Aetna

Your Aetna card might say HMO, PPO, EPO, or Medicare Advantage. We are in-network for Aetna Medicare Advantage at Moses Medical, 871B Westchester Ave in the Bronx. If you got Aetna through your job, network status depends on the specific plan, so call (646) 741-2111 with your card and we will check it before your visit.

The plan type on your card matters because it affects how much you pay and whether you need a referral. Aetna HMO members need their primary care provider to write a referral before seeing a specialist. PPO and EPO members can book specialist visits directly. If you are not sure which type you have, flip your card over. It is printed on the front.

What Aetna Pays For

Depending on your plan, your Aetna card may cover these visits at our office:

• Primary care visits including annual physicals, sick visits, and chronic disease checkups
• Primary care for conditions like diabetes, high blood pressure, and thyroid problems
• Internal medicine for ongoing blood pressure, cholesterol, diabetes, and chronic condition management
• Dermatology for skin exams, rashes, acne, and mole checks
• Mental health visits for evaluation, medication questions or management when appropriate, and referral planning for therapy or counseling when needed
• Podiatry for diabetic foot care, heel pain, and ankle injuries
• Lab work drawn on-site during your visit
• Medical weight loss with clinician-guided plans

Medicare Advantage members often have extra benefits beyond what Original Medicare covers. These can include hearing aids, dental visits, and fitness programs. Ask us or call Aetna at 1-800-872-3862 to find out what your specific plan includes.

Checking Your Benefits

Before your first visit, pull out your Aetna ID card and look for two things: plan type and group number. Bring the card and a photo ID to check-in.

If you have an HMO plan and need a specialist, ask Aetna whether this office is in network for your product, then start with a primary care visit and your provider can write the referral. PPO members can usually book with a specialist directly.

The front desk can run an eligibility check when you arrive and tell you what the plan reports before you see a provider, though an eligibility response is not a guarantee that a service will be paid. If a service requires prior authorization, staff can file the request with Aetna, and Aetna decides the outcome.

Getting More From Aetna

If you work and get Aetna through your employer: Schedule your annual wellness visit. Federal rules require most employer plans to cover in-network preventive care at no cost to you, so confirm network status first. This is separate from a sick visit. It includes age-based screenings, blood work, and immunization updates.

If you are on Aetna Medicare Advantage: Medicare Advantage plans include an Annual Wellness Visit with a personalized prevention plan. Your plan may also cover podiatry visits that Original Medicare limits. Ask Aetna what yours includes.

For everyone: Staying in network saves real money. On a PPO, an out-of-network visit can cost several times the in-network copay after coinsurance. On HMO plans, out-of-network care is generally not covered at all except in emergencies.

If you have a heart condition or a family history of heart disease, ask the care team to review your blood pressure, cholesterol, and risk factors at your next primary care visit.

Call (646) 741-2111 to book an appointment, or walk in during office hours. We are on Westchester Ave, about a 2-minute walk from the 2/5 trains at Prospect Av.