Before you order lab work or screening tests, schedule a surgery or prescribe medication, be sure you understand what is covered by Aetna Better Health of Ohio, Medicaid-only, what’s not and what requires prior authorization.
Members of our Aetna Better Health of Ohio, Medicaid-only plan are covered for Medicaid-covered medications that are listed on our List of Covered Drugs.
You can also call member services to request information on our Drug List and medications or view them here. Please note that our Drug List and list of medications can change so it is important for you to check this information when prescribing a medication.
All prescriptions will need to be taken to one of our network pharmacies. You can find a pharmacy, using the pharmacy locator too (link coming soon). You can also call member services to find a pharmacy in your area.
Aetna Better Health of Ohio offers an evidence-based care management program to help our members improve their health and access the services they need. Care managers typically are nurses or social workers. These professionals create comprehensive care plans that help members meet specific health goals.
All members are assigned their own care managers. The amount of care management a member receives is based upon his or her individual needs. Some of the reasons you may want to ask the health plan to have a care manager contact the member are:
- Does the member frequently use the emergency room instead of visiting your office for ongoing issues?
- Has the member recently had multiple hospitalizations?
- Is the member having difficulty obtaining medical benefits ordered by providers?
- Has the member been diagnosed with Congestive Heart Failure (CHF) diabetes, asthma, or Chronic Obstructive Pulmonary Disorder (COPD), yet does not comply with the recommended treatment regimen?
- Does the member need help applying for a state-based long-term care program?
- Does the member have HIV?
- Is the member pregnant with high-risk conditions?
- Is the member pregnant and over 35 years of age?
- Has the member received a referral to a specialist, but is unsure of the next steps?
- Does the member need information on available community services and resources not covered by Medicaid (e.g. energy assistance, Supplemental Nutrition Assistance Program (SNAP), or housing assistance)?
What happens after your referral?
After you make a referral, the member's care manager contacts the member. The care manager might also contact the member's caregivers or others as needed.
What will the care manager do?
To help the member learn how to manage their illness and meet their needs, a care manager contacts the member to schedule a time to complete an assessment. The care manager asks the member questions about his or her health and the resources currently being used. Answers to these questions help the care manager determine what kind of assistance the member needs most.
Next, the member and the care manager work together to develop a care plan. The care manager also educates the member on how to obtain what they need. The care manager also may work with the member’s health care providers to coordinate these needs. The amount of care management and frequency of contact with the member and others will vary based upon the individual needs of the member.
To make referrals for care management consideration, please call Provider Services at 1-855-364-0974.
A care manager will review and respond to your request within three to five business days.
Appointment Standards and Timeframes
To view Aetna Better Health of Ohio’s standards and timeframes for appointments with our members please click here.