Transition of Care
Aetna® is one of the largest and most diversified health care benefits companies nationwide. Due to Aetna’s large network of providers, it is unlikely you will have to change providers when Aetna begins to administer the medical plans beginning Jan. 1, 2025. Providence, St. Joseph Health, Covenant Health, Kadlec, PacMed and Swedish participating providers, facilities and clinics will be in-network with Aetna.
If your provider is not in the Aetna provider directory for 2025, you may be eligible for a transition of care. Below is general information about transition of care for 2025. You can submit transition of care requests to Aetna for review beginning in December 2024.
What is transition of care?
Transition of care may allow you to receive the in-network level of coverage of allowed expenses if you continue treatment for a period of time with a provider you are currently in an active course of treatment with but who is not an in-network provider with Aetna. Transition of care is intended to give you time to transition to an in-network provider and can be used only when you are in a qualifying active course of treatment for certain diagnosed health conditions. Transition of care includes Prior Authorizations for medications.
What health conditions may be eligible for transition of care?
Some examples of health conditions that may be eligible for transition of care include, but are not limited to, chemotherapy, transplant, terminal illness, third trimester of pregnancy, active treatment for mental health/substance use or medications you take that are not covered by the Aetna prescription drug formulary.
What should I do if I’m undergoing medical treatment?
You can use the provider directory* to check if the provider you are seeing is in the Aetna network or to look for a new provider in the Aetna network.
If you need assistance with your provider directory search, please contact the Aetna Service Advocate team.** Check the provider directory during benefits open enrollment this fall and when you seek care in 2025, as the provider directory is subject to change at any time.
If your provider is not in-network for 2025 and you would like to apply for a transition of care, you can submit your transition of care request to Aetna for review beginning in December 2024.
Who do I contact if I have general questions about transition of care?
Contact the Aetna Service Advocate team** at 833-529-1661 (TTY: 711), weekdays 8:00 a.m. to 6:00 p.m.
*The provider directory is subject to change at any time.
**Aetna Service Advocates do not have access to your personal information or 2025 benefits enrollment data until December, so they are unable to answer specific questions about your medical plan enrollment or benefits at this time.