Aetna Choice POS (Aetna HealthFund) Plan

The Open Choice PPO Plans give you the freedom to select any licensed provider when you need care. These plans offer both in-network and out-of-network benefits, but the plan’s reimbursement is higher when you use a network provider. You do not have to select a primary care physician (PCP) and no referrals are needed for specialty care and other medical services.

The main difference between the Aetna Open Choice PPO 1 and PPO 2 is the out-of-pocket expenses for coinsurance and copays. Please see the Aetna Open Choice PPO 1 and the Aetna Open Choice PPO 2 summary of benefits charts for more details.

You should choose an Open Choice PPO plan if:

• You need open access to any licensed health care provider.
• You are open to controlling your health care costs by using network providers and receiving higher benefits.
• You want to be able to visit specialists without getting referrals from a PCP.
• You are willing to pay higher out-of-pockets costs in exchange for more choice.

How Open Choice Works

Under the Open Choice PPO plan, you may receive care from any licensed, qualified doctor or other health care provider. You are not required to select a PCP and no referrals are required for specialty care. When you need care, simply choose the appropriate doctor and make an appointment.

While you are free to use any provider, you save money when you use providers who belong to the provider network. The network consists of more than 472,000 providers and includes both primary care physicians and specialists ranging from cardiologists, podiatrists, and OB/GYNs to oncologists, ophthalmologists and orthopedists. Facilities such as hospitals, urgent care centers and labs also belong to the network.

The PPO plan has two levels of benefits:

• In-network benefits. When you use in-network providers, you pay a fixed dollar amount, called a copayment (or copay), for doctor’s office visits and routine exams. For other services, you pay a lower deductible and the plan pays a larger share of your expenses. In addition, the network provider files claims for you and takes care of the plan’s precertification requirement.
• Out-of-network benefits. If you decide to use an out-of-network provider, you must meet a higher deductible and the plan pays a smaller share of your expenses. In addition, you must file your own claims and call Aetna when your doctor recommends care that must be precertified.A visit to a podiatrist is a benefit covered by most insurance plans. However, there can be restrictions due to changes in recent health care coverages.To avoid any additional cost to the patient, Podiatry Group of Georgia will work with your insurance company to get your services covered. Sometimes this requires our office to send in a letter of medical necessity which will state the reasoning behind the recommended treatment and include the patient’s history and diagnosis.As a courtesy to our patients, we will contact your insurance company prior to your visit to verify that services are covered and that no referrals are required. This allows us to provide you with the best care while making sure you are aware of your insurance benefits for any treatments or services recommended for your specific condition before they are performed.

If you are having any foot pain, or overall concerns with your feet and want to schedule an appointment, please contact our office at (404) 806-3731. We will be able to help to you with any of your insurance concerns. Your insurance company will also be able to review your plan with you prior to your visit.

Seeking Treatment

If you’ve been searching for Foot Doctor for all your foot and ankle needs, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta And Atlanta Area!