If you have Aetna, don't bother going to the doctor! They will look for an excuse to NOT pay your claims...
Earlier, I had to deal with Aetna refusing to pay my claims because, just out of thin air, they tried to say I have Medicare. They would reject my claims saying "we need member's MEDICARE statement of benefits."
Once I got THIS resolved, they then tried to deny my claims by claiming that the four office visits I am allocated before my deductible kicked in, had been made. Problem is - THEY HADN'T. They denied all claims from my FIRST doctor visit when I went for a bladder infection.
Guess how they justified this? By counting visits I made to a therapist/relationship counselor towards the 4 office visits, even though my plan SPECIFICALLY states that mental health benefits are separate.
I've been dealing with this since March. I have spoken to more Aetna reps than I care to count. Some of them have fought and argued with me on the point of whether the therapy visits counted, others of them contradicted the PREVIOUS reps and agreed with my reading of the plan, that mental health benefits are SEPARATE.
On 8/25, I thought I had this resolved. I spoke with an Aetna supervisor named Katrina who said the problem was caused by a technical glitch, and that she was going to escalate the problem. She gave me a tech support ticket number and told me to tell my drs office to re-submit the bill, and that Aetna would pay it.
On 9/4, my drs office resubmitted the bill at my request. IT NEVER GOT PAID.
On 9/22 I got a letter from a collection agency. The CFO at my drs office got tired of waiting and sent it to collections against me!
Today I ONCE AGAIN had to argue with an Aetna rep about whether the mental health visits apply towards the 4 office visits. When I called back later, I got a DIFFERENT rep who agreed with me yet again and agreed to call the collections agency on my behalf. I am not holding my breath that this is going to happen.
In the meantime, I disputed the charge in a certified letter against the collection agency. I'm seriously considering pressing my case against Aetna with an attorney. Any attorneys in the L.A. Area, I am more than open to being contacted through this site! I am fed up!!!
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