In this section, you'll find a number of resources to assist you in serving our Aetna Better Health of West Virginia members. Remember, you can always find more information in our provider manuals.
Resources and information
Quick Reference Guide
Who to contact when you need to reach us.
Medical Records Documentation Standards
Consistent, current and complete documentation in medical records is essential in quality patient care.
Derechos de los miembros
All members have certain rights and responsibilities. Members rights:
- Get information about Aetna Better Health, our services, our practitioners and providers, and your rights and responsibilities.
- Be treated with respect and dignity and have your privacy protected.
- Get interpretation services if you do not speak English or have a hearing impairment.
- Have materials presented in a manner or language that you understand, at no cost to you.
- Not be discriminated against by Aetna Better Health.
- Access all services that Aetna Better Health must provide.
- Choose a practitioner or provider in our network.
- Take part in decisions about your health care.
- Accept or refuse medical or surgical treatment and choose a different provider.
- Learn about other treatment options and different courses of care no matter how much they cost and/or if Aetna Better Health will pay for it.
- Have your doctor tell you how he or she plans to treat you.
- Your medical records.
- Change or correct your medical records if needed.
- Be sure your medical records are kept private.
- Tell us how we can improve our policies and procedures, including the member rights and responsibilities policy.
- Be free from any form of restraint or seclusion used as a means of force, discipline, convenience, or retaliation.
- Get covered services, no matter what your cultural or ethnic background is or how well you understand English.
- Get covered services regardless of any physical or mental disability, or if you are homeless.
- Refer yourself to in-network and out-of-network family planning providers.
- Access certified nurse midwife services and certified pediatric or family nurse practitioner services.
- Get emergency post-stabilization services.
- Get emergency health care services at any hospital or other setting.
- Receive information about advance directives, which tell how to have medical decisions made for you if you are not able to make them for yourself.
- Receive information about practitioner incentive plans upon request.
- Have your parent or a representative make treatment decisions when you can’t.
- Submit a complaint or appeal about Aetna Better Health or the services it provides.
- A quick response to problems raised around complaints, grievances, appeals, authorization, coverage, and payment of services.
- A state fair hearing after a decision has been made about your appeal.
- A copy of this member handbook.
- Disenroll from your health plan.
- Get accessible services.
RESPONSABILIDADES DEL MIEMBRO:
- Read your Member Handbook. It tells you about our services and how to file a grievance or appeal.
- Work with your PCP to manage and improve your health.
- Ask your PCP any questions you may have and call your PCP any time you need health care.
- Give all information about your health to Aetna Better Health and your doctor. Tell your doctor if you do not understand your health problems. You and your doctor should make plans together about your care.
- Show your ID card to each doctor before getting health services.
- Protect your member ID card. Do not lose or share it with others.
- Use the emergency room (ER) for true emergencies only.
- Make and keep appointments with doctors. If you need to cancel and appointment, it must be done at least twenty-four (24) hours before your scheduled visit.
- Follow what you and your practitioner agree to do.
- Follow your practitioner’s recommendations about appointments and medications.
- Go back to your PCP or ask for a second opinion if you do not get better.
- Call Member Services at 1-888-348-2922 whenever anything is unclear to you or you have questions.
- Contact DHHR Change Report Center at 1-877-716-1212 to report family size, employment, and/or address changes.
- Treat doctors, staff, and people providing services to you with respect.
- Tell Aetna Better Health if you have other health insurance, including Medicare.
- Give your doctor a copy of your living will and/or advance directive.