Posts Tagged ‘ Aetna ’

Paying Out of Network the Aetna Way: How Out-of-Network Charges are Determined

May 9th, 2009. By LucyC

If youâ€™re wondering how some of those big-name insurance companies figure out out-of-network medical fees, look no further than the Aetna website; better yet, read on—we did the search & click for youâ€¦

We blogged about the company Ingenix being a part of UnitedHealth. Aetna does disclose the relationship between UHC and Ingenix and the recent settlements with the NY Attorney Generalâ€™s office. It wonâ€™t increase how much reimbursement youâ€™ll get on your out-of-network medical expenses, but hey, at least theyâ€™re upfront about it. Read the rest of this entry »

Tags: Aetna, health insurance, out of network charges, United Health
Posted in Drugs/Medical | 671 Comment »2009-05-09+14%3A26%3A47LucyC

4 Tips to Avoid Out of Network Health Insurance Overchargesâ€¦Before They Happen

May 7th, 2009. By LucyC

If youâ€™re interested in how to avoid paying for insurance overages for out of network bills, these tips—from Consumer Reports Health blog (Ginger Skinner, 5/9/09) may help. Remember though, these are preventative measures—if you feel youâ€™ve already been overcharged for out-of-network medical reimbursements, it may be time to seek out an evaluation with a lawyer.

Get cost estimates from the hospital and the physicians, and try to find out if there are any incidental fees you can avoid.
Research what portion your insurance will cover. Know that most plans will only cover a percentage of charges they consider “reasonable and customary” [or â€œusual and customary (UCR)]. This may be a lot less than what the hospital and doctors charge; you’ll be responsible for the difference. And find out if your insurance company will pay the entire “reasonable and customary” portion, or if you’ll be responsible for some of it due to deductibles or co-insurance.
Ask doctors if they are willing to accept your insurance company’s payment for their services as payment in full, especially if they work in a hospital that’s covered by your plan.
Don’t be afraid to negotiate with your insurer in advance. They may be willing to pay for a procedure at an out-of-network hospital, or performed by an out-of-network specialist, if there aren’t any in-network options. Your physician should help you justify the necessity.

Want to know more?

Read our previous blog on this

Tags: Aetna, Blue Cross Blue Shield, Cigna, Health Link, Unicare, United Health Care, Wellpoint/Anthem
Posted in Drugs/Medical | 63No Comments »2009-05-07+14%3A08%3A35LucyC

Making Sense of Out of Network Medical Overcharges: Get it, Got it, Good!

May 5th, 2009. By LucyC

Hereâ€™s a riddle: whatâ€™s something you never want to be without but you can never quite â€œgetâ€?

Answer: Health Insurance.

Particularly if you live in New York and youâ€™ve been trying to â€œgetâ€ your out of network Explanation of Benefits statements. The recent NY Attorney General’s Health Care Report determined the database used by many big-name insurers (think Aetna, Blue Cross Blue Shield, Cigna, Health Link, Unicare, United Health Care, Wellpoint/Anthem) to compute out-of-network fees has been understating â€œusual and customaryâ€ rates. Translation: you may have paid more than you shouldâ€™ve when going out-of-network.

How so? Hereâ€™s an exampleâ€¦ Read the rest of this entry »

Tags: Aetna, Blue Cross, Cigna, health insurance, out of network medical charges, United Health Care
Posted in Drugs/Medical | 523 Comments »2009-05-05+23%3A55%3A07LucyC