Claims Within The USA

Treatment Within the USA

When you need medical treatment within the USA we are there to help you and to ensure that you get the care that you need.

Through our partnership with Aetna you have access to over 850,000 medical professionals and facilities to care for your needs.

Finding a Hospital

To find a Hospital click here or call the International Service Centre +1 877 248 2197 

Please note that all treatment in the USA must be received at a Preferred Provider Organization (PPO) facility unless it is an emergency. 

Outpatient Treatment

Definition: Out-patient treatment is treatment received in a doctor’s office and does not require admission to a hospital bed.

Aetna can arrange direct-settlement for all eligible bills relating to out-patient, day patient and in-patient treatment received at Aetna’s preferred provider facilities in the USA. 

In the USA, Aetna does not issue guarantee letters for any treatment under US$500. However, as long as you choose Aetna preferred providers in the USA and show your membership card to them, they will arrange direct-settlement with AETNA for your eligible bills.

Please bring your membership card to your appointment so the service provider can contact Aetna concerning the billing or pre-authorization for out-patient treatment estimated to exceed US$1,000.

Please keep [email protected] updated so we can help you too.

Pre-authorization for Treatment Inside the USA

Please note that all treatment in the USA must be received at a Preferred Provider Organization (PPO) facility unless it is an emergency.

Tel:     +1 877 248 2197

Email: [email protected]

Form required: HIPAA form

Treatment requiring Pre-Authorization

a) Planned in-patient or day-patient treatment (hospitalization)
b) Any pregnancy or childbirth treatment
c) Planned surgery
d) Evacuation
e) Psychiatric treatment – in-patient, day-patient and out-patient
f) Home nursing charges
g) Planned in-patient, day patient or out-patient MRI, CT & PET scans

Pre-Authorization Process

1. Email the completed  HIPAA form as soon as possible to: [email protected].  AETNA will then have your permission to speak to your medical provider to obtain your medical records to process your pre-authorization.

2. The service provider must submit the following info to Aetna’s Medical Team for assessment

a. The service provider’s pre-authorization request.

b. Name of insured, telephone, fax and address of facility, Referring Doctor, Treating Doctor, ICD-9 / diagnosis code, CPT / procedure code, Facility Tax ID, Supporting medical information. These are all terms with which a service provider in the USA will be familiar.

c. Email this info to AetnaCaseM[email protected] or faxed to: +1 860-262-9111

 d. Within the USA, please ensure that your medical provider has Aetna’s correct contact information. Please ensure they are aware that our program is an international program and therefore not to use the same contact details that they would normally use for Aetna’s domestic policies. 

 e. The providers need to submit your bills and copies of the UB04/HCFA forms to Aetna either electronically using Payor number 60054 or by mailing the claims to the following address: 

Aetna
P.O. Box 981543
El Paso, TX 79998-1543

If you need assistance communicating this to your medical provider, please contact us.

We will notify you as soon as possible if the medical condition or treatment required is not covered under the terms of your policy.

Claim Forms

When to contact Aetna for planned admission

For planned admission as day-patient or in-patient treatment, please obtain pre-authorization from the Aetna Medical Team, it can take 5 days to set up a direct billing arrangement with a medical provider. We recommend that you begin the pre-authorization process with Aetna at least 5 days in advance of your planned admission.

If you have any problems submitting a claim, please email us at [email protected]. We are here to help if things are not going as quickly as they should.

Potential issues using an Alpha Policy in the USA

In the USA, the Alpha program only covers unexpected medical conditions up to $50,000 that do not pre-exist and are within 60 days of your date of entry into the United States. Furthermore, unless it is an emergency or where there is no facility within 100 miles, you are required to arrange treatment at one of the PPO network facilities.

Should you have any difficulties with your claim submission or claim process, please contact us and the Talent Trust team will be happy to assist you.

Travel Claims (Non-Medical, Anywhere)

Please fill out only the relevant sections of the Travel Claim Form and ensure all necessary supporting information is attached …

  1. Travel tickets (used or unused).
  2. Travel agents’ invoice.
  3. Proof of withdrawal for Money/foreign currency claim.
  4. Traveller’s checks should be refunded by the issuing office, if not, provide evidence as to why they will not provide a refund.
  5. Policy report – showing time and date of loss within 24 hours of loss (money/theft/loss claims).
  6. Carrier report – showing date of loss/delay (baggage claims).
  7. Tradesman’s invoice for cost of repair and detail of repair, invoice for replacement item (if applies).
  8. Ticket/accommodation receipts for additional expense (Cancellation/curtailment claims).
  9. Hospital Discharge summary (Medical/Hospital claims).
  10. Carrier report, police report, public transport report showing reason and length of delay.
  11. Please complete the Payment Instructions section of Travel Claim form.

Aetna's guidelines for submitting claims for reimbursement

  1. Please send a single claim per e-mail. A separate claim form and all supporting documents (AS A SET) must be submitted for each medical condition -and/or- person claimed. Please DO NOT send one claim in parts over multiple emails.
  2. Attachments must be in PDF/JPG or JPEG file formats. 
  3. Please scan documents in 150 DPI (Dots Per Inch) resolution and compressed at ‘medium quality’’ for a smaller file size.
  4. The maximum size for a single email with attachments is 8 MB.