Hi,
In July I had a psychologist do a full ADHD assessment for me. This cost $2,200. At that time, they said they do not submit the bill to insurance, so I had to pay the entire amount. They provided me with an itemized invoice so that I could submit it to my insurance. The thing with the code they use, it’s not for a specific ADHD assessment, rather, they coded it to a psychological evaluation.
So when I submitted the invoice, my insurance said that the provider is in-network and therefore, the cost that for specific code from the invoice was, for me, only about $250. This basically means that my insurance (Aetna) is saying that the provider should be reimbursing me almost $2,000. Aside from that, because Aetna calculated “my cost” to only be $250, they are only applying $250 to my deductible, while I paid $2,200. If the full amount was calculated as “out of network”, I would’ve actually already hit my deductible and then I would’ve only paid 20% of the remaining amount for this visit (and other doctor’s visits for the rest of the year). Either way, it seems like I’m getting the worst of the both: Paid the full amount, AND it doesn’t apply to my deductible.
Aetna was obviously confused as to why they made me pay up front since they are in-network etc. I’m not sure either at this point.
Anyway, we’re a couple of months later, and the provider is basically saying: “Aetna didn’t pay us, so we can’t give you money back”. Aetna is saying: “You paid the full amount already, you should’ve only paid $250, so the provider needs to give you back $1,950”. To me it sounded like the provider messed up, but they should to eat the difference, not me.
This is the first time dealing with a situation like this for me – What is the best way forward to get the money asap and what are my options really?
Sorry if this is not the right subreddit.
Thanks for the help!
submitted by /u/konseptbe
[link] [comments]Hi, In July I had a psychologist do a full ADHD assessment for me. This cost $2,200. At that time, they said they do not submit the bill to insurance, so I had to pay the entire amount. They provided me with an itemized invoice so that I could submit it to my insurance. The thing with the code they use, it’s not for a specific ADHD assessment, rather, they coded it to a psychological evaluation. So when I submitted the invoice, my insurance said that the provider is in-network and therefore, the cost that for specific code from the invoice was, for me, only about $250. This basically means that my insurance (Aetna) is saying that the provider should be reimbursing me almost $2,000. Aside from that, because Aetna calculated “my cost” to only be $250, they are only applying $250 to my deductible, while I paid $2,200. If the full amount was calculated as “out of network”, I would’ve actually already hit my deductible and then I would’ve only paid 20% of the remaining amount for this visit (and other doctor’s visits for the rest of the year). Either way, it seems like I’m getting the worst of the both: Paid the full amount, AND it doesn’t apply to my deductible. Aetna was obviously confused as to why they made me pay up front since they are in-network etc. I’m not sure either at this point. Anyway, we’re a couple of months later, and the provider is basically saying: “Aetna didn’t pay us, so we can’t give you money back”. Aetna is saying: “You paid the full amount already, you should’ve only paid $250, so the provider needs to give you back $1,950”. To me it sounded like the provider messed up, but they should to eat the difference, not me. This is the first time dealing with a situation like this for me – What is the best way forward to get the money asap and what are my options really? Sorry if this is not the right subreddit. Thanks for the help! submitted by /u/konseptbe [link] [comments]Read Morer/HealthInsurance