A Guide To the Aexcel^® Network

The blue star on the results page identifies Aexcel^® specialists. These are doctors who meet our high standards for both clinical performance and efficiency. Going to an Aexcel specialist can lower your costs.

What does Aexcel mean?

You know what a network is, right? This is when a group of doctors agree to provide services to insurance companies' customers for less than they usually charge. Let's say you have an Aetna health insurance plan. When you go to a doctor in Aetna’s network, usually you pay less than when you go to a doctor who is not in the network.

But within the Aetna network, there is a group of specialists who meet additional clinical quality and cost criteria. These specialists receive the Aexcel designation.

You can read more about the Aexcel network on aetna.com. Just do a search for "Aexcel".

And, you can watch this short video to see for yourself how visiting an Aexcel specialist benefits you.

How do we decide which specialists are in the Aexcel network?

We consider three factors:

• Volume
• Clinical performance
• Efficiency standards

First, we look at all doctors in our network who are in one of the 12 Aexcel specialties. We identify those who have managed at least 20 "episodes of care" for our members over the past three years.

What's an episode of care?
Well, it might be a hip implant or treatment for a chronic heart condition. We include all services associated with the doctor, not just office visits. The review includes inpatient, outpatient, diagnostic, laboratory and pharmacy claims for patients of these doctors.

Second, we look at clinical performance
Here are some questions we ask:

• After a hospital stay do the doctor's patients go back in the hospital within 30 days?
• How often do serious problems develop during hospital stays?
• What industry recognitions does the doctor have?
• How does the doctor keep up board certification?
• Does the doctor use electronic prescribing or electronic medical records?

We also look at efficiency. These are the areas we examine:

• The cost for services
• The number and types of services performed
• Resources used to treat the doctor's patients

How can I talk to you about the Aexcel network?

We would like to hear what you have to say. Give us your feedback by taking this brief survey.

Do you have a complaint about the Aexcel network?

How can I file a complaint?

To obtain a review or file a complaint you can:

• Call Member Services at the phone number on your member ID card
• Submit a request in writing to the Appeals Resolution Team address shown on your Explanation of Benefits (EOB) or the Member Complaint and Appeal form
• Fill out a Complaint and Appeal Form on Navigator. Go to "Requests & Changes" and select "Forms"

Members in Metro New York may also file their complaint with the National Committee for Quality Assurance. Just send it to customersupport@ncqa.org or to NCQA Customer Support, 1100 13th Street, NW, Suite 1000, Washington, DC, 20005.

NCQA serves as an independent ratings examiner for Aetna.

Health insurance plans are offered and/or underwritten by Aetna Life Insurance Company (Aetna).

This material is for information only. The Aexcel network is only available in select locations. Aexcel is not available with HMO plans. Aexcel designation is only a guide to choosing a physician. Members should confer with their existing physicians and specialists they're selecting before making a decision. Designations have the risk of error and should not be the sole basis for selecting a doctor Health insurance plans contain exclusions and limitations. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health care services. Information is believe to be accurate as of the production date; however, it is subject to change.
Policy forms issued in OK include, GR-23 and/or GR-29/GR-29N.