If you have received medical care outside of University Health Services, you will likely receive a bill for charges that were not covered by your medical insurance. The information below is designed to help you plan for costs ahead of time, understand your medical bills, and seek financial assistance if needed. Your Out-of-Pocket Expenses $200 annual medical deductibleAn out-of-pocket expense you would need to pay during a 1 year coverage period before your plan begins to pay at an in-network or out-of-network rate.In-network Office visit $10 copayA fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service.In-network Services 10% coinsuranceYour out-of-pocket share for the costs of a covered health care serviceOut-of-network Services 30% coinsurance plus any amount over R&C chargesThe amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. Request an Estimate from Aetna If you want to plan ahead, Aetna can provide an estimate of your out-of-pocket expenses before receiving services from your provider. You may complete an Aetna Student Health Member Request for Estimate or contact Aetna Member Services at 1-877-437-6511. Your Costs after Receiving Medical Services Medical Office Visits: In-Network Providers Bring your Aetna ID card to your appointment. A $10 office visit copayA fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. will be collected during your appointment. The copay applies towards office visits only and is a non-reimbursable out-of-pocket expense.Any treatment or testing during your office visit would be subject to the annual medical deductibleAn out-of-pocket expense you would need to pay during a 1 year coverage period before your plan begins to pay at an in-network or out-of-network rate. ($200/met once per plan year) and 10% coinsuranceYour out-of-pocket share for the costs of a covered health care service. These are non-reimbursable out-of-pocket expenses.After your appointment, the medical provider will submit a claim to Aetna Student Health for services rendered.Aetna will process the claim and send you an Explanation of Benefits (EOB). The EOB is not a bill. It is for informational purposes only.Your EOB will show: (1) how the insurance plan processed your claim, (2) your projected out-of-pocket costs, and (3) the claim payment amount. Aetna’s claim payment will be sent to your medical provider. The provider will send you a bill for any balance due after they receive Aetna’s payment. You would pay the bill balance to the provider. Medical Office Visits: Out-of-Network Providers Bring your Aetna ID card to your appointment. The office visit, and any treatment or testing done at your office visit, would be subject to the annual medical deductibleAn out-of-pocket expense you would need to pay during a 1 year coverage period before your plan begins to pay at an in-network or out-of-network rate. ($200/met once per plan year), 30% coinsuranceYour out-of-pocket share for the costs of a covered health care service, and any amount that exceeds the reasonable and customary rate (the difference between the amount Aetna allows for that service and the amount your medical provider charged). These are non-reimbursable out-of-pocket expenses. The provider may collect full or partial payment at the time of your visit, or they may send you a bill for services after your visit. After you pay the medical provider’s bill in full, you would then file a claim with Aetna for reimbursement of the expense.Aetna will process the claim and send you an Explanation of Benefits (EOB). The EOB is not a bill. It is for informational purposes only.Your EOB will show: (1) how the insurance plan processed your claim, (2) your projected out-of-pocket costs, and (3) the claim payment amount.Aetna’s claim payment will be mailed to you. The payment will be in the form of a check and mailed to your campus or department mailbox. If you do not receive the reimbursement check, or are unsure where it was mailed, you may contact Aetna Member Services at 1-877-437-6511. Hospital/Emergency Room Visits Bring your Aetna ID card with you. You may receive multiple services, or be treated by multiple providers, during your hospital visit (such as ambulance transportation, testing, radiology, physician, facility, etc.). Each service related to your hospital visit will be billed separately. For hospital and emergency room services, it is very common to receive multiple bills from multiple providers for a single visit. Medical services would be subject to the annual medical deductibleAn out-of-pocket expense you would need to pay during a 1 year coverage period before your plan begins to pay at an in-network or out-of-network rate. ($200/met once per plan year) and 10% coinsuranceYour out-of-pocket share for the costs of a covered health care service. These are non-reimbursable out-of-pocket expenses.After your visit, the hospital/medical provider will submit a claim to Aetna Student Health for services rendered.Aetna will process the claim and send you an Explanation of Benefits (EOB). The EOB is not a bill. It is for informational purposes only.Your EOB will show: (1) how the insurance plan processed your claim, (2) your projected out-of-pocket costs, and (3) the claim payment amount. Aetna’s claim payment will be sent to your medical provider.The hospital/medical provider will send you a bill for any balance due after they receive Aetna’s payment. You would pay the bill balance to the provider. Understanding Insurance: Understanding coverage and payments Read Video Transcript Have questions about your bill?Questions about how your claim was processed, call Aetna Customer Service at 1-877-437-6511 or log into your Aetna account.Questions about billing and payment, contact the phone number on your billing statement. Financial Support Resources Graduate Student Funding Undergraduate Student Funding Other Resources Glossary of Health Coverage and Medical Terms Aetna Student Health Member Request for Estimate Aetna Registration
