Benefits and Services for our CCC Plus Members

The care you need, when you need it

As an Aetna Better Health of Virginia member, you have a variety of health care benefits and services available to you. Please take some time to learn more about your Aetna Better Health coverage. Begin by clicking on the + in the expandable boxes below.

You can also read our brochure.

Have a question? Call Member Services at 1-855-652-8249 (TTY 711). We are here for you 24 hours a day, 7 days a week.

  • Addiction and recovery treatment services
  • Behavioral (mental) health services, counseling and 24/7 crisis line
  • Care coordination services
  • Diagnostic services including x-ray, lab and imaging
  • Durable medical equipment (DME) and supplies
  • Emergency and urgent care
  • Family planning services
  • Health care for children including checkups, immunizations (shots) and screenings
  • Hospital and home health services
  • Interpreter and translation services
  • Maternity and high-risk pregnancy care
  • Medical transportation services
  • No co-pays except your patient pay towards long term services and supports and any Medicare Part D drug co-pays
  • Physical, occupational and speech therapies and audiology services
  • Prescription drugs and over-the-counter medications (when prescribed by doctors)
  • Preventive and regular medical care
  • Routine eye exams and glasses for children and routine eye exams for adults
  • Team approach (interdisciplinary care)
  • 24/7 nurse advice line
  • Women’s health services

As a member of Aetna Better Health of Virginia, you have access to services that are not generally covered through Medicaid fee-for-service. These are known as "enhanced benefits." If you have any questions about these added benefits, please call Member Services at 1-855-652-8249 (TTY 711).

Adult dental
Available to members 21 and older (no prior authorization required)
Exam and cleaning twice per year, annual set of bitewing X-rays, fillings, extractions, root canal or dentures (limited to $525 annually)

Adult vision
Available to members 21 and older (no prior authorization required)
Eye exam and $100 for frames, glasses or contacts each year

Adult hearing
Your Hearing Benefits are administered through HearUSA
Call Hear USA at 1-877-664-9353
Available to members 21 and older (with prior authorization)

Exam and one hearing aid per year, unlimited visits for hearing aid fittings (limited to $500 annually)

Personal care attendant
Available (with prior authorization) to high-risk members in a nursing facility
24 hours a day and seven days a week

Diabetes care

One pair of therapeutic shoes or shoe inserts per year (limited to $200 annually)

Medication Adherence Program for Chronic Illness
Available to members with chronic illness (no prior authorization is required)
Assists members with medications and help to ensure they are taking them as prescribed

Wellness rewards
Available to all members 21 and older (no prior authorization required)
Reloadable incentive card: $15 for diabetic dilated eye exam, $25 for wellness exam (to include HbA1c labs and LCL-C screening), $15 woman’s mammography, $15 cervical cancer screening, $25 initial colonoscopy, $15 flu shot, and $25 prostate cancer screening

Home-delivered meals
Available to members 21 and older with prior authorization
Members (post-discharge from inpatient stay) can receive two meals per day, tailored to their dietary needs and delivered to their home or community based setting for up to seven days

Weight management
Available to all members with prior authorization
12-week program and six-nutritionist-counseling visits—provided through certified nutritionists

Memory care
Available to members diagnosed with dementia or Alzheimer’s disease (requires prior authorization)
Two-door alarms and six window locks

Regional Wellness Centers
Available to all members
Regional Wellness Centers are available in each region we serve. These centers will function as a one-stop-shop where members, caregivers, providers, community organizations and other stakeholders can use our meeting spaces, computers and Internet, or access our community resources database

Community Health Workers
Available to all members (no prior authorization required)
Community Health Workers will be deployed throughout the community in each region to link members to: safe housing, local food markets, job opportunities and training, access to health care services, community based resources, transportation, recreational activities and other services. This assistance is available to all members.

Expanded Respite
Available to all members receiving respite services (requires prior authorization)
10 additional respite hours per month

Free Cell Phone
Available to members 18 and older (no prior authorization required)
Free cell phone with 350 minutes per month, data, free unlimited texting and free calls to member services

All plans cover LTSS if you are on a home and community based waiver or in a nursing facility. LTSS can help you live in your own home or other setting of your choice.

  • Adult day health care
  • Assistive technology
  • Environmental modifications
  • Personal care
  • Personal emergency response system (with or without medication monitoring)
  • Private duty nursing services
  • Respite care
  • Skilled and intermediate (custodial) nursing facility or long stay hospital
  • Help for members transitioning to the community from a nursing facility

Living with a mental health problem or recovering from substance abuse can be a long journey that requires you to be strong. You can help your chances for recovery by having support and not being alone. If you or if your child need help, talking with someone who knows what you are going through can help.

Learn more about peer support or family support partner services.

Post-stabilization services are services/care you get that is related to an emergency medical condition.

Aetna Better Health will provide follow-up care that is needed. This care can be to an out of network doctor or facility and will be covered. This care will be covered until your doctor states that your issue is stable or you are discharged. If you get your emergency care from an out of network provider we will move you to an in-network doctor once you are better. You may need to see a doctor to be sure you get better. Your visit will be covered by us. These visits do not need to be prior authorized.

Services covered by DMAS or a DMAS contractor:

  • Community mental health services
  • Dental services for children
  • Developmental Disabilities waiver services
  • School health services including some medical, mental health, hearing or rehabilitation therapy services as arranged by your child’s school

Benefits FAQs

Below are the answers to commonly asked questions. If your question and/or answer is not included below, please call Member Services. We are here for you.

To change your PCP, call Member Services. We can help. You need to do this before you visit your new doctor. Your change will happen the first day of the month. If you make your change by the 20th day of the month, you can use your new PCP or OB/GYN by the 1st of the next month.

Complaints/grievances are when you call or send a letter to Aetna Better Health to tell us you are not happy with any part of your benefits, services or Aetna Better Health.
 
If you:

  • Do not agree with a decision made by Aetna Better Health
  • Are not happy with any services received
  • Are not happy about any other part of Aetna Better Health or your provider, you can file a complaint/grievance.

You may do this by calling Member Services or writing it down and sending it to:
 
Aetna Better Health of Virginia
Attn: Grievances and Appeals Department
9881 Mayland Drive
Richmond, Virginia 23233
 
By doing this, you are filing a complaint to tell us why you do not like a decision. You can file a complaint/grievance at any time after the event you are unhappy about. It can be filed to any Aetna Better Health staff person, either orally or in writing.  If you need help in completing any forms or help with any other procedural steps to file a complaint/grievance, including interpreter services, please call Member Services.
 
If you call Member Services, we will take all of the information you give us and investigate the problem.
 
We may ask for the following information:

  • Your name
  • Your Aetna Better Health member ID number
  • Your date of birth
  • Your provider’s name
  • The date of service
  • Your mailing address

A complaint/grievance should be resolved within 30 calendar days from the date we receive it. You will not be punished in any way for filing a complaint/grievance.

Contact information for Aetna Better Health of Virginia Member Services

Medallion/FAMIS – Member Services

1-800-279-1878 (TTY 711)
24 hours a day, 7 days a week

CCC Plus – Member Services

1-855-652-8249 (TTY 711)
24 hours a day, 7 days a week

If you are not happy with our answer to your complaint/grievance or we have denied any part of your request for a health care service, you or someone with your okay can file something called an appeal. To file an appeal, or to request assistance with filing an appeal, call Member Services. You or your representative acting on your behalf have 60 calendar days after you receive our decision on your complaint/ grievance or you receive denial for any part of your request for a health care service to file an appeal.

To file an appeal you will need to send us a written request that has:

  • Your name
  • Your provider’s name
  • The date of service
  • Your mailing address
  • An explanation of why we should reverse our decision
  • A copy of any information that will support your request, such as additional documents, records or information that are relevant to your appeal

A written appeal needs to be mailed to:

Aetna Better Health of Virginia
Attn: Appeals Coordinator
9881 Mayland Drive
Richmond, Virginia 23233

If you are not able to file a written appeal, you or your representative can call us and we will ask for the information listed above and document the appeal for you. We will let you know we’ve received your appeal and you can get copies of documents, records and information about the appeal. We’ll give these documents to you for free.
 
A committee comprised of persons not involved with the original decision will look at your appeal. If your appeal involves a medical (clinical) issue, the committee will include a health care professional whose training and experience qualifies him or her to make a decision on this medical issue. If your appeal is administrative (not based on a medical issue), the committee will consist of members of our senior management staff. If desired, you can participate in the meeting and speak to members of the committee. You may also ask a doctor, health care provider or member representative to meet with the committee in your place. If you decide to meet with the committee, you will be provided a toll free number to call.
 
An appeal should be resolved within 30 calendar days from the date we receive it. If we need more time or more information for the appeal, or if you want to provide more information, you or we can ask for 14 additional calendar days to finish the appeal. If we need more time or information for the appeal, you will be sent a written notice of the delay and the reasons for it before the day 14. You will have the right to file a grievance if you disagree with the reason for the delay in the appeal decision. If you want to provide more information to us regarding the appeal, you must request the extension before the day 14. The time to make a decision on an appeal can be extended up to 14 more days if you or we need the extra time.
 
Fast (Expedited) Appeals

There is a fast appeal process to respond to cases where death or serious injury could result or in cancer patients when a delay in a decision could result in severe pain to the patient. This is also called an expedited appeal. You or your representative may call us for this type of appeal. If we allow the fast (expedited) appeal, we will make a decision as quickly as your condition requires, within 72 hours from the initial receipt of the appeal for Medallion and CCC Plus Members and 48 hours for FAMIS members.

For appeals relating to pain prescriptions for cancer patients, the decision will be made in 24 hours or less. If you want to provide more information or if it’s your interest, you or we can ask for 14 additional calendar days to finish the appeal. If we need more time or information for the appeal, you’ll be sent a written notice of the delay and the reasons for it.
 
We do not punish your doctor in any way for requesting a fast appeal or for supporting your request for a fast appeal.
 
If we decide your appeal is not a fast appeal, we will handle your appeal like a regular appeal. You and your doctor will receive a phone call or a letter letting you know that we will be following the normal appeal process. We will let you know what the normal appeal process time frames are when we call or send you and your doctor the letter.
 
State Fair Hearings Process (Medallion/CCC Plus)

If you are not happy with our appeal and your appeal is about our decision to deny, reduce, change or terminate payment for your health care services and you have exhausted our appeal process you or your representative can request a State Fair Hearing if it is within 120 days of the notice of the appeal decision from us.. You can only request a State Fair Hearing if it relates to a denial of a service, a reduction in service, termination of a previously preauthorized service, or failure to provide service timely. Your request for a State Fair Hearing should be in writing and sent to:
 
Division of Appeals
Department of Medical Assistance Services (DMAS)
600 E. Broad Street, Suite 1300
Richmond, Virginia 23219
1-804-371-8488

External Review (FAMIS)

If you are not happy with our appeal and your appeal is about our decision to deny, reduce, change or terminate payment for your health care services and you have exhausted our appeal process, you or your representative can request an External Review within 30 calendar days of the notice of the appeal decision from us. You can only request an External Review if it relates to a denial of a service, a reduction in service, termination of a previously preauthorized service, or failure to provide service timely. Your request for an External Review should be in writing and sent to:

FAMIS External Review
c/o KePro
2810 N. Parham Rd.
Suite #305
Henrico, VA 23294
804-622-8900

Contact information for Aetna Better Health of Virginia Member Services

Medallion/FAMIS – Member Services

1-800-279-1878 (TTY 711)
24 hours a day, 7 days a week

CCC Plus – Member Services

1-855-652-8249 (TTY 711)
24 hours a day, 7 days a week

When your family size changes, you move, or get health insurance other than Medicaid, call Aetna Better Health Member Services and your local DSS. Aetna Better Health Member Services can be reached at:

Medallion/FAMIS – Member Services

1-800-279-1878 (TTY 711)
24 hours a day, 7 days a week

CCC Plus – Member Services

1-855-652-8249 (TTY 711)
24 hours a day, 7 days a week

Call Member Services if:

  • You have a new person in your family.
  • Someone leaves your family home.
  • You move. If you move from your current address, we may not be able to cover you under the Aetna Better Health program but we will help you continue to get services until you are disenrolled. Aetna Better Health Member Services will be able to tell you if your new address is in our service area. Contact your local DSS if you move. You may be disenrolled from the Medicaid program if your mail is returned to DSS.

Babies born to mothers enrolled in Aetna Better Health will be automatically enrolled in Aetna Better Health for the birth month plus two more months. CALL YOUR LOCAL DSS TO GET A MEDICAID/FAMIS PLUS ID NUMBER FOR YOUR BABY. This is important to make sure your baby does not have a problem receiving care. If your baby does not have a Medicaid number by the end of the third month, your baby will no longer be covered by Aetna Better Health or Medicaid.

FAMIS MOMS

Babies born to FAMIS MOMS will be enrolled automatically in Aetna Better Health for the birth month plus 2 additional months. Please call your local DSS to get a Medicaid/FAMIS Plus ID number for your baby. This is important to make sure your baby does not have a problem receiving care. If the baby does not have a Medicaid/FAMIS Plus ID number by the end of the third month following birth, the baby will lose coverage.

Please call Member Services to let us know.

Medallion/FAMIS – Member Services

1-800-279-1878 (TTY 711)
24 hours a day, 7 days a week

CCC Plus – Member Services

1-855-652-8249 (TTY 711)
24 hours a day, 7 days a week

If your card is lost or stolen, please call Member Services immediately.

Medallion/FAMIS – Member Services

1-800-279-1878 (TTY 711)
24 hours a day, 7 days a week

CCC Plus – Member Services

1-855-652-8249 (TTY 711)
24 hours a day, 7 days a week