Network Providers

Beginning June 1, 2015, the Carpenters Health and Security Plan of Western Washington will be serviced by the Aetna Choice POS II provider network. Contact your current health care provider before your next appointment to find out if he or she is a participating provider.

Using participating (Aetna) providers
Carpenters and dependents with medical coverage are encouraged to select physicians, hospitals and other health care professionals from the Aetna Choice POS II network. Here's why:

  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 participating provider, you're able to take advantage of that negotiated rate. More important, you're guaranteed that 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 ($2,300), covered services from preferred providers are paid at 100%.
  2. Your provider will file your claim. As part of their contract, Aetna physicians, hospitals and providers agree to submit claims for patients.
  3. Your provider is responsible for approvals. By choosing a participating provider, the patient avoids the hassle of obtaining any preauthorization, preadmission certification or second surgical opinion required by the health plan. Your provider will handle it for you.

Using non-participating providers
The Carpenters Health and Security Plan allows covered individuals to receive care from any licensed physician, hospital or provider covered by the plan without a referral. Just be aware of the drawbacks of using a non-Aetna provider.

  1. Out-of-pocket costs will be higher. Because they do not contract with Aetna, non-participating 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 that your out-of-pocket share will not exceed 10% of the cost, or that it 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 to Aetna 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 the 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.

Choose the right provider
Deciding where and when to receive medical care are important decisions that impact the quality of care you receive.