Accreditation
This is proof that a health plan or hospital meets certain standards. An outside group decides this through an official review.
Adjudication
This is the way health plans decide how much they will pay for certain expenses.
Aetna Health Fund®
This is the name used for Aetna's consumer-directed health products. Each one comes with different types of funds to help members pay for their care. These funds are Health Reimbursement Arrangement (HRA), Health Savings Account (HSA), Retiree Reimbursement Account (RRA) and the Flexible Spending Account (FSA).
Aexcel®
Aetna uses this mark for some specialist doctors. These doctors have met certain performance levels for their medical care and cost.
Aexcel Designated Preferred Care Specialists
Aexcel Designated Preferred Care Specialists are Preferred Care Providers who have met designation criteria for thresholds for performance and effectiveness as established by Aetna. They will be shown in the Directory and on DocFind as Aexcel Designated Preferred Care Specialists for the specialty care involved.
The list of provider specialties are:
- cardiology;
- cardio thoracic surgery;
- gastroenterology;
- general surgery;
- obstetrics and gynecology;
- orthopedics;
- otolaryngology;
- neurology;
- neurosurgery;
- plastic surgery;
- urology; and
- vascular surgery.
Allowable Expense(s)
This is the part of a bill that is eligible to be paid under your health plan.
Ambulatory Care
See “Outpatient care.”
Ambulatory Surgery
See “Outpatient procedure.”
Ancillary Services
These are services provided to support your health care. Some examples include X-rays or lab tests.
Appeals Process
This process lets you ask for a review of claims that have been denied by your health plan.
Authorization
See “Precertification.”