Insurance that won't pay! Posted: 03-20-08 12:57pm
So, I've been covered under Aetna
Insurance (both Medical & Dental) for
a while now through my work, and I've
gotta say, this company has given me
nothing but trouble, any claim I've made
they've automatically denied and they make
me jump through hoops before they finally
pay (if at all). So I had to get my wisdom
teeth removed this past September, it was
an issue I knew would eventually had to be
taken care of since they had caused me a
great deal of discomfort and pain, and
lead to a couple of infections, I'd been
told by a couple of dentists that they
definately needed to come out, of they'd
cause more problems, and affect other
teeth, and possible nerve endings. My
insurance company told me they covered 60%
of the oral surgery operation I would
need, but there was a waiting period
before I would be covered of 90 days, my
dentist gave me the specific date I would
be covered, and I waited a week after that
date to be safe. The dentist's office
called my insurance company to see what
they would cover and were told that the
medical part covered bony impactions
(which were what I had) So I had to pay
$600 at the time of my surgery, and
insurance would cover the other $1,000.
The insurance company sent me a letter 4
months later saying they would not cover
it because the condition was not work
related, another month later they sent me
another letter saying they wouldn't cover
anything because it was not a condition
that was accidental. They've refused to
pay my dentist anything and now I'm being
charged for it. I've requested a copy of
my policy, which will take 12-14 days to
recieve to see if there's anything
concrete I can present to my attoney. In
the meantime is there any advise anyone
has for me on how to deal with insurance
companys who say they'll pay but refuse?
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insurance-egghead
New User, Becoming EHEALTHy
Joined: 26 Mar 2008 Posts: 1 Location: San Diego, CA United States
Posted: 04-02-08 13:20pm
Hello fierylabyrinth,
I am totally shocked that you are having
so many problems with Aetna as they are
one of the most reputable health insurance
companies. It must have something to do
with your employers insurance policy.
Maybe they purchased a really cheap
policy.
Anyhow, I suggest that you start with your
human resources manager or supervisor.
Someone at your company should have a copy
of the policy. Then read it over.
The larger companies are usually pretty
thorough and detailed with their contracts
but maybe your policy was entered wrong or
the billing for the procedure was entered
wrong. A misplaced letter or digit could
cause a bill to be rejected.
After you get the policy, go to the
medical biller. This may or may not be
your doctor's office. Explain the
situation to them and ask them to explain
everything to you. You may also have them
check to see if they entered everything
correctly. If they did, ask them to check
if Aetna got everything right.
If you find an error then call Aetna and
show them. Any errors they will probably
take care of right away. Like my company,
Aflac, Aetna has a solid reputation and
pays out pretty quickly. They are not in
the business of jipping people off...
that's just not good business.
However, they are also very strict about
paying only what is required by the
policy. Obviously, they won't pay for
something that they don't owe.
But, if your policy does cover your
procedure then have your attorney contact
the state insurance board.
Next to last, always get everything in
writing. One thing that I do for many
agreements that I make with businesses
over the phone is send an email to the
person that I spoke with (with a return
receipt) detailing what we agreed to. That
way there is hard proof. Of course, this
won't help you now, but it will in the
future.
Finally, do not simply ignore paying the
bill as it will negatively affect your
credit rating AND it could make it very
hard for you to get insurance in the
future. Pay the bill if you can be without
the money for a little while and then
clear up the problem. If you can't swing
that then ask them for a payment plan.
I know it sucks to be out the money right
now but you don't want to ruin your credit
also. If Aetna turns out to have made a
mistake, I do not believe that they will
refuse to pay you back. Like I said at the
beginning, their reputation is solid as is
their rating at AM Best and Standard &
Poors
