12-21-11 Update regarding Abington Medical Specialists and Abington Heart Group - click here. For a list of alternate participating providers, please click here.
Medical and Vision
Claim questions or issues- If you have a questions or experience a problem with a claim, contact Aetna Member Services using the toll-free phone number on the back of your ID card. If your issue cannot be resolved through Member Services, please contact the Health Trust at 267-781-0606. A signed HIPAA form is required for the Health Trust to assist you with a claim.
Finding an Aetna In-Network Provider- to find a participating Aetna, provider log onto www.aetna.com/docfind. Under "General Search" select the "Geographic Information" you wish to search on. Then select the "Provider Category" and "Provider Type." Select "Plan" (HMO, Open Choice PPO, QPOS, POSII, etc). Click "Search".
Aetna Rx Home Delivery - New and Improved October 15, 2011. Click Here for more information. Need an Rx Home Delivery Order form? Click Here.
Quest Diagnostics Easy Pay - click "here" for more information on Quest's new optional patient billing service (March 2011).
Important Information Regarding Experimental Lab Tests - There are several commonly ordered lab tests that Aetna considers "experimental and/or investigational." These lab tests are not covered under your health plan because evidence-based standards do not support their medical necessity/coverage. One such test is Polymerase Chain Reaction (PCR) test for Lyme Disease (CPT 87476). There are alternative tests that can be prescribed which are covered under your plan. Although Aetna has communicated to its participating providers that these tests are not covered, DVHIT wants its members to be aware that if your doctor orders a test that is considered experimental and/or investigational, you may be held financially responsible. Below is a list of commonly ordered lab tests that are not covered under your medical plan. Next to each lab test is a link to Aetna's Clinical Policy Bulletin (CPB) providing more information. We encourage members to share this information with their providers if there is any questions.
- Polymerase Chain Reaction (PCR) test for Lyme disease (CPT 87476) - CPB 0215 and CPB 0650
- Immunoassay for tumor antigen, quantitative CA 19-9 (CPT Code 86301) - CPB 0352
- Infectious agent detection by nucleic acid (DNA or RNA); Papillomavirus, human, amplified probe technique (CPT code 87621) - CPB 0443
- VAP cholesterol test (CPT 83701) - CPB 0381
Dental and Orthodontia Information-
Delta Dental FAQ's
What is a Predetermination of Benefits?- A predeterminations lets members know in advance what services are covered and how much your plan will pay. Predeterminations should be requested when costs are expected to exceed $300.00. Learn more about predeterminations.
How are Orthodontia benefits paid? - Click on the link "How are Orthodontic Benefits are Paid" to learn more.
Member Wellness Initiative
What is DVHIT"s Member Wellness Initative (MWI)? The Member Wellness Program or "MWI" is a value-added benefit offered exclusively to our members and their spouses. The MWI promotes healthier lifestyles through education and awareness. DVHIT pays participants cash incentives for taking a proactive approach to their health care. For more information click HERE. A user name and password is required. First time users will be asked to create an account.
How do I sign-up for the Fitness Reimbursement/Colonoscopy/Women's Health Initiative program? Participants do not need to sign up in advance for our wellness programs. Members participating in the Colonoscopy and Women's Health Initiative programs simply need to sign a HIPAA form and return it to DVHIT along with proof of their completed procedure(s). Member participating in the Fitness Reimbursement program need to submit proof of 100 completed gym visits within a 365 day period, in addition to proof of the total payment(s) made to the fitness facility during that time period. All paperwork should be submitted to the Trust within 90 days of completion.
Where do I submit colonscopy and/or Women's Health Initiative incentive requests? Please mail incentive requests to: DVHIT, Attn Wellness Nurse, 1015 York Road, Willow Grove PA or fax 215-706-0942. Proof of procedure(s) and a signed HIPAA form are required.
What are acceptable forms of proof of a "completed procedure" for participation in the Colonoscopy or Women's Health Initiative? Acceptable proof of a completed procedure can be obtained from Aetna Navigator, or by providing documentation on the doctor's/medical facilities' letterhead stating the member's name, the name of the completed procedure and the date it was completed.
How do I receive a Fitness Reimbursement? Members and their spouses are eligible to receive up to a $250.00 fitness reimbursement (each) in a rolling calendar year. You must complete 100 visits to your gym/fitness center within a 365-day period. To receive reimbursement, please submit paid receipt and proof of visits (computer generated verification from your gym/fitness center documenting your visits or completed DVHIT Fitness Reimbursement Card documenting visits and staff signature to: DVHIT Fitness Reimbursement, 1015 York Road, Willow Grove, PA 19090 or fax 215-706-0942. Please allow 4 to 6 weeks for processing. DVHIT Fitness Reimbursement cards are available through your Human Resources Department. Click here to download our fitness flyer.
What are acceptable forms of proof of "total payment" made to a fitness facility? Cancelled checks, copies of bank/credit card statements, and/or a receipt or letter on the fitness facilities letterhead are all acceptable forms of proof of "total payment" made. Fitness facility contracts indicating a dollar amount to be paid each month is not an acceptable form of proof unless the contract specifically states that monies were paid upfront or in full.
When submitting a bank/credit card statement as proof of automatic payment to a fitness facility, is one statement indicating the amount automatically withdrawn for that one month sufficient? No. A bank/credit card statement would need to be submitted for every month, or at least for enough months to total the maximum reimbursement amount of $250. If only one bank/credit card statement is submitted than the member would only be reimbursed for the dollar amount listed on that individual statement.
If I previously participated in the Fitness Reimbursement program, when will I be eligible to start accruing my next 100 gym visits? Members can begin accruing their next 100 gym visits "365 days" after the first day of their last submission. For example, if a member's first documented gym visit was on March 1, 2010 and their 100 required gym visits went through February 28, 2011, than the member would need to wait until March 1, 2011 before he/she could begin to accrue their next 100 gym visits. Members may also contact DVHIT to find out when they are eligible to begin accruing their next 100 gym visits.
When will I receive my incentive/reimbursement check? Check processing may take up to six weeks depending on when the paperwork is received at the Trust.
To learn more about the Health Trust's wellness programs including the MWI Physical, Colonoscopy Incentive, Women's Health Initative, Fitness Reimbursement, and area hospital-based smoking cessation programs, please click HERE.