Hi, my question pertains to Coordination of Benefits between No fault auto insurance, and my commercial insurance.

I was involved in an auto accident in New Jersey. The emergency room sent the claim to my auto carrier, the bill was $1000. My auto carrier "approved" $175 based on the new jersey fee schedule, and applied it to my deductible. The hospital then sent me a bill for $175, saying the rest was a write off.

Since the $175 had gone to my auto deductible, i sent the bill along with the primary EOB to my medical insurance, Aetna. It is a self insured employer based insurance. They received the $1000 bill and "allowed" $400 based on their contract with the hospital. The $400 was applied to my Aetna deductible, but was paid to the hospital automatically from my health savings account.

Can aetna do this? if the hospital was accepting the auto carriers allowed amount of $175, can aetna allow $400 based on their contract , which then raises my responsibility to the hospital? Its as if i got penalized by filing with my secondary insurance! I called aetna and they said they are still obligated to pay the hospital what their contracted rate is, even if they were prepared to accept the lower approved amount from the auto carrier.

Can you provide me some insight into this?

Thanks,