Medical provider billed nearly 5x what Insurance EOB states I owe

Hi All,

Currently in a panic because a healthcare provider I visit is charging me nearly 5x more than what my insurance company says I owe. I have a PPO healthcare plan through Aetna. $500 deductible, $6,000 OOP max. Deductible was met within the first couple weeks of January of this year but the OOP max has not been met so I completely expected to be paying something, just not this… Reading reviews for this place and it seems like I'm not the only one.

I had two MRAs and an MRI done back in March with referrals from my neurologist. Prior Authorization was received from Aetna immediately. MRIs/MRAs were done within about 2 weeks after authorization.

I received two separate bills. One bill for one of the MRAs. The bill matches Aetna's EOB exactly and I have paid it in full. The second bill is for the other MRA and the MRI. The charges match the EOB but the payments and adjustments from Aetna do not match which is causing the difference between what the healthcare provider says I owe and what Aetna says I owe.

This is the bill I received from my healthcare provider: https://imgur.com/a/mrkmAum

This is what Aetna is saying: https://imgur.com/a/G2ASnbe

The issue seems two fold (please correct me if I'm wrong):

The healthcare provider has applied the incorrect payment AND adjustment from Aetna for the MRI. The healthcare provider is breaking the contract with Aetna and is charging me for the MRA even though Aetna seems to be saying that due to their agreement, I owe nothing.

Provider says they're correct. Insurance company says they're correct. What should do I do? Is the remark from Aetna for the MRA incorrect because it's not part of "same procedure" as the others?

submitted by /u/SleepyHobo
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