omgzchristie
Contributor
Hello all. I work for a bariatric surgeon. Recently we have noticed payers like Aetna and UHC reimbursing us at wildly different rates (we are out of network with them). For example, a patient will have an upper endoscopy that is paid almost in full ($11K). The EOB states the reimbursement is based on Multiplan's contracted rate. I should note that no negotiation with Multiplan was made. Then when the patient has a laparoscopic sleeve gastrectomy, the insurance reimburses us what EOB states is 140% of Medicare's rate (only $1K). My understanding was that the reimbursement rate is determined by the plan that the patient has. How can it be that the reimbursement is different for the same patient with the same insurance plan across all treatment? This doesn't seem right. Has anyone else experienced this? If so, any suggestions on how to fight it?
Thanks so much.
Thanks so much.