Are there circumstances when a doctors office can bill a patient for a service reduced by an insurance co.

Question

My hearing aids purchased through an ENT were submitted to Aetna. The doctor is a contracted provider under Aetna.  That claim was in network and the allowed amount was reduced from $5800 to ~$900.  The doctor is now charging me for the reduced amount.

Tim Akpinar · Answer

Your post mentions that the amount "was reduced... " If the amount was reduced after you had already agreed on terms with the doctor's office for the services/hearing devices, and there were original figures that you both relied upon, that could be something to discuss with your insurance carrier. Good luck

James L. Arrasmith · Answer

Yes, there are situations where a doctor's office might bill you for the difference after your insurance company reduces the allowed amount. Even if the provider is in-network, certain services like hearing aids may have specific coverage limits or restrictions. It’s important to review your insurance policy to understand what is covered and any out-of-pocket costs you might be responsible for, such as co-pays or deductibles. 
 
Sometimes, billing errors can occur, so it’s a good idea to contact both your doctor’s office and Aetna to clarify the charges. Ask for a detailed explanation of how the allowed amount was determined and why the remaining balance was passed on to you. If you believe there has been a mistake, you can request a review or appeal the decision with your insurance company. 
 
If after these steps you still have concerns, consider seeking assistance from a patient advocate or your state’s insurance commission. They can help you navigate the process and ensure that you’re being charged correctly according to your coverage. It’s important to address these issues promptly to avoid unexpected medical bills.

Q: Are there circumstances when a doctors office can bill a patient for a service reduced by an insurance co.