Hi Guys,
I got a claim with the blow remarks. This claim shows a out-of-network provider but it actually happened during the period I stayed in an in-network hospital. is this remark related to the Suprise Bill Act or something like that?
This provider is not a part of our network. The services are considered at the in-network benefit level. Your plan covers expenses at the plan allowance in the area that this service was done. The amount allowed on this claim is not a contracted or agreed upon rate. Under your benefit plan, you are responsible for any applicable copayment, coinsurance or deductible. If the provider bills you for an additional amount, please call us at the number on the back of your ID card and we will re-review the claim. If you prefer, send a copy of this Explanation of Benefits and the bill from the provider to the address listed on the back of your member ID card and we will re-review the claim. Make sure your member ID number is on the bill. If we allow an additional amount and your in-network copayment, coinsurance or deductible have not been met on other claims you may owe this provider up to the covered billed charges. Note: Some state laws do not allow providers to balance bill you if your plan is fully insured. Refer to your Plan Summary to confirm your plan’s funding. You can also go to Aetna.com, select Disclosure Information, then State Specific Information for the state’s regulation. [W39]
Thanks for any information.
submitted by /u/New-Anything-4694
[link] [comments]Hi Guys, I got a claim with the blow remarks. This claim shows a out-of-network provider but it actually happened during the period I stayed in an in-network hospital. is this remark related to the Suprise Bill Act or something like that? This provider is not a part of our network. The services are considered at the in-network benefit level. Your plan covers expenses at the plan allowance in the area that this service was done. The amount allowed on this claim is not a contracted or agreed upon rate. Under your benefit plan, you are responsible for any applicable copayment, coinsurance or deductible. If the provider bills you for an additional amount, please call us at the number on the back of your ID card and we will re-review the claim. If you prefer, send a copy of this Explanation of Benefits and the bill from the provider to the address listed on the back of your member ID card and we will re-review the claim. Make sure your member ID number is on the bill. If we allow an additional amount and your in-network copayment, coinsurance or deductible have not been met on other claims you may owe this provider up to the covered billed charges. Note: Some state laws do not allow providers to balance bill you if your plan is fully insured. Refer to your Plan Summary to confirm your plan’s funding. You can also go to Aetna.com, select Disclosure Information, then State Specific Information for the state’s regulation. [W39] Thanks for any information. submitted by /u/New-Anything-4694 [link] [comments]Read Morer/HealthInsurance