Insurance woes

mycatsnameisbug

:: sigh :: so I just got a bill for over 5 grand for my surgery. Not
For a copay.... Because the actual surgical procedure was not covered. Anesthesia, hospital stay... Thankfully covered.

Idk what to do. I am going to talk to my insurance company (Aetna) to find out why they are listing it as an exclusion when they said they approved it in January pre op.

So frustrated I could cry. I will keep everyone posted, hopefully whatever I learn will help. Has anyone else had this happen?

boomerkae

I had Aetna, although our plans could vary. I was approved and since I'd already met my out of pocket deductible, it was covered. Hope you get some answers.

mycatsnameisbug

So just got off the phone with Aetna... They screwed up. It thankfully will be paid 90%. I will owe 10% of the negotiated rate (about 2800). I saw the hospital stay may also cost me about $2000 but we will see what their actual bill says first (hopefully... I don't get one!) Such a HUGE relief! I was so mad, I work in ins so I know how they "get" you and I did my homework so I was very surprised to see a bill. Moral for newly sleeved is ask questions!!!

juneaubug

mycatsnameisbug wrote: »

So just got off the phone with Aetna... They screwed up. It thankfully will be paid 90%. I will owe 10% of the negotiated rate (about 2800). I saw the hospital stay may also cost me about $2000 but we will see what their actual bill says first (hopefully... I don't get one!) Such a HUGE relief! I was so mad, I work in ins so I know how they "get" you and I did my homework so I was very surprised to see a bill. Moral for newly sleeved is ask questions!!!

Oh good! I also had Aetna and I did end up getting a bill from a random doctor that checked on me while I was in the hospital. He was out of network, so they initially didn't pay the full amount and his office sent me a bill. I called Aetna and they ended up paying him since the surgery was approved. Keep that in mind in case that happens to you too!

mycatsnameisbug

Thanks! I told them if they didn't approve it I was gonna be in for a coronary lol. I am going to be especially careful to see who else I get a bill from

Thaeda

BTW, if you do end up owing, they have to let you arrange for a payment plan- they cannot come after you if you make a good faith attempt to pay-- and that can even be just $50 a month or whatever you can swing. Hopefully you do not have to pay anything, but in case you do, hopefully it won't break your budget if you get to choose the payment.

boomerkae

Glad to hear. In the end, I didn't pay anything out of pocket for my surgery, but only because I had met deductible ANF out of pocket personal max for all the blood work, preop visits and the like!! Like Thaeda said, I'm on payment plans with the doctors and the hospital.

DJRonnieLINY

You have to stay strong and take charge of managing the payments. Insurance companies will try to intimidate and lie. Make a payment plan, stick to it and always challenge any attempts to force a greater amount of payment.

Interestingly, many of the same skills and disciplines we need to develop with respect to dieting are the same for other areas of our lives. Develop and nurture that inner strength. Don't be scared and don't be a victim.