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Aetna

· 3 Gong sources

Aetna

Overview

Commercial + government insurer (CVS Health). Aetna Better Health is the Medicaid managed-care arm, operated state-by-state with distinct LOBs (e.g. Aetna Better Health Illinois, Aetna Better Health Ohio).

Active Work / Processes

  • Aetna Better Health complex care work for Theoria Medical is now client-owned — Theoria works directly with Janelle (Aetna contact) and provides rosters directly.
  • First Choice Health delegation (Montana) — Aetna delegates credentialing to First Choice Health in Montana. Frontier Psychiatry is contracted through First Choice Health (not direct Aetna contract); providers must be enrolled via the First Choice Health pathway. Aetna directory will show the provider but may show no network information because the contract lives at First Choice Health. Enrollment applications should be submitted under First Choice Health, not Aetna directly; follow-up calls go to First Choice Health. VACCN/enrollment SOP being updated by Leigh Howle (Gong 2026-04-20).

Pain Points / Open Issues

  • Aetna Better Health exited Ohio in 2026 — common point of confusion with Paramount (which did NOT exit Ohio); confirmed during 2026-04-15 Theoria/Complex weekly sync.

Decisions & Commitments

  • 2026-04-17 — Aetna Better Health Illinois (both complex cares) + the Ellen White complex care enrollment flipped client-owned for groups + providers; Theoria handles rosters directly with Janelle. Source: Svetlana in 17 weekly sync.

Key Facts

  • Aetna Better Health = Medicaid managed care (state-by-state LOBs)
  • Ohio exit: Aetna Better Health exited Ohio in 2026 (not Paramount)
  • Theoria contact: Janelle (Aetna Better Health, complex care)
  • Theoria Medical — Aetna Better Health Illinois (both complex cares) + Ellen White complex care, client-owned
  • Frontier Psychiatry — contracted via First Choice Health delegation (Montana); not direct Aetna contract

Source History

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