HUGE Insurance bill due to Maximum Benefit for service Exceeded AETNA

[cadladykim 55]

Okay I just got a $25k+ bill from my hospital today! WHAT???? I expected some copays but never this!!!

The note at the bottom said "Your insurance has informed us that you have met your benefit max for this service and therefore has denied payment...etc." Original bill was over $41k

surgery was January - I called in December SPECIFICALLY asking if this surgery was covered (January starts the new plan year, we kept the same insurance company but I just wanted to know if anything changed or if this was not covered) at no time was I told there was a maximum benefit amount. I would have certainly talked to my doctors office ahead of time if there was! I didn't even know there was such a thing!

Anyone experience this? What can I do???

I cannot afford this bill! the hospital finance department will allow you to make payments for a year to pay off your amount. I don't have $2200 a month!!! I'm so depressed and pissed and I don't even know what else. Normally I go eat when I feel like this - I cant even do that!

[Crosby 303]

Call your insurance company. I was billed for the entire anesthesia bill by mistake.

[Sue Magoo 71]

Hello:

Please do call your insurance company and you may want to speak with the insurance expert in your surgeon's group too. Many hospitals make arrangements with insurance companies with pre-determined rates that will be reimbursed for particular procedures and if approved, the hospital has to accept that amount as payment in full, and they adjust off the difference. I hope that is what is happening here.

Good luck, and please let us know so that we can learn from your experience.

Sue

[peg from Minnesota 33]

I am sorry, insurance is really hard to understand, hope they will help you because that is so stressful.

[dhrguru 1,238]

Call your insurance company. I was billed for the entire anesthesia bill by mistake.

That happened to me too

[cadladykim 55]

Insurance says there was a max and I exceeded it. Everything past that is my responsibility.

The bill is the excess that exceeded the allowed amount ????????????

[woo woo 872]

My understanding is that as long as you pay something on it each month, even 10 bucks, they can't put you in collections.

Definitely verify that but I had a coworker tell me this once (he was uninsured).

[AllisonK1986 68]

I would tell them I can pay what I can, but can't afford 2200 a month. They will give u a hard time but give in the end. Bc some money for them is better than none.

[brownsugar73 1]

Yes...you need to verify your plan documents to see what is your annual and lifetime max on your policy. If you look into Aetna navigator and look at the benefit tab it should show you.

Generally, if you have a max cap, any amout above that is patient responsibility.

Being a covered benefit is not the same as the benefit or policy maximum.

Also. ...ask if the hospital has a charity or financial assistance program. Generally you would have to qualify for a certain percentage of your income and there are times when you're able to adjust a large portion of the bill and you make monthly payments on the remaining amount

Edited July 21, 2015 by brownsugar73

[cadladykim 55]

I'm still disputing it with them.

That's jut it - I specifically called Aetna in December and asked for every piece of information prior to the surgery, then I talked to my workplace plan admin to verify what I needed as well as what was covered. There was nothing about a maximum plan benefit amount. The only thing I was told AND found in writing was it needed pre-approval and I had to meet requirements. Which I did and got the approval letter from Aetna. That's my dispute. There is still nothing what so ever on the Navigator website about a benefit maximum amount.

Then to make matters worse - Aetna's negotiated price for the bill went from 41k to 16k. Aetna paid 6k (what they said was left from the max benefit amount). so that left a 10k balance on the negotiated price.

Well no... since Aetna told the hospital that i maxed out the benefit, the hospital then classified me as un-insured for the balance of the original bill (not the insured discount price). And that is why they say I owe 25k instead of 10k.

so I have 2 fights - 1 with my insurance for failure to disclose the max benefit amount even after my attempts to get all the information in advance. 2nd with the hospital for classifying me as uninsured in order to get more money.

[brownsugar73 1]

@cadladykim....send me a PM...i'm in Healthcare field and deal with this on a daily basis. I can help send you in the right direction.

Yes. ..there are contacted and non contracted rates. If Aetna paid what the allowable is, then the rest can be deemed non covered. What is your coverage percentage? Do you have a ppo? Usually when or before you're admitted they verify your policy limits. Generally, admitting doesn't know contract info, that's the business office.

[her1981 448]

If you can prove financial hardship, the hospital should forgive a large portion of the debt. I have a high deductible ppo and I've been able to get the hospital charges waived twice.

[tcon 305]

Sorry you're going through this. Hope you get this resolved soon.