• Report: #1114937

Complaint Review: Aetna

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  • Submitted: Sun, January 12, 2014
  • Updated: Sun, January 12, 2014

  • Reported By: Krissy235 — Staten Island New York
Aetna
, Select State/Province USA

Aetna Consistent denials despite benefit coverage Nationwide

*Consumer Comment: Sorry you're experiencing all this, but there are several things you should do..

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I ensured that all of my prenatal testing would be covered undered the Aetna Individual plan I had purchased before making the decision to stick with this plan rather than switching to my employer-based plan, which appeared to have been more costly. I even had my OB billing dept. speak to customer service at Aetna to confirm and was given an estimate as to what my OOP costs would be with the plan I had. All seemed copacetic.

Since I have begun having testing in late-summer 2013, I have been getting bill after bill from service providers citing denial of payment by Aetna. Each time I have contacted the company, I get a different explanation as to why X service was not covered and an assurance that a future service WILL be covered as long as it does not fall under some arbitrary code. For example, I was told that my standard prenatal bloodwork would not be covered but my glucose test would be covered. Sure enough, I just received a bill for this testing and was told by a CS rep that NO testing beyond standard appointments are covered. Meaning, no utlrasounds, no labwork, no stress testing, NOTHING. This is a complete turnaround from what I was told when I made the decision to stick with the plan or else I NEVER would have done so. My benefits package states that ALL prenatal testing is covered and maternity is not, which is why I have changed to a new plan effective January 1, 2014.

I now have several thousand dollars in medical bills to account for and despite my plans to make payment arrangements as best I can, I am told that even WITH a payment agreement, the hospital cannot promise that my account will not be sent to collections at some point upon future review. I have great credit and I cannot believe that I will have to contend with the lingering fear that it will be ruined by this until I have paid off the balance, which will not be before at least 18 months have gone by. I specifically went through each service that my OB stated I would need during this pregnancy and was given the green light by Aetna. I have no recourse now at all. 

 


This report was posted on Ripoff Report on 01/12/2014 08:35 AM and is a permanent record located here: http://www.ripoffreport.com/r/Aetna-/Select-StateProvince/Aetna-Consistent-denials-despite-benefit-coverage-Nationwide-1114937. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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#1 Consumer Comment

Sorry you're experiencing all this, but there are several things you should do..

AUTHOR: Ken - ()

First, carefully read your policy for what's covered and what's excluded.  Verbal promises are not worth the paper they're written on. The WRITTEN policy governs ALL coverages and exclusions.

Then, IF they are not paying as agreed, in WRITING, notify your states insurance commissioner.  If they are following the policy, there's probably not much recourse.  Good luck to you, especially with your new policy.  Please read it carefully, to include when coverage for procedures begins.

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