Just received a notification from Aetna that I need to pay a balance bill of $10k although the provider told me that everything is covered. Has anyone experienced that? What’s the recommended course of action?

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If it’s the Explanation of Benefits and the provider says you owe nothing, then you actually owe nothing.

I would follow up with the provider and just double check that the account post-insurance is balanced.

Why this exists: Your provider charges Aetna that set amount (or near that amount) but Aetna only pays a fraction thinking you are liable for the rest, BUT often times the provider just takes what they can get from Aetna and ends it there. This happens a lot in health insurance.

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Wait for the provider to contact you. Usually that happened is because the provider used some out-network lab or services as part of your treatment. If this is the case, usually the provider don’t bill you. I won’t read too much into the insurance company’s EOB.

Happened to me. Called the billing company and they say it’s because my provider hasnt provided some documents needed for aetna to confirm coverage. I gave it some time and it was eventually resolved

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