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documents/insurance/medical/jiang_medical_insurance_card.md

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+---
+type: insurance
+category: medical-insurance-card
+person: Jiang, Erica (Xuewei)
+provider: Aetna
+source: jiang_medical_insurance_card.png
+---
+
+# Medical Insurance Card - Erica Jiang (Xuewei)
+
+## Member and Network Information for Providers
+
+| Field | Value |
+|-------|-------|
+| Group # | 16426 |
+| Network | Aetna Network |
+| Member | YANXIN LU |
+| Member ID | 3928092626 |
+| Dependent | XUEWEI JIANG |
+| Network | Aetna Choice POS II |
+| Plan | EPO |
+| Claims Payor | Mertian Health |
+| | For Subscriber, see reverse |
+
+### Cost Share
+
+| Service | Cost |
+|---------|------|
+| Office Visit | $15 |
+| Specialist | $15 |
+| Urgent Care | $15 |
+| ER | $110 |
+| INV OOP $6,000/Family | |
+
+---
+
+## Pharmacy Plan
+
+| Field | Value |
+|-------|-------|
+| Logo | CVS Caremark |
+| RXPCN | ADV |
+| RXBIN | 004336 |
+| RXGRP | RX2543 |
+
+---
+
+## Providers Only
+
+| Field | Value |
+|-------|-------|
+| Provider Service | 888 632 3862 |
+| Precertification | 866 415 6831 |
+| Member | 844 246 4511 |
+| Pre-Certified Svc | 877 344 3256 |
+
+---
+
+## Member Support
+
+| Field | Value |
+|-------|-------|
+| Call Insurance Company Concerns at | 844 287 3866 |
+| www.aetna.com | |
+| if member accessible | |
+| Download Aetna Mobile to send a secure message with questions about eligibility, claims and plan benefits. | |
+| Available by phone 24/7 | |
+
+---
+
+## Claims Submission / Appeals
+
+**Mail All Claims & Correspondence to:**
+Mertian Health, PO Box 853921
+Richardson, TX 75085-3921
+
+**EDI:** AetnaMyMedAdv/EnvisionChange
+Healthcare 41124 or MedAdvantage/
+Health 17181
+
+**Mail All Appeal Correspondence to:**
+Mertian Health, PO Box 27881
+Philadelphia PA 19134-2881
+
+---
+
+## Precertification
+
+For a referral to see a specialist, a primary care doctor may require precertification. Without precertification, you may have a higher copay. For a list of services that require precertification and to request precertification, call 866.415.6831 or comply with your plan's precertification requirements. To determine if a service requires precertification, Call Progyny at 844.734.8586 to Pre-certify and enhance any fertility benefits.
+
+---
+
+## Elected into the NY Pool
+
+Aetna participating Doctors and Hospitals are independent providers and are neither agents nor employees of Aetna.
+
+**Network:** First Health Network