If you’ve received a surprise medical bill, these resources can help you understand your plan coverage and learn about your options. And we’re always here to help.
Your first step to avoid a surprise bill is to understand your plan coverage and costs. But even if you feel you followed your plan’s guidance, you may still receive a bill with charges you didn’t expect.
Common reasons for a surprise bill:
We’re here to help. Just call us at the number on your member ID card, and we can walk through these charges together.
Tips to avoid surprise costs
Set aside time to get to know your plan coverage and costs. You can also use your Aetna® member website to find participating providers and estimate care costs.
If you’ve been billed charges that you feel aren’t valid, you have options.
Learn your rights and how you’re protected
As an Aetna® member, you have the right to certain information from us and the health care professionals who care for you. You also have the responsibility to know how your plan works and to communicate with your doctor about your care.
Your rights and responsibilities
Learn what steps to take next
You are your most powerful advocate. So if you see a bill with a charge that doesn’t look correct, you have the right to ask about it.
3 steps to take:
More help is available
You’re entitled to protection from your state, the federal government and outside organizations. And in some cases, you may only be responsible for your plan deductible, copay or coinsurance.
Get help filing a complaint, grievance or appeal
Get help appealing a denied claim
We’ve put together tips and information to keep in mind every time you go for care.
Save money by staying in network
Maybe you’ve heard staying in network saves money, but you don’t know why. Or maybe your plan covers out-of-network care, but you’re not sure of the cost. This explanation can help.
Learn about in-network and out-of-network care
Know before you go
Your doctor can refer you for tests and screenings to help you stay healthy. But this care may not always be covered or in network. Or you may need approval from us. This guide can help you avoid surprises.
Procedure authorization guide (PDF)
Learn about emergency care coverage
Even though your plan covers emergency care, some services related to that care — like an ambulance ride or an MRI scan — may be performed by noncontracted providers, which can bring surprise costs. These FAQs can help you prepare.
These tools and resources can help you be proactive about your care, which can help you keep your costs more affordable.
It’s easy to find providers who participate in our network — like doctors, hospitals, pharmacies, labs and urgent care centers.
Compare costs for over 650 medical tests, services and procedures, and get an estimate based on your plan. And find average network and out-of-network costs for tests, procedures, ER visits and more.
Explore some of the terms and phrases you might come across on your health care journey, so you can stay informed.
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Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
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Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
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The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.
Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.
The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.
Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.
Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.
