CSC Preferred Access – In-Area Feature
Open access to care providers with no referrals required.
How the In-Area Feature works
When you need care, you have a choice:
You may visit an in-network provider.
You may make an appointment directly with a primary care provider, specialty care provider or other health care provider who belongs to Aetna's network – no referral is required.
When you visit an in-network provider:
- You will pay a flat fee, called a copay, for services such as office visits.
- You will be required to meet a deductible before the plan begins to pay benefits for other types of services. The plan will then pay a percentage of covered expenses (called coinsurance).
- You'll have a higher level of coinsurance reimbursement for services, such as hospitalization, x-ray and lab.
- Provider is responsible for precertification requirements.
- The provider will file the claim.
You may visit an out-of-network provider.
You also may make an appointment directly with a primary care provider, specialty care provider or other health care provider who does not belong to Aetna's network – no referral is required.
When you use an out-of-network provider:
- You must meet a higher deductible each year before the plan starts to pay benefits.
- After you meet the deductible, the plan will pay a percentage of the remaining expense (coinsurance). This percentage will be lower than it would be if you used an in-network provider. In addition, the plan's benefit will be based on the reasonable and customary charge for a given service. If the reasonable and customary charge is lower than the actual charge, you must pay the difference.
- You must call Aetna to start precertification for certain types of care.
- You may be required to file your own medical claims.