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FAQ

General information

Simpler health care: how does it work?

Combining the clinical expertise of Texas Health with the stability of health care coverage from Aetna, we offer members simpler access to care that’s personalized, convenient and lowers costs.

It all begins when you select a primary care physician (PCP), a local doctor who’s your first point of contact for all care. They’ll refer you to specialists and hospitals within the Texas Health Aetna network as needed, and help you keep track of your prescriptions, lab results, health history and more.

Texas Health Aetna also offers virtual care 24/7 through the Anytime-MD app on your phone or computer: this allows you to speak to a local physician about a specific health issue, whether it’s simple or complex, within minutes. Not only does this platform provide immediate answers, but it also saves you from wasting time and money at the ER or on non-emergency urgent care visits.

Plus: we’re here to help you understand the details of your care and coverage every step of the way. If you have any questions, simply call the #800 number on your member ID card.

Why should I choose a primary care* physician when I enroll?

Your PCP is effectively the first point of contact for all your care, the coordinating head of your care team: they get to know you, your health needs, ensure you get the right care at the right time. We provide members with access to more than 3,000 primary-care physicians across 1,200 locations so you have plenty of options that fit your needs. At TH+A we offer forward-thinking primary care physicians that not only personalize your care, but ensure preventative measures are taken to potentially avoid extended complications and costs.

*In Texas, PCP is known as physician (primary care).

How do I find providers?

For a full listing of doctors and specialists in the Texas Health Aetna network on this website, just click on “Find a Doctor” at the top right. You can also call the 800# on the back of your member ID card and one of our team members can confirm if a doctor or specialist is in-network.
Find a doctor

Do I need a referral to see a specialist?

Most of our plans allow you to self-refer to specialists within the Texas Health Aetna network. However, if your employer offers an HMO plan, you’ll need to see your PCP for a referral. Either way, your doctor is a great resource and can suggest an in-network specialist for you. Call the 800# on the back of your member ID card and one of our team members can verify the type of coverage offered by your employer.

What about house calls?

If you need care right away, and your regular physician isn’t available, you may be in one of the areas served by a care team from DispatchHealth, which can be sent to you via Anytime-MD.

  • Local medical teams with nurses and EMTs, able to provide advanced care in your home.
  • Can treat a wide range of injuries and illnesses, from common to complex.
  • Available in select areas of North Texas, may be billed as an urgent care appointment, with related copay/deductibles applying.

What if I’m in the middle of care or treatment with a physician outside the Texas Health Aetna network?

You can request transition-of-care coverage and, upon approval, you can stay and work with your out-of-network physician for a limited time, and have this covered at the same level as your current benefit. Please note that transition-of-care coverage is for your current physician only and does not cover health care facilities, durable medical equipment (DME) or prescription drugs, so you’ll need to use Texas Health Aetna network facilities, DME vendors and pharmacies while you’re in treatment with that out-of-network doctor. To save you time and stress, we are more than happy to help you transfer to a new physician within the Texas Health Aetna network before your grace period ends.

How can Texas Health Aetna network plans help me cope with my chronic condition, such as diabetes or high blood pressure?

Whether you’re at risk, recently diagnosed or are trying to get a condition under control, your personalized care team is there to help. The goal of your care team is to ensure you get the right treatment and level of care, at the right time. Some of the ways we do this include:

  • Ensuring you understand the personalized care plan for your health needs
  • Educating you about your condition and preventative tips
  • Monitoring your progress, assistance with navigating your plan
  • Checking in to confirm you’re taking your meds, refilling prescriptions, are able to follow your provider’s care plan
  • Encouraging you to be actively involved in your care, and to call with any issues or concerns
  • Offering you resources to help you throughout your health care journey

What if I'm in an emergency situation and not at home and need care?

If your health or life is in serious danger, call 911 or go to the nearest hospital. You’ll be covered as though you stayed within the network.

What if I have a child or dependent who lives outside North Texas?

Members can enroll their dependents in a Texas Health Aetna Out-of-Area Dependent PPO plan. They’ll also have access to the Anytime-MDapp as well as any MinuteClinic® location across the United States.

What if I am traveling and need care?

If you’re ill and out of state, you still have in-network coverage: use the Anytime-MDapp 24/7 to speak with a doctor, or for in-person care visit any MinuteClinic® for non-emergencies anywhere in the United States. Genuine emergencies are also covered at the in-network benefit. This can include chest pain, shortness of breath, weakness down one side of your body, blackouts, a bad injury or wound.

Language services can be provided by calling the number on your member ID card. For additional language assistance: Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other Languages…

Health benefits and health insurance plans are offered and/or underwritten by Texas Health + Aetna Health Plan Inc. and Texas Health + Aetna Health Insurance Company (Texas Health Aetna). Each insurer has sole financial responsibility for its own products. Texas Health Aetna are affiliates of Texas Health Resources and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Texas Health Aetna.

Self-funded plans are administered by Texas Health + Aetna Health Insurance Company.

This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Health benefits and health insurance plans contain exclusions and limitations. Providers are independent contractors and not our agents. Provider participation may change without notice. We do not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability are subject to change and may vary by location. If you are in a plan that requires the selection of a primary care physician and your primary care physician is part of an integrated delivery system or physician group, your primary care physician will generally refer you to specialists and hospitals that are part of the delivery system or physician group. Information is believed to be accurate as of the production date; however, it is subject to change.

Physicians on the medical staff practice independently and are not agents or employees of the hospital or Texas Health Resources.

©2021 Texas Health + Aetna Health Plan Inc. & Texas Health + Aetna Health Insurance Company