Signed in as Maya Chen
Sandbar Health
Insurance

Plans, benefits, and claims

Member ID card

Aetna
Aetna PPO — Open Access
Member
Maya Lin Chen
Member ID
W271849503
Group
GRP-88421
Effective
Jan 1, 2026
PCP
Dr. Elena Vasquez — Foxhall Primary Care
PCP
$25
Specialist
$35
Urgent
$75
ER
$250
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Benefits summary

Deductible
$320.00of $500.00 met
Family deductible: $1,000.00
Out-of-pocket max
$485.00of $4,000.00 met
$3,515.00 remaining this plan year
Copays
PCP visit
$25
Specialist
$35
Urgent care
$75
Emergency room
$250
Coinsurance: 80/20 after deductible (in-network) · 60/40 after deductible (out-of-network)
Prescription tiers
Generic
$10
Preferred brand
$30
Non-preferred brand
$60
Specialty
20%
RxBIN 004336 · RxPCN ADV

Claims

Year-to-date member cost: $202.40
Office visit — follow-up
Dr. Elena Vasquez · Foxhall Primary Care
In networkProcessed
Date
May 8, 2026
Billed
$285.00
Plan paid
$228.00
You owe
$25.00
Applied to: Copay
Lab work — comprehensive metabolic panel, A1C, lipid panel, CBC, TSH
Labcorp · Labcorp — Dupont Circle
In networkProcessed
Date
Apr 22, 2026
Billed
$412.00
Plan paid
$329.60
You owe
$82.40
Applied to: Deductible
Rx — Metformin 500 mg (90-day supply)
Walgreens Pharmacy · Walgreens — 14th & U
In networkProcessed
Date
Apr 10, 2026
Billed
$48.00
Plan paid
$38.00
You owe
$10.00
Applied to: Copay (generic)
Rx — Sertraline 50 mg (90-day supply)
Walgreens Pharmacy · Walgreens — 14th & U
In networkProcessed
Date
Mar 15, 2026
Billed
$42.00
Plan paid
$32.00
You owe
$10.00
Applied to: Copay (generic)
Office visit — preventive / annual wellness
Dr. Elena Vasquez · Foxhall Primary Care
In networkProcessed
Date
Mar 3, 2026
Billed
$350.00
Plan paid
$350.00
You owe
$0.00
Applied to: Preventive — covered in full
Urgent care visit — sinus infection
CVS MinuteClinic · CVS MinuteClinic — 17th St NW
In networkProcessed
Date
Feb 12, 2026
Billed
$195.00
Plan paid
$120.00
You owe
$75.00
Applied to: Copay (urgent care)
Prior authorization — Ozempic 0.25 mg
Aetna Pharmacy Benefits · Aetna Prior Auth
In networkPending
Date
May 14, 2026
Billed
$0.00
Plan paid
—
You owe
$0.00