$103k in hospital bills denied?
Last week, I went to the ER for internal bleeding and needed an IR embolization to stop it. I ended up spending the night in the hospital for monitoring.
I have Aetna insurance, and now I’m seeing $103k in bills marked as denied in the Aetna app.
Does this mean they expect me to cover these costs? How serious is this situation?
EDIT: I plan to call Aetna today, but I’d appreciate any thoughts or advice from anyone here.
I’m really sorry to hear about the situation; that sounds incredibly stressful. Denials like this can happen for a variety of reasons, such as coding errors, medical necessity issues, or the hospital not being in-network.
It’s good that you’re planning to call Aetna, as they can give you specific details about why the claims were denied. Make sure to have your policy information and any relevant details about your treatment handy when you call.
In the meantime, here are a few things to consider:
Review Your Policy: Check your Aetna policy documents to understand your coverage for emergency services and any potential limits on the care you received.
Billing Codes: Hospitals use specific billing codes for procedures and treatments. If those codes are incorrect or not justified by medical necessity, it could lead to a denial.
In-Network vs. Out-of-Network: Make sure that the hospital and the providers involved in your care were in-network. If they were out-of-network, there may have been higher out-of-pocket costs.
Appeal Process: If the denial is based on incorrect information or if you believe the services were necessary, you can appeal the denial. Aetna should provide instructions on how to do this.
Financial Assistance: If you do end up being responsible for a significant amount, ask the hospital about payment plans or financial assistance options.
Stay Calm: It’s frustrating, but keep calm and remain persistent. Many people have successfully challenged denials.
I hope you get this sorted out quickly and that you’re recovering well!