Aetna Out-of-State Network
Effective July 1, 2009, the Aetna Signature Administrators Preferred Provider Organization became PEIA PPB members' network for out-of-state services. Prior to implementation, ASA worked diligently to assure the PEIA members would see little network disruption from this change.
PEIA and Wells Fargo will also maintain some direct contracts with out-of-state providers. Follow the link below to access Aetna's Doc Find tool to find out-of-state network providers:
www.aetna.com/docfind/custom/asa
There are a few providers who are listed in the ASA PPO who are EXCLUDED from PEIA's network:
- UPMC Health System
- In Boyd County, Kentucky, PEIA is not using the ASA PPO. All providers, including Kings Daughters Medical Center, Our Lady of Bellefonte Hospital and physicians are out of network. For services, members should look to providers in Cabell County, WV or other nearby counties.
- In Gallia County, Ohio, PEIA is not using the ASA PPO, but is contracting directly with providers. Holzer Clinic is in-network but, at this time, Holzer Medical Center is out of network. For participating providers, check out this list of Gallia County, Ohio Contracted Providers.
- Effective July1, 2010, River Valley Health Alliance (RVHA) in Washington County, Ohio, is no longer a participating provider for PEIA members. Marietta Memorial and Selby General Hospitals and several physician groups are in RVHA and will no longer be participating in PEIA’s network.
Remember, PEIA's rules for accessing out-of-state care have not changed.
PEIA PPB Plan participants who live in West Virginia or a bordering county of a surrounding state may access care from any of the following providers without receiving prior approval:
- Any West Virginia health care provider who provides health care services or supplies to a PEIA participant, or any network provider located in those bordering counties.
- All services, except emergency care, provided outside of West Virginia beyond the bordering counties requires prior approval.
For PEIA PPB Plan participants who reside outside the State of West Virginia (beyond the bordering counties of surrounding states), PEIA has made special arrangements. Participants who live more than one county outside the State may seek care from any network provider. Care from network providers does not require prior approval, and that care will be covered at the in-network benefit level (typically 80%). Precertification of inpatient stays and certain outpatient procedures is still required.
To start the prior approval process for out-of-state services, contact
ActiveHealth at 1-888-440-7342.
Learn more about ActiveHealth:
Healthy Tomorrows Flyer.