When you use a doctor in our network, you generally don’t need to file a claim. Just show your ID card, and your doctor files the claim for you. Make sure you carry your ID card with you at all times since it includes the address your provider will need to submit your claims. Also, you might need to buy prescriptions at a network pharmacy and you’ll need your ID card to do so.
For your convenience, you can view and download a copy here.
Doctors in our network usually file claims for you. But, if you need to submit a claim please use this address:
Foreign Service Benefit Plan
1620 L Street, NW
Washington, DC 20036-5629
To file your claim, print this form. Then fill out the form and mail it to the address provided on the form. If you have questions, just give us a call at 202-833-4910.
Claims must be submitted using the Foreign Service Benefit Plan (FSBP) secure website.
Then follow the instructions to submit your claims. If you have any questions, just contact us at email@example.com or 202-833-4910.
Follow the Federal Employees Health Benefits Program disputed claims process outlined in Section 8 of the FSBP Plan Brochure if you disagree with our decision on your claim.
You, your representative, your doctor, or your hospital must call us prior to admission. The toll-free number is 800-593-2354. Provide the following information:
We’ll tell the doctor and hospital the number of days in which the patient is approved to stay in the hospital. Our decision will be sent to you, your doctor, and the hospital.
Yes. The federal government requires that all members of a fee-for-service plan must precertify their hospital admissions. We will reduce our benefits for the inpatient hospital stay, Skilled Nursing Facility stay or residential treatment care by $500 if no one contacts us for precertification. If the stay is not medically necessary, we will only pay for any covered medical services and supplies that are otherwise payable on an outpatient basis.
Exceptions: You do not need precertification in these cases:
Other services require precertification, prior approval, concurrent review or prior authorization. You, your representative, your doctor, or treating facility must call us at 800-593-2354 (except for prior authorization on prescription drugs – see below) before the admission or care, such as:
For complete list refer to www.aetna.com/health-care-professionals/precertification/precertification-lists.html.
When there is an emergency admission you, your representative, the doctor, or the hospital must call 800-593-2354 within two business days after the day of admission, even if the patient has been discharged from the hospital.
You may visit our Find a Provider tool to look up providers who are in the network. You may also call 202-833-4910, and we will help you find a participating provider near your home or office.
Provider information can change. So please call your doctor before your appointment to confirm his/her network status.
Paper directories become outdated quickly as new providers join our growing network.
You can easily print a copy of the directory from our Find a Provider tool by selecting the "Print" option at the top of your search results.
Members have access to providers in our network virtually anywhere in the United States. Whether you are on vacation, business travel or away at college, you and your eligible dependents can find providers who participate in our network.
Yes. While we encourage doctors in our network to refer their patients to other network doctors, this may not always be possible. We recommend that you always confirm that the doctor is a member of our network. Likewise, if your doctor refers you to a hospital, please confirm that the hospital is part of our network.
Yes, you can self-refer and choose specialists without being referred by your doctor.
If your doctor does not currently participate in our network, you may submit a Provider Nomination form to have him/her considered. Fill out the patient section and ask your doctor to complete the rest. After we receive the form, it can take up to six months for us to complete the review process. If you have questions, please call 202-833-4910 for assistance.