Aetna and Deductible?

[Natosha Williams 3]

My paperwork is being sent off to Aetna tomorrow (yay!!!) but I do have a question or two

Did you guys have to pay your deductible before you completed the surgery? I've done ALLLL the physician appts, nutritionist appts, x-rays etc and I haven't touched my deductible yet! These appts were copays only and counted towards my out of pocket max, but not my deductible.

[Pinkgirl1234 761]

Yes with my first surgery I had Aetna.l would get that out of the way or prepare to....

[Natosha Williams 3]

At what point did you have to pay it?

[Invictus 56]

It seems strange that those fees don't go toward your deductible and out of pocket. Mine did. I had met my deductible before surgery due to various issues. My plan also required a $5000 copay for bariatric surgery, but not sure if they are still requiring it since I also had a hernia repaired. Still waiting on all the money/bills to work out.

[acyum2008 55]

@@Natosha Williams I have Aetna, and I have my last NUT visit this Friday, but I spoke with Aetna and I have met my $1000.00 deductible. And some of the OOP Max I believe you will still have to pay off the deductible. You shouldn't have to before surgery because once fees from the Dr, surgeon hospital start to accrue you will definitely meet it. My copay for inpatient hospital is only 500 and my OOP deductible was only 3500 of which I only really have to pay 25% of my surgeon cost etc the inpatient stay is covered 100%.... But I do work for a major hospital corp and it could be the insurance premiums are different. @@Invictus your copay was ridic OMG I would've flipped my lid.

Hope this all makes sense...Its so early

Edited September 16, 2015 by acyum2008

[Natosha Williams 3]

Invictus, yes I thought it was strange too! I did a little more research and some services (like dr's appts, surgeon consults, etc) are copay only on my plan. $5000 is a lot, Did you have to pay that before you had your surgery and since you had a hiatal hernia repair done are they reimbursing some of it?

acyum2008, it definitely made sense. Just trying to wrap my mind around paying MORE money I don't know why I never considered the fact that I would have to pay something before surgery!

[Sajijoma 1,324]

My NUT visits aren't covered at all under my plan. If I wanted to go to my PCP and get a referral to a covered one, I could have, but they would not be a bariatric surgery qualified NUT and would not know anything about preparing a person for bariatric surgery. They'd probably be more like the tyrant I had for my gestational diabetes "counseling"(more like saying your fat and stupid and that's why you are here so let's play plastic food and talk about how you are fat because you deserve it by being a fat pig who eats too much than actual help) so I chose to pay for my NUT out of pocket. The grief saved alone was worth the $150 per visit hour rate. It doesn't count toward my deductible either sadly. I've only accrued $45 towards my personal deductible, but my kids have been to doctors and specialists even a trip to the ER so I'm hoping we are near the family max deductible. Which is $2500. I wondered if we had to pay our part up front before the surgery too or if it would be a wave of bills for the next month afterwards.

[acyum2008 55]

Expect a wave of bills after surgery after any procedure LOL

[Natosha Williams 3]

LOL getting my wallet ready now!

[acyum2008 55]

Is your procedure being done inpatient or outpatient?

[Natosha Williams 3]

It's being done inpatient.

[Invictus 56]

Natosha I have a refund coming from the surgeon. I paid his fee of $4k before the surgery. I'll be getting most of that back. Still waiting to see if I get any more bills.

[Sharon1964 2,530]

At my first appointment at the surgeon's office, I met with his patient coordinator who had run my benefits. She said that she expected they wouldn't be billing me at all since it looked like my max out of pocket would be going to the hospital.

I had surgery nine months later. About ten days before surgery, the hospital called me and told me they expected my portion to be $3,000 to $3,500, based on my current benefits and what I'd spent already this year. They asked how much I would be paying on surgery day, and I told them $3,000 (I've been saving like mad). Since this isn't emergency surgery, they expect the majority to be paid before services are rendered. My insurance has now processed, and I owe the hospital an additional $100, and I owe the surgeon around $300 - looks like he got his bill in before the hospital got theirs in.

I've now met my maximum out of pocket cost for the calendar year, so any other medical stuff this year should be at no copay to me.

[mskami77 295]

I met my deductible before surgery so I only had to pay 1700 out of pocket but my surgeon let me make payments. I had a partial hysterectomy at the same time so it increased my fees a bit.

[newmebithebypass 713]

this is the reason i am glad i have two insurances i have private insurance through my dads employer and state insurance that will foot the bill for what ever isnt covered under the private insurance. most of the time i have zero copays and pay nothing for prescriptions its been a great year considering one of my meds before i meet my deductible is around 150 a month