As an Aetna Better Health of Michigan plan member, you get benefits to help you be healthier.
As an Aetna Better Health of Michigan member you will not have any copays or deductibles with your benefits. Aetna Better Health will pay for all of your covered services.
There are no copayments, deductibles or any other out of pocket cost for covered services. You should not sign any paperwork or agree to pay for any services that are covered by the health plan.
If you ask for or receive any services that are not covered through Aetna Better Health, you may have to pay for them yourself.
Covered Benefits & Services
The following are covered benefits and exclusions. See your Certificate of Coverage in the Member Handbook for additional information on these benefits.
Covered Benefits and Services
We provide a full range of covered services. They include the following:
- Ambulance and other emergency medical transportation
- Breast pumps; personal use, double-electric
- Blood lead testing in accordance with Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) policy
- Certified nurse midwife services
- Certified pediatric and family nurse practitioner services
- Chiropractic services
- Dental benefits are covered for pregnant women
- Diagnostic laboratory, x-ray and other imaging services
- Durable medical equipment (DME) and supplies including those that may be supplied by a pharmacy
- Emergency services
- End Stage Renal Disease (ESRD) services
- Family planning services (e.g., examination, sterilization procedures, limited infertility screening, and diagnosis)
- Health education
- Hearing and speech services
- *Hearing aids
- Home Health services
- Hospice services (if requested by the Enrollee)
- Inpatient and outpatient hospital services
- Intermittent or short-term restorative or rehabilitative services, in a nursing facility, up to 45 days
- Maternal and Infant Health Program (MIHP) services (effective Oct 1, 2016)
- Medically necessary weight reduction services
- Mental/Behavioral health services
- Non-emergent medical transportation (NEMT) to medically-necessary, covered services
- Out-of-state services authorized by the Contractor
- Parenting and birthing classes
- Pharmacy services
- Podiatry services
- Practitioners' services
- Preventive services required by the Patient Protection and Affordable Care Act as outline by MDHHS
- Prosthetics and orthotics
- Restorative or rehabilitative services in a place of service other than a nursing facility
- Sexually transmitted infections (STI) treatment
- Tobacco cessation treatment including pharmaceutical and behavioral support
- Therapies (speech, language, physical, occupational and therapies to support activities of daily living) excluding services provided to persons with development disabilities which are billed through Community Mental Health Services Program (CMHSP) providers or Intermediate School Districts
- Transplant services
- Vision services
- Well-child/EPSDT for persons under age 21
Healthy Michigan Members (HMP)
There are additional services covered for Healthy Michigan Plan Enrollees. The covered services provided to HMP Enrollees include all those listed above plus the following services:
- Habilitative services
- Dental services
- *Hearing aids
- Enhanced Fitness
- Weight Watchers
- Disease Management Sessions
- Tobacco Cessation
- Wellpass Text messaging - Two way communication with your care coordinator by text
24-Hour Nurse Line - Línea de Enfermeras de 24 horas
When you have a health question, the best place to start is our FREE 24-Hour Nurse Line! Friendly registered nurses give expert advice and quick answers. They will help you decide what to do next - see your doctor, go to the emergency room or help you treat the problem at home. 1-866-711-6664 24-Hour Nurse Line/Línea de Enfermeras de 24 horas
VSP Vision Care
VSP is the vision care provider for Aetna Better Health of Michigan Members.
Eye care services are provided through our eye doctors. If you need glasses or an eye exam, just call 1-866-316-3784, TTY 711. You can also call a provider from our list of vision providers. For medical eye problems, talk to your PCP.
Inpatient & Outpatient Patient Services
- Semi-private room & board
- Routine nursing services
- Anesthesia, laboratory, radiology, pathology services
- Special care services (operating room, intensive care, and coronary care)
- Delivery room
- Nursery care for newborns
- Short term restorative and rehabilitative Nursing Care
- Transplant Services
- Office visits
- Surgery (when medically necessary)
- Doctor visits and services for hospitalized members
- Certified Nurse Midwife Services
- Professional Services
The following services are excluded from coverage. For more information on non-covered services see the Certificate of Coverage (COC) in the Member Handbook.
- Elective abortions and related services
- Experimental/Investigational drugs, procedures or equipment
- Elective cosmetic surgery
- Services provided by any out of network doctor (other than Emergency services or services with prior approval by Plan)
- Any costs incurred in connection with services that are not covered
- Services that are not Medically Necessary as determined by Plan, or a third party used by the Plan to perform utilization review services
- Services and supplies necessary to diagnose or treat any condition resulting from the Member's attempt to commit a crime or participate in illegal activities
- Charges for Member's failure to keep appointments
- Except as required by law, care provided in a government hospital or by a government-related health care provider
- Payment for services performed before the Enrollment Effective Date or after the Enrollment Termination Date
- Services paid by or provided for under worker's compensation, no-fault or other automobile insurance, any other insurance plan, any educational program, Medicare, CHAMPUS, and some other third-party payors
- Employment-related examinations
- Court-order examinations, tests, reports or treatment for mental health and
- Chemical Dependency/Substance Abuse or for parole/probation evaluations
- Cognitive Services
- Infertility treatment and related services
- Services related in any way to surrogate parenthood
- Cosmetic services or any services performed for cosmetic purposes
- Food and dietary supplements, vitamins, minerals and infant formula
- Long-term rehabilitative treatment provided through day treatment programs, residential/transitional facilities
- Fees, costs, and expenses incurred by a person who donates an organ or tissue, unless the recipient is a member of the Plan and the donor's own health plan does not cover the expenses
- Reversal of sterilization
- Testing to determine parentage or DNA testing
- Autopsies, except when provided because the Member died while in the hospital.
Member ID Card
You should carry your Member I.D. Card with you at all times. Your I.D. Card is the key to getting all of the health care services to which you are entitled.
The back of your card provides you with phone numbers to call in case of an emergency. It also tells providers how to get approvals and referrals. You will receive a Member I.D. Card for each covered member of your family. If you did not receive an I.D Card for each covered family member or need to add a new family member call us at 1-866-316-3784. If you need to replace a lost or stolen Member I.D. Card, call us.
Use your member I.D. number in the Member Portal
Your Primary Care Provider (PCP) - When you enroll with Aetna Better Health you are required to select a personal doctor. This doctor is known as your PCP. Your PCP is your health care manager who directs all of your health care services.
Some in-network services do not require a referral from your PCP. Call us at 1-866-316-3784 to find out more
You can choose a PCP from the Aetna Better Health Network. Use our online Find a Provider search.
Families covered by Aetna Better Health can select a PCP for each family member. For example, a Pediatrician may be selected for a child, an OB/GYN for mom, and an Internist for dad.
You may change PCPs at any time. Online at the Member Portal, or just call us at 1-866-316-3784.
Your PCP will arrange all specialty care. If you need to see a specialist, your PCP must give you a prescription or other piece of paper that tells the specialist why you need to be seen. No referral form is needed.
Accessing Behavioral Health Services
You may receive services from a local community mental health agency for substance abuse and mental health services. A referral is not needed to receive services directly from a community mental health agency.
Aetna Better Health of Michigan covers outpatient visits for behavioral health services. You can call Behavioral Health Services at 1-866-827-8704. You do not need to call your primary care doctor to get behavioral health services. If you have a serious behavioral health illness, you may be referred to the community mental Health Program in your county. If you’d like more information, just call Member Services at 1-866-316-3784, TTY 711.
Behavioral Health Services 24 hours at 866-827-4704
Drug & Alcohol Abuse
Signs of alcohol addiction (alcoholism)
Do you want to have more fun, to fit in, to cope better with your problems? It’s as easy as taking a drink — if you believe what you see on television. But if you think that alcohol will improve your life, you’re fooling yourself. Relying on alcohol to relax you or cheer you up can be dangerous. You may find yourself using it more and more in this way. This can lead to addiction. If this is happening to you, take action now to change your behavior and find caring people to help you.
Coordinating Your Care
We will help direct the care of members with health problems. Aetna Better Health has RNs to assist members, doctors and hospitals with making sure needed health care is performed when needed. Aetna Better Health will direct your care between the PCP, the specialist and the hospital.
We follow standard health care rules for routine screening, case management, and hospital stays. These rules are used by our health care staff to decide what treatment you should receive.
We review your benefits and coverage.
We do not give money to staff based on whether they approve or deny care. If you have questions on how care is approved, call us at 1-866-316-3784.