In-network contracted rate for office visit almost 2x Uninsured rate
Need advice. Saw a family practitioner for the first time a few months ago. The doctor, which is affiliated with a large hospital in South Carolina, was listed as in-network through Aetna’s website and the doctor’s office confirmed they were in-network. fwiw – I have a high deductible Aetna plan through Cobra – it’s full coverage through my former employer. Since it was an initial visit, I expected the charge to be a little more than typical office visit, but I also expected to receive a reasonable discount/contracted rate as I had with other doctors. Per the EOB and doctor's bill, the retail price was $364.00. My insurance’s contracted rate brought my obligation down to $344.84. The in-network discount was $19.16, which is only ~5.2%.
The office visit was coded as a 45 minute office appointment, so I don’t think much leverage with that aspect. I’ve spoken with Aetna, hospital billing, and the doctor’s office, and come up empty handed. Granted the doctor’s office admitted the EOB looked odd and verified there wasn’t an error with the contracted amount applied. The incredibly infuriating part is that Uninsured patients are charged 50% of the retail rate, or $182.00. When I asked to be charged the same as an insured patient, I’m told that’s not allowed because I have insurance. I’m stunned this is legal! I’ve never had an issue like this so beyond refusing to pay, I’m not sure what else I can do. If anyone has experience in this area, would really appreciate some advice, for several reasons I’d like to pay a reasonable amount and not be hounded by debt collectors.
Needless to say I’ll be cancelling the $700/mth Aetna plan in December and will move to an Obamacare plan.
submitted by /u/retech2
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