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Help with a surprise bill
If you’ve received a surprise medical bill, these resources can help you understand what that means, your plan coverage, and what your options are. We’re always here to help.
Learn what you can do about surprise costs
Understand what a surprise bill is, why you might get one, and what steps you can take to address it. Remember to always review your bills and talk to your provider if you have questions.
Understanding what a surprise billing is
A surprise bill, also known as “balance billing,” occurs when you receive health care services and are unexpectedly billed for more than you anticipated. This typically happens in two different situations:
- When you receive emergency care from providers or facilities that are outside of your health insurance network.
- When you visit an in-network facility (like a hospital or surgical center) but are unknowingly treated by an out-of-network provider working at the facility.
If these situations, the out-of network provider may bill you for the difference between what your insurance plan agreed to pay and the full amount charged for the service. This difference is called a “balance bill.”
These unexpected charges are typically much higher than what you would pay for the same services from an in-network provider, and they often don’t count towards your annual out-of-pocket limit.
Some reasons for surprise bills
The best way to avoid a surprise bill is by understanding your plan’s coverage, and what care costs. But even if you follow 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 review these charges together.
You have options
If you’ve been billed for charges that you feel aren’t valid, you have options.
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.
1. Review your bill. Ask the provider for an itemized statement so you can easily review what each individual charge is on the bill.
2. Talk to your provider. Ask them directly about charges that don’t look correct.
3. Give us a call. In some cases, it may just be a billing error that we can address for you.
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
Resources for your state
Some states offer specific protection for a surprise bill.
- Resources for Colorado (PDF)
- Resources for Connecticut (PDF)
- Resources for New York (PDF)
- Resources for Washington (PDF)
Helpful resources to avoid surprise costs
We’ve put together some tips to help you stay informed. Use this information to avoid unexpected healthcare costs every time you seek care.
Save money by staying in-network
You may have heard that staying in-network can save you why but understanding why is important. Even if your plan covers out-of-network care, the costs can be significantly higher. Here’s a detailed explanation to help you understand the benefits of staying in-network.
Learn about in-network and out-of-network care
Know if your care is covered before you go
Your doctor may refer you for tests and screenings to help you stay healthy. However, not all care is covered, and some services may be out-of-network. Additionally, you may need prior approval from us to avoid unexpected costs. Use this guide to help you prepare and avoid surprises.
Procedure authorization guide (PDF)
Learn how emergency care coverage works
While your plan covers emergency care, some related services – such as ambulance rides or MRI scans- may be provided by out-of-network providers, leading to surprise costs. These FAQs can help you understand and prepare for these situations.
Manage the costs for your care
Use these tools and resources to be proactive about your care. They can help you keep your costs more affordable.
Find care
We care about your health. That’s why we make it easy to find doctors, specialists, and other healthcare providers. We’re here to help, whether you choose an in-network or out-of-network provider.
Compare and estimate costs
Want to know how much your care could cost? Log in to your member account to use our cost estimator tool. Compare prices for over 650 medical tests, services, and procedures, and get an estimate based on your plan.
Learn health care terms
Check out some of the words and phrases you might hear when you or your family visit the doctor. Knowing these terms can help you understand what’s happening when you are getting care.
Need more help? Our team is here for you.
If you need help understanding or reviewing a surprise bill, give us a call and we can walk through it together.
Legal notices
Student health insurance plans are insured by Aetna Life Insurance Company. Self-insured plans are funded by the school and administered by Aetna Life Insurance Company. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company and its affiliates (Aetna).
Health benefits and health insurance plans contain exclusions and limitations.