Why a Pennsylvania woman's hospital bill spiked $393 after she proved her daughter was insured

A Pennsylvania mother took her daughter to Abington-Lansdale (Pa.) Hospital at 2 a.m. due to severe head pain. In their rush, they forgot the family's Aetna insurance card at home — a mistake that cut their hospital bill by $393, The Inquirer reports.

The hospital, part of Philadelphia-based Jefferson Health, charged Annette Alexander $1,642 for her 24-year-old daughter's two-hour visit. Physicians diagnosed Ms. Alexander's daughter with a migraine headache. Under Abington-Lansdale's uninsured patient program, the hospital docked Ms. Alexander's out-of-pocket payment to $821.

But Ms. Alexander, realizing her daughter's insurance status was not accurate, called Abington-Lansdale Hospital to provide her daughter's Aetna insurance information. She then received a new bill: the $1,642 charge was lower, but her portion of the bill jumped $393 to $1,214.

"I wanted to go back and ask if I could pretend I didn't have insurance anymore," Ms. Alexander told The Inquirer.

Ms. Alexander's daughter and her husband are covered under an Aetna high-deductible plan through her husband's employer. When the hospital submitted the bill to Aetna, the payer negotiated rates much less than the hospital charged, leaving the family on the hook for the $1,214 negotiated rate.

Aetna spokesperson Shelly Bendit told The Inquirer Aetna couldn't speak about the bill directly due to confidentiality rules. She said while Aetna "works with hospitals to negotiate the best rates for our members, there are many factors which contribute to a member's ultimate cost. Additionally, Aetna has no control over a hospital's billing policies and whether they're determined by coding, charitable missions, or any other policy that the hospital may apply."

High-deductible health plans are increasing consumer awareness of healthcare prices. Ron Peck, a health benefits lawyer for the Phia Group, told The Inquirer, "With these high-deductible plans, the curtain is pulled back and you see some of these nonsensical calculations going on."

So consumers like Ms. Alexander are stuck with two options: Fight to pay the initial $821 bill or buck up the $1,214. Ms. Alexander's decision? Pay the $1,214 toward her daughter's $2,500 deductible.

More articles on payer issues:
Poll: 61% of ACA enrollees satisfied with marketplace insurance options
How Cigna is betting on collaborative care: Q&A with Cigna Senior Director Lynn Garbee
CareFirst phishing attack affects 6.8k

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