Determine patient payment responsibility with the Aetna Payment Estimator

As costs shift to the patients’ responsibility, providers struggle with determining patient amounts. As a result, it is extremely important to give providers the necessary online tools that enable them to determine a more accurate estimate of the patient responsibility amount. An online tool that does exactly that is the Aetna Payment Estimator, available via NaviNet.

Note: The Payment Estimator can only be used with patients enrolled in Aetna’s commercial medical benefits plans.

The Payment Estimator is available to Aetna participating medical providers in one or more Aetna networks and will:

  • Help your office determine more reliable estimates of patient responsibility amounts (copayments, coinsurance and deductibles, etc.).
  • Provide information to initiate financial discussions with patients prior to, or at time of care.
  • Reduce, and potentially, eliminate after-the-fact financial surprises for you and your patients.

For professional and outpatient services, after entering key member and "claim" information, your office will receive the following details:

  • Aetna’s contractual adjustment and other non-covered amount(s).
  • Patient responsibility amounts (copayment, deductible, coinsurance, etc.).
  • Aetna’s estimated payment to the provider.
  • Adjustment reason codes and associated text.

For inpatient services, after selecting the member and choosing the appropriate procedure, your office will receive:

  • Patient responsibility amounts (copayment, deductible, coinsurance, etc.).
  • Aetna's estimated payment to the provider.

Because an estimate request is processed in real-time, it is accurate for the point in time in which it is received. The estimate may differ from the explanation of benefits if claims for other providers are received and processed prior to receiving the claim for which an estimate was submitted. The Payment Estimator does not automatically generate a claim. A claim must be submitted in order for your office to receive reimbursement.

Note: Although nonparticipating providers can access the Payment Estimator, estimate submissions will receive an error response.


Learn how to use Aetna’s Claim and Account Management Tools

Join us for a free, live, interactive seminar, and we’ll show you how we can make it easier for you to manage claims payments.

During this 30-minute session, you’ll learn how to access and use:

  • Claim status inquiries
  • Claim status reports
  • Electronic Explanation of Benefits (including claim reconsiderations)
  • Claim history reports
  • Provider Payment Estimator
  • ERA/EFT (electronic remittance advice/electronic funds transfer)

You’ll also have time to ask questions about how you can use these easy tools in your office or facility.

Sessions are held on the first Thursday and third Tuesday of every month from 12:00 p.m. to 12:30 p.m. ET (11:00 a.m. to 11:30 a.m. CT; 10:00 a.m. to 10:30 a.m. MT; 9:00 a.m. to 9:30 a.m. PT).

Register for one today!

Prior to the webinar, be sure to register for our secure provider website.



For information on getting started with the Aetna Payment Estimator, review the Begin to Estimate section.