Saw a bill summited by doctor for cpt 59400(global maternity) to Aetna of amount $3000.
Aetna decided to apply In-Network rate of $2000 ($1800 by insurance + $200 patient copay).
Usually they put remaining $1000 as discount/declined as part of in-network negotiated rate with Doctor. I also confirmed with one of their chat support member that their negotiated rate with doctor is $2000.
But when i see EOB it says, “The payment has been prorated based on your effective date of coverage. You can submit the balance to your prior carrier for consideration. You may be responsible for this charge. [V60] “. And hence i may owe upto $1200 ($200 copay + $1000).
Chat rep said that ideally patient may owe upto $200, and $1000 are over-charged and hence discounted by insurance, but as insurance started mid-pregnancy and so they can’t discount those $1000.
– Does this means that if patient would have had insurance from start of pregnancy she would have paid only $200, but as it started later she is liable for $1200 to doctor?? seems complete absurd.
Notes:
– This is just OB Doctors bill. Hospital, Pediatrics and other bills are separate.
– This is billed on date of childbirth.
– As person switched her job, her insurance changed. (though it doesn’t matter because of ACA below)
– Under health care law after the ACA, insurance companies can’t deny you coverage or charge you more money to care for pre-existing conditions. LINK
Any help would be appreciated.
submitted by /u/karan43210
[link] [comments]Saw a bill summited by doctor for cpt 59400(global maternity) to Aetna of amount $3000. Aetna decided to apply In-Network rate of $2000 ($1800 by insurance + $200 patient copay). Usually they put remaining $1000 as discount/declined as part of in-network negotiated rate with Doctor. I also confirmed with one of their chat support member that their negotiated rate with doctor is $2000. But when i see EOB it says, “The payment has been prorated based on your effective date of coverage. You can submit the balance to your prior carrier for consideration. You may be responsible for this charge. [V60] “. And hence i may owe upto $1200 ($200 copay + $1000). Chat rep said that ideally patient may owe upto $200, and $1000 are over-charged and hence discounted by insurance, but as insurance started mid-pregnancy and so they can’t discount those $1000. – Does this means that if patient would have had insurance from start of pregnancy she would have paid only $200, but as it started later she is liable for $1200 to doctor?? seems complete absurd. Notes: – This is just OB Doctors bill. Hospital, Pediatrics and other bills are separate. – This is billed on date of childbirth. – As person switched her job, her insurance changed. (though it doesn’t matter because of ACA below) – Under health care law after the ACA, insurance companies can’t deny you coverage or charge you more money to care for pre-existing conditions. LINK Any help would be appreciated. submitted by /u/karan43210 [link] [comments]Read Morer/HealthInsurance