Understanding Your “Cost Sharing” with SHP
What is “cost sharing”? Cost sharing is defined as the share of costs covered by your insurance portion that you pay out of your own pocket for a medical or pharmacy service. This term generally includes deductibles, coinsurance, and copayments, but it does not include the premium (the annual cost to be enrolled) or the cost of non-covered services.
In most cases when you are seen by your doctor, you will have an office visit copayment. This is a flat rate established by the insurance company and that is the patient responsibility cost share. With SHP, diagnostic testing ( x-rays, MRIs), lab work, and surgical procedures carry a coinsurance. Coinsurance is not a flat rate, but a percentage of the total cost of the procedure billed to the insurance company that is the patient cost share. You, the patient, is responsible for a portion of the cost of the service.
With Cornell’s Student Health Plan (SHP) you have a different cost share based on whether the doctor, lab, or hospital are within the Aetna network, also called a participating provider, or out of network, meaning the provider is not participating with Aetna. You can search for participating In Network providers through a DocFind search on our website.
Details on your cost share responsibility with SHP can be found on the Plan Overview & Documents page.
Each office visit, procedure, lab testing, or diagnostic procedure will prompt an Explanation of Benefits (EOB). The EOB comes directly from Aetna and specifically describes how much the provider billed the insurance company, how much the insurance company paid, and most importantly – the patient responsibility or cost share associated with the service provided. The EOB is NOT a bill from Aetna, merely an explanation of costs associated with the medical service provided. You can access a chronological list of all EOBs through the Aetna website. You will need to create a login and password to access your personal information.
In order for the insurance company to make a payment on your office visit or procedure, it must be determined to be medically necessary or a covered benefit. A covered benefit means that the medical service is deemed appropriate and eligible for payment by the insurance company; it does not mean that the visit or procedure is paid in full by the insurance company. Most covered benefits are subject to patient cost share.