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Answers to common questions

Questions?

Just call Member Services at 1-888-348-2922 (TTY: 711). We’re here for you 24 hours a day, 7 days a week. 

COVID-19

We know you have lots of questions about COVID-19. We’re here to support you with answers. Just check these resources to learn more:

 

COVID-19 FAQ page for Medicaid and Medicare members 

General questions

Medicaid is a program that provides health care for millions of Americans. In West Virginia, it’s part of Mountain Health Trust. It covers low-income workers and:

 

  • Children
  • Pregnant women
  • Elderly people
  • People with disabilities 

 

If you qualify, you can get coverage for things like:

 

  • Preventive care
  • Vision care 
  • Dental care
  • Medications
  • Disease management
  • Mental and behavioral health
  • Transportation

 

In West Virginia, there are different plan options.

 

Before you can get coverage, be sure you qualify for Medicaid or CHIP.

 

You can also read the answers to 10 common questions about qualifying for Medicaid.

 

If you qualify for Medicaid or CHIP, you can apply. 

 

Learn more about how to enroll

 

Once your application has been approved, the next step is choosing Aetna Better Health of West Virginia as your health care plan. If you don’t choose a plan, the state will choose one for you.  

 

Learn more about choosing your plan 

To keep your coverage, you must renew every year.

 

Learn how to renew

We want you to be happy with the care you get. So if you’re ever unhappy with your health plan or a provider, you can file a complaint. Or you can file an appeal if you don’t agree with a decision we make. If you don’t agree with the decision on your appeal, you can ask for a state fair hearing.

 

Complaints and appeals

Tell us. You have the right to report anyone you believe is committing fraud or abuse.

 

Fraud and abuse

Member Services

You’ll find your health plan summary and benefits info in your member handbook or on your Member Portal or Aetna Better Health app.

 

Learn more about your Member Portal and app

 

We’re here for you 24 hours a day, 7 days a week. Just call us at 1-888-348-2922 (TTY: 711).

 

You can also use the Contact us page to get in touch. Or log in to your Member Portal or Aetna Better Health app. 

 

Learn more about your Member Portal and app

You have some options if you lose your member ID card. You can log in to your Member Portal or Aetna Better Health app. There, you can:

 

  • Ask us to mail you a new ID card
  • Find the electronic version of your ID card — as long as you have your smartphone, you’ll always have your ID card with you for health care visits

Or call us at 1-888-348-2922 (TTY: 711).

 

Learn more about your Member Portal and app

My health care providers

Your PCP is a medical provider who will manage your health care. They’re the doctor, nurse, physician assistant or clinic that provides your main health care. They’ll help you get all the covered services you need.

 

Find a provider

You can change your PCP through your Member Portal or Aetna Better Health app. You can also call Member Services at 1-888-348-2922 (TTY: 711). This is the number on your ID card.

 

You can also learn more about choosing a PCP.

 

Learn more about your Member Portal and app

Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal or Aetna Better Health app.

 

Learn more about your Member Portal and app

Specialists are providers who treat specific conditions. Your PCP might refer you to a specialist in our network. Or they may recommend you see one. Need help finding a specialist? Just call us at 1-888-348-2922 (TTY: 711).

 

Find a specialist

You can use the provider search tool to find providers for the health care services you need. 

 

Find a provider

Call the provider’s office and let them know you have Aetna Better Health. This means you shouldn’t get a bill. If you keep getting bills, just call us at 1-888-348-2922 (TTY: 711).

Coverage and care

Whether it’s day or night, your PCP or on-call provider can tell you what to do. If they’re not in the office, leave a message. They’ll return your call. Your provider must see you within 24 hours if you need urgent care.

If you're having an emergency, call 911 or go to the closest hospital.

 

You’ll only need emergency care if you think your health is in serious danger. Emergencies may include:

 

  • Severe pain
  • Serious injury
  • Sudden illness
  • Illness that is quickly getting much worse
  • Heavy bleeding that doesn’t stop, especially if you’re pregnant

 

If it’s not an emergency, but you need medical advice, call us 1-888-348-2922 (TTY: 711). Then, choose the option for the 24-Hour Nurse Line. A nurse can help you decide if you need to go to the ER or urgent care.

 

Check out some of these articles to learn more about getting the right care at the right time:

 

 

Find a hospital

If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency. 

 

Need a ride to your doctor visits?

 

We work with ModivCare to cover rides for your nonemergency medical needs. You can get a ride for visits to your: 

 

  • Health care provider  
  • Dental or vision provider 
  • Mental or behavioral health care provider 
  • Pharmacy

 

How to schedule a ride

 

You must schedule rides at least two business days before you need them. To schedule a ride, just call ModivCare at 1-844-549-8353. Or visit the ModivCare website.

If you’re away from home and have an emergency, go to the closest hospital or call 911. The hospital doesn’t have to be in our network for coverage and care.

You can use the provider search tool to find a hospital. Or you can call us at 1-888-348-2922 (TTY: 711) for help. 

 

Find a hospital

Pregnant women need special care. You’ll want to see a provider within three weeks of a positive pregnancy test (home or lab). We can help with pregnancy care. Just call us as soon as you can at 1-888-348-2922 (TTY: 711).

 

You can also visit our health and wellness library to learn more about pregnancy, women’s health and other topics to help keep you healthy.

 

Pregnancy care

If you just had a newborn baby, you’ll need to enroll them into benefits. After your baby is born, call the DHHR (Department of Health and Human Resources) Change Center at 1-877-716-1212. Your baby will be eligible for benefits for a minimum of 60 to 90 days, starting on the first day of their birth. This helps ensure they’ll get all the care they need.  

 

If you have questions or need help, just call us at 1-888-348-2922 (TTY: 711).

When you have a condition, you’ll work with your health care provider to set up a treatment plan. The plan will likely include certain steps, like: 

 

  • Taking medication 
  • Making lifestyle changes, like eating and exercise 
  • Finding emotional support 

 

Some conditions can benefit from disease management, like: 

 

  • Asthma 
  • Chronic obstructive pulmonary disease (COPD) 
  • Diabetes 
  • Heart failure 
  • High blood pressure (hypertension)
  • Coronary artery disease (CAD) 
  • Depression

 

Do you have one of these conditions? If yes, you may be able to get help from a case manager. You can learn more on our page about disease management. Or call us at 1-888-348-2922 (TTY: 711).

 

Disease management

Dental and vision benefits

 

You can learn more about dental and vision benefits.

 

Medicaid

 

CHIP

Pharmacy

We help you manage drugs you get while at your doctor’s office, in the hospital or at an infusion center. We do not handle the drugs your doctor prescribes that you pick up at a pharmacy. West Virginia Medicaid Management System (VMMIS) manages those.  

 

To find a pharmacy in the state network, visit WVMMIS Provider Search. Scroll through the list of “Specialists” and choose “Pharmacist”. You can also call 1-888-483-0797.

 

Learn more about pharmacy benefits

Your health

Staying active is one of the best things you can do for your health. It can:

 

  • Give you more energy
  • Help you feel better 
  • Prevent some health problems that go along with aging

 

Some physical activity is better than none at all. But check with your doctor before you start — just to be sure it’s safe. Want to learn more about staying active? 

 

Learn more about exercise 

 

You can learn more about health goals, info and coaching.

 

Health coaching

You’re not alone. During the COVID-19 pandemic, many people have felt more stress and anxiety than ever. They need more help than usual coping with everyday pressures. Things like job loss, child care issues and other challenges are very real.

 

Did you know that stress can affect your health? It’s common during times of stress to pick up some unhealthy habits. Don’t be too hard on yourself. It’s not always easy, but you can learn ways to:

 

  • Eat healthy
  • Exercise regularly
  • Start other healthy habits 

 

Learn more about healthy habits:

 

 

Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. Or you can find this info on your Member Portal or Aetna Better Health app.

 

Learn more about your Member Portal and app

It may not be easy, but you can stop using nicotine — whether it’s smoking, vaping, chewing or another form. Let’s quit together.

 

Find more support

 

You can also learn more about quitting from the:

 

 

If you have questions or need help, just call us at 1-888-348-2922 (TTY: 711).

Learn more about substance use and mental health issues from the:

 

And be sure to check out even more mental and behavioral health resources.

 

Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal or Aetna Better Health app.

 

Learn more about your Member Portal and app

If you have thoughts of harming yourself or others, get help right away. You can call:

 

And be sure to check out even more mental and behavioral health resources.

The Great American Smokeout is a registered trademark of the American Cancer Society, Inc.

 

Alcoholics Anonymous is a registered trademark of Alcoholics Anonymous World Services, Inc.