How do I obtain care when I am in the Aetna Medicare OpenSM Plan (PFFS)?
When you go to a provider, you must inform the provider that you are enrolled in the Aetna Medicare Open Plan (PFFS) Private Fee-for-Service plan, and show them your ID card. The ID card will indicate that you are enrolled in a PFFS plan and will give providers directions about whom to contact to obtain additional information on the PFFS Plan, including the Plan’s Terms and Conditions of Payment. Your provider can decide if he or she will treat you as a member of the Aetna Medicare OpenSM Plan (PFFS). If the provider decides to treat you, you are required to pay the cost-sharing amount allowed by your plan. The provider will bill Aetna for the rest of the fee. If the treating provider does not accept Medicare assignment, you may be balance billed up to the Medicare limiting charge (up to 15% of the Medicare allowable charge).
