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Out-of-Network Reimbursement Guidelines

Posted by on Aug 14, 2014 in Education, Small Business, Small Group |

Written by Robert Guenther, HIP Pre-Sale Support Specialist Warner Pacific Insurance Services

This applies to California Small Group Plans.

AETNA From the plan summary: For out-of-network care, Aetna limits the amount it will pay. The limit is called the recognized or allowed amount. Aetna recognizes an amount based on what Medicare pays for these services. The government sets the Medicare rate.