Aetna Better Health of Louisiana

Behavioral health

Aetna Better Health of Louisiana covers behavioral health services. The services include specialized behavioral health services provided by psychiatrists, psychologists, licensed clinical social workers, licensed professional counselors, mental health clinics, and mental health rehabilitation service providers (public or private). Aetna Better Health of Louisiana also covers inpatient hospital services for acute medical detoxification.

If you would like to join our Behavioral Health provider network, contact our provider relations department at 1-855-242-0802. You may also send an email directly to our network contracting department.

Aetna Better Health of Louisiana is committed to having an integrated care model that looks at all that affects a person – physical, emotional, lifestyle, beliefs and values. We treat behavioral and physical health together.

Since December 1, 2015, Aetna Better Health of Louisiana covers specialized behavioral health services which include mental health and substance use treatment. Different members may be covered for different services.

They have 4 groups of members:

  1. Members who receive all their physical and behavioral health services from us
  2. Members who are eligible to receive only their behavioral health services and non-emergency ambulance transportation from us
  3. Members who receive behavioral health and non-emergency medical transportation from us
  4. CSoC (Coordinated System of Care ) members who receive only physical health services from us

Members should contact the enrollment broker, Healthy Louisiana, to discuss their eligibility and learn about all their plan options.


Making a difference every day

At Aetna Better Health of Louisiana, we’re dedicated to our members. We want you to get quality health care that treats you as a whole person.

We work within your community to get you the care you need

You’ll benefit from our national experience, combined with our knowledge of your community. Aetna Better Health of Louisiana have many resources to help our members with their health care needs. They work directly with health care providers and the community to coordinate  services and assistance.

You can have confidence in an industry leader

We are part of Aetna Medicaid. Our company is a national leader in managing care and services for people with special needs. We bring over 30 years’ experience helping people manage complex illnesses.

Aetna Better Health® of Louisiana will use an integrated approach to the administration of benefits. They will empower you, and your family, by giving you tools to live a healthy life.

Our approach focuses on not just part of you, but all of you. Everything around you affects your health: Where you live. What you eat. Your family and friends. Your activities. Your age. Your emotions.

That’s why it’s so important to treat behavioral and physical health together.

Connecting you to care

We want to know your goals, use your strengths and understand your needs. You deserve quality health care. We’re here to help you get the care you need.

We work with your family, caregivers, providers, advocates, peer and family organizations and community groups to help you reach better health outcomes. We integrate physical and behavioral health. We help you connect to resources and provide vital services to get you access to the services you need.

It’s important you get the right care, at the right time, in the right place. By collaborating with a large network of providers, you’re able to get this.

We work with members and providers to focus on prevention and wellness:

  • Screening for issues that could lead to illness and treating them early with whole-person approach
  • Providing classes and services with providers and others to help members learn to better manage their own care

Basic Behavioral Health Services are provided in medical clinics, such as primary care or ob/gyn clinics, by medical professionals or behavioral health consultants. Common services that may be offered in medical clinic settings include screening for common mental health conditions, screening for alcohol or substance use issues, medication management and coordination of referrals to specialized behavioral health services.

Specialized Behavioral Health Services are provided by licensed mental health or addiction professionals in a setting that is most suitable to the individual and family members’ need. Non-emergent services may be provided in outpatient clinics or in intensive treatment programs. Some members may also be eligible for Home and Community Based Services. Crisis intervention services are available to all members, including inpatient hospital treatment for the most serious cases.


Covered services

The Covered Services Matrix shows what services Aetna Better Health of Louisiana covers. Look at your benefits closely. It’ll help you understand what is covered by your plan, what is not and how you can get the right care when you need it.

You have access to services like doctor’s visits, lab testing, X-rays and much more. These benefits and programs help you live a healthier life. Your benefits also include preventive care and help for serious health concerns. These may be chronic diseases or mental health issues. We also can connect you with resources in your community for extra help.

Some services need prior approval before you can get them, this is called prior authorization. All decisions are based on:

  • whether the service is needed (medical necessity)
  • whether the service is likely to be helpful (clinical appropriateness)
  • if you have coverage

Check with your Primary Care Provider (PCP) or you can call Member Services at 1-855-242-0802, TTY 711.

We do not reward providers for denying, limiting or delaying coverage of health care services.  We also do not give monetary incentives to our staff to make medical necessity decisions that provide less health care coverage or services.

As an Aetna Better Health member you do not have any copays. You do not pay anything to get services we cover. If a provider bills you, do not pay it and call us right away.


You have rights and responsibilities as an Aetna Better Health of Louisiana member

As a Plan member, you have rights and responsibilities. If you need help understanding your rights and responsibilities, call Member Services at 1-855-242-0802, TTY 711.

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As a member, or the parent or guardian of a member, you have the right to:

  • Be treated with respect and with consideration for your dignity and privacy.
  • Participate in decisions regarding your health care, including the right to refuse treatment for religious reasons or for any other reason.
  • Talk about appropriate or medically necessary treatment options for your conditions. This should happen even if it is not a covered benefit and no matter how much it costs.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • Be able to request and receive a copy of your medical records, (one copy free of charge) and request that they be amended or corrected.
  • Receive health care services that are accessible, are comparable in amount, duration and scope to those provided under Medicaid Fee-For-Service and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished.
  • Receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition.
  • Receive all information in a manner and format that you can understand.
  • Receive assistance from both LDH and the Enrollment Broker in understanding the requirements and benefits of Aetna Better Health of Louisiana.
  • Receive oral interpretation services free of charge for all non-English languages.
  • Be notified that oral interpretation is available and how to access those services.
  • As a potential member, to receive information about the Healthy Louisiana program, which populations may or may not enroll in the program, and Aetna Better Health of Louisiana’s responsibilities.
  • Receive information on Aetna Better Health of Louisiana’s services, such as:
    • Benefits covered
    • What to do to get benefits, including any authorization requirements
    • Any amounts you must pay (co-pays)
    • Service area
    • Names, locations, telephone numbers, and non-English language spoken by current contracted providers
    • How and when you can change PCPs or see other providers
    • Providers not accepting new patients
    • Benefits not offered by Aetna Better Health of Louisiana but that you can get under Medicaid
  • Receive information about your disenrollment rights at least annually.
  • Receive notice of any changes in your benefits and services and to be informed at least 30 days before the change takes place.
  • Receive information on grievance, appeal and State Fair Hearing procedures.
  • Voice complaints, grievances, or file appeals about Aetna Better Health of Louisiana or the care you get.
  • Receive information on emergency and after-hours coverage, such as knowing:
    • The definition of  emergency medical conditions, emergency services, and post-stabilization services
    • That emergency services do not require prior authorization
    • The process and procedures for obtaining emergency services
    • The locations of any emergency settings and other locations at which providers and hospitals furnish emergency services and post-stabilization services covered under the contract
    • Your right to use any hospital or other setting for emergency care
    • Post-stabilization care services rules
  • Receive our policy on referrals for specialty care and other benefits not provided by your PCP.
  • Tell us what you think about our rights and responsibilities policy.
  • Have your privacy protected.
  • Exercise these rights without being treating negatively by Aetna Better Health of Louisiana, our providers, or LDH.

 

 

As a member or the parent or guardian of a member, you have the responsibility to:

  • Use your ID cards when you go to health care appointments or get services and do not let anyone else use your card.
  • Let us know if you lose your ID card or if it is stolen.
  • Know the name of your PCP and your case manager, if you have one.
  • Know about your health care and the rules for getting care.
  • Tell us when you make changes to your address, telephone number, or other information.
  • Understand your health problems and particiapte in setting your health goals.
  • Let your provider know if your health changes.
  • Be respectful to the health care providers who are giving you care.
  • Asking questions of your providers to determine potential risks, benefits and costs of treatment alternatives.
  • Following the prescribed treatment of care recommended by the provider or letting your provider know the reasons the treatment cannot be followed as soon as possible.
  • Schedule your appointments during office hours when you can — you also need to be on time and call if you are going to be late to or miss your appointment.
  • Provide participating network providers with accurate and complete medical information.
  • Tell us about your concerns, questions or problems.
  • Ask for more information if you do not understand your care or health condition.
  • Tell us about any other insurance you have or if you are applying for any new benefits.
  • Bring shot records to al lapoointments for children under 18 years of age.
  • Give your provider a copy of your living will or advance directive.
  • Get all the preventive care you need to stay healthy, live a healthy lifestyle and avoid unhealthy activities.
  • Follow the steps to file a grievance If you don’t agree with a provider and want to complain.