In order to receive the highest level of benefits, employees in the Midwest Division enrolled in the Well Care PPO plan must seek care from designated HMCC PHO physicians, HCA-affiliated facilities and HMCC PHO affiliated facilities.
The HMCC PHO network service area encompasses the following counties. (If you live outside the HMCC PHO service area, you must use the Aetna PPO national network in order to receive the highest level of benefits.)
Kansas: Johnson, Wyandotte
Missouri: Cass, Clay, Jackson, Lafayette, Platte, Ray
Prior to your first appointment with any physician, verify if he or she participates in the HMCC PHO Network, if they are taking new patients and if they have admitting privileges to an HCA affiliate or HMCC PHO facility when inpatient and outpatient services are anticipated.
To determine if medically necessary services are available at an HCA affiliate or HMCC PHO facility, participants must call Aetna member services. If Aetna determines that a covered service is unavailable, participants must utilize a facility that participates in the Aetna PPO network to avoid penalties. If care is not received at an HCA affiliate or HMCC PHO facility when it was available, penalties will apply. All medical claims and/or benefit-related questions should be submitted to:
P.O. Box 14079
Lexington, KY 40512
Member Services representatives are available between 7 a.m. and 5 p.m. Central, Monday-Friday
Behavioral health providers are not included in the HMCC PHO or Aetna PPO network for HCA. The behavioral health plan is administered by New Directions. All services for mental health and/or chemical dependency treatment or services, except for the first 20 outpatient visits, must be pre-certified in advance by New Directions. After visit 20, an outpatient treatment report from your provider is required for benefits to continue. Eligible providers are defined as licensed psychiatrists, licensed clinical psychologists, licensed or certified master's level clinical social workers, licensed or certified masters level psychiatric nurse specialists, or licensed professional counselors. For more information about behavioral health benefits, contact New Directions at (800) 528-5763.
You must consult with Aetna Member Services or the Summary Plan Description to determine what type of providers and services are covered. Failure to refer to these resources may result in lesser reimbursement for certain medical expenses. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services.
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Well Care administered by Aetna - HMCC PHO - Kansas City Area (Level 1, 2 and 3)
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company.