Important Changes to Managed Care Medical Assistance Plans
Patients who are on managed care medical assistance plans through Aetna Better Health, AmeriHealth Caritas/Northeast and Gateway Health Plan need to be aware that ExpressCARE services are not covered as per their insurance payment policies.
These patients should contact their primary care physicians for the minor ailments treated at ExpressCARE, as visits to primary care physicians are generally covered by their insurance plans. Examples of minor ailments include common colds, flu-like symptoms, seasonal allergies, bronchitis, ear infections, sore throats and fever, poison ivy and rashes, strains and sprains, and cuts and lacerations. Patients with more serious health problems that need attention right away should visit an emergency room.
There are exceptions that may be covered by these insurance plans for visits to certain ExpressCARE locations:
Aetna Better Health and AmeriHealth Caritas/Northeast will only cover ExpressCARE visits if:
- A patient visits ExpressCARE locations at LVHN–Tilghman in Allentown or the Health Center at Bangor in Pen Argyl. (Please note service fees at the ExpressCARE at LVHN–Tilghman are higher than at other ExpressCARE locations.)
- A patient’s primary care physician is located at one of the following locations and that patient visits the ExpressCARE that is at the same location as the primary care physician:
LVPG Internal Medicine–Muhlenberg LVPG Family & Internal Medicine–Bethlehem Township
LVPG Family Medicine–Fogelsville LVPG Family Medicine–Macungie
LVPG Family Medicine–Nazareth LVPG Family Medicine–Moselem Springs
LVPG Family Medicine–Whitehall
Gateway Health Plan will only cover ExpressCARE visits if:
- A patient visits our ExpressCARE location at LVHN–Tilghman in Allentown. (Service fees apply as listed above.)
- A patient’s primary care physician is with one of the practices listed above and the patient uses the ExpressCARE service that is at the same location as the primary care physician.
Please understand this directive comes from Aetna Better Health, AmeriHealth Caritas/Northeast and Gateway Health Plan. Patients should contact their insurance providers with any questions.