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Frequently asked questions

General questions

Medicaid is a program that provides health care for millions of Americans. In Louisiana, it’s called Healthy Louisiana. It covers low-income adults, children, people with disabilities and women who are pregnant or need treatment for breast and/or cervical cancer. If you qualify, you can get coverage for things like: 

 

  • Preventive care 

  • Vision care

  • Dental care

  • Medications 

  • Disease management

  • Behavioral health services 

Learn more about what’s covered

 

Find out if you qualify

Before you can get coverage, be sure you qualify for Medicaid. 

 

If you qualify, you can choose Aetna Better Health as your health plan in your Healthy Louisiana application.

 

You can also read the answers to 10 common questions about qualifying for Medicaid.

 

Learn more about how to enroll

Yes. To keep your coverage, you must renew every year.

 

Learn more about renewal

We want you to be happy with the care you get. So if you’re ever unhappy with your health plan or a provider, you can file a grievance. Or you can file an appeal if we deny, delay or change a service. If you don’t agree with the decision on your appeal, you can ask for a state fair hearing.

 

Learn more about filing a grievance or an appeal

Tell us. You have the right to report anyone you believe is committing fraud or abusing the Medicaid system. You can use this form to report fraud or abuse

 

Learn more about fraud or abuse

Member Services

You’ll find your health plan summary and benefits info in your member handbook or on your secure Member Portal. 

 

Log in to the Member Portal

We are here for you 24 hours a day, 7 days a week. Just call 1-855-242-0802 (TTY: 711) or log in to your Member Portal. You can also use the “Contact Us” page to get in touch.

Just log in to your Member Portal to ask for a new ID card. Or call us at 1-855-242-0802 (TTY: 711).

My health care providers

Your PCP is a medical provider who will manage your health care. They’re the physician, nurse or clinic that provides your main health care. They’ll help you get all the covered services you need.

You can change your PCP through your Member Portal. Or call Member Services at 1-855-242-0802 (TTY: 711), and just follow the menu options. This is also the toll-free number on your ID card. 

 

You can also learn more about choosing a primary care physician.

 

Log in to the Member Portal

Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal.

 

Log in to the Member Portal

Specialists are providers who treat specific conditions. Your PCP might refer you to a specialist in our network or recommend you see one. Need help finding a specialist? Just call us at 1-855-242-0802 (TTY: 711).

 

Find a specialist near you

Call the provider’s office and let them know you have Aetna Better Health. If you keep getting bills, just call us at 1-855-242-0802 (TTY: 711).

Coverage and care

Whether it’s day or night, your PCP or on-call provider can tell you what to do. If they’re not in the office, leave a message. They’ll return your call. Your provider must see you within 24 hours if you need urgent care.

If you're having an emergency, call 911 or go to the closest hospital.

 

You’ll only need emergency care if you think your health is in serious danger. Emergencies may include:

 

  • Severe pain
  • Serious injury
  • Sudden illness
  • Illness that is quickly getting much worse
  • Heavy bleeding that doesn’t stop, especially if you’re pregnant

 

If it’s not an emergency, but you need medical advice, call us at  1-855-242-0802 (TTY: 711). The 24/7 Nurse Line can help you decide if you need to go to the ER or urgent care.

 

Find the closest hospital

Check out some of these articles to learn more about getting the right care at the right time:

 

If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency for all members. 

 

Need a ride to your doctor visits? You can get help with rides to medical services we cover. We work with One Call to offer you rides for your nonemergency medical needs. You can get a ride for visits to your:

 

  • Provider 
  • Dental provider
  • Pharmacy
  • Behavioral health care provider 

Learn more about covered rides 

If you’re out of the area and have an emergency, go to the closest hospital or call 911. The hospital doesn’t have to be in our network for you to get care.

You can use the provider search tool to find a hospital. Or you can call us at 1-855-242-0802 (TTY: 711) for help.

Pregnant women need special care. You should see a provider within three weeks of a positive pregnancy test (home or lab). We can help with pregnancy care. Just call us as soon as you can at 1-855-242-0802 (TTY: 711).

 

You can also visit our health and wellness library to learn more about pregnancy, women’s health and other topics to help keep you healthy.

 

You’ll want to make sure your baby has medical coverage. If you don’t have insurance when your baby is born, you must enroll them in Healthy Louisiana. You can do so by contacting the Louisiana Department of Health or a Medicaid Application Center near you.

 

If you have questions or need help, just call us at 1-855-242-0802 (TTY: 711).

Pharmacy

A PDL is a state-run list of medications that a health plan covers. These medications treat a variety of conditions.

 

Learn more on our pharmacy benefits page

You can ask your provider:

 

  • To give you a similar medication that is preferred on the list
  • To get prior authorization (PA) to cover this medication if they think it’s necessary to treat your medical condition

First, your provider will contact us. Then, our pharmacy staff will review the info your provider gave us. Finally, we’ll make a decision. 

Some health care services and supplies need approval before you can get them. We follow nationally recognized guidelines to make these decisions. Not sure if a service needs PA? Just call us at 1-855-242-0802 (TTY: 711)  to ask for the most current PA list. Before providing a service, your provider should check the list. It may change from time to time. 

You don’t need a referral to see in-network doctors for routine and preventive health care services. 

 

You do need PA for some health care services and supplies before you get them. We use nationally recognized guidelines to make PA decisions about care your provider suggests. 

 

Your provider must check to see if your service requires PA before they provide it. To ask for the current PA list, just call us at 1-855-242-0802 (TTY: 711).

We work with the state to set quantity limits for different reasons. Some medications have a maximum limit or dose for safety reasons. Our clinical staff sets the limits based on proven standards of care, such as the Food and Drug Administration (FDA) guidelines. In some cases, we make exceptions. Have your provider contact us. We’ll review the info from your provider and make a decision.

These types of medications aren’t covered on the PDL:

 

  • Cosmetic 

  • Hair growth

  • Infertility or erectile dysfunction 

  • Experimental or investigational 

Mental health

You’re not alone. During the COVID-19 pandemic, many people have felt more stress and anxiety than ever. They need more help than usual coping with everyday pressures. Things like job loss, child care issues and other challenges are very real.

 

Did you know that stress can affect your health? It’s common during times of stress to pick up some unhealthy habits. Don’t be too hard on yourself. It can be hard to eat healthy, exercise and follow all the other habits that are part of good self-care. 

 

Learn more about healthy habits: 

 

Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. Or you can find this info on your Member Portal

 

Learn more about mental and behavioral health

It may not be easy, but you can stop using nicotine — whether it’s smoking, vaping or chewing. Let’s quit together.

 

Smoking Cessation Trust

 

Did you smoke a cigarette before September 1, 1988? If yes, you can get help quitting through the Louisiana Smoking Cessation Trust. This program includes support and medication. 

 

What if you didn’t smoke before September 1, 1988? Just check with us. If you qualify, we’ll contract with the Trust to cover the same services. Program members can get:

 

  •  Office visits and counseling with smoking cessation service providers
  • Unlimited toll-free calls to the 24/7 program quit line
  • Help from a quit coach, who creates a personal program for you
  • Online smoking cessation info and tools, as well as printed materials

 

Start to Stop program

 

This quit-smoking program includes: 

 

  • A one-on-one consultation with a nurse, including a nicotine dependence assessment
  • A personal smoking cessation plan and education based on your needs and goals
  • Ongoing coaching and support to quit smoking

 

Members ages 18 and older can take part in one of these programs — the Trust or Start to Stop. If you’re under age 18, you can get started with written consent from your parent or guardian.

 

Questions on how to get started? You can call us at 1-855-242-0802 (TTY: 711) .

 

Find more support

 

You can learn more about quitting from the:

 

Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal.

Learn more about substance use and mental health issues from the:

 

Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal.

 

Learn more about mental and behavioral health

If you have thoughts of harming yourself or others, get help right away. You can call:

 

Learn more about mental and behavioral health

The Great American Smokeout is a registered trademark of the American Cancer Society, Inc.

 

Alcoholics Anonymous is a registered trademark of Alcoholics Anonymous World Services, Inc.

Have a question?

Just call Member Services at 1-855-242-0802 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.