Aetna's National Advantage Program (NAP)

The National Advantage Program (NAP) offers you access to Aetna-contracted rates for many hospital and doctor expenses that would otherwise be billed at the provider's normal rate. These include:

  • For the PPO Options, eligible expenses provided by providers who are not Choice POS II network providers but who are Aetna NAP providers.
  • For the OOA Options, eligible expenses provided by a provider who is an Aetna NAP provider.

You may save money with the NAP because the contracted rate is generally lower than the provider's normal charge. In addition, you should not be billed by the provider for the difference between the provider's normal charge and the contracted rate (i.e., no balance billing).

In order to qualify for Aetna’s contracted NAP rates, the expense must be covered under the plan and the provider must submit the charge to process at the contracted amount before you pay for services. It is therefore important to remind the provider to submit the claim to Aetna directly before you pay.

The NAP network consists of many of Aetna’s directly contracted hospitals, ancillary providers and doctors, as well as hospitals, ancillary providers and doctors accessed through vendor arrangements where Aetna does not have direct contractual arrangements. NAP-participating doctors include primary care doctors, obstetricians, gynecologists, radiologists, anesthesiologists, pathologists and other specialists. 

NAP ancillary providers include:

  • Acute rehabilitation facilities.
  • Ambulatory surgical centers.
  • Dialysis centers.
  • Freestanding hospices.
  • Infusion centers.
  • Nursing care agencies.
  • Skilled nursing facilities.
  • Substance abuse facilities.

Certain claims are not eligible for a NAP discount, including:

  • Small hospital or ancillary provider claims (currently below $151) that require manual intervention to obtain a discount.
  • Claims involving Medicare or Coordination of benefits (COB) when the plan is not primary.
  • Claims that have already been paid directly by the plan participant before the provider has submitted the claim to Aetna at the contracted rate.
  • Claims that are not covered by the plan.

To learn more about the providers who participate in the NAP, contact Aetna Member Services or access BP’s custom DocFind website.

 

Publication date: April 2019

 

© 2000-2019 BP Corporation North America Inc. All Rights Reserved. | Legal disclaimer | Privacy statement | PrintPrint this page