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FSBP is a Federal Employees Health Benefits (FEHB) high-option closed plan with affordable premiums that covers you everywhere in the world.
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.
When you have double coverage, one plan normally pays its benefits in full as the primary payor and the other plan pays a reduced benefit as the secondary payor. We, like other insurers, determine which coverage is primary according to the National Association of Insurance Commissioners’ (NAIC) guidelines. For additional information on NAIC rules regarding the coordinating of benefits, visit the NAIC website at www.NAIC.org.
The provider should call 202-833-5751.
FSBP has a special arrangement with the Clinic by Cleveland Clinic and Children’s Hospital to provide our members with the option of a second opinion for certain diagnoses received from a foreign provider. The Overseas Second Opinion benefit provides access to nationally recognized specialists for a second opinion via the Clinic by Cleveland Clinic and Children’s Hospital. Once you obtain the second opinion, you choose whether to proceed with the original course of treatment, seek out another opinion, or arrange care with an alternate physician. To determine if you are eligible to participate, e-mail the Plan at secondopinion@aetna.com.
The Plan has a special arrangement with Children’s National Hospital to provide patients who receive treatment in foreign countries access to Virtual Second Opinions. This program allows you to have your medical diagnosis and treatment reviewed by expert specialists from Children’s National Hospital who can help you with many health challenges.
The Children’s National RSO Program provides patients access to leading pediatric specialists, without ever having to travel outside of their home. For each RSO, our physician reviews the patient’s medical information and compiles their findings into a comprehensive written report.
Process for Requesting an RSO
To request a Virtual Second Opinion for treatment received outside the U.S., simply complete the online intake form Children’s National – Online Request Form.
If you would like to see a second provider of your choice while serving overseas, the consultation and any medically necessary tests or services will be covered in the same way as any overseas provider. For more information about coverage while overseas, visit our Overseas page.
FSBP provides access to Aetna’s Aexcel specialists network. Aexcel is a designation for doctors and doctor groups in 12 medical specialty areas:
Doctors with the Aexcel designation will have a blue star next to their listing in the provider search results. The Evaluation Standards are:
This does not mean the doctor does not provide quality services. It could be that Aetna does not have enough information available to evaluate a particular doctor or the doctor’s specialty is not one of the 12 specialty categories. An Aexcel designation is not a guarantee of service quality or treatment outcome. Therefore, the Aexcel designation should not be the only reason for choosing a specialty doctor. The Aexcel designation is only a guide, and all ratings have a chance for error.
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