We cover the cost of services differently based on whether doctors are “in network” or “out of network.” We want to help you understand how much Aetna pays for your out-of-network care. At the same time, we want to make it clear how much more you will need to pay for this care. See our introduction about how your out-of-pocket costs will be higher.
When you choose to see an out-of-network doctor, we pay for your health care using the "Reasonable Charge" and "Prevailing Charge" method:
Click on the link above to learn about the way this method works based on the type of benefits you are using. You can also see examples that show how much Aetna will pay – and how much you will pay – when you choose to use out-of-network doctors.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Disclaimer: This material is for informational purposes only. For more information about Aetna, please refer to www.aetna.com.