Aetna will not require higher copayments, coinsurance, deductibles or additional cost sharing arrangements for direct access services provided to an enrollee in the absence of a referral from the Primary Care Physician. Local quality committees, composed of community practicing physicians and health plan staff review, update and adopt the review criteria at least annually and more frequently as necessary. Milliman and Robertson's Healthcare Management Guidelines and Length of Stay Guidelines 2. Aetna U. S. Healthcare developed Coverage Policy Bulletins 5. You or your dependents will not be discouraged from using the local pre-hospital emergency medical service system, the 911 telephone number, or the local equivalent.
Medical transportation is covered for an emergency medical condition.
You or your dependent should notify your primary care physician as soon as possible after emergency care treatment. Notice given to Aetna, its designee or your primary care physician by the attending emergency care physician will satisfy this requirement.