Received a $12,000+ bill for my RNY - anyone else experience this?

As you can imagine from the subject line, I am freaking out.  About a week ago I got a bill from the hospital where I had RNY on 12/16/13.  The hospital bill was an original $48,000+, then it showed my pre-payment of $1,200+, then my insurance paid $10,000 and somehow I am left with $12,000+ (I know, 48-10 is not 12).

I called Aetna a week ago and they said I had a limit of $10,000 for bariatric surgery!  Well this was news to me!  So I have been playing phone tag with my surgeon's office.  I finally reached the woman there today and she basically said I should appeal to Aetna.  She claims that the doctor contracts his work to the hospital and the hospital cannot lower their $48,000 price tag (I was there one night, no complications).

I have already drafted an appeal to Aetna pleading for them to pay the $12,000 since I had this surgery in order to not incur any future obesity-related healthcare costs.  

Does anyone else have any experience with this, and any ideas about what else I should include in this letter?

Obviously had I known I would be responsible for another $12,000, I would have been on a plane to Mexico.

Sincerely, a person who is severely freaking out :(

That's totally baloney!  When you were in the run-up to surgery, did Aetna ever discuss this with you?  It should be their responsibility to fully disclose what you and they are responsible for and if they did not, then they should pay the whole thing.  It's ridiculous because you could have done the whole shebang in MX for $12k!

Good luck and keep us posted!

Jen

Nope, Aetna never told me or my doctor's office about the limit...and that includes today when we called both the provider line and the member service's line.  Crazy.  I am going to appeal.  Ugh!  

Have a good weekend!

Contact the hospital. They should have a contract with your insurance company to accept a certain amount for the surgery and should not bill you for the difference.

Try not to stress.  You should not have to pay it.  It will just be a pain to get it sorted out.

Thanks for the optimism :)  The doctor's coordinator and I called Aetna and they explained my coverage and did not mention the $10,000 limit.  Then we called Member Services and same thing.  So now I am writing an appeal.  Hopefully they will see that by NOT communicating to either the doctor or me about this limit, they should pay it.  It's stressful for sure, but I am going to try to enjoy the weather, get lots of steps in this weekend, and not think about it :)

This just shows how everything is so screwy with health insurance.

My wife and I both had RNY at the same hospital, same surgeon and same duration in the hospital.

She had it late November 2013, I had it 3 months later in Feb 2014.

The surgeon billed more for her since she had scar tissue from having c-sections, but the insurance paid to the penny the same for us both.

The hospital billed 48k for her (3 days, 2 nights) and the insurance paid 21k.  For me, they billed 58k (same everything except the time it was done, why was mine 10k more, I actually had less issues than she did, though neither of us needed additional medical care).  We even were in the same exact room in the hospital.  Her time was even over the weekend, so I could see her's costing more, but not mine.

Anyway, my same insurance company paid 45k for mine.  Paid it, twice as much as what they paid for her.  Paid almost as much for mine as they billed for hers.  It makes no sense.

Of course they still want my deductible and out of pocket max, but they got twice as much money from the insurance company for my surgery than they did from my wife's.

It will be a hassle, hopefully you can work it out in your benefit.  Just keep pressing the insurance company and the hospital.

I'm so sorry about this. It's very very odd that they never mentioned anything to you, your doctor's office or the hospital when any of you called to get preapproval. Is it possible that this is something that was put into your policy at the start of the calendar year, and they're mistakenly applying the limit to your surgery from 2013?

I hope you get this sorted out with nothing additional out of pocket, hon!

This was my first thought too - well worth checking out!

Ouch.  That's terrible.

Keep fighting both your insurance company and the hospital.  Aetna should have a written policy (and dated as to when it went into effect) regarding how much they cover for WLS.  Request copies IN WRITING to document your case.

My bill his was that but I expected it as I have a $5000 deductible and a Wls deductible of $5000. My hospital bill was billed at $98,000 and with insurance at 48, 000

First they reported I owed the whole 98,000 that I hadn't done it at a blue ribbon facility but I did!  Whew! 

I hope it works out!