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  1. procure's Avatar
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       #1  
    Hi,

    I'm hoping there are some people knowledgeable about insurance who can help me with this:

    I have insurance with Aetna. I recently received some hospital bills,
    in which the biller is charging me MORE than the original amount, in
    order to meet the maximum allowable limit. In other words, the
    hospital submitted a charge of $200 to Aetna. Aetna deemed the
    allowable amount to be $300, so now I'm stuck with a $300 bill instead
    of $200 (the numbers are hypothetical; I actually owe more). I know
    this because the hospital sent me a notice stating that a claim had
    been filed with Aetna for $200. I then received paperwork from Aetna
    saying that I owe $300, and then I received a bill from the hospital
    for $300, with $100 classified in the "Other Adjustments" category.
    I'm responsible for this entire amount as our deductible has not been
    fulfilled yet. Please tell me this is not common or even legal. I
    have not contacted Aetna or the hospital yet, but I plan to as soon as
    I get some advice.

    Thanks in advance.
  2. #2  
    Thats not legal. If you have the original bill from the hospital, you can pretty clearly illustrate the charges. If they wish to for some reason raise the charge, they would at minimum have to provide you with an explanation of why the first bill was incorrect. The insurance company allowing more for thet service is hardly justification.

    Here's what I'd do. Check with your local tv stations and see if any of the news channels have a consumer helper. Here we have 2 on your side and Fox friends. Tell them your story and support it with all the docs. Tell them you want to expose this to protect yourself and other consumers. Most reporters will jump on this. The hospital will quickly correct their error is suspect.

    Good luck and keep us posted.
    “There are four boxes to be used in defense of liberty: soap, ballot, jury, and ammo. Please use in that order.”
    — Ed Howdershelt
    "A government big enough to give you everything you want, is big enough to take away everything you have."- Thomas Jefferson
  3. procure's Avatar
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       #3  
    Thanks for your reply Woof. I called the hospital, and they could not explain the "Other Adjustments". They told me to call the insurance company. So I did that, and after two days of research, Aetna called me back and removed the extra charge. So now it seems the matter is resolved, but this whole thing seems very shady to me. I may still contact a TV station or consumer affairs, or something like that, because I'm sure other patients are also being overcharged, and may not scrutinize their bill closely enough to notice it. I'm just not sure who to blame: the insurance company, the hospital, or both.

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