John Doe
DOB: 01/15/1975 • Aetna • Member ID: AET123456789
Status Timeline
✓
Request Submitted
Mar 15, 2024
2
Insurance Review
Expected within 24 hours
Assigned Pharmacy
Cost Estimate
List Price: $1200.00
Insurance Coverage: -$1080.00
Copay Assistance: -$100.00
Your Cost: $20.00
Based on your Aetna coverage
Status Timeline
✓
Request Submitted
Mar 10, 2024
2
Insurance Review
Expected within 24 hours
Assigned Pharmacy
Cost Estimate
List Price: $2500.00
Insurance Coverage: -$2300.00
Copay Assistance: -$150.00
Your Cost: $50.00
Based on your Aetna coverage
Insurance Coverage
Aetna
Open Choice PPO
Group #
12345
Effective Date
01/01/2024
Deductible Progress $750 / $2000
PCP Copay $25
Specialist Copay $40