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Refunding overpayments

If you identify an overpayment

If you identify an overpayment

If you believe you have received an overpayment. first review the coordination of benefits (COB) status of the member.

In some cases, coverage with a maintenance of benefits (MOB) provision will result in a higher-than-expected payment.

Under an MOB provision, we first look at the Aetna normal benefit amount. in the absence of any other carrier. Next. we subtract the primary carrier's payment from the Aetna normal benefit. We then pay the difference. The result can be a higher payment than what a provider would see with 100% allowable coordination of benefits.

For example:

100% allowable COB: $370 bill results in $0 primary carrier payment and $25.04 patient responsibility per primary carrier. We pay $25.04.

MOB provision: $370 bill results in $65.70 Aetna normal benefit. Subtracting the primary carrier payment ($0), we pay $65.70.

Before sending us a check, please consider that your payment may have resulted from applying an MOB provision.

If you are sure that you have received an overpayment, please submit the following information:

  • A check issued to Aetna in the amount of the overpayment
  • The name and ID number of the member for whom we have overpaid (Include a copy of the member's Aetna ID card, if available.)
  • The dates of service
  • Supporting documentation, including but not limited to:

    • A letter explaining the reason for the refund
    • A copy of your Explanation of Benefits (EOB) statement
    • In the case of incorrect coordination of benefits, the primary carrier's EOB statement
    • Corrected bill
    • Any other documentation that would assist in accurate crediting of the refund

Mail this information to the address on the EOB statement or on the member's ID card. Once we receive the information, we will correct the member's file.

If the EOB statement or the member's ID card is not readily available, send information to:

Aetna Inc.
PO Box 14079
Lexington, KY 40512-4079

If we identify an overpayment

If we have identified an overpayment and request a refund, please mail the check. along with a copy of the overpayment request letter we sent you, to the address provided in the letter.

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Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

See all legal notices

Also of interest: