View coverage and benefits

We help you get medically necessary health care services in the most cost-effective way under your health plan. And we work with you and doctors to evaluate services for medical appropriateness, timeliness and cost.

Specifically, we:

• Base our decisions on appropriateness of care, service and plan coverage
• Use nationally recognized guidelines and resources to make changes
• Don’t pay or reward providers, employees or others for denying coverage or care
• Focus on reviewing the risks of members who aren’t fully using certain services

Doctors and health care companies continuously develop new technologies. This can include anything from a new procedure to a new way to use a device.

If you’re enrolled in an Allina Health | Aetna Medicare Plan (PPO)

You have flexibility to receive covered services from network providers or out-of-network providers. Out-of-network/non-contracted providers are under no obligation to treat Allina Health | Aetna Medicare members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing for out-of-network services.

Although you don’t have to choose a primary care provider, we encourage you to do so. If you receive covered services from an out-of-network doctor, it’s important to confirm that they:

• Accept your PPO plan
• Are eligible to receive Medicare payment

Telehealth — or telemedicine — means virtual care you can get at home or away. These visits are live, video conferences between you and a doctor over a computer or smart phone. Consider using telehealth when you have a time sensitive medical need or can’t get to the doctor in person.

Your plan covers certain telehealth visits with in-network

• Primary care doctors
• Mental health providers, and
• Urgent care facilities

Not all provider visits can be handled through telehealth. You can view and download a list of potentially covered telehealth services here. Ask your doctor whether they offer these services via telehealth and how to schedule a visit.

Telehealth visits with out-of-network providers are not covered. Please refer to your provider directory to find an in-network provider.

Note: Certain services may require a prior authorization (pre-approval). See your Evidence of Coverage for details.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.