Provider and Pharmacy Directory

Service area

We will refer to these groups as "network providers" in this Directory. These providers signed a contract with us to provide you services. This is a list of Aetna Better Health of Ohio’s network providers for

Central Region (Columbus area)	Northwest Region (Toledo area)	Southwest Region (Cincinnati area)
Delaware County	Fulton County	Butler County
Franklin County	Lucas County	Clermont County
Madison County	Ottawa County	Clinton County
Pickaway County	Wood County	Hamilton County
Union County		Warren County

Disclaimers

ATTENTION: If you speak Spanish or Somali, language assistance services, free of charge, are available to you. Call 1-855-364-0974 (TTY: 711), 24 hours a day, 7 days a week. The call is free.

ATENCIÓN: Si habla inglés o somalíes, tiene a sudisposición servicios gratuitos de asistencia lingüística. Llame al 1-855-364-0974 (TTY: 711), durante las 24 horas, loos 7 días de la semana. La llamada es gratuita.

FIIRI: Haddii aad ku hadasho isbaanish ama ingiriis, adeegyada lluqadda, oo bilaash ah, ayaa laguu heli karaa adiga. Wac 1-855-364-0974 (TTY: 711), 24 saacadood maalintii,7 maalmood todobaadkii. Wicitaanku waa bilaash.

If you wish to make a standing request to receive all materials in a language other than English or in an alternate format, you can call Aetna Better Health of Ohio Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week.

Getting started in Aetna Better Health of Ohio

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 services and supports, 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 services and supports.
  • 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 family practitioner; general practitioner; geriatrician; certified nurse practitioner; internist; obstetrician/gynecologist; pediatrician or physician assistant 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.
• You also have access to a care manager and a care team that you choose. Your PCP will work closely with your care manager and care team.
• Your care manager helps you manage all your providers and services. He or she works with your care team to make sure you get the care you need.
• Your care team includes you, your family members, caregivers, care manager, PCP, specialists and anyone else you want included. 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, or PCP. If you do not choose a PCP, we will assign one to you. You may be able to have a specialist act as your PCP. The specialist will have to first agree to do so. If you want a specialist to be your PCP, talk to your care manager. Your care manager will work with the specialist to become your PCP. You may also want to contact the specialist directly to discuss your needs.

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

• choose a provider that you use now, or
• choose a provider who has been recommended by someone you trust, or
• choose a provider whose offices are easy for you to get to.

If you want help in choosing a PCP, please call Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week. The call is free. Or, visit www.aetnabetterhealth.com/ohio.

If you have questions about whether any service or care that you want or need is covered, talk to your care manager or call Member Services to ask before you get the service or care.

Getting long-term services and supports

You may be able to get long-term services and supports (LTSS) which are also called Medicaid “waiver services”, such as home health care, adult day care services and specialized medical equipment as an Aetna Better Health of Ohio member. Long-term services and supports give assistance to help you stay at home instead of going to a nursing home or hospital. If you have questions about LTSS or to see if you qualify, call your care manager.

 

Identifying Providers in Aetna Better Health of Ohio’s Network

You must get all of your covered services from providers within our network. These providers have an agreement to work with us and provide you services. We call these providers "network providers."

The exceptions to this rule are when you need long-term nursing home care, urgent or emergency care, or dialysis and cannot get to a provider in the plan, such as when you are away from home. Also, for a specific period of time after your enrollment with Aetna Better Health of Ohio, you can see your out-of-network physicians and other service providers, including nursing homes and assisted living providers, home health nurses, aides and LTSS or "waiver services" providers. You can also go outside the plan if Aetna Better Health of Ohio gives you permission first. Call Member Services to ask for the use of providers outside of our network, so we can make arrangements for you.

• 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 for any reason you want to change your PCP, you must first call Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week to ask for the change. The change will take effect immediately upon receipt of the request. You will receive a new member ID card within 14 days. If you need to see your PCP before you get your new member ID card, your PCP’s office can call us to verify your eligibility. If you are thinking about changing your PCP, talk to your care manager.
• Aetna Better Health of Ohio 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 of Ohio can help you. Talk to your care manager for assistance.

Finding Aetna Better Health of Ohio providers in your area

This Directory includes providers of both Medicare and Medicaid services. It is arranged by provider type, region, county and city. The regions listed are:

• Central (Columbus area)
• Northwest (Toledo area)
• Southwest (Cincinnati area)
• Out of Region (Neighboring counties and states)

The counties in each region are listed in the table on page I. The Out of Region section lists providers that are not located in one of our regions but are in our network and may be close to you. They are located in counties or states that are near our regions. For example, members in the Northwest region may choose to see a provider in our network who is located in Michigan. You may go to these providers listed in the Out of Region section since they are part of our network.

To find a provider, first look for the provider type. Then look for your region, county and the city you live in (or one near you) and find a provider near you. You can also check the Out of Region section to see if there is a provider in another county that is close to you. Aetna Better Health of Ohio may add or remove plan providers from our provider/pharmacy directory. You can also get current information about Aetna Better Health of Ohio providers in your area on our website www.aetnabetterhealth.com/ohio or by calling Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week.

List of network providers

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

• Health care professionals (for example, primary care physicians, specialists, mental health providers, Qualified Family Planning Providers (QFPPs), dentists, and vision care providers);
• Facilities (for example, hospitals, long-term care facilities and skilled nursing facilities for rehabilitation, mental health facilities, Federally Qualified Health Centers, and Rural Health Centers); and
• Support providers (for example, adult day services, assisted living, home-delivered meals, home health agencies, and home medical equipment providers).
• Federally Qualified Health Centers/Rural Health Centers (FQHCs/RHCs) You are entitled to access the services of any federally qualified health center (FQHC) or rural health center (RHC) providers. The following is a list of the FQHC and RHC providers in your county. Those providers listed with an asterisk (*) are contracted providers with Aetna Better Health of Ohio. You might also see providers from these facilities listed individually in other parts of this Directory.
• Qualified Family Planning Providers (QFPPs) You are entitled to self-refer to any of the following family planning providers. In addition, you may self-refer to certain family planning providers in other counties. For more information about access to these services, please contact Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week. The call is free.

Pharmacies

This part of the Directory provides a list of pharmacies in Aetna Better Health of Ohio’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 of Ohio area in which you live. You may also fill your prescriptions at these pharmacies. Please contact Aetna Better Health of Ohio at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week for additional information.

Aetna Better Health of Ohio 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 or urgent care situation, including when you are out of the service area, call Aetna Better Health of Ohio’s toll-free Member Services or 24‑hour nurse advice line for assistance in getting your prescription filled.
• 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 of Ohio 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 of Ohio network pharmacies in your area, please visit our website at www.aetnabetterhealth.com/ohio or call Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week. The call is free.

To get a complete description of your prescription coverage, including how to fill your prescriptions, pleas read the Member Handbook and Aetna Better Health of Ohio’s List of Covered Drugs. You can find the List o Covered Drugs on the Aetna Better Health of Ohio website at www.aetnabetterhealth.com/ohio or by calling Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week. You can also search by drug using the online formulary search tool.

Identifying pharmacies in our network

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

• Mail Order Pharmacies
• Home infusion pharmacies
• Long-term care (LTC) 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.

Aetna Better Health of Ohio’s Network Pharmacies

This section of the Directory includes pharmacies arranged by provider type, region, county, pharmacy type and the cities where they are located. Look for the county and city you live in (or one near you) and find pharmacy close to where you live for your prescription needs.

The regions listed are:

• Central (Columbus area)
• Northeast (Toledo area)
• Southwest (Cincinnati area)
• Out of Region (Neighboring counties)

The counties in each region are listed in the table on page I.

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

You can go to any of the pharmacies in our network. Retail and Mail Order Pharmacies are accessible to all members. Home Infusion and Long-Term Care pharmacies are accessible to members as long as they are eligible for their services.

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 (hearing impaired only, TTY 1-800-231-4403). 　

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, if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact us at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week. To learn more about mail order pharmacies, see Chapter 5 of the Member Handbook.

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.

Home Infusion Pharmacy

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 of Ohio will cover home infusion therapy if:

• Your prescription drug is on the Aetna Better Health of Ohio 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 of Ohio network pharmacy.

If you have questions about home infusion pharmacies in our network call your care manager or Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week.

Network Pharmacies outside the Aetna Better Health of Ohio Service Area

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

Long-Term Care Pharmacy

Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under Aetna Better Health of Ohio 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.

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 your care manager or Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week.