Reimbursement
NOTHING!
They will repay nothing because I had it done before the certification. I have a very small window of filing a claim for the charges. Aetna said very clearly that, they have the right not to pay at all because I paid ahead of pre-certification. If they paid they will pay up to, of course my plan limits.
2400 to residents clinic
4600 to hospital
Luckily for me they are both considered IN NETWORK, breaking down to 65% minus my deductible of 2250...Hopefully they combine the two , then I might get a meaningful amount back. But if they are separated then I'm somewhat screwd on the surgeons fee, as it doesn't even cover the deductible. Sadly, they approved the surgery that I had already out-of-pocket done, but denied my second leg portion for August 4th. Also out-of-pocket. Who approves the LBL but denies severe gynocomastia (you can even see some of the problem in my abdomen photos).
They will repay nothing because I had it done before the certification. I have a very small window of filing a claim for the charges. Aetna said very clearly that, they have the right not to pay at all because I paid ahead of pre-certification. If they paid they will pay up to, of course my plan limits.
2400 to residents clinic
4600 to hospital
Luckily for me they are both considered IN NETWORK, breaking down to 65% minus my deductible of 2250...Hopefully they combine the two , then I might get a meaningful amount back. But if they are separated then I'm somewhat screwd on the surgeons fee, as it doesn't even cover the deductible. Sadly, they approved the surgery that I had already out-of-pocket done, but denied my second leg portion for August 4th. Also out-of-pocket. Who approves the LBL but denies severe gynocomastia (you can even see some of the problem in my abdomen photos).
Oh my gosh, that is amazing that you were approved at all. I know this doesn't aid in your frustration and I hope you do get some reimbursement back. For the frustration of it all if nothing else. But, I hope you don't mind me asking- I too have Aetna as my insurance carrier, and I would be so grateful if could tell exactly how you were able to get an approval for such surgery. I honestly am do discouraged with their policies that I haven't even tried such a thing.
Good luck to and good for you.. I takes a lot of work I am sure.
Shelly
Good luck to and good for you.. I takes a lot of work I am sure.
Shelly
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