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:
I owe: $1,055.13
The secondary evaluated the claim in this way:
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?
Since your secondary states you responsibility to be $201.57 then your provider made an error.
Some just don't think about what they are posting. Here is an eob that paid zero, no other insurance, therefore balance due from the patient. They should have taken a secondary insurance adjustment and billed you according to what that eob stated.