Does doctor have to honor insurance negotiated rate on non covered service/ how to handle?
In-network ENT I went to performed a procedure that has been partially denied by Aetna. I asked the nurse if the procedure was authorized by my insurance before they started and he said yes, apparently they were lying. I learned a hard lesson here, I need to see it in writing first.
The doctor has horrible reviews on google for going after patients and being unrelenting regarding bills.
They always send the bill the day before the next appointment (might be paranoid but this seems like a pressure tactic). I am expecting no mercy, but I don’t have the bill yet.
3 parts of the claim have issues
1 not covered Billed: $14,747 Plan discount: $10,703 Paid: 0
2 denied because of “incorrect place of service” (MBQ) Billed: $2040 Plan discount: $1300 Paid: 0
3 more than one of same procedure on the same date (one for each nostril) Covered at 50% Billed: $5206 Discount: $3478 Paid: $1727
Does the doctor have to honor these plan discounted prices? The total “billed” amount before discount is $27,000 and the plan paid $5000.
Is the best case scenario I owe $4000 and the worst I owe $22,000?
What should my next steps be?
Edit: I am in New York City
submitted by /u/Recent_Science4709
[comments]
