How to use your benefits

You can get the following services from providers without  referral or pre-authorization from Aetna Better Health:

  • Women’s health services
  • Emergency services
  • Behavioral health
  • Diagnostic ultrasounds, except pregnancy
  • Doppler studies, except cardiac
  • Emergency care
  • Immunizations
  • Laboratory services provided by contracted laboratory
  • Mammogram, routine or diagnostic
  • Routine exams/services
  • Transportation including emergency
  • Well-care checkup – one per year

Your PCP can request any of these services for you. Other than emergency services, all require in-network providers and facilities.

Your PCP

A PCP can be a nurse practitioner, a clinic, or a doctor of obstetrics (OB), family practice, internal medicine, general practice or pediatrics. In certain situations, a specialist may be able to serve as a PCP. This is based on the type of care you need and if the specialist agrees.

PCPs help keep you healthy by:

  • Keeping immunizations up-to-date
  • Providing care when you are sick
  • Providing treatment before a health problem becomes serious
  • Teaching you how to stay healthy

Your PCP takes care of your health care needs, 24/7. You should receive most, if not all of your health care needs, from your medical home PCP. If the office is closed, call the PCP after-hours number. If you cannot reach your PCP, call the 24-Hour Nurse Line at 1-800-475-1142. If your PCP is in the Children’s Mercy Pediatric Network (CMPCN) call 1-888-670-7264.

  • Don’t forget, your PCP’s phone number is on your Aetna Better Health Member ID card 
  • If you need care after your PCP’s office closes, call the office to find out how to get care after hours. There will be an answering service If it’s not an emergency, leave a message. Someone will call you back. Please allow time for them to answer
  • If you can’t reach your PCP or the doctor on call, call 24-Hour Nurse Line at 1-877-620-1945 or 1-888-670-7264 if your PCP is in the Children's Mercy Pediatric Care Network (TTY 711)
  • You can change your PCP at any time by calling us at 1-800-566-6444 (TTY 711 or TDD 1-800-735-2966). There‘s no limit to how many times you can change your PCP

If you need a Provider Directory, call Member Services at 1-800-566-6444 (TTY 711 or TDD 1-800-735-2966 and we will mail one to you. You can always search online for a provider.

DentaQuest provides you with your dental benefits. If you have questions about your benefits, Member Services can help. You can get help with arranging your dental care. You can also ask for a listing of our in-network dentists. Just call 1-800-566-6444.

Your dental benefits include:

  • Six month routine dental check-up (ages 21 and under)
  • Preventive and restorative dental care (ages 21 and under)
  • Dental services for pregnant women (ages 21 and over)
  • Once a year dental exam, x-ray and cleaning (ages 21 and older)

Aetna Better Health manages your behavioral health. It can include:

  • Minor depression
  • ADHD
  • Mental or emotional problems
  • Treatment for addiction

For more information about behavioral health services call us at 1-800-566-6444Member Services can also help you find a provider within our network.

You should also know that:

  • You don’t need a PCP referral to get behavioral health care
  • You can go to any behavioral health in-network providers

Children who are in Alternative Care or get Adoption Subsidy get behavioral health care through MO HealthNet Fee-for-Service using MO HealthNet approved providers.

March Vision Care provides your eye care benefits. Providers are family eye doctors and retail chains with evening and weekend hours.

You are eligible to see March Vision providers who contract with Aetna Better Health. You don’t need a referral to see an in-network eye doctor*.

Vision benefits include:

  • One routine eye exam every 2 years (age 21 and older)
  • One routine eye exam once a year (age 20 and under and pregnant women)
  • One pair of glasses every 2 years (all ages)
  • Medically necessary contact lenses (ages 20 and under when criteria are met*)
  • Replacement** pair of glasses (ages 20 and under when glasses are misplaced or broken and are necessary for school)
  • Replacement lenses when medically necessary

 * Some benefit and eligibility restrictions may apply.
**Require prior-authorization.

Inpatient pharmacy
Aetna Better Health covers inpatient pharmacy costs as part of inpatient hospital costs. MO HealthNet covers all other pharmacy costs.

Pharmacy dispensing fees
Children under age 19 do not have to pay a pharmacy dispensing fee. Members age nineteen (19) and older pay a pharmacy dispensing fee for each drug they get. This fee is $0.50 up to $2.00 for each drug. The amount of this fee is based on the cost of the drug. You should never pay a fee of more than $2.00 for each drug. Remember, if you get more than one drug at the same time, you will pay these fees for each drug you get.

You will not pay a dispensing fee when the medicine is for an emergency, family planning, a foster child, EPSDT/HCY services, or a pregnancy related reason.

You will be able to get your prescription even if you cannot pay. You will still owe the fee and must pay it like your other bills.

Over-the-Counter drugs
Your MO HeathNet benefits include some over-the-counter drugs. You can find out which drugs are covered through MO HealthNet here. Or you can call 1-800-392-2161 or 1-573-751-6527.

Preferred drug list
To prevent extra costs, check that your medicines are on the preferred drug list. This is called the formulary. If you have questions, just call Member Services at 1-800-566-6444, TTY 711. Have a list of your prescriptions ready when you call. Ask us to look up your medicines to see if they’re on the list.

You can get help with transportation

Emergencies
If you have an emergency, call 911 for an ambulance. We cover ambulance rides in a medical emergency for all members.

Rides to see the doctor
If you don’t have transportation, we’ll help you get a ride to medical services we cover and MO HealthNet  Fee-for-Service. Non-Emergency Medical Transportation (NEMT) is a service you can use if you don’t have a way to get to your health care visit. It is at no cost to you. We may use public transportation or bus tokens, vans, taxi, or even an ambulance, if necessary.

*Some people do not get NEMT as part of their benefits. To check, call Member Services at 1-800-566-6444. If you have questions about who can

You need to call to schedule your ride at least three days before your appointment

To schedule a ride, call NEMT at 1-800-688-3752 You may be able to get a ride sooner if your health care provider gives you an urgent care appointment. Call Member Services at 1-800-566-6444.

Who can get NEMT services?
You must be anAetna Better Health member on the day of your appointment. Some people do not get NEMT as part of their benefits. For example, Members who pay a premium to MO HealthNet are not eligible for the transportation benefit. For more information about transportation benefits, call Member Services at 1-800-566-6444. You can also read the Transportation section your Member Handbook.

Mileage reimbursement
You may be able to get help with gas costs if you have a friend or a neighbor who can take you.  On the day of your appointment, have someone at your provider’s office sign the trip log. Then, send the signed log within 60 days of the appointment to:

Medical Transportation Management
ATTN: Mileage Reimbursement
16 Hawk Ridge Drive
Lake Saint Louis, MO 63367

Or fax your trip log to 1- 888-513-1610

You can also take a photo of the log with your phone and e-mail it to: mileagegasreimbursement@mtm-inc.net

To receive a trip log, just call us at 1-800-688-3752. You can also download a trip log (English/Spanish). Once we receive your trip log, we’ll verify that the appointment has occurred. Then we’ll send you your payment.

There are some added benefits you recieve as an Aetna Better Health of Missouri member.

Review your Member Handbook to learn more. Or you can call Member Services at 1-800-566-6444