Out of pocket cost with Aetna

[ozzy22 0]

I know every plan differs, but I just want some rough idea on how much I will need to come up with. I think my plan covers 85%.

I was just wondering anyone who was Aetna, how much did you end up paying for everything?

[MINI-Me 196]

This is going to be almost impossible for anyone to answer unless they have your same insurance and same surgeon.

Do you have an Out of Pocket Maximum? If so, that should be the maximum you will have to pay. Otherwise, have your surgeon provide the codes he will be billing and his charges. Then, call Aetna & have them tell you their allowed amount and payment. Your copay should be the difference in their paid and the allowed amount. The surgeon may be able to give you similiar information about the hospital charges.

[former_vbg 198]

I know every plan differs, but I just want some rough idea on how much I will need to come up with. I think my plan covers 85%.

I was just wondering anyone who was Aetna, how much did you end up paying for everything?

I have an Aetna PPO plan, my work offers two different versions of the Aetna insurance policies. I chose the one that would limit my out of pocket expense. In my case I have a $200 deductible for outpatient services, and I think $500 for inpatient. Once I meet my deductible, they pay at 100%.

So, provided I qualify (think I should), I will only have to pay my inpatient deductible. Some surgeons cover follow up office visits with the surgery costs for a short period (normally 90 days), some do not- that will be up to the surgeon.

I would suggest calling Aetna and asking them about your specific plan, they should be able to tell you exactly what your responsibility will be for the surgery.

Don't forget to ask about your responsibility for the charges above the negotiated rate. For example, if your surgeon/ hospital bill the insurance company for $20,000 for that procedure (assuming no complications), and they have a negotiated contract rate of $12,000- you shouldn't be responsible for the difference because that is what the surgeon agreed to be paid for that procedure. You should also confirm this with the billing staff and/or surgeon you are working with.

Hope that helps some.

[newnatalie 20]

Hi Ozzy,

I have a PPO with Aetna. I paid a $500 co-pay for the surgery. This was only because I had to stay in the hospital overnight, otherwise it would have been $250. I also paid $250 co-pay for my upper endoscopy. This is because it was done in a hospital. All my other labs and test were covered 100%.

Your plan may be different. It really helped me to call and talk the insurance company myself and not take the doctor's staff information at face value. I knew exactly what to expect!

I wish you the best!

[onedivanms 1]

I know every plan differs, but I just want some rough idea on how much I will need to come up with. I think my plan covers 85%.

I was just wondering anyone who was Aetna, how much did you end up paying for everything?

I have Aetna as well. It depends on a few things. My normal co-pay is $20.00 for office visits in network.. I was originally told that my hospital co-pay would be areund $2,000.00 and I believe that my surgeon would be around $500.00. Neither quote was correct. I will end up paying around $1200.00 for my surgery. I also had to mack 4 monthly visits to be on a doctor's supervised diet pre-op.

Hope it helps