My wife gave birth to our daughter in an in network hospital. They offered a $4500 cash pay option if we paid that day. I took that deal.
Aetna covers 80% after a $2k deductible. The deductible was met with the OB’s invoice. This means that 20% of 4500 is less than 20% the much larger amount they wanted to submit. I paid and submitted the itemized invoice and receipt to Aetna. They are now telling me they are not able to reimburse me if I agreed to be a cash pay customer. They are able to process the claim if the hospital submits it however. If the hospital submits the claim, I will owe over $2000 as the 20% copay. If Aetna reimbuses me, I’ll pay $900 out of pocket as the 20% copay.
This doesn’t make any sense as everyone pays less if they just reimburse me for 80% of what I already paid.
Help?
submitted by /u/mineuserbane
[link] [comments]My wife gave birth to our daughter in an in network hospital. They offered a $4500 cash pay option if we paid that day. I took that deal. Aetna covers 80% after a $2k deductible. The deductible was met with the OB’s invoice. This means that 20% of 4500 is less than 20% the much larger amount they wanted to submit. I paid and submitted the itemized invoice and receipt to Aetna. They are now telling me they are not able to reimburse me if I agreed to be a cash pay customer. They are able to process the claim if the hospital submits it however. If the hospital submits the claim, I will owe over $2000 as the 20% copay. If Aetna reimbuses me, I’ll pay $900 out of pocket as the 20% copay. This doesn’t make any sense as everyone pays less if they just reimburse me for 80% of what I already paid. Help? submitted by /u/mineuserbane [link] [comments]Read Morer/HealthInsurance