About Aetna
Founded in 1853, Aetna is among the leading health insurance providers in the USA. The company offers comprehensive coverage across various health sectors, including vision, medical, dental, and prescription drug plans. According to theAetna website, about 39 million people have enrolled in their insurance products.
What are deductibles, copays, and coinsurance?
Navigating the domain of health insurance involves dealing with jargon. Whether selecting a new health plan or trying to understand your current coverage, being familiar with healthcare terminology is essential. Here are a few basic terms you may encounter:
- Deductibles—The deductible is the amount you need to pay out of pocket for covered medical services before your insurance coverage begins. Typically, plans with monthly premiums of lower amounts have higher deductibles, and vice versa. For example, if your plan has a $500 deductible and your doctor charges $350 for a procedure, you pay the entire $350. For a subsequent procedure costing $700, you would pay $150 out of pocket plus any applicable copay or coinsurance. At this point, you've met your deductible, and your insurance will cover the remaining costs. Many plans cover services like check-ups and disease management programs for chronic conditions, even without the fulfillment of deductibles.
- Coinsurance—Coinsurance is the percentage of the cost of covered healthcare services that you pay after meeting your deductible, with your insurer financing the remaining balance. Coinsurance rates are generally lower for in-network services than for out-of-network services. For example, if your coinsurance for a therapy session is 30% and the session costs $150, you would pay $45 out of pocket, assuming you have met your deductible.
- Copays—A copay, or copayment, is a fixed fee for a doctor's visit, prescription refill, or other covered service, with your insurer covering the remaining cost. Copays are typically lower for in-network providers than for out-of-network providers. For example, if the copayment for your doctor's visit is $20, you would pay $20 out of pocket for the appointment, regardless of the total cost, assuming you've met any deductible.
Who is an OB-GYN?
An OB-GYN or obstetrician-gynecologist is a certified doctor with specific education and training in obstetrics and gynecology. They examine, detect, and treat issues in the female reproductive system, such as abnormal menstrual bleeding or irregular periods, vaginal pain, menopause, and the like.
An obstetrician (OB) is a doctor specializing in obstetrics, which deals with childbirth and the health of pregnant women. A gynecologist (GYN) is an expert in gynecology, which is about female reproductive health issues. Since these two fields of medicine are closely related, most doctors pursue both.
Having a trusted OB-GYN from a young age can help adolescents and teens build a strong relationship with their doctor. Often, preteens and teenagers do not feel comfortable asking adults and caregivers personal questions regarding concerns like periods, sex, and birth control. This can be harmful and lead to gathering misinformation online. An OB-GYN provides accurate answers and corrects any misconceptions parents or children have. If you need help finding an in-network provider, check Zocdoc's list of providers. You can directly search for Aetna OB-GYNs near you on Zocdoc.
What kind of education and training do OB-GYNs receive?
To become an OB-GYN, one must complete undergraduate studies in subjects like biology, chemistry, and math. Subsequently, students should enroll in a medical school, where they study and train for four years to earn a medical degree. The first two years of medical school involve learning theory in classrooms and laboratories. In the next two years, students gain practical experience and considerable hands-on practice by undergoing clinical rotations and treating people in medical settings, such as hospitals and clinics, under the guidance of experienced doctors and specialists.
The syllabus for aspiring OB-GYNs and general physicians is almost the same. However, the former can also select courses focusing on obstetrics and gynecology.
After completing medical school, students earn a Doctor of Medicine (MD) or a Doctor of Osteopathy (DO) degree.Those wanting to become OB-GYNs must do an internship and a residency program. While the internship is a year-long, medical residency may last 3 to 7 years, depending on the specialty. Here, they learn to treat pregnant women, help deliver babies, and provide postpartum care, in addition to treating women's reproductive system-related conditions.
Upon completing the residency, OB-GYNs can begin practicing after clearing a state licensure examination. Some specialize further by doing a fellowship and focusing on a subspecialty. Those who complete this stage are considered the best in their field.
Common reasons to visit a gynecologist
The frequency of visits to a gynecologist depends on various factors, including age, health history, and pregnancy status. You may visit an OB-GYN for several reasons, including:
- Pap smears: In most cases, individuals with a cervix should begin receiving pap smears at age 21. Go for these screenings every three years after that. A gynecologist receives training to conduct this crucial cancer screening.
- Birth control: A gynecologist can assist in determining the most suitable contraception method based on your health history and lifestyle. They can also prescribe birth control if necessary.
- STDs: Gynecologists can diagnose and treat sexually transmitted diseases (STDs). If you experience any abnormal discomfort or unusual discharge following sexual activity, the healthcare specialist can assist in identifying the cause and providing appropriate treatment.
- Pregnancy: OB-GYNs and obstetricians are experts in addressing the unique healthcare needs during pregnancy. They provide comprehensive care throughout gestation, including prenatal check-ups, delivery, and postnatal care.
Does Aetna cover gynecological and pregnancy care for women?
Yes, through various Aetna plans, members can access various gynecological and pregnancy services, including maternity care, prenatal and postnatal care, educational materials, preventive screenings, vaccines, and medications. Note that the benefits you receive depend on your specific plan. Make sure you check your insurance policy as well as its coverage, limitations, and exclusions before availing of any service. Below are some benefits that may be covered in some Aetna plans:
Pregnancy Services and Products:
- Under individual and family plans, Aetna's maternity program offers help for family planning all the way to pregnancy and postpartum care. Staffed by qualified nurses with maternity experience, the Aetna Maternity Program offers educational materials (in English and Spanish) on prenatal care, labor and delivery, and newborn care, a pregnancy survey that may help determine your risk for certain pregnancy complications, a preterm labor program to support high-risk women, access to nurses trained specifically for high-risk pregnancies, and individual counseling to help pregnant women quit smoking.
- Some plans may also cover routine pregnancy services (including prenatal and antepartum care). Routine care typically covers recording medical history, weight, and blood pressure readings, physical exams, monthly visits up to 28 weeks of the gestation period, biweekly visits to 36 weeks of gestation, postpartum visits (for 45 days post delivery), fetal heart monitoring, and routine urinalysis.
- Other pregnancy-related tests and services covered include only those that monitor the baby's health and development. Services that may not be covered are ultrasounds done to determine the sex of the baby or to provide the parents with a photograph of the baby, 3-D ultrasounds, paternity testing, and Lamaze classes.
- Coverage for newborn care depends on your plan and the services required at birth. Charges for healthy newborn deliveries will be covered. However, if a delivery is complicated, there may be a charge for services needed for treatment.
- You may get a breast pump at no charge or at a discounted rate from one of Aetna's medical equipment suppliers. This includes a non-hospital grade manual or standard electric pump at the time of pregnancy or for the duration of breastfeeding and another set of breast pump supplies for members who become pregnant again before they are eligible for a new pump.
Non-pregnancy Gynecological Services:
- Most Aetna medical plans cover preventive services at no extra cost. Preventive exams conducted at a gynecologist's office include a pelvic and breast exam to detect physical changes and other concerns, as well as a Pap smear to screen for cancerous or precancerous cells. You can also get a mammogram done at an imaging center or a Human Papillomavirus (HPV) vaccine administered by a gynecologist, pediatrician, or primary care doctor's office or at a retail health clinic, like MinuteClinic, at CVS locations.
- Aetna members can also get treatment for menopause symptoms at MinuteClinic and schedule an appointment with an in-network specialist via Gennev, a virtual menopause clinic covered by Aetna insurance.
- Members can also get some medicines under the condition that they have a prescription. Some of these medicines may be available for over-the-counter purchase. Your plan may not cover certain drugs for infertility, erectile dysfunction, and weight loss. These include medications for the prevention of breast cancer, oral, vaginal, and transdermal contraceptives, IUDs, emergency contraceptives, and condoms (male and female). Note that specific religious organizations or religious employers may be exempt from offering contraceptive services. Check your plan documents or log into your member account to check the coverage of a specific drug.
- If you are covered under employee health and wellness programs, you may be able to access infertility providers, learn infertility information, and enroll if needed.
Finding an Aetna OB-GYN near you in Atlanta, GA
A trusted OB-GYN helps ensure good reproductive and sexual health for women. However, the process of finding one can be complicated. Moreover, not all doctors accept your health insurance. But do not worry; Zocdoc is the solution to both of your concerns!
Zocdoc offers an extensive online repository of top-rated healthcare providers. Each doctor listed here has a unique profile containing information about their educational qualifications, experience, certifications, etc. Before making an informed choice, you can also check past patient reviews and ratings on doctors' profiles. Furthermore, Zocdoc allows you to filter your search results based on the provider's gender, spoken languages, and whether they treat children.
With Zocdoc, you can schedule in-person and online appointments with an Aetna OB-GYN in your area. To get started, visit the Zocdoc website, create a free account, and enter your requirements: specialty, location (in this case, Atlanta), and preferred date and time. The website will then show you a list of all OB-GYNs matching your criteria.
Using Zocdoc's insurance detector, you can check which doctors your health insurance covers. Adding an image of your medical insurance card to your Zocdoc account makes it easier to select your plan and identify an Aetna OB-GYN near you. However, you can manually pick your insurance plan and provider from a dropdown menu if you do not want to upload a photo. For more insurance-related queries, check Zocdoc's patient help center.
All bookings made through Zocdoc are fast, 100% free, and safe!
Health insurance-related statistics for Georgia and USA
According to America's Health Rankings data, in 2023, about 11.4% of people in Georgia were uninsured, much higher than the US average of nearly 8%.
As per the 2022 data published by the National Center for Health Statistics on health insurance coverage in the USA, roughly 27.3 million people below 65 years old were uninsured. Almost 4.2% of children below 18 years and nearly 12.2% of adults in the 18-64 age group were uninsured. Also, roughly 27.8% of people below 65 years and almost 44% of children below 18 years had public insurance. About 64.2% of people below 65 years and nearly 54.3% of children below 18 years old had private insurance.
Sources
Healthline
American College of Surgeons
BestAccreditedColleges.org
Tufts Medical Center
Baylor Medicine
Medical News Today
WebMD
Aetna[1]
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Gennev
UChicago Medicine
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