Long story short, I had a surgery in October 2020 and originally the entire surgery (doctors fee, anesthesia, and hospital fees) were covered at 100% because I had hit the Out of Pocket Max EXCEPT for $1,200 which was for an “extensive treatment planning” CPT code. The reason for nonpayment of that fee was “Noncovered benefit, please see plan members benefit guide for more details”. I thought it was weird to be required to pay a planning fee for a covered surgery (it should be included with the surgery CPT code), so I called Aetna and they ran things though again. This time, they deemed it to be incidental. Meaning they won’t pay it, but I don’t need to pay it either, the doctor needs to write it off.
The doctors office continued sending me bills for the $1,200 and telling me I needed to pay it, even though I said the claim was resubmitted and on my end, no, I shouldn’t owe anything. I kept calling with each bill they sent and kept being promised “they would look into it”. After threatening to send me to collections, I ended up finally just paying them in July 2021.
Paying them just made things worse I think. I contacted them again regarding the issue in September ‘21, October 21’ (and this time had Aetna resend the EOB), November ‘21, and December ‘21… each time I called “they’re in a meeting” or “will look into it and call me back”. Which I think is very reasonable. I understand there are other patients, but just call me back within a week… each of those time nobody has ever called back. I have called Aetna regarding this as well, and they just do what I do… get on the phone and call the office and tell them that I don’t owe those fees.
How do I actually get this money back? Like I said… I’m understanding to the fact that these people are busy…. But I’m just not seeing how this is even legal at this point. Lmfao literally I feel like an interest free bank….
submitted by /u/itsconnorbro
[link] [comments]Long story short, I had a surgery in October 2020 and originally the entire surgery (doctors fee, anesthesia, and hospital fees) were covered at 100% because I had hit the Out of Pocket Max EXCEPT for $1,200 which was for an “extensive treatment planning” CPT code. The reason for nonpayment of that fee was “Noncovered benefit, please see plan members benefit guide for more details”. I thought it was weird to be required to pay a planning fee for a covered surgery (it should be included with the surgery CPT code), so I called Aetna and they ran things though again. This time, they deemed it to be incidental. Meaning they won’t pay it, but I don’t need to pay it either, the doctor needs to write it off. The doctors office continued sending me bills for the $1,200 and telling me I needed to pay it, even though I said the claim was resubmitted and on my end, no, I shouldn’t owe anything. I kept calling with each bill they sent and kept being promised “they would look into it”. After threatening to send me to collections, I ended up finally just paying them in July 2021. Paying them just made things worse I think. I contacted them again regarding the issue in September ‘21, October 21’ (and this time had Aetna resend the EOB), November ‘21, and December ‘21… each time I called “they’re in a meeting” or “will look into it and call me back”. Which I think is very reasonable. I understand there are other patients, but just call me back within a week… each of those time nobody has ever called back. I have called Aetna regarding this as well, and they just do what I do… get on the phone and call the office and tell them that I don’t owe those fees. How do I actually get this money back? Like I said… I’m understanding to the fact that these people are busy…. But I’m just not seeing how this is even legal at this point. Lmfao literally I feel like an interest free bank…. submitted by /u/itsconnorbro [link] [comments]Read Morer/HealthInsurance