Insurance rant/advice help?

[Moore Changes 1]

Hi everyone! I saw a thread the other day in regards to Aetna insurance and all the posts on that thread were helpful and I'm hoping I can get some more input from you all to hold me over until I can call them tomorrow.

I had my consultation on Monday. When I scheduled the appointment I was told by the woman who knows everything about insurance that it'd all be covered by Aetna but I'd have to pay for the 90 day program and Psych eval ($300). When I got there, I was told I just had to pay my "specialist copay" but they couldn't see what it was and I wasn't sure if it was $35 or $50 so they told me that they will just send me the bill once they know what to charge me and I can pay at my next visit. I just checked my claims page and see that the appointment cost $404 and I'm going to be responsible for $235 of it. What the heck? That's more than half!

I looked up the "cost of care" of the sleep study at this hospital too and it says $3000. Is that what my insurance will be billed or what I will have to pay out of pocket?

I'm really starting to stress. I was so excited to see insurance covered this procedure and while I know it wasn't ALL covered, I'm 3 days in and haven't even gone to my first NUT appointment and I've spent $535. We have a high deductable too and my surgery isn't until late January/early February and everything resets January 1st, so everything spent now won't count towards the deductable. I have to get the sleep Study done by the end of my 90 days (12/21/15) but everything else can wait until closer to my surgery date.

I worry about everyone involved in the surgery being covered. My husband broke his arm 11 years ago and needed surgery. The surgeon and hospital were in network but the anesthesiologist wasn't so it cost $2,000.

[KensingtonWalk 10]

Have you met your deductible? I had to pay out of pocket for the psych portion as well. That was $430. I am submitting it to my FSA. The cost of medical care in general in this country is out of control.

[Moore Changes 1]

It is out of control. I don't want to get started on all of that because I will get angry! lol!

I was able to pull up my booklet and it says that I have to pay 15% of the cost plus the deductible until it is met, and then just the 15%. My deductible is not yet met, so I'm now really confused where the charge for $235 comes from. I wonder why I wasn't charged the full amount? I don't understand a lot of this stuff and I think that's what they often count on. I'm going to give them a call now and see what's up!

[KensingtonWalk 10]

Insurance companies make deals with healthcare systems. So they agree to pay so much for a service and no more. It is likely that your insurance co has an agreement with your health care organization and you received a discount based on their agreement. This is a possibility.