Reply to insurance surprise--price of 3 stitches

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[quote=Anonymous]In August we were in NYC and our toddler fell in our hotel room. The concierge sent us to an urgent care a block away rather than the ER. The urgent care doc suggested a plastic surgeon they "always send people to." So DH stayed to pay for urgent care, I took a cab to plastic surgeon with DS, their nurses rushed us in and the secretary said "we'll do paperwork afterwards." So DS gets 3 stitches (in less than 15 minutes) just below his eyebrow. We then check out and sign the paperwork and they tell us they'll send the bill to Aetna, but that they aren't contracted with Aetna. I didn't think much of it. We pay our ped. directly and Aetna reimburses us 90-100%.

Anyway, you know where this is going. Today I get a bill saying their "Complex would repair--eye" was $4,500 and Aetna paid $2,880--so we owe $720. That seems outrageous to me. Reading the CPT coding, I don't see how it was complex--seemed simple to me, literally 3 stitches. And it seemed like somewhere along the way--at urgent care when they made the referral and called to make an appt. for  us, or at some point, they should have said--and by the way, these three stitches will cost 5k.

So what do I do? Write a letter to the doctors office asking for them for the exact CPT code? Say the price is outrageous and offer to pay $200?

Or do I go to Aetna?

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