Aetna announced in its September 2024 OfficeLink Updates that it is experiencing problems with electronic eligibility verification transactions for Aetna Passport to Healthcare PPO members, causing enrollees to appear ineligible for benefits even though they are eligible.

According to Aetna, due to how eligibility checks are currently run, the system does not display eligibility or benefits information Aetna Passport to Healthcare members. Instead, it will give you a phone number to call to verify the member’s coverage. Practices can also verify eligibility by calling the number indicated on the back of the member’s ID card.

Aetna’s Passport to Healthcare PPO plan, typically identified by group numbers that begin with 8639 or 1493, utilizes the Aetna Open Choice PPO for members who are in the United States for temporary and long-term work assignments, to attend a college or university, and/or for personal travel. 

The California Medical Association has inquired with Aetna about when the payor expects to have a system fix implemented and will publish an update when more details are available.   

For more information, see the Aetna OfficeLink article “Be sure to verify whether Aetna® members are eligible for care before turning them away.”