If they paid it, then I guess they can sue back but how did this make it through the algorithms that check for this stuff?  I have not met a doctor yet who could bill for such a large fee.  What code did they use?  I want to know on this one just for my own knowledge as it has made me curious.  image

The insured were taken care of inside network hospitals but the MDs were out of network if I am reading this correctly.  There were some other strange billing issues here too but the one consult stands out!  As one source stated one MDs income rose from $137k in one year to $2.7 Million in 6 months of the following year.  Again, where were those algorithms that check all the transactions I wonder.  This doesn’t make the lack of IT at Medicare look so bad after all <grin>.  In reality, I’m thinking though this must have been a paper claim.  BD  

Aetna sued six out-of-network doctors in New Jersey, whose bills for care for the insurer’s patients, including one for $56,980 for a bedside consultation, were “unlawful and excessive.”

The battle between Aetna and the doctors is over out-of-network fees, an area where insurers and providers are increasingly butting heads. In each case, the patient was referred to in-network hospitals but received care from the –out-of-network provider, with whom the insurer has no contract and therefore must pay whatever rate the provider charges.

Aetna sues six N.J. doctors over ‘excessive’ out-of-network fees | Insurance & Financial Advisor I IFAwebnews.com


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