When you visit Aetna providers, you have an annual deductible to pay before your insurance helps cover expenses. You can use your health care flexible spending account (FSA) or health savings account (HSA), if you have one, to help meet your deductible and eligible expenses. Once you've met your deductible, you still pay a portion of expenses through coinsurance until you reach your out-of-pocket maximum. After you reach your out-of-pocket maximum, the plan covers your expenses at 100% for the remainder of the year. Preventive care is the only exception. There is no charge for preventive care. (Take advantage of this very important benefit each year.)

It’s up to you, not your provider, to make sure your provider is in our Aetna network. This includes any medical care outside of your doctor’s office for diagnostic tests such as X-rays, MRI or CT scans, lab work or outpatient surgery—even if your in-network doctor provides the referral. Click for Memorial Hermann ACO, and here for HDHP and Choice POS or call Aetna Member Services at 877-224-6857 to check before you go for these services. 

Memorial Hermann ACO

Primary care
You may use any primary care physician in the Aetna network. You’re not required to designate a primary care physician. Find a Memorial Hermann ACO provider here.

Hospitals
You must use a Memorial Hermann facility.

Specialists

You can see a specialist without a referral. Make sure your specialist is in-network by using Aetna Docfind or calling Aetna Member Services at 877-224-6857. You are not covered for out-of-network care, except in case of an emergency.

HDHP and Choice POS

Primary care 
You may use any primary care physician in the Aetna network. You’re not required to designate a primary care physician.
  
Hospitals 

You can go to any hospital or facility within the Aetna network. You will pay considerably more if you go to an out-of-network facility. There is a separate deductible and out-of-pocket max for out of network care.

Specialists 

You do not need a referral to see a specialist of your choice. You’re free to use any specialist in the larger Aetna network. You will pay considerably more if you go to an out-of-network specialist. There is a separate deductible and out-of-pocket max for out-of-network care.

If you go to the doctor for a preventive care checkup, such as your annual physical or well-person exam, it’s free. But if you ask the doctor to take a look at your sore throat, for example, the visit is no longer a preventive checkup. If you’re not sure what services are considered preventive, call Aetna Member Services at 877-224-6857.

You can use the Aetna Navigator cost estimator tool to find out how much you might expect to pay for many common procedures. Under Coverage & Benefits, choose Estimate the cost of care.

If you have a true emergency, head straight to your nearest ER. For help deciding if an urgent care or retail clinic is a better choice, call the 24/7 Nurse Line at 866-222-KISD (5473).

For alternative health care services such as massage therapy, acupuncture, chiropractic care, dietetic counseling and discounts on vitamins and supplements, log on to Aetna Navigator and search for Aetna Natural Products and Services.