Aetna Better Health of West Virginia
500 Virginia Street East, Suite 400
Charleston, WV 25301
AETNA BETTER HEALTH® OF WEST VIRGINIA
Referrals and Prior Authorization
Referrals
Your Primary Care Provider (PCP) provides most of your health care. Some health care will be given
by other doctors. These doctors are called specialists. Your PCP can send you to a specialist. This is
called a referral. If you feel you need to see a specialist, talk to your PCP. Your PCP may also set up
the referral visit for you.
Let your PCP know about any care you get, so he/she can help with all your care.
Authorizations (Approvals)
You do not need approval for family planning services. You must get approval to get care from
providers that are out of your network for all other services that are not emergencies.
You do not have to get approvals for in-network services. Your doctors will get these approvals. You
do not have to pay for in-network services that your doctor does not get approved.
Services that need to be approved (including but not limited to):
Chemo and Radiation Oncology services
Chiropractic services
Clinical trials
Durable Medical Equipment (DME)
Elective sterilization
Enteral feeding supply and formulas,
additives, all pumps
Genetic Testing
Home based services including hospice
Hospital services
Imaging (scans)
Injectables
Inpatient
services
Orthotics/Prosthetics
Outpatient
surgery
Prescription
drugs
over
the number
limit
or
not
on
the preferred
drug
list
Services
from
providers
not
in
your
network
Sleep
studies
Supply
based
services
Therapies
If you have questions or need approval for out-of-network services, you can call Aetna Better Health
of West Virginia toll free at 1-888-348-2922. More info is in your member handbook.
***Please Note*** The above list of services is broad. Specific services that need to be approved
are at the code level. Your provider should use the online Prior Authorization Lookup Tool (ProPAT)
for clear direction on when a service needs to be approved.
www.aetnabetterhealth.com/westvirginia
VA-16-03-12
