Initiate a Direct Settlement

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Initiate a Direct Settlement Request

For a true emergency, please have the missionary seek care at the closest facility and contact Aetna afterward to arrange for payment of services.

Reminder: For pre-planned services or care, it is recommended that you submit this form to the Aetna International Service Center so as to allow a reasonable amount of time for arrangements to be made prior to your planned date of service. For urgent care, please make sure the request is clearly marked as urgent.

For an immediate response, you can contact Aetna customer service by phone. Contact details are available on country specific pages.

Please Provide the following information:

*Choose a Country

*Missionary Name

*Missionary Aetna W-ID (numbers only)

*Mission Name

*Missionary/Patient Date of Birth

Missionary Email Address (if available)

*Missionary Mobile Phone Number

*Missionary’s Location (City/Town)

*Missionary’s medical complaint & Brief description of services needed*

Is this an urgent request? (care needed same day or following day)

Yes

Date of Service or Appointment if scheduled already

Other Pertinent Information You Want to Share, if any

Mission Contact/Requester information:

*Name of contact submitting this request (Requester)

*Phone number where we can reach you (including country code)

*Requester's Email Address

*Requester’s location – city/town

Provider Information:

IMPORTANT: If you know which provider or facility the missionary will be going to, or if you have one you are requesting, please input that information here. We need as much information as you have. If you are not sure and looking for suggestions, please include the following in the Provider’s Name: Please Recommend Provider.

*Name

Address

City

State/Province

Zip/Postal Code

Country

Phone Number