Provider and Pharmacy Directory

Getting started in Aetna Better Health Premier Plan

This section explains key terms you’ll see in our Provider and Pharmacy Directory.

• Providers are health care professionals and support providers such as doctors, nurses, pharmacists, therapists, and other people who provide care and services. Services include medical care, long-term supports and services, supplies, prescription drugs, equipment and other services.
  • The term providers also includes facilities such as hospitals, clinics, and other places that provide medical services, medical equipment, and long-term supports and services.
  • Providers that are a part of our plan's network are called network providers.
• Network providers are the providers that have contracted with us to provide services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay nothing for covered services.
• A Primary Care Provider (PCP) is a clinician of primary care such as a general practitioner, an internist, a family practitioner, an OB/GYN, a geriatrician or a nurse practitioner who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time.
• Specialists are doctors who provide health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:
  • Oncologists care for patients with cancer.
  • Cardiologists care for patients with heart conditions.
  • Orthopedists care for patients with certain bone, joint, or muscle conditions.
• Your provider may need prior authorization or an approval from Aetna Better Health Premier Plan before you get certain services. Covered services that need prior authorization are marked in the Benefits Chart in Chapter 4. Some drugs are covered only if you get prior authorization from us. Covered drugs that need prior authorization are marked in the List of Covered Drugs.
• You also have access to a Care Coordinator and a Care Team that you choose.
  • A Care Coordinator helps you manage your medical providers and services.
  • Your Care Team includes you or your chosen legal representative, your care coordinator, your primary care provider, your LTSS Coordinator or PHIP Supports Coordinator (as applicable), and others as needed. Everyone on the Care Team works together to make sure your care is coordinated. This means that they make sure tests and labs are done once and the results are shared with the appropriate providers. It also means that your PCP should know all medicines you take so that he or she can reduce any negative effects. Your PCP will always get your permission before sharing your medical information with other providers.

Choosing a Primary Care Provider (PCP)

You can get services from any provider who is in our network and accepting new members.

First, you will need to choose a Primary Care Provider. You may be able to have a specialist act as your PCP. If you would like a specialist to be your PCP, please talk to your Care Coordinator or call Member Services. The specialist must agree to be your PCP. Specialists who perform primary care functions including specialists who provide primary care in FQHCs, rural health clinics, health departments and other similar community clinics may act as PCPs.

To choose a PCP, go to the list of providers on page 1 and choose a provider:

• whose offices are easy for you to get to.
• who has been recommended by someone you trust, or
• that you use now, or
  • If you want help in choosing a PCP, please call Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week. The call is free. Or, visit www.aetnabetterhealth.com/michigan.
  • If you have questions about whether we will pay for any medical service or care that you want or need, call Member Services and ask before you get the service or care.

Getting long-term supports and services

As an Aetna Better Health Premier Plan member, you may be able to get long-term supports and services (LTSS), such as home health, personal care, nursing home and home and community based services (adult day program, respite, expanded community living supports, preventive nursing services, private duty nursing, and other services). Long-term supports and services supports are help for people who need assistance to do everyday tasks like taking a bath, getting dressed, making food, and taking medicine. Most of these services are provided at your home or in your community but could be provided in a nursing home or hospital.

You should discuss long term supports and services with your Care Coordinator to determine which services you qualify for and how to access them.

Identifying Providers in Aetna Better Health Premier Plan’s Network

You must get all of your covered services from providers within our network. If you go to providers who are not in Aetna Better Health Premier Plan’s network (without prior authorization or approval from us), you will have to pay the bill.

The exceptions to this rule are when you need urgent or emergency care or dialysis and cannot get to a provider in the plan, such as when you are away from home. You can also go outside the plan for other non-emergency services if Aetna Better Health Premier Plan gives you permission first.

• You may change providers within the network at any time. If you have been going to one network provider, you do not have to keep going to that same provider. If you would like to change your PCP, talk to your Care Coordinator or call Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week.
• Aetna Better Health Premier Plan works with all the providers in our network to accommodate the needs of people with disabilities. As applicable, the list of network providers in this Directory includes information about the accommodations they provide. If you need to see a provider and are not sure if they offer the accommodations you need, Aetna Better Health Premier Plan can help you. Talk to your Care Coordinator for assistance.

Finding Aetna Better Health Premier Plan providers in your area

This directory is arranged by provider type, county, specialty and city. Look for the county and city where you live and find a provider near you.

List of network providers

This Directory of Aetna Better Health Premier Plan’s network providers contains:

• Health care professionals including primary care providers, who may be physicians, physician assistants, or nurse practitioners; hearing, dental, or vision specialists.
• Facilities including hospitals; urgent care centers; skilled nursing facilities/nursing facilities; Prepaid Inpatient Health Plan (PIHP) facilities for needs related to behavioral health, intellectual/developmental disability, and/or substance use; and Federally Qualified Health Centers (FQHCs); and Rural Health Centers (RHCs); and
• Support providers including adult day programs; assistive technology; chore services; community transitions; environmental modifications; home-delivered meals; LTSS and non-LTSS home health agencies; medical supplies; non-medical transportation; personal care; preventive nursing; private duty nursing; respite care.

You may get services from any of the providers in this directory. This directory includes providers of both Medicare and Medicaid services.

Pharmacies

This part of the Directory provides a list of pharmacies in Aetna Better Health Premier Plan’s network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.

We also list pharmacies that are in our network but are outside the Aetna Better Health Premier Plan service area in which you live. You may also fill your prescriptions at these pharmacies. Please contact Aetna Better Health Premier Plan at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week, for additional information.

• Aetna Better Health Premier Plan members must use network pharmacies to get prescription drugs.
  • You must use network pharmacies except in emergency or urgent care situations. If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the Aetna Better Health Premier Plan Member Handbook for more information.
• Some network pharmacies may not be listed in this Directory.
  • Some network pharmacies may have been added or removed from our plan after this Directory was published.

For up-to-date information about Aetna Better Health Premier Plan network pharmacies in your area, please visit our web site at www.aetnabetterhealth.com/michigan or call Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week. The call is free.

To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook and Aetna Better Health Premier Plan’s List of Covered Drugs. These documents and an online formulary search tool can be found on the Aetna Better Health Premier Plan website at www.aetnabetterhealth.com/michigan.

Identifying pharmacies in our network

Along with retail and chain pharmacies, your plan’s network of pharmacies includes:

• Mail-Order Pharmacies
• Home infusion pharmacies
• Long-term care (LTC) pharmacies
• Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies

You are not required to continue going to the same pharmacy to fill your prescriptions.

Long-term supplies of prescriptions

• Mail-Order Programs. We offer a mail-order program that allows you to get up to a 90-day supply of your prescription drugs sent directly to your home. A 90-day supply has the same copay as a one-month supply.
• 90-Day Retail Pharmacy Programs. Some retail pharmacies may also offer up to a 90-day supply of covered prescription drugs. A 90-day supply has the same copay as a one-month supply.

Network Pharmacies outside the Aetna Better Health Premier Plan service area

You can get your drugs covered at any of our network pharmacies. This includes our network pharmacies outside of our service area.

Aetna Better Health Premier Plan’s Network Pharmacies

This directory is arranged by pharmacy type, county, city and pharmacy name. Look for the county and city where you live and find a pharmacy near you.

Retail and mail order pharmacies are accessible to all members. Home Infusion, Long-Term Care and Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies are accessible to members as long as they are eligible for their services.

The legend in the front cover of the directory provides information on symbols used in the pharmacy listing.

Mail Order Pharmacy

You can get prescription drugs shipped to your home through our network mail order delivery program which is called CVS Mail Order Pharmacy.

You also have the choice to sign up for automated mail order delivery through our CVS Mail Order Pharmacy. The pharmacy must obtain consent before shipping or delivering any prescriptions you do not personally initiate.

1. New prescriptions the pharmacy gets from you

The pharmacy will automatically fill and deliver new prescriptions it gets from you.

2. New prescriptions the pharmacy gets directly from your provider’s office

The pharmacy will automatically fill and deliver new prescriptions it gets from health care providers, without checking with you first, if either:

• You used mail order services with this plan in the past, or
• You sign up for automatic delivery of all new prescriptions you get directly from health care providers. You may ask for automatic delivery of all new prescriptions now or at any time by contacting CVS Caremark Customer Care at 1-800-552-8159 (TTY: 1-800-231-4403).
• If you used mail order in the past and do not want the pharmacy to automatically fill and ship each new prescription, please contact us CVS Caremark Customer Care at 1-800-552-8159 (TTY: 1-800-231-4403) and let them know how you would like to receive your mail order prescriptions or register online with CVS Caremark at http://www.caremark.com/. You can change your mail order preference at any time.  

If you have never used our mail order delivery and/or decide to stop automatic fills of new prescriptions, the pharmacy will contact you each time it gets a new prescription from a health care provider to see if you want the medication filled and shipped immediately. This will give you an opportunity to make sure that the pharmacy is delivering the correct drug (including strength, amount, and form) and, if necessary, allow you to cancel or delay the order before it is shipped. It is important that you respond each time you are contacted by the pharmacy, to let them know what to do with the new prescription and to prevent any delays in shipping.

To opt out of automatic deliveries of new prescriptions you got directly from your health care provider’s office, please contact CVS Caremark Customer Care at 1-800-552-8159 (TTY: 1-800-231-4403).

       3. Refills on mail-order prescriptions

For refills, please contact your pharmacy 15 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time.

So the pharmacy can reach you to confirm your order before shipping, please make sure to let the pharmacy know the best ways to contact you. Contact CVS Caremark Customer Care at 1-800-552-8159 (TTY: 1-800-231-4403) to tell them the best way to reach you. If we don’t know the best way to reach you, you might miss the chance to tell us whether you want a refill and you could run out of your prescription drugs.

Typically, you should expect to get your prescription drugs within 10 days from the time that the mail order pharmacy gets the order. If you do not get your prescription drug(s) within this time or if you would like to cancel an automatic order, please contact us at CVS Caremark Customer Care at 1-800-552-8159 (TTY: 1-800-231-4403). To learn more about mail order pharmacies, see Chapter 5 of the Member Handbook.

Home Infusion Pharmacies

Home infusion pharmacies are included in the network. These pharmacies supply drugs that may need to be given to you by an intravenous route or other non‑oral routes, such as intra‑muscular injections, in your home.

Aetna Better Health Premier Plan will cover home infusion therapy if:

• Your prescription drug is on the Aetna Better Health Premier Plan formulary
• We have approved your prescription drug for home infusion therapy
• Your prescription is written by a doctor

You get your home infusion services from an Aetna Better Health Premier Plan network pharmacy.

If you have questions about home infusion pharmacies in our network call Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week.

Long-Term Care Pharmacies

Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under Aetna Better Health Premier Plan through the facility’s pharmacy or another network pharmacy. To learn more about drug coverage in special cases, see Chapter 5 of the Member Handbook.

Long‑Term Care (LTC) pharmacies are included in the network. These pharmacies offer pharmacy services to patients that are housed in a type of group home like a nursing home or rehabilitation center. Generally, all LTC pharmacies are in network. LTC pharmacies will fill prescription orders written by medical staff in the group home and deliver the medication directly to the medical staff who will distribute the medication to the members. Generally, each group home will have one or two LTC pharmacies that supply most of the pharmacy services to all of the members residing in the facility.

To get information about filling your prescriptions at an LTC pharmacy call Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week.

Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies

Only Native Americans and Alaska Natives have access to Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies through Aetna Better Health Premier Plan’s pharmacy network. Those other than Native Americans and Alaskan Natives may be able to go to these pharmacies under limited circumstances (e.g., emergencies).

An I/T/U Pharmacy is a operated by the Indian Health Service, an Indian tribe or tribal organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.

To get information about filling your prescriptions at an I/T/U pharmacy, call Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week.