How do I address excessive ‘agreed’ costs with Aetna and provider.
Back in July of this year I was briefly admitted into the ER at my in network provider. About a month later I received an invoice from my insurance company that the agreed cost of service $10,720 and my responsibility is $3856 after my deductible was met. Based on the service provided I was prompted to review the providers cost of services for all of the applicable codes to find the standard gross charge of service was $8061, the standard negotiated charge was $2517 and the max standard charge is $4968. My health insurance provider, Aetna, told me that they negotiated to the $10,720 figure. Is it possible to get them to negotiate to something that isn’t MORE expensive than what the expected charges are? I don’t disagree with the calculation of the amount due based on the plan and its deductible, but the agreed amount really throws things out of whack.
I had originally submitted a dispute to Aetna back in October. They had waited the full 30 days they were allowed to wait to respond. They had only read the first line of my dispute citing that they agreed with the cost of a service that was only billed at $29 and neglected to review further. I submitted the rebuttal to this immediately with a more detailed explanation and evidence of what I had researched. They then waited almost the full 60 days they were allowed to respond to this and denied again for the same reason and told me that I am out of disputes. The amount due has been sent to collections and my understanding is because they hadn’t sent the EOB to the health care provider.
