So, in February my son needed a dental procedure done that required anesthesia. I was told our health insurance would typically cover the anesthesia. The dentist only works through two local facilities, both out of network with Aetna. I chose the one closest to us bc its part of a hospital and my son is only 3– I wanted to make sure he'd be taken care of if something went wrong.

Before the procedure, I called the facility to see what their services would cost. I was told "We're in network! You just pay your deductible!" …. I called at least 4x and explained that my insurance was not showing them in network and asking ehat the out of pocket cost is. Finally, the last call, I spoke to a woman who called Aetna while I was on the line– she came back and provided me with the Aetna employees name and a reference number and said it'd been confirmed to be in network.

So, we proceeded with it. Well of course we then got an EOB stating we were out of network and are responsible for a $17K bill for the anesthesia. We filed an appeal, provided the reference number and employees name who'd told the provider they were in network. The appeal was denied– the letter basically said something along the lines of "we understand you thought this was in network because we told you it was, but it was out of network and you should've filed a pre-authorization first".

Is there anything else I can do here? I've called the facility MANY times and have just been told repeatedly its "under review" and giving me nothing really to work with.

See also  OBGYN won’t bill my health insurance until after baby is due….is this right??

submitted by /u/CrookedPJs
[comments]