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
Insurance billing
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