Transplant services

The Institutes of Excellence (IOE) network is the claims administrator’s network for transplants and transplant-related services, including evaluation and follow-up care. This is a network of facilities that have demonstrated success at performing these highly specialized procedures.

For the PPO Options:

  • The network level of benefits is paid for treatment received at a facility designated by the plan as an IOE for the type of transplant being performed. Each IOE facility has been selected to perform only certain types of transplants.
  • Services obtained from a facility that is not designated as an IOE for the transplant being performed will be covered as out-of-network services and supplies, even if the facility is a network facility or IOE for other types of services.

The National Medical Excellence (NME) Program coordinates transplants and other specialized care that may not be available in your local area. If you are referred to a facility that is more than 100 miles from your home or you are required to remain within a certain radius of the treating facility that is farther than your home, the NME Program will help pay certain travel and lodging expenses for you and a companion.

If you or one of your covered family members could be a potential transplant candidate, contact the claims administrator to learn more about this program.

Out-of-country care

The National Medical Excellence (NME) Program coordinates care when an Aetna plan participant develops an urgent or acute illness when traveling outside of the United States. Coordination of some or all of the following may apply:

  • Assessment of the urgent or acute care facility’s appropriateness for the required care;
  • Transfer of the plan participant to a more appropriate acute care facility for stabilization;
  • Transfer of the plan participant back to the United States; and
  • Transfer of the plan participant to his/her home.

 

Publication date: April 2019

 

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