---
type: financial
category: insurance
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

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## 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.

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## 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