AETNA PPO said plan discount for out of network provider?
Aetna has never consistently processed any of my claims with out-of-network provider.
So this most recent one I have filed was acupuncture that my insurance covers. But my provider is out-of-network. I paid 165 per visit. But Aetna’s EOB says my plan discount is 121. So I’m only supposed to pay 44 for my visit. And the insurance pays nothing of that 121 and does not count that 121 as part of my deductible either. Basically they are just saying that neither me nor the insurance should be responsible for the 121 and the provider should suck that up. And since they only count that 44 as my deductible, they don’t have to reimburse anything since I haven’t hit my 1000 deductible yet. I paid totally over 3000 for all of my 20 visits allowed by the plan, they only counted 900 something towards my out-of-network deductible. So they reimbursed nothing to me.
My question is that since the provider is out-of-network, how is the provider supposed to have an agreed price for the service they claim is a plan discount for me?
Because I already paid my provider, I’m not going to get that 121 back from the provider. Aetna can say whatever their plan discount is and not pay me.
I am really sick of calling Aetna and tell them this is not how you processed my claims before.