Frequently Asked Questions
The co-payment is an amount that the member must pay in advance before the consultation (for example: general practitioner, emergency services…).
A deductible is a threshold of expenses that the member must reach before his health insurance begins to reimburse his care.
The co-insurance is an amount not covered by health insurance, which the member must pay to the healthcare provider.
PPO stands for Preferred Provider Organization. If you have a PPO plan you do not need a referral to see a Specialist and you may have different benefit levels for out of network healthcare partners.
No, because you have a PPO plan.
An Urgent Care Center is a walk-in clinic where you can see a Primary Care Physician without an appointment. Urgent Care Centers are convenient because they are usually open early in the morning until late in the evening, and often on weekends. Urgent Care Centers may also be equipped to perform X-rays and/or CT scans. Please note that specialists (cardiologist, ENT, GI, etc.) are not available through Urgent Care Centers.
Inform them you have a PPO plan and provide them the contact info that appears on your Aetna card so they can get in contact with us and we will verify eligibility and benefits.
Any services considered invasive such as outpatient surgeries, hospital admissions, treatment of a catastrophic diagnosis, specialty drugs and injections. Please always verify with your insurance as there may be additional services requiring a prior-authorization based on the type of policy you have.
You can as you have a PPO plan, however check with your insurance to confirm the benefits for going out of network as they may be different than your in network benefits.
You only need to notify us if you are going to have a service that requires a prior authorization. Always provide your Aetna card to your healthcare partner so they may call us for any questions about your benefits.
It is very common that healthcare partners send a bill to patients instead of the insurance even though they had your insurance information. Do not panic. Contact us so we may review a copy of the bill.
Please contact us and we will direct you to the healthcare partner of your choice within our network.
