Doctor Visits and Hospital Stays

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

Map to U-M Hospital Emergency Room

doctor visits

To save money, try to go to a doctor or hospital in the PREFERRED PROVIDER NETWORK (you can use any other hospital or doctor worldwide outside the Preferred Provider Network, but the cost to you will be higher). The University of Michigan Health System is part of this network. To find other Preferred Providers and to find Aetna-network pharmacies, visit the Aetna website or call 1.800.239.9697.

Hospital Stays

  • For an inpatient non-emergency hospital admission, where 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. 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. 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.

Preferred Provider Network

In all cases, it costs less to go to a hospital or doctor in the PREFERRED PROVIDER NETWORK (you can use any other hospital or doctor worldwide outside the Preferred Provider Network, at possibly slightly higher expense).The University of Michigan Health System is part of this network. To find other Preferred Providers and to find Aetna-network pharmacies, visit the Aetna website or call 1.800.239.9697.

* 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.