Aetna Better Health provides every member with a nurse care manager and a care management team. The nurse care manager leads the team. Your nurse care manager is a registered nurse (RN). The care management team also includes a social worker (SW) and a care management associate (CMA) to help with your daily needs. They will work with you to make sure you get the health care and services you need.
Once you agree to become a member of Aetna Better Health, you will be assigned to a care manager. Aetna Better Health nurses are bi-lingual, and we will work to assign a care manager who speak your language . This care manager will know all the information that you communicated to the nurse who made your home visit. Your care manager will contact you to talk with you to better understand your needs. Together, you will develop your plan of care.
Your plan of care is based on your health status and health care needs. Your primary care provider may give us information, talk with you and your care manager, and help develop your care plan. With your permission, we also get input from your family, caregivers, and others who you think are important for us to talk with.
The care plan will describe the personal care hours you need. It also will list other services you will get from Aetna Better Health. In addition, it will describe the services that Aetna Better Health will cover and the schedule for delivering the services.
After your care plan is developed, your care team will help you get all the care and services you need. The team will work with you to make appointments for care. They also will also set up transportation if you need it for your medical appointments.
Your care manager will call you at least once a month to check on you. You will always have your care management team's phone number and you can call to talk to your care team for help at any time.
If you need help after work hours or on weekends, your call will be sent to someone who can help you right away. For example, if you need to know where to go for a pharmacy or for urgent care, your call will be sent to the on-call staff. If that happens, your care manager will get information about your call so that someone on your care management team can make sure you got what you needed.
Services will begin the first day of the month after your enrollment application is approved.
Your care management team will help to coordinate your care with other health providers such as physician visits, eye doctor appointments, dental appointments, and hearing evaluations. You can participate in your care by sharing with your team your needs and concerns so that you may continue to live independently in your community.
While you are a member of Aetna Better Health, you will receive a home visit from the Assessment Nurse at least two times a year. Just like when you first join Aetna Better Health, the Assessment Nurse will do assessments to see if your health has changed. After the home visit, the Assessment Nurse will let your care management team know to review your care plan. The Assessment Nurse and care team will also review your care plan if your condition changes to make sure you receive the services you need.
Aetna Better Health members must use providers who are part of our network to get covered long-term care services unless approved by the care management staff ahead of time. If we don't have the type of provider you need, your care management team will find a provider who is out of network. If you need a provider who is not in our network, please call your care management team and they will explore your options with you.