I work for a company that self-insures and uses Aetna to administer their plan. This is the primary insurance. I'm retired from federal civil service, which also self-insures and uses Aetna to administer its plan, which is the secondary insurance.
The primary evaluated a claim in this way:
Billed: $15,516.45
Allowed: $10,551.18
Paid: $9,496.05
I owe: $1,055.13
The secondary evaluated the claim in this way:
Billed: $15,516.45
Allowed: $9,697.78
Plan benefit: $8,354.23
Less paid by primary: $9,496.05
Amount paid: $0
Amount the hospital may bill me: $9,697.78 allowed - $9,496.05 paid by primary = $201.73.
I paid the provider $201.73, but they say I owe $1,055.13.
Can't seem to get anyone to do anything differently. Anyone got any ideas?
