Aetna Sues Over OON Charges

[Crabcake Johnny]

Sometimes you just can't make it up. Aetna is suing over OON charges. Look up "irony" in the dictionary.

Outraged Aetna sues over $59K ultrasound bill | Hartford Business

"Hartford managed care provider Aetna Inc. is suing six New Jersey doctors over medical bills it calls "unconscionable," including $56,980 for a bedside consultation and $59,490 for an ultrasound that typically costs $74, Bloomberg News reports.
The lawsuits could help determine what pricing limits insurers can impose on "out-of-network" physicians who don't have contracts with health plans that spell out how much a service or procedure can cost, the online news service said.

One defendant billed $30,000 for a Caesarean birth, and another raised his fee for seeing a critically ill patient in a hospital to $9,000 in 2008 from $500 the year before, the insurer alleges in the suits. The Caesarean price was more than 10 times the in-network amount Aetna quotes on its website."

 

[STIBROKER]

I remember when they tried to repossess a prosthetic.......

 

[Crabcake Johnny]

Look up "comeuppance."

 

[STIBROKER]

or karma.......

Look up "comeuppance."

 

[dgoldenz]

$59k for an ultrasound should be considered fraud IMO.

 

[Crabcake Johnny]

We've had this discussion before and it went nowhere. All charges need to be transparent.

I just went to the ER - no bill yet - for a kidney stone. What's stopping them from billing me, say $5,000. How about $8,000? Maybe the bill is only $400. Do I know? No.

However, everything could be transparent - like auto shops work. I got a CT scan when I was there. Why can't I know what it'll cost before I get scanned. Anyone?

 

[TxOnline]

"Why can't I know what it'll cost before I get scanned. Anyone? "

How can they rip you off if they tell you their costs UP FRONT?

Might depend upon whether the doc's wife just bought another Mercedes or not.

Price transparency is one of the BIGGEST problems with the cost of healthcare. Prices will go down when (if) transparency becomes a law....and policyholders are forced to buy HIGH deductible policies. They'll never care how high the costs are while their employers are offering them a $250 deductible policy.....premiums paid by employer.

Yes, I got a call today from someone wanting to beat the price of their $250 deductible from the employer. Employer has decided not to KEEP paying 100% of premium.

 

[AndreaSti]

"Yes, I got a call today from someone wanting to beat the price of their $250 deductible from the employer. Employer has decided not to KEEP paying 100% of premium.

Let me guess, they have to start paying 10-25% of their premium now and they are pissed. Do like our agent here does, tell em "you can't beat that on the individual market since you aren't paying for much of it, unless you buy a 10K deductible. Stay right where you are, but feel free to call us back if you lose your cushy job in the future."

 

[TxOnline]

Yes, that awful employer now wants them to pay $1000 month for their rich benefits!

But, that wonderful hospital can charge $5000 for a cat scan & they don't blink.

And, that awful insurance company can make them pay a whopping $100 copay for their cat scan! The nerve of them!...when you've already MET your $250 deductible!!!

It's all about greed. How much MORE can I GET from you?

I applaude Aetna for their lawsuit!
I hope there are MANY more!

I'm through with intimidation from medical providers, too! If they can't give me a price (like my auto repair man CAN), they won't get MY business!

 

[Crabcake Johnny]

Whoever paid the first bill is to blame. If my auto shop gets some new techie gizmo, it doesn't matter that it might have cost the gizmo company 20M to invent and produce it. The shop can't charge $3K for them to use it per customer.

So...whoever decided to pay, for example $2K for a MRI was the one who started this whole mess.

The hospital says; "Hey, we got this brand new technology that'll really help us......but we have to bill $2K per use."

The carriers should have said; "Actually, technology lowers your overall costs and doesn't increase them. We'll pay $150 per MRI exam - not a cent more."

Or...

Tech company's pitch to the hospital: "We have our newest flux capacitor and it does all kinds of cool stuff. The cost is $250,000."

What hospitals should all say; "Wow...sounds great....for about 15K. Until then thanks for the presentation."

...then some of you are going to say "but then nothing new will be invented." Wrong. It'll still be invented.