this test is also called a stool DNA test. It is a combination test that looks for blood and changes in the DNA of your stool.
Comprehensive Diabetes Care:
Blood Pressure Control
It is recommended that members between the ages of 18-75 who have Diabetes have the following:
- Hemoglobin A1c testing at least once a year
- Your provider will tell you what your target Hemoglobin A1c is, however, on the average it should be <8%.
- Dilated Retinal Eye exam
- Urine test that checks if your diabetes is affecting your kidneys
- Blood pressure less than 140/90
Completing these screenings will help your provider and you manage your diabetes better. Also, having these screenings regularly will make sure that you stay ahead of any possible complications from diabetes.
Statin Therapy for Patients with Diabetes:
Received Statin Therapy and
Statin Therapy Adherence
Members between the ages of 40-75 who have diabetes are recommended to take a cholesterol-lowering medication in the “statin” family, and take it as prescribed by the doctor. “Statin” medications may help reduce the risk of developing heart disease in people who have Diabetes.
Antidepressant Medication Management
If you are 18 years of age or older and have a diagnosis of major depression and were prescribed medications to treat your depression, also known as antidepressants, it is recommended that you take your medications for depression regularly from the time you were prescribed them by your provider and continue taking them. It can take up to 3 weeks for you to start feeling better or see effects of your antidepressant medication when you first start taking it and that is why it is important to continue taking them as prescribed by your provider.
Follow Up after ED visits for Mental Illness
It is recommended that if you visited the emergency department (ED) for mental/behavioral health related illness or intentional self-harm that you a follow-up with a Behavioral Health Provider within 7 days of your ED visit. Your Behavioral Health Provider will review the reason for your ED visit and will work with you to help you manage your condition that resulted in you visiting the ED.
Follow-Up After Emergency Department Visit for Alcohol and
Other Drug Abuse or Dependence:
It is recommended that if you visited the emergency department (ED) for either alcohol or other drug abuse reason that you a follow-up with a Behavioral Health Provider within 7 days of your ED visit. Your Behavioral Health Provider will work with you to get you’re the right treatments.
Transition of Care and Medication Reconciliation Post-Discharge
If you were recently discharged from a hospital be sure to follow up with your provider within 30 days of your discharge or sooner. During your follow up visit, your provider will review the reasons for your hospital admission and will review your medications. Tell your doctor about ALL the medications and supplements that you are taking. Your provider can review the medications that you were prescribed and make sure that:
- you are not taking the same medications under different names, or
- your medications do not interact with each other which could be harmful
Your provider will also make sure that you do not have any additional needs after your hospital stay.
Use of Opioids from Multiple Prescribers and Pharmacies
Because of the national crisis of opioid overdoses, it is our goal to make sure that you are safe and that you do not take the same medications under different names. It is recommended that if you’re taking a controlled medication, such as a medication in the opioid family, that you use only one provider and one pharmacy to obtain your medications.
Osteoporosis Management in Women Who Had a Fracture
If you are woman between the ages of 67–85 and had had a broken bone it is recommended that you have a bone mineral density test or take a medication to treat or prevent worsening of osteoporosis within six months after having the broken bone.