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Aetna sucks.

 
Old 05-14-2019, 08:14 PM
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Slo Yelo C5
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Default Aetna sucks.

Went in for part 1 of a 4 part medical procedure. Out of network specialist. The procedure was the least serious of the 4. It was supposed to be 90% covered by Aetna and I pay 10%.

Turns out, a BS billing technicality means Aetna pays ~35% and i pay ~65%. So i asked the Aetna rep, "What's the difference between "billing A" and "billing B" which changes it from 90/10 billing structure to 35/65?"

Aetna rep: Im not sure. It's really an explanation only a medical professional would understand.

Me: So you, Aetna rep, cant even explain the reason the billing shifting 90/10 to 35/65, but me, who has no knowledge of medical billing, should know?

Aetna rep: Well, uh...ultimately it's the customer's responsibility to pay the bill. So this will be your responsibility.

Me: So you cant explain why my out of pocket cost went up 7x, but I'm just supposed to pay it? And that's reasonable?

Aetna rep: Sir, it's your financial responsibility.

So I told her that since they're gouging me, I want to dispute it. Apparently, there is an internal billing dispute department within the company. Can anybody tell me the likelihood of winning this billing dispute?
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Old 05-14-2019, 08:15 PM
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Originally Posted by Slo Yelo C5 View Post
Went in for part 1 of a 4 part medical procedure. Out of network specialist. The procedure was the least serious of the 4. It was supposed to be 90% covered by Aetna and I pay 10%.

Turns out, a BS billing technicality means Aetna pays ~35% and i pay ~65%. So i asked the Aetna rep, "What's the difference between "billing A" and "billing B" which changes it from 90/10 billing structure to 35/65?"

Aetna rep: Im not sure. It's really an explanation only a medical professional would understand.

Me: So you, Aetna rep, cant even explain the reason the billing shifting 90/10 to 35/65, but me, who has no knowledge of medical billing, should know?

Aetna rep: Well, uh...ultimately it's the customer's responsibility to pay the bill. So this will be your responsibility.

Me: So you cant explain why my out of pocket cost went up 7x, but I'm just supposed to pay it? And that's reasonable?

Aetna rep: Sir, it's your financial responsibility.

So I told her that since they're gouging me, I want to dispute it. Apparently, there is an internal billing dispute department within the company. Can anybody tell me the likelihood of winning this billing dispute?
Didn't read.
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Old 05-14-2019, 08:16 PM
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Originally Posted by Slo Yelo C5 View Post
Didn't read.

Ok. F off.
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Old 05-14-2019, 08:16 PM
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Originally Posted by Slo Yelo C5 View Post
Ok. F off.
I'm reporting this.
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Old 05-14-2019, 08:17 PM
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Originally Posted by Slo Yelo C5 View Post
I'm reporting this.
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Old 05-14-2019, 08:20 PM
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"So I said to myself, 'Self.'"
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Old 05-14-2019, 08:21 PM
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OP is a hot mess.

He could have ice cream served to him by a Victoria secret model and it would somehow become a bad experience.
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Old 05-14-2019, 08:23 PM
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Originally Posted by Der Flieger View Post
"So I said to myself, 'Self.'"
I decided to mess around as if other goofballs in here responded.

Back to the topic.
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Old 05-14-2019, 08:24 PM
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Originally Posted by Slo Yelo C5 View Post
Can anybody tell me the likelihood of winning this billing dispute?
In my experience disputing insurance claims, probably close to 0%.
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Old 05-14-2019, 08:25 PM
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Originally Posted by LarsAtTheBeach View Post
OP is a hot mess.

He could have ice cream served to him by a Victoria secret model and it would somehow become a bad experience.

What did I do wrong? Got a medical procedure. It said it was 90% covered in the pamphlet. Then some BS billing technicality means its 35% covered.

And I shouldn't be upset losing hundreds on some BS, unknowable, fine print crap?

I can only imagine how bad the **** beating will be on part 2 with anesthesia....
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Old 05-14-2019, 08:26 PM
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phase 1 of your transition?
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Old 05-14-2019, 08:27 PM
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Originally Posted by Slo Yelo C5 View Post
What did I do wrong? Got a medical procedure. It said it was 90% covered in the pamphlet. Then some BS billing technicality means its 35% covered.

And I shouldn't be upset losing hundreds on some BS, unknowable, fine print crap?

I can only imagine how bad the **** beating will be on part 2 with anesthesia....
I was speaking in generalities.
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Old 05-14-2019, 08:29 PM
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Originally Posted by C4DC View Post
In my experience disputing insurance claims, probably close to 0%.

I found it humorous that the company's own employee rules on a billing dispute. I wonder if even 0.0000000000000000000001% of billing disputes are found in the customer's favor?

No conflict of interest or anything...
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Old 05-14-2019, 08:30 PM
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Originally Posted by LarsAtTheBeach View Post
I was speaking in generalities.
How's that 4 cylinder truck treating ya?
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Old 05-14-2019, 08:31 PM
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It's kinda' like Quality Control working for Production. Yeah, that will work.

Last edited by Der Flieger; 05-14-2019 at 08:57 PM.
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Old 05-14-2019, 08:31 PM
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Originally Posted by KarlK View Post
phase 1 of your transition?
Next is losing the Frank and beans.
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Old 05-14-2019, 08:36 PM
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Originally Posted by Slo Yelo C5 View Post
How's that 4 cylinder truck treating ya?
1986 was my last (only) 4cyl truck. Those old Toyota trucks were awesome.
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Old 05-14-2019, 08:37 PM
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Originally Posted by LarsAtTheBeach View Post
1986 was my last (only) 4cyl truck. Those old Toyota trucks were awesome.
Did the frame shatter so it looked like a truck that fell off a cliff?
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Old 05-14-2019, 08:37 PM
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Originally Posted by KarlK View Post
phase 1 of your transition?
Finally getting that Cranial-Rectal Inversion problem fixed.
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Old 05-14-2019, 08:42 PM
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Originally Posted by Slo Yelo C5 View Post
Did the frame shatter so it looked like a truck that fell off a cliff?
Nope. You are confusing the 86 with the 1st gen Tacoma.
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