Plan Overview

A PPO plan comes with more flexibility. For example, there’s no need for you to choose a primary care doctor. You can see in-network and out-of-network doctors without referrals. However, you’ll have lower out-of-pocket costs when you stay inside of their network. 

If you have a PPO plan, you can seek care through our statewide PPO network in Michigan and northwest Ohio (Defiance, Fulton, Henry, Lucas, Ottawa, Williams and Wood counties). When outside of that network, use the Aetna Signature Administrators® Network for covered service at the in-network cost-share amount.

Referrals 

HAP doesn’t require you to get a referral to see a specialist in your network for an initial consultation. However, the specialist you visit may require a referral from your primary care physician. The schedules for certain specialists get filled months in advance. They may only accept patients whose primary care physician believes the patient needs specialty care. 

Example: 

Mary suffers from chronic sinus infections several times a year, so she wants to see an ear, nose and throat doctor. She schedules an appointment with the specialist within her network.  

HAP doesn’t require a referral for Mary to see this doctor.  

The doctor’s office may require a referral from Mary’s PCP. This isn’t a HAP requirement. HAP doesn’t have any involvement in the doctor’s request. 

Prior authorization 

Prior authorization is an approval from HAP to get a specific covered treatment or procedure. It’s required before you can get certain tests, treatments, medication or supplies. We require prior authorization so we can make sure you’re getting the care you need. 

Example: 

When Mary visits the ear, nose and throat doctor for the first time, she pays her specialist office copay. After her consultation, the ENT recommends a sinus surgery. Before Mary has surgery, the ENT’s office must get prior authorization from HAP to make sure the service is covered and medically necessary. 

For hospital stays 

For inpatient hospital stays, your doctor will get prior authorization from HAP. Emergency room visits don’t require prior authorization. 

HMO: For everyday health care services, you must see a doctor in HAP’s HMO network. But, if you have an emergency, your services are covered 24/7 at any emergency room or Urgent Care Facility.

PPO: If you have a PPO plan can, you can seek care through our statewide PPO network in Michigan and northwest Ohio (Defiance, Fulton, Henry, Lucas, Ottawa, Williams and Wood) or use the Aetna Signature Administrators® Network when you outside of that network. Or if you have an emergency, your services are covered 24/7 at any emergency room.

Assist America offers global emergency medical services if you’re ill or injured while traveling more than 100 miles from home, or while in a foreign country.

Use our Find a Doctor tool to find an in-network provider.