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home | health insurance | doctor visits, hospital visits, and referrals
Doctor Visits, Hospital Visits, and Referrals
This section provides information needed when you, your spouse, or your child must visit the doctor or hospital, or are referred to a specialist.
Doctor Visits
You (The Policy Holder)
- If you are sick or have hurt yourself, it is best to go to University Health Service (UHS) first. If you do not go to UHS, you will be charged a deductible of $50. A deductible is a charge that you must pay before the insurance company will pay its portion of your costs. If you do not go to UHS, it is a good idea to go to a 'preferred provider'. If you do not visit a 'preferred provider' it is possible that you will be charged more than the 'reasonable and customary charge' which will increase the amount you will have to pay. You can find names of preferred providers at the Aetna Insurance home page. Please remember that even if you visit a preferred provider, you will still be charged the deductible.
- Visiting scholars can also use North Campus Family Health Service. This is an excellent alternative to UHS because the normal $50 deductible will be reduced to $10. In addition to the $10 deductible, North Campus Family Health Service offers international visitors many important services. Please see Advantages of North Campus Family Health Service. Please note: If students use North Campus Family Health Service, they will be charged a $50 deductible.
- If UHS or North Campus Family Health Service cannot assist you, they will give you a referral to a specialist or to the U of M hospital. You will not have to pay the $50 deductible, as long as the referral comes from UHS (for students or scholars) or North Campus Family Health Service (for scholars).
- If you have an emergency for which you need immediate attention, go to the emergency room of the hospital or call 911 for an ambulance. (You will be charged the $50 deductible.)
- If you must go to the hospital, it is best if you choose one of the hospitals that are included in the network for this plan (consult www.aetnaushc.com/docfind). Hospitals in the network cost less than those outside of the network.
The local Ann Arbor hospital in the network is the University of Michigan Health System.
Please consult the insurance brochure for additional information about network providers.
- In many cases, the doctor/hospital will bill the insurance company directly. If so, either you will not receive a bill at all or you will be billed for the portion of the services that the insurance company does not cover, such as the deductible.
Your Spouse
- If your spouse has an emergency, go to the emergency room directly or call 911 for an ambulance. You will be charged the $50 deductible.
- If it is not an emergency, it is also best for your spouse to go to either UHS or the North Campus Family Health Service because you will avoid the $50 deductible, as explained above. When using UHS, the deductible is reduced to zero. When using the North Campus Family Health Service, the deductible is reduced to $10. UHS and North Campus Family Health Service will bill the insurance company directly, and they will also make referrals to other doctors, if necessary.
Your Child
- If your child has an emergency, take your child to the emergency room of the hospital or call 911 for an ambulance. You will be charged the $50 deductible.
- If it is not an emergency, and your child is under 18 years of age, it is best to take your child either to Pediatric Primary Care at East Ann Arbor Health Center or the North Campus Family Health Service. By going to either of these two places, the deductible will be reduced to $10. Please note that a child must be at least 10 years old in order to be seen at UHS.
- Pediatric Primary Care at East Ann Arbor Health Center and North Campus Family Health Service will bill the insurance company directly and make any necessary referrals.
Hospital Visits (for You, Your Spouse, or Your Child)
- For an inpatient non-emergency hospital admission, when you will be in the hospital for 18 hours or longer, you must notify the insurance company at least three (3) working days prior to admission in order to obtain Pre-Certification for the hospitalization. Either you, your doctor or the hospital must call the insurance company at 800.239.9697. The insurance company will ask you why you are planning to go into the hospital and will certify your visit over the phone.
- For an inpatient emergency admission, you must notify the insurance company by phone within one (1) working day of admission to the hospital. Either you, your representative, your doctor, or the hospital must call the insurance company at 800.239.9697.
- Pre-Certification or Notification for hospitalization is required by the insurance company. If you do not follow this procedure, the first $200 of the hospital bill will be your responsibility.
Referrals to a Specialist
- Any time that a physician from UHS, North Campus Family Health Service, or Pediatric Primary Care at East Ann Arbor Health Center refers you to another specialist, you will receive a note from the referring doctor. It is a good idea to make a copy of this referral note and keep it for your records because the insurance company might ask to see it.
Last reviewed: 5/07
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