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<br />USAccess gives <br />you the flexibility <br />to choose how you <br />access your care. <br /> <br /> <br />{, .:1ldc{' >; <br /> <br />Self-Refer Outside the Network <br />You can even seek care for covered services outside of the network <br />without a referral. When you choose a licensed physician or hospital <br />outside the network, you pay a portion of your medical expenses <br />through a deductible and coinsurance. Certain benefit limitations <br />apply. You may also need to file a claim form and may receive balance <br />bills (the difference between the physician's actual fee and the <br />amount covered by your specific plan). Balance bill payments are not <br />a covered benefit. <br /> <br />! l/'( '( '(' rli Ikd lion I\\'q u if'(' m I' 11 L..; <br />To have the lowest out-of-pocket costs when you self-refer, you must <br />obtain authorization from Aetna U.S. Healthcare prior to receiving <br />certain self-referred medical services. This authorization is called <br />precertification.* <br /> <br /> <br />Choice 1 <br /> <br />Choice 2 <br /> <br />{~CllOi <br />'''''i?".~,__~_..ce. 3 <br /> <br />Visit your PCP, <br />get a referral <br />to a participating <br />specialist or <br />hospital <br /> <br />Go directly to <br />.. any participating <br />. .. physician or <br />- hospital <br />'\,('''''','' <br /> <br /> <br />cost to you: <br />Copay <br /> <br /> <br />'Failure to precertify may lead to substantially reduced benefits. Refer to your plan documents for a list of medical services that require precertification. <br /> <br />3 <br />