Determine patient payment responsibility with the Aetna Payment Estimator

As costs shift to the patients’ responsibility, providers struggle with determining patient amounts. As a result, it is extremely important to give providers the necessary online tools that enable them to determine a more accurate estimate of the patient responsibility amount. An online tool that does exactly that is the Aetna Payment Estimator, available via NaviNet.

Note: The Payment Estimator can only be used with patients enrolled in Aetna’s commercial medical benefits plans.

The Payment Estimator is available to Aetna participating medical providers in one or more Aetna networks and will:

  • Help your office determine more reliable estimates of patient responsibility amounts (copayments, coinsurance and deductibles, etc.).
  • Provide information to initiate financial discussions with patients prior to, or at time of care.
  • Reduce, and potentially, eliminate after-the-fact financial surprises for you and your patients.

For professional and outpatient services, after entering key member and "claim" information, your office will receive the following details:

  • Aetna’s contractual adjustment and other non-covered amount(s).
  • Patient responsibility amounts (copayment, deductible, coinsurance, etc.).
  • Aetna’s estimated payment to the provider.
  • Adjustment reason codes and associated text.

For inpatient services, after selecting the member and choosing the appropriate procedure, your office will receive:

  • Patient responsibility amounts (copayment, deductible, coinsurance, etc.).
  • Aetna's estimated payment to the provider.

Because an estimate request is processed in real-time, it is accurate for the point in time in which it is received. The estimate may differ from the explanation of benefits if claims for other providers are received and processed prior to receiving the claim for which an estimate was submitted. The Payment Estimator does not automatically generate a claim. A claim must be submitted in order for your office to receive reimbursement.

Note: Although nonparticipating providers can access the Payment Estimator, estimate submissions will receive an error response.


Learn how to use Aetna’s Claim and Account Management Tools

Join us for a free, live, Claims management tools webinar. We'll show you how we can make it easier for you to manage claims payments. This 45-minute webinar covers everything related to patient accounts, including claim status, claim reports, online Explanation of Benefits (EOB) statements, and single and multiple claims considerations. This webinar is offered the third Thursday of every month at 2 p.m. ET.

Register today! Send an email to In the subject line, insert the name of the webinar. In the body of your email, include:

  • Webinar name and date
  • Tax identification number (TIN)
  • Practice name
  • Attendee name
  • Attendee email address

You’ll get a confirmation email from us that will include a WebEx presentation invitation.

For information on getting started with the Aetna Payment Estimator, review the Begin to Estimate section.