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Answers to common questions

Questions?

Just call Member Services at 1-888-348-2922 (TTY: 711). We’re here for you 24 hours a day, 7 days a week. 

COVID-19

General questions

  • Medicaid is a program that provides health care for millions of Americans. In West Virginia, it’s part of Mountain Health Trust. It covers low-income workers and:

     

    • Children
    • Pregnant women
    • Elderly people
    • People with disabilities 

     

    If you qualify, you can get coverage for things like:

     

    • Preventive care
    • Vision care 
    • Dental care
    • Medications
    • Disease management
    • Mental and behavioral health
    • Transportation

     

    In West Virginia, there are different plan options.

     

  • Before you can get coverage, be sure you qualify for Medicaid or CHIP.

     

    You can also read the answers to 10 common questions about qualifying for Medicaid.

     

    If you qualify for Medicaid or CHIP, you can apply. 

     

    Learn more about how to enroll

     

    Once your application has been approved, the next step is choosing Aetna Better Health of West Virginia as your health care plan. If you don’t choose a plan, the state will choose one for you.  

     

    Learn more about choosing your plan 

  • To keep your coverage, you must renew every year.

     

    Learn how to renew

  • We want you to be happy with the care you get. So if you’re ever unhappy with your health plan or a provider, you can file a complaint. Or you can file an appeal if you don’t agree with a decision we make. If you don’t agree with the decision on your appeal, you can ask for a state fair hearing.

     

    Complaints and appeals

  • Tell us. You have the right to report anyone you believe is committing fraud or abuse.

     

    Fraud and abuse

Member Services

  • You’ll find your health plan summary and benefits info in your member handbook or on your Member Portal or Aetna Better Health app.

     

    Learn more about your Member Portal and app

     

  • We’re here for you 24 hours a day, 7 days a week. Just call us at 1-888-348-2922 (TTY: 711).

     

    You can also use the Contact us page to get in touch. Or log in to your Member Portal or Aetna Better Health app. 

     

    Learn more about your Member Portal and app

  • You have some options if you lose your member ID card. You can log in to your Member Portal or Aetna Better Health app. There, you can:

     

    • Ask us to mail you a new ID card
    • Find the electronic version of your ID card — as long as you have your smartphone, you’ll always have your ID card with you for health care visits

    Or call us at 1-888-348-2922 (TTY: 711).

     

    Learn more about your Member Portal and app

My health care providers

  • Your PCP is a medical provider who will manage your health care. They’re the doctor, nurse, physician assistant or clinic that provides your main health care. They’ll help you get all the covered services you need.

     

    Find a provider

  • You can change your PCP through your Member Portal or Aetna Better Health app. You can also call Member Services at 1-888-348-2922 (TTY: 711). This is the number on your ID card.

     

    You can also learn more about choosing a PCP.

     

    Learn more about your Member Portal and app

  • Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal or Aetna Better Health app.

     

    Learn more about your Member Portal and app

  • Specialists are providers who treat specific conditions. Your PCP might refer you to a specialist in our network. Or they may recommend you see one. Need help finding a specialist? Just call us at 1-888-348-2922 (TTY: 711).

     

    Find a specialist

  • You can use the provider search tool to find providers for the health care services you need. 

     

    Find a provider

  • Call the provider’s office and let them know you have Aetna Better Health. This means you shouldn’t get a bill. If you keep getting bills, just call us at 1-888-348-2922 (TTY: 711).

Coverage and care

  • Whether it’s day or night, your PCP or on-call provider can tell you what to do. If they’re not in the office, leave a message. They’ll return your call. Your provider must see you within 24 hours if you need urgent care.

  • If you're having an emergency, call 911 or go to the closest hospital.

     

    You’ll only need emergency care if you think your health is in serious danger. Emergencies may include:

     

    • Severe pain
    • Serious injury
    • Sudden illness
    • Illness that is quickly getting much worse
    • Heavy bleeding that doesn’t stop, especially if you’re pregnant

     

    If it’s not an emergency, but you need medical advice, call us 1-888-348-2922 (TTY: 711). Then, choose the option for the 24-Hour Nurse Line. A nurse can help you decide if you need to go to the ER or urgent care.

     

    Check out some of these articles to learn more about getting the right care at the right time:

     

     

    Find a hospital

  • If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency. 

     

    Need a ride to your doctor visits?

     

    We work with ModivCare to cover rides for your nonemergency medical needs. You can get a ride for visits to your: 

     

    • Health care provider  
    • Dental or vision provider 
    • Mental or behavioral health care provider 
    • Pharmacy

     

    How to schedule a ride

     

    You must schedule rides at least two business days before you need them. To schedule a ride, just call ModivCare at 1-844-549-8353. Or visit the ModivCare website.

  • If you’re away from home and have an emergency, go to the closest hospital or call 911. The hospital doesn’t have to be in our network for coverage and care.

  • You can use the provider search tool to find a hospital. Or you can call us at 1-888-348-2922 (TTY: 711) for help. 

     

    Find a hospital

  • Pregnant women need special care. You’ll want to see a provider within three weeks of a positive pregnancy test (home or lab). We can help with pregnancy care. Just call us as soon as you can at 1-888-348-2922 (TTY: 711).

     

    You can also visit our health and wellness library to learn more about pregnancy, women’s health and other topics to help keep you healthy.

     

    Pregnancy care

  • If you just had a newborn baby, you’ll need to enroll them into benefits. After your baby is born, call the DHHR (Department of Health and Human Resources) Change Center at 1-877-716-1212. Your baby will be eligible for benefits for a minimum of 60 to 90 days, starting on the first day of their birth. This helps ensure they’ll get all the care they need.  

     

    If you have questions or need help, just call us at 1-888-348-2922 (TTY: 711).

  • When you have a condition, you’ll work with your health care provider to set up a treatment plan. The plan will likely include certain steps, like: 

     

    • Taking medication 
    • Making lifestyle changes, like eating and exercise 
    • Finding emotional support 

     

    Some conditions can benefit from disease management, like: 

     

    • Asthma 
    • Chronic obstructive pulmonary disease (COPD) 
    • Diabetes 
    • Heart failure 
    • High blood pressure (hypertension)
    • Coronary artery disease (CAD) 
    • Depression

     

    Do you have one of these conditions? If yes, you may be able to get help from a case manager. You can learn more on our page about disease management. Or call us at 1-888-348-2922 (TTY: 711).

     

    Disease management

  • Dental and vision benefits

     

    You can learn more about dental and vision benefits.

     

    Medicaid

     

    CHIP

Pharmacy

  • We help you manage drugs you get while at your doctor’s office, in the hospital or at an infusion center. We do not handle the drugs your doctor prescribes that you pick up at a pharmacy. West Virginia Medicaid Management System (VMMIS) manages those.  

     

    To find a pharmacy in the state network, visit WVMMIS Provider Search. Scroll through the list of “Specialists” and choose “Pharmacist”. You can also call 1-888-483-0797.

     

    Learn more about pharmacy benefits

Your health

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