In accordance with your Aetna provider contracts, but subject to any applicable state law, you are permitted to request that patients pay their copayments, deductible and/or coinsurance at the time of service. To help you with this, we offer the Payment Estimator tool to better inform you about patient responsibility before or at the time you perform services. However, in many, if not most circumstances, it may make sense to wait to collect payment from your patient until after the claim is processed. This helps you avoid potential administrative effort in dealing with overpayments in the event you perform a different procedure than what is estimated, or if the member reaches their deductible between the time of the estimate and the time the claim is paid.

In addition, some Aetna members are enrolled in a Flexible Spending Account (FSA) and/or a Health Savings Account (HSA) that have auto-debit features. When this happens, you will be paid directly by Aetna for any patient responsibility, if funds are available in the patients’ accounts.

Of course, you should make an individual decision on these practices, considering your own administrative capabilities and your patients’ satisfaction.

In the event that your Aetna patient makes an overpayment to your office, use the following quick facts to help you and your patient settle the charges quickly and easily.

Preventing overpayments:

If you collect payment from the patient at the time of service, please be sure that you appropriately indicate the patient paid amount on the claim submission. (For facility claims, you can indicate patient paid amounts only via electronic claims submission.) This information allows us to auto-adjust claims to reflect amounts patients have already paid. In the case of an overpayment, (unless there is law that prevents it) Aetna can also refund the patient directly, so that you don’t have to.

How to handle patient overpayments:

  • If the patient overpaid using an HSA Visa debit card, please credit that amount back to the HSA Visa debit card.
  • If the patient overpaid using cash, check, or another credit/debit card, please work with the patient to issue a refund.
  • If you were paid from the patient’s FSA, please work with the patient to issue a refund.