Quote:
Originally posted by AGDLynn
Okay so the other day I get a bill from the dr.'s office that I have been going to for 6 years. The items are from 08/03 and 12/04. I emailed Aetna asking why I was getting billed because looking at their statements, it looks like I or the ins. company paid for everything.
Today I get a response and here's something....please help me to understand, lol. I don't do well with insurance math.
1. Dr. is not a participating Aetna provider....my insurance hasn't changed in 6 years so why are they saying this?? When hubby was there a couple of weeks ago, they didn't say that the dr's office wasn't a participant.
2. I was questioning a $78 charge...."The allowable charges of $443 were reimbursd at 70%, after the 2003 $300 deductible, for a total payment of $100.10 (okay I get that). The allowable amount for the $78 was $64. The $64 was included in the $300 deductible. The balance of $14 was denied, as it exceeded the plan's allowable amount. Based on this information, the patient is responsible for the $78 charge.....((okay why not $14?))
3. I was questioning $68 for a metabolic panel of tests..."The $68 charge was not denied. That..had a contract rate of $14.05. The patient responsibiiity for this office visit is $15.00 (okay I paid that). We paid $160.52 on the claim and the rest is a write off for the provider (who apparrently is/isn't a participant). ((So why am I asked to pay the $68 to the dr's office??)
Thanks y'all!!!
Lynn
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Georgia law and Florida law work differently in health insurance. If I were you, I'd call up your agent have him put it in lamens terms for you and make him do his dam job. If you deal directly with Aetna (which is completely stupid because Aetna tends to have more moorons working for them than any other carrier I know of (thats why I stop sending a decent amount of business their way....because of stuff like this) then I would suggest looking up an Aetna agent, not a CSR-customer service rep, and talkign to him about why is it this is happening with the health insurance.
Also, if you dont have an agent and do decide to call up one.....act as though you're interested in swtiching from dealing directly with the company to having him/her as your agent so that they'll help you through this mess. Otherwise, you may just be shit out of luck.
If you lived in Florida I could answer all your questions. But seriously, if you don't have an agent, you really need to look one up and talk to him and not a secretary/CSR...ask for the health insurance agent.
Cashmoney