What you pay when you are balance billed does not count toward your deductible. This is called “balance billing.” A network doctor has agreed not to do that. We do not know in advance what the doctor will charge.Īn out-of-network doctor can bill you for anything over the amount that Aetna recognizes or allows. We do not base our payments on what the out-of-network doctor bills you. It is usually higher than the amount your Aetna plan “recognizes” or “allows.” But it pays less of the bill than it would if you got care from a network doctor.Īlso, some plans cover out-of-network care only in an emergency.Īn out-of-network doctor sets the rate to charge you. Your Aetna health benefits or insurance plan may pay part of the doctor’s bill. There are many reasons you will pay more if you go outside the network. If you go out of network, your out-of-pocket costs are usually higher. There may be times when you decide to visit a doctor not in the Aetna network. The information on this page is for plans that offer both network and out-of-network coverage. Otherwise, you are responsible for the full cost of any care you receive out of network. For those plans, out-of-network care is covered only in an emergency. Some plans do not offer any out-of-network benefits. You pay your coinsurance or copay along with your deductible. And they agree to accept the contract rate as full payment. This rate is usually much lower than what they would charge if you were not an Aetna member. These health care providers have a contract with us.Īs part of the contract, they provide services to our members at a certain rate. It includes doctors, specialists, dentists, hospitals, surgical centers and other facilities. We’re here to help you understand.Ī network is a group of health care providers. Maybe you’ve read that one of the best ways to save on health care costs is to “stay in network.” But you’re not sure what that means.
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