 |  |  |
|
|||
 |
 |
 |
 |
 |
|
|
About AWCA: Frequently Asked Questions
AWCA is an Aetna product that offers workers' compensation claimants access to a network of physicians, hospitals, pharmacies and other health providers who provide health care services for work-related injuries. What can you expect from this network?
Is Aetna providing workers' compensation insurance through AWCA? No. Workers' compensation carriers and other customers will work with Aetna to allow workers' compensation claimants access to health-care services through the AWCA network. How do claimants get access to the AWCA network? Claimants will get access through their employers, who have contracts with workers' compensation carriers that have a relationship with AWCA. Whom should I contact if I have more questions about AWCA?
Do all providers that participate with AWCA also participate with Aetna Health Plans? No. While most providers who participate with Aetna for our health plans also participate in our AWCA network, we do supplement our AWCA network with any interested provider whose specialty may treat a work-related injury and meets Aetna credentialing standards. How can I see my state-specific fee schedule? To identify your state-specific maximum fee schedule, you can use the link provided within this website to navigate to your state department that regulates workers' compensation or you can directly contact your state workers' compensation insurance department or commissioner. AWCA is not the payor and does not adjudicate the claim. The workers' compensation carrier or the third-party administrator will be responsible for adjudicating the bills submitted and may also be responsible for paying for the services (payor). A listing of Aetna customers who access this network is included in this site. The payor is responsible for paying compensable work-related claims.
What do I do if I no longer want to participate in the AWCA network? If you are also a participating provider in the Aetna Health Plans and have workers' compensation included in your product offering, you must follow the notice requirement of your contract to terminate any product. Otherwise, you may send a letter to AWCA. Aetna Worker's Comp Access The letter should also include: Full name If you have additional questions, please contact the AWCA Service Center at 1-800-AETNA-06 (1-800-238-6206) Can I change my mind and re-join the network at a later date? Yes. If you decide that you want to participate in AWCA after leaving the network, you should call our toll-free AWCA number at (800) AETNA-06 (238-6206). We will refer your request to an AWCA network manager assigned to your state, who will contact you directly. Where are the AWCA networks available? Please refer to the interactive map section within this website to see a current view of where AWCA has a current presence and into which states it intends to expand. Will participation in AWCA affect my participation in other Aetna plans and products? No. I became a par provider with Aetna after you invited providers to join your workers' comp network. How can I participate in AWCA? If you are interested in becoming an AWCA network provider, call AWCA at (800) AETNA-06 (238-6206) to let us know of your interest. A network manager assigned to your state will contact you to discuss your situation.
How do I know what workers' comp coverage the injured worker has? The injured worker may or may not present with workers' comp coverage information. If not, your office staff or the claimant will need to contact the individual's employer directly to verify coverage. Will my office have to collect a co-payment from an AWCA claimant? No. There are no co-payments or deductibles to collect. Will claimants need referrals to receive workers' comp services from me, or will I need to issue a patient referral to another provider? No. In general, written referrals are not required to treat a claimant. Providers should, however, keep referral patterns to specialists within the AWCA network of available providers for the full spectrum of care to the injured worker. A complete listing of AWCA participating providers is available on this website through the AWCA DocFind link. How does the claimant access the AWCA network? To use the AWCA network, an injured worker must either: a) work for an employer who purchases workers' comp insurance through one of the carriers or customers with whom AWCA has a relationship, or b) be covered by an employer that self-insures its workers' comp coverage and is a customer of AWCA. Do employers offering Aetna health benefits automatically include workers' compensation benefits with AWCA? No. AWCA is a separate administrative service that workers' comp insurance carriers can purchase from Aetna. General Workers' Comp Questions
Who regulates the workers' comp system? Each state has their own department which has jurisdiction over workplace health and safety and workers' compensation insurance. For example, in some states it is the Department of Labor, in other states it may be the Department of Banking and Insurance, etc. Does everyone have workers' compensation insurance? Most states require employers to have workers' compensation insurance for their employees. Why do employers offer workers' compensation insurance to employees? In addition to state regulations, having workers' compensation insurance sets limits on an employer's liability arising from workplace accidents. It also provides coverage to help an injured employee get the appropriate medical treatment and return to the job in a timely manner. What are the benefits to employees covered under workers' compensation? The major benefits for injured workers or dependents of workers killed in work-related accidents are:
|
 |
|
|||
 |
|||
| Copyright 2004 Aetna Inc. | Web Privacy Statement | Legal Statement | Privacy Notices | ||
|
|||