I recently had surgery which apparently required a surgical assistant. Throughout the whole surgical process, x-rays, MRI, pre op appointments, the hospital confirmed each procedure was covered by my insurance (Aetna PPO) before allowing me to schedule an appointment. The surgery was no different. The hospital, surgeon, and anesthesiologist are all in network and covered.
A claim from the surgical assistant was submitted to Aetna - $13,700, to which Aetna agreed to pay $118 because the surgical assistant was out of network.
I have two issues with this. First, I was under the impression that surgical assistants performing work in an in netowrk facility under the direction of an in network doctor would be covered as in network. Second, I had no choice in who the surgical assistant was, didn't even know I needed one until the surgery. Since I had no choice in the matter I couldn't tell them to make sure the guy was in network.
What are my options to get this bill covered as in network? I contacted Aetna and they said a surgical assistant is covered under their plan, but said they would need to investigate whether or not this specific specialty was on their approved list.
Has anyone else had experience with this issue?
Thank you.
Submitted May 01, 2019 at 09:03AM by NotAYankeesFan http://bit.ly/2LiAiHS
