98 lines
2.2 KiB
Markdown
98 lines
2.2 KiB
Markdown
---
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type: insurance
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category: medical-insurance-card
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person: Jiang, Erica (Xuewei)
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provider: Aetna
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source: jiang_medical_insurance_card.png
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---
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# Medical Insurance Card - Erica Jiang (Xuewei)
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## Member and Network Information for Providers
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| Field | Value |
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|-------|-------|
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| Group # | 16426 |
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| Network | Aetna Network |
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| Member | YANXIN LU |
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| Member ID | 3928092626 |
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| Dependent | XUEWEI JIANG |
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| Network | Aetna Choice POS II |
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| Plan | EPO |
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| Claims Payor | Mertian Health |
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| | For Subscriber, see reverse |
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### Cost Share
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| Service | Cost |
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|---------|------|
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| Office Visit | $15 |
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| Specialist | $15 |
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| Urgent Care | $15 |
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| ER | $110 |
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| INV OOP $6,000/Family | |
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---
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## Pharmacy Plan
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| Field | Value |
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|-------|-------|
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| Logo | CVS Caremark |
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| RXPCN | ADV |
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| RXBIN | 004336 |
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| RXGRP | RX2543 |
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---
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## Providers Only
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| Field | Value |
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|-------|-------|
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| Provider Service | 888 632 3862 |
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| Precertification | 866 415 6831 |
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| Member | 844 246 4511 |
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| Pre-Certified Svc | 877 344 3256 |
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---
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## Member Support
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| Field | Value |
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|-------|-------|
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| Call Insurance Company Concerns at | 844 287 3866 |
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| www.aetna.com | |
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| if member accessible | |
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| Download Aetna Mobile to send a secure message with questions about eligibility, claims and plan benefits. | |
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| Available by phone 24/7 | |
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---
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## Claims Submission / Appeals
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**Mail All Claims & Correspondence to:**
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Mertian Health, PO Box 853921
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Richardson, TX 75085-3921
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**EDI:** AetnaMyMedAdv/EnvisionChange
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Healthcare 41124 or MedAdvantage/
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Health 17181
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**Mail All Appeal Correspondence to:**
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Mertian Health, PO Box 27881
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Philadelphia PA 19134-2881
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---
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## Precertification
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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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---
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## Elected into the NY Pool
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Aetna participating Doctors and Hospitals are independent providers and are neither agents nor employees of Aetna.
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**Network:** First Health Network
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