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87 lines
2.0 KiB
Markdown
87 lines
2.0 KiB
Markdown
---
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type: medical-form
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category: insurance
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person: Yanxin Lu
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source: lu_medical_card.png
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---
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# Yanxin Lu — Aetna Medical Insurance Card
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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 # | 16424 |
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| Member | YANXIN LU |
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| Member ID | 3928092626 |
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| Network | Aetna Choice POS II |
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| Plan | EPO |
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### Copays
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| Service | Copay |
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|---------|-------|
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| Office Visit | $15 |
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| Specialist | $15 |
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| Urgent Care | $25 |
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| ER | $100 |
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| INN OOP | $3,000 |
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- **Claims Payer**: Meritain Health
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- For Submission, see reverse
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## Pharmacy Plan
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| Field | Value |
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|-------|-------|
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| RXBIN | 610014 |
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| RXPCN | ADV |
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| RXGRP | RX2336 |
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**Pharmacy**: CVS Caremark
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**Pharmacy Member**: 844.248.4511
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**Pharmacy Provider**: 800.364.6331
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## Providers Only
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| Field | Value |
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|-------|-------|
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| Provider Service | 866.761.3018 |
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| Precertification | 866.415.6831 |
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| Non-Physician | $42 |
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## Member Support
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| Field | Value |
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|-------|-------|
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| Call | 844.287.3866 |
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| Website | mymeritain.apcbcbs.com |
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Download Acrcolade Mobile to send a secure message with questions about eligibility, claims and plan benefits.
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Extras available by phone 24/7.
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## Claims Submission / Appeals
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**Mail All Claims & Correspondence to:**
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Meritain Health, PO Box 853921
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Richardson TX 75085-3921
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EDV: WidER/Endpoint/ChangeHealthcare
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at 47424 or MascoCapGroup/Health 1933
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**Mail All Appeal Correspondence to:**
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Meritain Health, PO Box 27651
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Golden Valley MN 55427
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## Precertification
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Pre-authorization is required before a primary care doctor may refer to another physician. Some services may require precertification. Without pre-approval, you may be responsible for some or all costs. Please review or comply with your plan's precertification requirements listed on the back of this card.
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Call Progyny at 844.734.8366 to pre-certify and enhance any fertility benefits.
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## Elected into the NY Pool
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The Plan Sponsor 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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