Health Insurance Glossary / FAQ

Claims Address

Aetna Student Health
PO Box 15708
Boston, MA 02215-0014
(877) 437-6512

FAQ

• What is my Aetna ID number?
• How do I contact Aetna?
• Months ago, I submitted a claim, but have not heard anything. What should I do?
• Does our insurance cover contraceptives?
• How do I know if a medicine is covered?
• How does the new billing at the Health Center work?
• Rejection?! My insurance coverage is not in effect???
• Minor surgical procedure at an outpatient surgery center, any problems?

Insurance Terms Definitions:

• Copay
• Coinsurance
• Deductible
• Preferred/Non-Preferred Providers
• Explanation of Benefits (EOB)
• Negotiated Charge
• Reasonable Charge
• Claim

FAQ

Your ID number is a 12-digit number that can be found on the front of your Aetna ID card. If you do not have the card with you, your ID number is also your IU student identification number, with the first three 0's replaced by the numbers "223." For example, if your IU ID number is 0001579378, your Aetna ID number would be 2231579378.

• IMPORTANT: You should be sure to write your ID and Group number on any bills or correspondence you are sending to Aetna Student Health. The group number for the SAA/International plan is 812849, and is also found on your Aetna ID card.

The insurance website is http://www.aetnastudenthealth.com/. There you can access our plan brochure, find a doctor, or check claim status online. The toll-free number is 1-877-437-6512, and is found on the front of your insurance ID card.

• If you are calling about a rejection or problem with an insurance payment, you need to ask for the claims department.
• If you are calling to find out if a service will be covered or to find a doctor in your network, you should ask for the benefits department.
• If you feel that Aetna has made a mistake in processing your charge, call them! Insurance companies make many mistakes in processing claims and calculating payments, so if you feel they have made a mistake you should always call before paying a bill. If you don't get a satisfactory answer on your first call, call back - you'll probably get a different representative.

At this point you should make sure that the insurance has received the claim. A common problem with insurances is that they mysteriously "lose" several claims every month. If two months or so has passed with no payment or rejection from the insurance, you should log onto the Aetna website to check the claim status via the online system, or call the insurance to see if they have received the bill. It is important that you keep up with the claims you submit, because our insurance has a 90-day filing deadline. If the insurance doesn't receive the bill for the first time within 90 days (even if it's their fault for "not receiving" a bill you sent in), they will reject it as being beyond the filing deadline and it is very hard to get them to pay at that point. If they claim to have lost or never received the claim, ask the doctor's office to resend or fax the claim, verifying the address to which they are sending the claim and patient ID number.

Our insurance does cover oral contraceptives, but not contraceptive injections (i.e., Depo-Provera). Note that you no longer have to fill your oral contraception prescriptions at the IU Health Center pharmacy to get them covered. You may fill your prescription at any in-network pharmacy, subject to a copay and the policy deductible.

Students are responsible to know what their insurance covers. Doctors are not knowledgeable about all available medications, and while they try to offer cheaper alternatives, it is ultimately the student who needs to know her/his coverage.

If you have coverage from Aetna, the Health Center will automatically file the claim for you - both for the pharmacy and for office visits, lab tests, etc. If Aetna does not cover some of the services, the bill will come back to the Health Center at which point the student will receive notification and will have a choice to pay off the bill by credit card, in cash, or by transfering the ballance to the Bursar's account.

If you have coverage from an insurance company other than Aetna, you will have to mail in your own claim. An exception is the pharmacy at the Health Center as it has contracts with several providers, so they might be able to file it for you.

Your insurance takes effect on August 15th before your first semester at IU, and is continuously in effect until you leave the program, unless you request to end your coverage prior to leaving the program. Anytime you receive a rejection stating that your coverage is not in effect, you need to call the insurance. Occasionally this will happen around the middle of August of each year, as new members are enrolled in the plan, and the insurance for existing members "resets" for the next year and the benefits are altered slightly or our group number is changed. In addition, there are occasionally communication issues between IU and Aetna that means that certain students' enrollment forms aren't received at Aetna until after the fall semester starts. Once these are received, however, you can call Aetna to have them reprocess any claims that you incurred from mid-August, as your coverage will have been in effect the entire time.

Under our plan, any surgical procedure done in Bloomington must be performed at Bloomington Hospital (check the online DocFind service for other area hospitals and facilities). While some surgeons prefer to use outpatient surgery centers to save on time and costs (such as the Bloomington Surgery Center on West 2nd Street or Southern Indiana Surgical Center on Tapp Road), these facilities are not in-network under our plan. Even if you have a procedure at one of those facilities using an in-network provider, it will be paid at the out-of-network rate because the facility would be out-of-network. So what can I do? Let your surgeon know that outpatient surgery centers are not covered under our insurance, and s/he should be more than willing to perform the surgery at Bloomington Hospital or another hospital covered by our insurance. If your doctor insists on using a surgery center, seek a second opinion.

Insurance Terms Definitions:

The copay is a flat dollar amount that must be paid every time you (or your spouse or child) visits a doctor or has a service by a medical provider outside of the IU Health Center. This amount is different than your deductible or coinsurance amount. The most commonly used copay for most patients is the office visit copay, which is $25 per doctor visit. Each time you go to the doctor anywhere except the IU Health Center, you must pay a $25 copay. The copay at the IU Health Center is $10.

Copays also apply for various other services (e.g., there are $10, $30, and $50 copays for prescriptions, a $200 copay for inpatient hospital admissions, and a $10 copay for lab services).

The percentage of the medical charges that the patient is required to pay after insurance pays. This is separate from the copay and deductible and is typically calculated as a percentage. Coinsurance will not typically apply for services rendered by preferred providers. For non-preferred providers, you will typically be responsible for approximately 50% of the charges, in addition to the copay and deductible.

Deductible: Your deductible is the amount you must pay to your doctor before the insurance will start making payments to them. Our deductible is $500 for a preferred provider and $1000 for a non-preferred provider, therefore you can pay up to $1500 in deductible payments each year (however, you will only pay $500 if you use only preferred providers, and $0 if you use the IU Health Center exclusively). The amount the insurance tells you that you must pay under your deductible each year should never exceed these amounts, so be sure to keep track. If it does, the insurance has made an error and needs to be contacted. The deductible does not apply, under any circumstances, to services rendered at the IU Health Center.

Your deductible will reset every year (as of now, on or around August 15th), so that you will be responsible for the first $500 (or $1000) of your medical expenses outside the Health Center each year. This applies even if you have been seeing the same doctor for years -- you will still have to pay the first $500 (or $1000) at the beginning of each year before your insurance will start to pay claims.

Preferred providers are those who have signed agreements with Aetna to accept special negotiated rates for their services. It is to your benefit to use a preferred provider whenever possible, because the costs to you will be much lower. You can find a preferred provider in the "DocFind" system on the Aetna website. Both the deductible and the coinsurance amount you will be required to pay are much lower for preferred providers; for example:

The detailed statement you will get from Aetna following each claim submission. It will tell you the types of services that were charged, how much was charged for each service, how much the insurance in paying, and how much you must pay via copay, deductible, and coinsurance.

Negotiated Charge:The amount that preferred providers have agreed to accept as full payment for their services when treating Aetna patients. For example, a doctor may charge $100 for an office visit. However, if they are preferred providers, they will have agreed to accept a lower amount from Aetna (i.e., $78), as full payment. If you are seeing a preferred provider, you may not be billed by your doctor for the $22 difference, regardless of what your insurance pays.

This discounted amount applies to non-preferred providers, and it is an amount determined by Aetna without any input from the provider. Providers do not typically accept "reasonable charges" as full payment for their services. The reasonable charge is calculated based on typical charges in the doctor's geographic area and the charges the insurance determines are appropriate for the services rendered. However, the patient is often still responsible for the difference between the amount charged and the "reasonable" charge as determined by the insurance. So, if a doctor charges $100 and Aetna determines that $78 is a "reasonable charge" and limits its payments to that amount, the patient may still be responsible for the $22 difference.

The itemized bill submitted to Aetna by the doctor's office on your behalf. It lists your identifying information, along with a detailed statement of the services rendered and the charges incurred, along with the provider's name and address.