People are paying more of their health care costs these days. It’s no wonder there is a lot of interest in keeping these costs down.
A smart way to do this is to avoid using doctors and hospitals that are “out of network.” We do not have a contract for reduced rates with an out-of-network doctor or hospital. So you could end up with higher costs and more work.
There are many reasons you probably will pay more out of pocket:
With most plans, your coinsurance is higher for out-of-network care. Coinsurance is the part of the covered service you pay for (e.g. the plan pays 80% of the covered amount and you pay 20% coinsurance).
Plus, when you visit an out-of-network doctor, you handle precertification, if needed. This means more time and more paperwork for you.
Before you decide where to receive care, look up your estimated costs for that care if you were to stay in-network. It’s easy with our cost of care tools. If you’re a member, log in to your secure Aetna Navigator® website to use these tools.
We do not know what an out-of-network doctor will charge you. Check with your out-of-network doctor what they will charge you. Then make a decision based on what is right for you.
You are covered for emergency care. You have this coverage while you are traveling or if you are near your home. That includes students who are away at school.
Sometimes you don’t have a choice about where you go for care. Like if you go to the emergency room for a heart attack or a car accident. When you need care right away, go to any doctor, walk-in clinic, urgent care center or emergency room. When you have no choice, we will pay the bill as if you got care in network. You pay your plan’s copayments, coinsurance, and deductibles for your in-network level of benefits.
We’ll review the information when the claim comes in. If we think the situation was not urgent, we might ask you for more information and may send you a form to fill out. Please complete the form, or call Member Services to give us the information over the phone.
The plan you or your employer pick determines how much you pay for care out of the network. The exact amount depends on the:
Take a look at some examples of how your benefits pay for care.
Does your Aetna ID card have “NAP” on the front? That stands for National Advantage™ Program. And it has benefits for you:
Check your most recent ID card to see whether your plan has the program. Some plans that used to have NAP no longer have the program.
Did you go to an out-of-network doctor or hospital, and then get surprised with a very large bill? Sometimes a provider will allow you to pay a reduced fee. Sometimes they will work out a payment plan for you. You may be able to work this out with the provider by yourself. You also can get professional support. Here’s how that works.
You can get that support if you:
As an Aetna member, you can get discounted services with a claims negotiating company. The company, the Karis Group, has been helping individuals with outstanding medical bills nationally since 1996.
For an affordable fee, the Karis Group will negotiate with the provider for you. They may be able to reduce the amount you owe or arrange a payment plan. They also may be able to qualify you for programs to resolve your balance due.
As an Aetna member, you will receive a large discount for these services. They can’t guarantee they will be successful. But if they don’t get any results for you, they will refund your fee.
Are you interested in this service? Here’s how you can learn more:
While Aetna has arranged for this discount for our members, we are not part of any agreements between our members and the Karis Group. We honor your privacy. We do not share our member information with the Karis Group.
Health benefits and health insurance plans are offered and/or underwritten by Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products.
IN CT, THIS PLAN IS ISSUED ON AN INDIVIDUAL BASIS AND IS REGULATED AS AN INDIVIDUAL HEALTH INSURANCE PLAN.
This material is for information only and is not an offer or invitation to contract. Plans may be subject to medical underwriting or other restrictions. Rates and benefits vary by location. Health benefits and health insurance plans contain exclusions and limitations. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is believed to be accurate as of the production date; however, it is subject to change.
Policy forms issued in OK include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N.