Aetna health insurance and the 20 week u/s -- BEWARE

[Anonymous]

I still think Foxhall should give you a choice so you can make an informed decision: Do you want the routine ultrasound that Aetna pays for, or the more complex one that costs $612?


Also, I am one of the PPs and asked for the discount but they told me the best they could do was $320 - did you really get them down to in the $230s?

[Anonymous]

21:48 (and other PPs) -- again, this only applies for low-risk pregnancies. If you are over 35, this can be enough for insurance to cover the level II.

22:07, I had the claim activity from Aetna which showed that the amount that Aetna would reimburse is $238. I pointed out that if I paid $238, Foxhall would not be losing anything. Can you show them the claim activity? Do you know if your amount was $238? Maybe that varies by plan?

Like I said, she said verbally that she wouldn't charge me more than they would get reimbursed, but it's not final yet, so I can't say for sure I'm going to get it.

[Anonymous]

Forgot to add, I totally agree that Foxhall should give you a choice.

I just feel like, as a first time mom, I'm going into this completely dependant on my doctor to look out for me. All the information advantage is on their side, and it sucks when you feel like your doctor isn't on your side.

That's why I wanted to bring this to the forefront and educate others in the same situation.

[Anonymous]

Anonymous wrote:OP here. I've been putting off updating because things aren't completely finalized yet, but I think the dr's office will agree to charge us the discounted Aetna price for the u/s instead of the full $612.

The PPs were right, talking to the doctors wasn't helpful at all. Their stance is that the detailed ultrasound is necessary and the docs don't deal with billing. For the PPs that are in the same situation, I'd recommend going in person and speaking to the office manager, Kathy Johnson and negotiate a discount. I think that's the best that's going to happen. When I pointed out that it would be good practice to warn the Aetna patients that this would be an issue, Kathy said that if they couldn't risk doing that, or Aetna would drop them from their network.

This is one of the craziest things I have ever heard. So Aetna wants doctors to determine whether a patient needs detailed u/s and then prefers that is be a "special surprise" between them and the patient when they get the bill??? Yeah, right. Why would it matter to Aetna? I never met an insurance company that wasn't more than willing to let patients know what they will not cover. And I have met many a doctor who make it very clear what is not covered so that they are sure patient will pay them - some even post signs in their waiting room. It is bad enough that this is Foxhall's practice but to make things up as an excuse is really beyond.

Am I missing something here?

[Anonymous]

I know, it's crazy, right? Foxhall's explanation was, if they specifically pointed out that Aetna's coverage is lacking compared to other plans, they would be making Aetna look bad, and then Aetna would not want to do business with Foxhall anymore.

Yeah, I think that's a total bs excuse as well.

[Anonymous]

Its also BS that the doctors don't have anything to do with billing. The office manager works for the doctors in the group practice she is not an independent contractor. The doctors in the practice are the ones responsible for setting their policies and if they are upcoding they are the ones responsible.

[Anonymous]

>>>>>>> When I pointed out that it would be good practice to warn the Aetna patients that this would be an issue, Kathy said that if they couldn't risk doing that, or Aetna would drop them from their network.

Sorry, but that sounds like BS to me. I find it hard to believe that an insurance company would do that. I've never had Aetna, but have had several others (BCBS, Cigna, United Health) and you can always call and find out ahead of time what would be covered. I had my pregnancy with Georgetown, and they warned me when I was making the appointment for NT scan that it might not be covered by insurance (in fact, their policy is to charge everyone who is under 35 upfront and then let them submit claim to the insurance company).

[Anonymous]

I agree, it makes so sense that they cannot warn patients-- in fact, they already do. They gave me a waiver and asked me to sign it that says something to the effect of, "Aetna has become increasingly limited about the ultrasounds they cover," and then the patient agrees to cover whatever Aetna doesn't. So they already provide a warning, but in a very vague and unhelpful way.

[Anonymous]

Foxhall DEFINITELY warned me about this. They gave me a waiver to sign, the receptionist mentioned it to me, and Dr. Pardo brought it up as well. They also said that if my insurance won't cover it I have to get it at Washington Radiology instead.

[Anonymous]

This entire thread should be brought to the attention of the medical board. It sounds like Foxhall is giving patients, and probably insurance companies, the run-around.

[Anonymous]

FWIW, I have the exact same Aetna plan and also go to Foxhall OB/GYN. I am under 35, had the detailed scan and I paid like $20 for it. Foxhall should definitely be more upfront and give you a choice (they did not warn me either), but as PPs have pointed out the charges are all up to your employer -- they are the ones who ultimately decide what will be covered. So it doesn't really matter if someone else has Aetna or another insurance company, it depends on your individual insurance. That is pretty crappy that your employer does not pay for 20 week scan.

[Anonymous]

PP, was there ANY reason for you to have the detailed scan and not the basic? If not, than it is an unnecessary procedure and Foxhall should NOT be making money off of Aetna or you for it.