Gap Exception- Plan Allowances/Balance Billing Questions. Not allowed to speak to Insurance
Facts:
Background: I received a Network or Gap Exception to see an out-of-network Neurologist.
Numbers:
Plan Allowance for an Office Visit (CPT 99215) for an In-Network Neurologist in Washington, DC: $144
Some Questions:
Apparently, my Plan rules, etc are via Aetna, but it’s ‘managed’ by a 3rd party, a non-profit. So, for questions and bills, I have to contact this non-profit, not Aetna. Does that change anything?
The non-profit Rep stated, it does not know if Aetna’ll use the same Plan Allowance mentioned above or a different one, because officially, my doctor is out-of-network. Do you happen to know?
Balance Billing: For an Office Visit, the Neurologist charges $350. Is there a way for my Plan to fully cover this so I don’t have to pay the difference ($350-$144)? The link below says to speak to a Supervisor at the Insurance company re: MNRP, but I’m not allowed to.
Link: https://www.reddit.com/r/HealthInsurance/comments/xl05fe/balance_billing_for_innetwork_care_under_gap/
Thanks!
