This section is a user guide to your LM HealthWorks Plan that takes you step-by-step through the process of seeking care and using your benefits.

How to Seek Care, Out of Network

Using out-of-network providers

If you seek care outside the network, the plan works a little differently. Here’s what you need to know:

seek-icon-out-01.gif Show your LM HealthWorks Plan medical ID card.
seek-icon-out-02.gif Depending on the provider, you may need to pay in full at the time of your visit, then submit a claim to Aetna, the LM HealthWorks Plan administrator, for reimbursement. Remember, when you use out-of-network providers, you are responsible for filing claims.
seek-icon-out-03.gif You can call the LM HealthWorks Plan toll-free number at 1-877-458-4975 to request a claim form. Or, you can download a claim form at Aetna Navigator. Follow the instructions on the form and remember to include the provider’s original bill for services.
seek-icon-in-07.gif Once you have filed a claim, you will receive an Explanation of Benefits (EOB) statement by mail that shows the total charge for care and the amount the plan will pay. It also shows how much of the out-of-network deductible you’ve met, and how much remains to be met. (Note that the plan’s in-network and out-of-network deductibles are separate. Out-of-network expenses do not apply toward the in-network deductible and vice versa.) Remember, you can “turn off” paper EOBs at Aetna Navigator and just receive them online.
seek-icon-in-06.gif After the deductible is met, you and the plan share in the cost of your care. You pay a percentage of your expense (called coinsurance).  For covered preventive care services, the plan typically pays 100% of the recognized charge with no deductible. The Benefits Summary chart shows how you and the plan share expenses.
seek-icon-out-07.gif Once the claim is processed, you are reimbursed for the plan’s share of the covered expense. Payments to the provider will be your responsibility.

Keep in mind that out-of-network expenses are paid according to what the plan considers the recognized charge, that is, the charge most often made for a service or supply in a geographic area. If your health care provider charges more than the recognized charge, you pay the difference.

If you are receiving ongoing care from an out-of-network doctor, you may want to consider nominating him or her for membership in the network. Learn more »

Once you become a member of the LM HealthWorks Plan and register for Aetna Navigator, you can check the status of a claim, your HealthFund balance and progress toward your deductible at Aetna Navigator.

Not yet an LM HealthWorks Plan member?
Use this guest ID and password to visit Aetna Navigator and see what you’d be able to do as a member.

User Name/Guest ID: cpos2guest1
Password: cpos2guest1

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