Northwest Carpenters Health and Security Plan

Why Use Aetna Providers?

The Carpenters Health and Security Plan allows covered individuals to receive a covered service from any licensed physician, hospital or provider without a referral. However, there are several advantages to using providers from the Aetna Choice POS II network. Search online directory.

Network Providers

1. Your Out-of-pocket Costs Will Be Lower.

Aetna negotiates with physicians, hospitals and other providers to offer their services at discounted rates. When you use a network provider, you're able to take advantage of that negotiated rate. More important, you're guaranteed your out-of-pocket share of a covered service will not exceed 10% of the billed amount. And after satisfying your annual out-of-pocket maximum, covered services from network providers are paid at 100%.

2. Your Provider Will File Your Claim.

As part of their contract, Aetna providers agree to submit claims for patients.

3. Your Provider Is Responsible for Approvals.

Aetna providers take responsibility for obtaining any preauthorization, preadmission certification, or second surgical opinion required by the health plan.
Non-network providers
Covered individuals are allowed to receive covered services from non-network providers, but it is important to know the consequences.

1. Your Out-of-pocket Costs Will Be Higher.

Since they do not have a contract with Aetna, non-network providers can charge more. Sometimes they charge a lot more than the amount the health plan will cover. The gap between the amount charged and the amount paid by the plan is the patient's responsibility.

• There is no guarantee your out-of-pocket share will be limited to 10% of the cost.
• There is no guarantee benefits will be paid at 100% if you satisfy the annual out-of-pocket maximum.

2. Patients File Their Own Claims.

Patients who use non-Aetna providers may be required to submit their own claims for reimbursement. The filing address is on the back side of the Aetna/Carpenters ID card.

3. Patients Are Responsible for Obtaining Approvals. 

Preauthorizations, preadmission certifications and second surgical opinions (if required by the plan) are the patient's responsibility when using non-Aetna providers. If approval is not obtained and it's determined that the service was not medically necessary, the patient could be responsible for paying the entire charge.

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