Summary Plan Description
How To File A Medical Claim
Network providers bill Aetna directly. Aetna reprices the claim based on the network provider discounts and then forwards the repriced claim to Carpenters Trusts. Carpenters Trusts processes the claim and provides you with an Explanation of Benefits (EOB) describing what this plan paid, the network discount(s) and what is owed by the patient as part of the annual deductible, copayment, coinsurance, and noncovered expenses.
Non-network providers may require you to submit the bill:
- Submit the provider's itemized bill to Aetna. The address is provided below and is also on the back of the Aetna/Carpenters Trusts ID card:
Aetna Life Insurance Company
PO Box 981106
El Paso, TX 79998-1106
- If you are covered under another health care plan or Medicare, and the other plan or Medicare is the "primary" plan, you must also include the primary plan's Explanation of Benefits with the provider's itemized bill. The Explanation of Benefits and the provider's itemized bill must correspond. Inaccurate or incomplete information can create unnecessary paperwork and delay processing.
- Claims for services received outside of the U.S. are converted to U.S. currency based upon the conversion rate at the time of service and then paid directly to you. Itemized bills must be translated into English before being submitted. A claim must be accompanied by records which describe the services rendered and the condition being treated (medical or hospital).
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