How Aetna pays out-of-network benefits
Based on whether doctors are “in
network” or “out of network” that aetna cover the cost of services differently,Aetna want to help you understand how much Aetna pays for your out-of-network
care. At the same time, how much more you will need to pay for this care so aetna
want to make it clear.
“In network” – This means you
can save more money by using doctors who are in our network, because Aetna have
a contract with that doctor or other health care provider. Aetna negotiate
discounted rates with them to help you save money.
The benefits to using doctors in
our network is : For the difference between their standard rates and the rate
they’ve agreed to with us, so they won’t bill you. And network doctors
will handle any precertification requirements. All you have to pay is your
coinsurance or copay, along with any deductible.
“Out of network” –In case
we don’t know exactly what an out-of-network doctor will charge you because we
do not have a contract for discounted rates with a doctor.
Your Aetna health plan may pay
some of that doctor’s bill if you choose a doctor or other health care provider
who is out of network. If you get care from a doctor in our network, it will
usually pay less than. you will have to handle any precertification that
may be required by your plan.
Difference in what you will pay
If you decide to use an
out-of-network doctor, you will pay substantially more money out of your own
A network doctor has agreed not
to do that give you “balance billing.” An out-of-network doctor can bill
you for whatever Aetna does not pay that is one big reason. You should
also note that amounts billed by an out-of-network doctor above what Aetna
allows for a service or procedure do not count toward your health plan’s
deductible – or toward any out-of-pocket maximums. You must fully responsible
for paying everything above the amount that Aetna allows for a service or
Your health plan typically will
pay a smaller percentage of coinsurance than if you get care from a doctor in
Aetna’s network. You also may have to meet a separate deductible if you
get care out of network.
Finally, On what the doctor bills
you, Aetna does not base its payments. In advance what your out-of-network
doctor will charge ? Aetna do not know. Instead on other methods, we base our rates.
If you choose to get your care
out of network what we’ve just said applies. if you don’t have a choice It’s
different – in case, if you end up in an out-of-network emergency room after a
car accident. Your deductible and coinsurance for the in-network level of
benefits will be applied and when you have no choice in the doctors you see, and
you should contact Aetna if your doctor asks you to pay more. Generally, for
any outstanding balance billed by your doctor in an emergency situation you are
not responsible unless you have an Open Choice PPO plan.
Aetna’s out-of-network rates are
On the plan you or your employer
picks, how much your insurance covers for out-of-network depends?. The
out-of-network benefit is based on the location of your employer’s home office If
you get your health insurance through your employer. Your benefit is based on
your residence If you have an Individual plan,.
Aetna pay for your health care
using one of three methods, when you choose to see an out-of-network doctor, Your
plan will state which method should be used. The methods are Aetna
Out-Of-Network Rates (called Aetna Market Fee Schedule in some plans) or Medicare-based
rates or “Reasonable Charge” and “Prevailing Charge”.