Surprise Medical Billing & Cost Tips & Support

Some reasons for surprise bills

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:

You got lab work at an out-of-network facility.
You received a service that was only partially covered under your plan.
You had surgery at a network facility, but some services related to that procedure — like lab work, ambulance transportation or anesthesiology services — were out of network.
You have a deductible to meet before a service is covered.

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.

6 tips to avoid surprise medical bills

A nurse showing a pregnant woman and her mother something on a tablet

You have options

You have options

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:

Review your bill. Ask the provider for an itemized statement to easily review charges.
Talk to your provider. Inquire about charges that don’t look correct.
Call us. In some cases, it may just be a billing error.

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

Important plan disclosures

Resources for your state

Helpful resources to avoid surprise costs

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.

Emergency care FAQs