Aetna Insurance

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NEW YORK -- There is a loophole in the COBRA LAW so companies can get out of it which needs legislation. Please everyone here write to congress. For companies who do not willingly want to give it, they can claim a payment was late and are not obligated to let you know you were cancelled!Morally that is reprehensible and I would hope any human with a heart would agree, but surprise, surprise, some people have no concern. Once a time period elapses, you are taken off the COBRA. I emailed and called non stop asking why the last checks were not being cashed but was not responded to. I cannot send these checks directly to AETNA, which would have prevented my being in the dark about cancellation. The administrator can be very sneaky and just cancel then wait so that you do not find out til it is too late.We should be given that choice to deal directly so this cannot happen.

After my divorce I was entitled to COBRA from the firm my company has worked for almost 16 years. I asked if I could remain on the family plan but the attorneys nixed that and so my ex told his Benefits Dept. to take me off. Originally my ex and I agreed he would pay medical for several years and I knew that was the way it would work smoothly between us.It is standard for that to be done. But his lawyers knew otherwise and wanted to be a bigshot at my expense. Since I was unemployed, my only option to have continuous coverage at a reasonable group rate was to get COBRA, a Federal law that mandates I be given insurance. That is the area in which I fit neatly, per law and per design.
I filled out the COBRA forms and mailed/faxed in the payment, addressed to his company. This was done timely. The check was not cashed for more than a month and I was sent a new card ( AETNA claims in error) but this time, again "family". I was OK with that as it is not uncommon to be carried by an ex on the family plan. But Aetna said that was an error. So finally, after prodding my ex, I was sent the individual AETNA plan card and I sighed in relief. I spoke to a Benefits woman who was highly disrespectful (as I am THE ex-spouse, so however the ex dictates,that is how they fall in line too,and our relationship just deteriorated. But I asked my ex to find out why I had no insurance card when we were still amicable, and he also paid that one time, from money he owed me.Benefits told me to send my checks in before the 20th and I did so, but she never cashed them. I tried calling and leaving messages, every day, about why never cashed and I have several emails to the ex as proof. I did take care of my affairs and a professional would have done her job to enforce COBRA but here it was a power thing. I did all proper steps to ensure coverage.Their case hinges on accusing me of being a rude person (I am not) but labels stick and cause the ruining of reputations. Rude people do need health insurance.Criminals need health insurance. Anyone on earth good or bad needs health care. If anytime someone decides you are rude they can terminate benefits few would have insurance. How could I dream she might deny receiving them timely as all I had was timely entries? I am a professional and do not work that way and would not expect anyone else to. So I sent the last check certified, and it was signed for, proving they were received as none were returned.I was wondering if they moved, still giving them the benefit of the doubt that they could not possibly be this callous. But apparently they just did not deposit, as though not received.. She is either showing no compassion about my situation or deliberately saying a payment was not given her or simply made a clerical error. I would easily choose the latter, but have not had that corrected. It is being covered up if it was their error and I am being blamed. I am being denied what the Federal Law gave me. This is cold hearted .IT IS MY RIGHT GIVEN TO ME BY CONGRESS AND A CLERICAL ERROR BY THE FIRM SHOULD NOT CAUSE CONSEQUENCES TO ME AND NONE TO THEM! That any one person can try to keep me from getting health care, sadly and put me through THIS, is mind boggling! Who can I report this to and what can I do? Aetna says they have me in their system until 091409 ( that is after I proved they cashed August check).Until I produced that check they had me cancelled 082109 ( fishy) THAT IS WHY COBRA IS MANDATED BY LAW. BUT there is a HUGE loophole so companies can get out of it which MUST be fixed. Please everyone here write to congress . For companies who do not willingly want to give it, they can claim a payment was late and ARE NOT REQUIRED to let you know so can you remedy it.I only found out when I went to a doctor! I am extremely upset. Any suggestions? Is there a Commission to review this? Labor Dept has been notified and is working on it but so far I still do not know. They seem to want to just get the case closed any which way and a big firm catches their attention more than a simple woman in need. Again, I questioned this continuously. This is terrorizing and frightening me beyond belief. IT IS A NECESSITY! I should not be fighting this fight all over again. CONGRESS AGREED WE DO GET THIS BENEFIT AS AN EX SPOUSE. THAT IS WHY A LAW WAS PASSED. It is NOT up to someone deciding it again, at all. It is a Law in place for all.For rude people and nice people and young people and all who fall into it. As I do. To allow me on it just to then cancel and not notify was NOT why this law was passed and legislated. Please everyone ask why the cancellation to the individual is not required so this law can be enforced as needed.
By the way, companies who are not afraid will just give that excuse. And more often they will have a simple clerical error and cover it up and say it was the person's fault and get away without consequences. Are they not afraid of God though? Heartless anguish totally unnecessary. Do unto others is not their motto.
I am still praying this will take a turn for the right course.
But I do intend to write Congress why this loophole is there. But really folks, if a human being is receiving monthly timely checks they have a clue you are sending for a reason. Luckily I saved the emails.
Thanks again all.
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dan gordon on 01/04/2010:
I'm on COBRA and the benefits are administered by a Cobra administrator. I pay the administrator not the company. Something is very fishy here. There is a federal office that administers these options. I'm thinking its the dept of justice but can't find the number with my info. If I do I'll repost.
voiceoff on 01/04/2010:
Who are your checks made out to? The company? What do you mean by administrator? I think that is the Benefits Dept.
dan gordon on 01/04/2010:
cobra benefits are administed by a Cobra administrator. They are allowed to charge 102% of the actual employers costs. There are times when the company self insures in which case you would pay the company but that is very rare these days.
Anonymous on 01/04/2010:
Your idea of sending certified was a good one, except you should have done that from the start. Initially, you have an election form to fill out and send in. You have 60 days to send it in, and 45 more days to send first payment. You should have copied those, then sent those certified also. Then you should have called the administrator shortly thereafter to make sure you were in the system. When they didn't cash your first check in a timely manner, you should have called to see why. As Dan Gordon said, there is an administrator involved. You should be dealing with them, not your husband's work. Your husband's place of work should not care if you are on the policy since you are paying for it. And they should be out of the loop anyway. Something isn't right here.
Class Advocate on 01/04/2010:
Just to repeat the theme from the above comments, something is really odd about your situation. Who is the employer? In what state do you reside? Almost sounds like the company dropped the ball, but simply not enough information.
momsey on 01/04/2010:
You have to be talking to the company your ex husband works for. That's who is handling the COBRA administration. It's not Aetna. They only receive information from the company as to who should be covered and how much, etc.

Do you have a contact at your ex's company? Who signed for the check when it was sent certified? I can almost guarantee you're not the only person from your ex's company who is on COBRA. Depending on how big the company is, there might be a person whose sole job is COBRA. It shouldn't be this difficult!

Dan Gordon is incorrect. My former employer did not self-insure, but my COBRA checks were made out to the company, NOT the insurance company. Since the employer was doing the administration, they took in the COBRA payment, took their cut, and then handled everything from there.
Anonymous on 01/04/2010:
momsey, how long ago were you on COBRA? The last time I was on it, there was an independent administrator. (2005, in KY) I've used COBRA so much that I feel like an expert. One thing for sure, you can't be refused if you do the few things required of you. If your former employer is messing with you, you can DEFINITELY do something about it, and I think that's why the independent admin was instituted. Maybe some companies offer to send your money along to that admin, but I don't think you have to let them.
Anonymous on 01/04/2010:
For people that don't know, when you leave a company for ANY reason, you can continue your health insurance for up to 18 months via COBRA. Your employer should provide you with a COBRA election form. You have 60 days to return that form to the administrator. If you elect to use the COBRA, you still have 45 days from that point to make your first payment. Of course by then you will owe for 3 months. However, this is an excellent way to cover yourself if you change jobs and have a 90-day waiting period. By waiting the full 60 days to elect coverage of Cobra, then by waiting the additional 45 days to send payment, you now have the ability to either pay 3 months and be covered by cobra, or, if your new insurance has kicked in, you can tell COBRA that you no longer need them. That's 105 days of retroactive coverage anybody can take advantage of. If you're lucky, you can make sure you are covered if needed, yet not have to pay if you don't end up needing it.
Anonymous on 01/04/2010:
And that, my friends, is some of the best advice ever given here on M3C, if I do say so myself. Don't bother calling the COBRA admin to check it because non of them understand it that well. Just ask the 2-part question: Do I have 60 days to decide before sending in my "yes or no" answer? After they say yes to that, ask "After I elect to use COBRA, do I have 45 days to make the first payment? The answer to both questions is yes. Therefore, as I said, you can be retroactively covered for 105 days. If you need it, you start paying. If you don't need it, lucky you.
voiceoff on 01/04/2010:
I think they do self insure after a certain point. It is a very big company but privately owned. I do not want to say name.
The administrator seems to think she can decide yes or no depending on her liking me or office politics, thinking the owner would save $$ or my ex would approve. But this is URGENT and no one out there cares about anyone at all on a human basis anymore, it seems. How could they dare leave someone out in the cold? Heartless. I was told the Labor Dept. handles it not the insurance commission.
Anonymous on 01/04/2010:
In the course of my3cent's history there have been many good answers, spatterings of best answers and on rare occasions truly brilliant answers. We've got some smart people on here but I must say in all my time on my3cent's I can not recall coming across a comment of the magnitude of greatness as the comment offered up by TheNewSheriff. I'm speechless - I'm without speech. All I can say Sheriff is that I'm truly humbled by your brilliance. GREAT COMMENT my good man!
Anonymous on 01/04/2010:
voiceoff, I'm not sure who to turn to in your situation, but I can assure you that the ruling will be in your favor if you've followed the steps. It's the law, so an attorney that deals in things such as workman's comp may be a good person to call. You shouldn't have to go that far. NOBODY decides whether you "get" it or not. You qualify regardless of why you no longer work there. I'd call someone in the company that is higher up than the HR/Ins jerk that is messing with you and explain to them that you are prepared to take legal action. Explain to that person why you will win and I'd bet the HR person will get his/her butt chewed.
Anonymous on 01/04/2010:
Wow Stew, you're too kind. Thank you my good man.
Slimjim on 01/04/2010:
Good in-the-know advice sheriff. Maybe not the #1 best here, as we did have that guy who solved the Acura small seats riddle, noting the seats were built for those smaller Asian persuasion consumers (sobs and regains control). A close second none the less.
Class Advocate on 01/04/2010:
Net/net, the employer seems to be screwing with the OP's health insurance. I do not understand the motivation though. After all, under COBRA isn't she responsible to make the full insurance payment (not just the employee portion but also the employer portion).
Anonymous on 01/04/2010:
Yes, she pays the full premium, not just what her portion was before. this is why it makes no sense for the employer to toy with her. And I would be on that phone with the company asking to speak with HR's boss.
voiceoff on 01/04/2010:
Maybe this will give you an idea what I am up against. The head of personnel is the one who is in charge of this COBRA, and also her husband has a very high profile position as head of another important department in this company.
Power pushing perhaps. Wants you to say pretty please and be forever thankful to her personally that she lets you on the plan..
I called the Labor Dept but they said they would call back. I may have to sue but meanwhile I am uninsured???
Any suggestions re temporary insurance?
Class Advocate on 01/04/2010:
In what state do you reside Voiceoff?
Anonymous on 01/04/2010:
Pay attention voiceoff. COBRA is a federal law. Nobody can deny you of it. NOBODY from your husband's company is in charge of it. Someone from the company is OBLIGATED to issue you a Cobra election form which should have the mailing and contact info. Maybe there is a person at your husband's company that is responsible for helping you get the information. but they are NOT in charge of Cobra. That person may be ignorant, or may be toying with you, but they cannot keep you from obtaining insurance coverage via Cobra. I can't make it any more clear. Once again I tell you, call someone who is above this person. Explain what is going on and that you will take legal action if necessary. You are not without insurance unless you allow them to bully you for 60 days and you miss your opportunity to sign up. Listen to what I'm telling you and stop letting yourself be bullied. Be forceful, yet polite.
PepperElf on 01/04/2010:
I thought Cobra was GI Joe's enemy...
Class Advocate on 01/04/2010:
Sheriff is right! The reason I asked about what state you live in is that in some states you can get near immediate help with these matters. Some states have far more aggressive enforcement agencies, even when enforcing federal law.
Anonymous on 01/04/2010:
Thanks Class Advocate. I know a lot about COBRA and how it works, but I wasn't exactly sure who to turn to when you're getting messed over by the company you (or in this case her husband) worked for. I did have problems once with a nasty HR person, but one call to the GM took care of that.
voiceoff on 01/05/2010:
An insurance agent/broker that a friend referred me to called the Labor Dept and they said they only can go back 2 months to reinstate and since my insurance was terminated in August after I started it, the Labor Dept told this insurance agent that I have personally sue this huge company!
I had called this agent who my friend recommended thinking I could get alternate insurance, but he only does groups or maybe someone self employed with proof of income, which I am not. So yes it may be the mean HR head who is doing this personally as she refused to cash any checks from Aug until today and will claim they are not sent. But it could also be the owner of the company ( I doubt that), who would not win but would cost me too much in lawyers to pursue it. I am reaaly really desperate now as I have another DR's appointment and cannot be without any insurance even for one minute as no one should be. I would be put into bankruptsy God forbid if I needed hospitilization.
So where do I go now for IMMEDIATE help and reinstatement?
momsey on 01/05/2010:
P.S. I was on COBRA from August 2008 through September of 2009. Every check I wrote was made out to my company, and my health insurance was with UnitedHealthcare.

And just a p.s. to the New Sheriff's good info, only companies with more than a certain number of employees (50?) are required to offer COBRA. This is besides the point with the OP, since her ex obviously works at a company that is required to offer COBRA.

Good luck!
Nohandle on 01/05/2010:
Perhaps it has to do with the state or the size of the company. A company with under 50 employees is classified as a small business and not subject to the same regulations. At mine, if an employee signs up with COBRA the company completes the initial paperwork verifying prior employment and the employee having been covered under our insurance plan. After that the former employee is billed and submits payment directly to BC/BS. The company in no way is involved after that.
voiceoff on 01/05/2010:
The company has more way than 50 employees but not all get health insurance coverage. It depends (on what they do and whether part time, maybe).
I was told to write to the company and what is BC/BS?
I called the insurance commission today and was given a name of whom to call back to but they were gone for the day as I called rather late.
One of the complications here is that I am an ex spouse not an ex employee and that is also in a way working against me because I cannot get the reduced rate now for those unemployed though I too am unemployed.
Anonymous on 01/05/2010:
voiceoff, tell us which State you live in. Some of us may be able to help more if we know this. momsey, thanks for the info. I guess some companies still act as middlemen. I believe in most cases it's as nohandle described: The company completes the initial paperwork, then turns it over to an administrator. Your case is complicated by the fact that you were part of a family plan, now you will be separate. I'm sure it's easier for the company when all they have to do is to continue making payments on an established member.
Anonymous on 01/05/2010:
voiceoff, If you don't have any serious health issues, you may want to just look into buying a personal policy from an insurance company. Even if your ex-husband's company manages to get it right, you are probably not going to see much of a discounted premium, and you can only have COBRA for 18 months. If you do need this COBRA, I still say that you should call someone higher in the company than the person you've been dealing with. Start there. Also look in the yellow pages for lawyers that deal with these types of issues.
voiceoff on 01/05/2010:
I would gladly do that but as an individual plan without COBRA Aetna will charge more than twice, if they accept me at all. It is profitable to kick you off and charge more but that is why there is this COBRA law but how is it enforced if a HR admin does not do so?
Anonymous on 01/05/2010:
Once again, here's what I'd do. Speak with a higher-up in the company. Explain that you are entitled via federal law and that HR is giving you a hard way to go. Explain that they will be in trouble if they don't comply. Threaten them legally if needed. If that doesn't work, get legal help. Anybody else have any ideas? Again, Cobra only lasts 18 months anyway. Cobra doesn't hold the cost down. If the cost is cheaper it's because the company has a group rate. I pay $525/month for an individual health insurance policy. Sux, but that's reality.
Anonymous on 01/05/2010:
So, to answer your question, it's enforced by being a federal law. That by itself won't make a lazy, or ignorant, HR person take the steps needed to get the ball rolling for you. However, it's in neither side's best interest for this to come to a legal battle. That's why I say again, talk to HR's boss. Do this tomorrow. Tell us what happens.
Nohandle on 01/05/2010:
voiceoff: Sorry, I should have spelled it out. BC/BS=Blue Cross Blue Shield. I realize a different insurance company but that's the one we use for our health insurance. No matter, in this state COBRA is continued with the carrier a company is using at the time employment is terminated. The employee pays all premiums and as Sheriff stated it can only be carried for a max of 18 months.
voiceoff on 01/05/2010:
I was told that the 18 months were extended to 36 months but need to verify. I am in NY. I would get another carrier in a heartbeat but they have many eligibility employment etc. which I can't meet. I wish I could just get something else. Their going to say they never got the checks and therefore cancelled ( without notification). Seems a very easy way to get out of this law IF someone is so inclined. You can send it but they are the ones who must cash it. I wish I had sent them all certified but who would think I would run into a prob after I already had a card in hand and was continuing timely paymenst. I hope you are right that the company will get this done and I just sent a letter to them, not the HR.
Anonymous on 01/05/2010:
You said in the review that they cashed the first check you sent. That should have gotten you started in the system. I'm sorry to say this, but you messed up by trusting people. You can't do that when it comes to something like this. Even well-meaning people will mess over you accidentally. I always check to see that my premium gets cashed before its too late to send it a 2nd time. But, you could be saved by the fact that they cashed your first check. Will your husband vouch for you as far as you trying to send in the papers?
voiceoff on 01/06/2010:
The main problem is that there was no cancellation notice or call stating that this was not in place, or I could remedy it immediately. Evry other check that is sent is received and normally cashed immediately. I had no inkling this was a situation to be handles other than that. They got many checks so had to realize I thought I was covered so it is their responsibility to fill out those papers and resubmit it. I am certain the law is not supposed to be denied for a clerical or deliberate error on another's part so that an innocent person is caused gross damage.
I am sure AETNA would reinstate if they own up to not notifying me and leaving me in a place between a rock and a hard place. There is nothing for them to object to it is NOT their choice as it is a mandated law. No one should Ever be in a spot like this over another's error. Trusting is not wrong in this case. There was ample time to notify me. The company may be responsible for all my medical bills out of pocket unless I am reinstated. I hope they do the right thing. This is a serious breach and HR messed it up. But the consequenses are on me so unless there is a way to remedy they are in a breach of that law.
Anonymous on 01/06/2010:
Sorry voiceoff, but you can't cancel something that doesn't exist yet. Since you were going from a family plan to an individual plan, they were going to have to add you as if you were a new employee. You should have followed up to make sure they did their part. You should have asked about your card, and kept asking. Part of this is on you. Start now by immediately taking an active role in taking care of this, which is what you should have done in the beginning. You are entitled to COBRA, but it won't happen automatically. There is not a lot for you to do, but what little there is, you must make sure gets done. YOU have to make sure you get signed up correctly, and of course the payment is your responsibility. Even though someone in HR messed over you, you may have waiting too long to fix this.
Anonymous on 01/06/2010:
Aetna is not a big part of this loop, as far as responsibility goes. Your husband's company has to tell them to add you as an individual plan. Then the Cobra administrator makes sure the money is paid. Aetna can't contact you to say that you no longer have a policy if you never had one to begin with. You were part of your husband's policy.
Anonymous on 01/06/2010:
I think that from the amount of time I've spent talking to you about this, it should be obvious that I feel badly for your situation. But I get the feeling that you didn't do enough on your end to make sure you were signed up. Combine that with a HR dept that was either incompetent, non-caring or just plain forgot, and you are now in a bad spot.
voiceoff on 01/06/2010:
TNS, thank you for your ability to analyze this.Other than sending my applications and my checks, there is nothing else I am supposed to do. When I got the card, it meant that I was enrolled, as why else would a card be issued.
But I am trying to remedy this if it can be acknowledged that all my checks were received and not simply ignored. So if they cover themselves by denying I did do what would have been sufficient, this could be remedied. But if they stubbornly refuse that, we are not dealing with a "human" resources after all. The ball is now in their hands and that is way too much power for a person with a slight vendetta to have. Personalities should not com ein here. It is a business deal mandated by law and just pretending a check was not given is too easy a way to circumvent the law and get away with it.
I am still praying and do appreciate your concern. It means a LOT to me that perfect strangers take time to help.
Anonymous on 01/06/2010:
When did you get a card? I thought you didn't get one. If you did indeed get a card showing you had a policy, then all that is left to do is pay on-time. If you pay at the last minute, use certified mail that they must sign for. If you pay earlier, watch your checking account to make sure the check gets cashed. I have to do this every month. If a check gets lost in the mail, I'm screwed unless I'm paying attention. Therefore I take it upon myself to make sure they receive payment. Everybody is in the same boat when it comes to making payments.
voiceoff on 01/06/2010:
It seems they could claim that the very month after I got the card my payment was not received and I was cancelled.But since there was no notification of cancellation I did not realize they did not cash the check. It was not returned so I think it was received, just not sent on to Aetna. I do not know their policy re cashing. They did the same thing for the first check. Kept it more than a month before it was cashed. That is their internal procedures sonot my business. The checks were not returned and I was not aware of cancellation.
Anonymous on 01/06/2010:
Your story changes and I feel frustrated for the time I've spent trying to help you. I don't know how old you are, but there will be many important payments you make in your future. There are many ways to obtain proof of payment. You need to learn them. If you didn't notice that your checks weren't cashed, you're either better off financially than most folks, or you need to take more responsibility towards your financial matters.
DebtorBasher on 01/06/2010:
As always, Sheriff has great advice regarding COBRA. His advice helped me a great deal when I was unemployed and he was able to explain it to me in a way that made it easy to understand...(not to mention that cute Kentucky accent as he explained it to me)...

I'd listen to Sheriff if I were you, because you're not going to get better advice than what he is offering. Good luck!
Anonymous on 01/06/2010:
It's not all for naught Sheriff we've all walked away a little smarter from your wisdom on this one. You did a good job.
DebtorBasher on 01/06/2010:
Stew...we need to get Sheriff his long overdue 3rd, what are you going to due to help him get it?
Anonymous on 01/06/2010:
Thanks DB. Thanks Stew. God Bless us everyone!
voiceoff on 01/06/2010:
I did not change my story ever. Yes I should have realized the checks were being received but not applied but they did that also for first check. It is unusual but that is their policy. Usual cashing is the proof. I too am frustrated and will be continuing to get this dealth with properly. I have started that process. I had a dispute a few years ago and it did get successfully completed bc of help on this site. The main thing here is that there is no law to make them tell you of a cancellation. They kept getting checks so morally and ethically if not legally they HAD to know I was thinking myself covered. The letter of the law may have been followed but not the spirit. The law's intent is to protect the consumer but here a technicality could circumvent that intent unless the Labor Dept enforces it. But hey ya know how it is? The SEC and the auditors back the company instaed of the investor and it's the same everywhere. The individual is just overlooked and not given concern. My ex's company is not at fault it is the HR who just ignored these checks and never told me AETNA had cancelled ( I suppose they were notified) and is doing this and can undo it and hopefully will.
I am sending letters where needed. This cannot happen to anyone else ever. Congress did not pass that law to be so easily avoided with no consequences. I will keep you posted per progress. My last prob was resolves via BBB.
Anonymous on 01/06/2010:
Your story changed. You state in the review that you never got a card. Then, after two days of banter on here, you say you have a card. That changed everything. Also, your last post makes no sense when you say your husband's company is not to blame but HR is. ??? "Morally and ethically" sounds great. Better way is to pay attention to your affairs. Nobody else will. Did you even call Aetna? Ask them when and why you were canceled. You'll find their number on the card you never got.
voiceoff on 01/07/2010:
I reread the post and I did not include all the details from start to finish so yes it did seem as though I NEVER got the card. What I should have written to clarify is that the card was delayed several months after the application and check were submitted and that is why I was already fearful that this HR was not doing things properly. The HR said that they do not issue cards and only Aetna does so I had to wait. In other words, I did not know how long it should take to issue the card and it seems the company was dragging it's feet because they did not cash the FIRST check for six weeks so of course Aetna did not issue the card if the paperwork was not forwarded immediately. My ex has worked there closer to two decades and this HR is several years and things went smoothly before her with the company so it is not the company but her department that is not caring at all when they are supposed to be "human" resources. How can anyone simply ignore a check every month ? One was late so why not let the person know the policy will be cancelled and not have them send checks for another six months?
I did my end. How many times must I say that. I filled out the forms and I sent in the checks. And yes I did call AETNA who would reinstate if told to, they claim. But since the plan administered from the company, Aetna can only do what the company tells them. Apparently the company, via the HR Dept. is claiming a check was late,AND they are NOT REQUIRED BY LAW to notify me of cancellations. EWWWW. I hope this happens to that lady one day and I believe what goes around comes around so it will! They just cancelled and my problem regarding being without insurance was the last thing they cared about. What kind people we have here.. After my ex works 17 years and our marriage is 25+, a late check is how this company claims I do not deserve any coverage. It is a fabrication. Totally. Unless there was a problem with US postal service because all the checks went out way in advance. THEY DID NOT FORWARD THE PAPERWORK. Some people just like to watch others squirm. Yes that is part of human nature too. They kicked me out and I am fighting for reinstatement now which is my RIGHT. I take care of MY affairs. They did not!
voiceoff on 01/07/2010:
UPDATE - I went to the Dr. today and very bad news...Aetna closed my account completely and told the Dr I am liable for all costs and said I am no longer active in the system as before. Apparently calling the Labor Dept. was not helpful. The lady just hing up on me and wrote me up as rude when I told her she is supposed to support the Federal Law to make sure people have continuous coveraghe and NOT to side with the HR *** who is trying and succeeded in kicking me off. What mean spirited uncaring people exist in this universe.
voiceoff on 01/07/2010:
Any suggestions how to get affordable health care as an individual?
DebtorBasher on 01/07/2010:
I can't help you on that one. When my COBRA ran out...I've just been without any. I still have a small Healthcare Debit card account, I can deposit money into an use it, but I have no health insurance. Everything I looked at was way too high.
voiceoff on 01/07/2010:
If you worked within the last 52 weeks and live in some states ( New York for one) there is a health care program you can get. But you have to be eligible. A few days in a hospital and you can be bankrupt.
DebtorBasher on 01/07/2010:
There are a lot of programs, but they all cost so much. I'm just working from home right now, trying to get a business going.
voiceoff on 01/07/2010:
NOPE. I do not care how expensive they are. Thay are worth it and needed. I just cannot get on any under 1000/mo and that is way too much.
DebtorBasher on 01/07/2010:
That IS a lot for a single person.
voiceoff on 01/08/2010:
I updated ny original review so maybe it is more clear now.
Write congree about this loophole which allows an individual to be cancelled but not notified and so a clerical error can cause this easily and not remedied. I sent emails asking why my checks were not applied, so I WAS on top of it, but they can claim anything if there is no need to notify you. And if they avoid messages because they have upset you so much you are labeled "rude" for demanding this coverage, that just gives them a right to put a nail in the coffin after murdering you. Never an obscenity was used. But repeatedly asking for reinstating my rights is RUDE?
By the way, coverage is 36 months now.
voiceoff on 01/09/2010:
It is now for 36 months.

To keep a check and then say it came late? They can get away with that? NOT !!
voiceoff on 01/09/2010:
I submitted a dispute with aetna re closing the account and got a letter today acknowledging it. Please pray for me as I am frantic and panicked.
DebtorBasher on 01/09/2010:
Best of luck...keep us updated!
voiceoff on 01/10/2010:
Thanks DB for staying with me on this throughout. Praying is all I can do now.
voiceoff on 01/10/2010:
TNS, I do not appreciate your turning on me, saying I banter amd make no sense when I am hurting so much. I did nothing to stop from getting COBRA. They held on to my check and now are claiming I sent it late and the Labor Dept. checked and found out that they can get away with that since there is no requirement to warn about a pending cancellation. If this was NOT deliberate than they can and would reinstate me. I cannotbeg for my life, which is what this is.
voiceoff on 01/10/2010:
Momsey but did they cash them timely or give you a hard time? Maybe it is easier if you are the employee rather than the ex spouse but the LAW ststes ex spouse is also entitled.
DebtorBasher on 01/10/2010:
Voice...Sheriff is a good man and he does know a lot about the COBRA insurance. I think there is just a mis-communication somewhere there. We've all learned a lot from him with the info he provided here.
Anonymous on 01/10/2010:
voiceoff, I did not turn on you, but I did grow tired of trying to help you when you did not provide all of the information up front. Your story did change as you lead us to believe you were never signed up. Later we find that you actually received a card. From that point, you merely need to make your payments on time. They even have a 30-day grace period. So if you truly paid on-time, then they supposedly held your payment for more than 30 days. You messed up by not making sure they cashed your check. I'm sorry, but that's just the bottom line. You messed up. Since checks can get lost in the mail, or lost in the shuffle at the company, you MUST follow up. And, to be honest, some of you comments did not add up, like the one where the company was not to blame, but HR was. To be honest, I still don't understand your entire situation. You were either making your payment to an independent administrator, or you were sending payment to your husband's company.
Anonymous on 01/10/2010:
I noticed the same thing, Sheriff and I agree with all of the advice you have given.
Anonymous on 01/10/2010:
You also mentioned after 4 days that one of your checks were late. Well, they state very clearly that if you miss the grace period, you WILL be canceled. That may be a bit inhumane, but it's the same rules for all of us. Sounds to me as if you were late on a payment, then got canceled as a result. I have sympathy for you, but you came on this thread acting like a victim of a total ripoff. You did not disclose the whole truth, while trying to garner sympathy. When a lot of the truth finally surfaced, seems to me that you are at fault. That's my take on this. I'm sorry for your situation, but you need to move forward. This is a great site for help, but get on the phone and find out what your options are.
Anonymous on 01/10/2010:
Thank you ProConsumer.
Anonymous on 01/10/2010:
When did this site start allowing the original review to be edited? Should there be something at least above the review saying that it was edited, and the time and date it was edited?
Nohandle on 01/10/2010:
Sheriff, you did the best you could with the information given comment by comment. I initially offered what I could based on what I was familiar with my company in my state. Yours is by far the best advice and by no means turned on the OP. It just seemed to me to be one of those reviews where fellow members were trying the best they could to offer assistance and something new cropped up every other reply.

Voiceoff, listen to what Sheriff has stated. He knows what he is saying and has tried the best he could to offer you sound advice. Pay attention and thank your lucky stars someone took that much time to deal with your problem.
Anonymous on 01/10/2010:
There is something I am going to check on, and that is the independent administrator part of the COBRA equation. The last two times I used COBRA, there was an independent administrator. I assume the company I worked for would provide the amount of money needed for the monthly premium. Then, it was up to me to pay the administrator. The admin would send the money either to the company I had worked for, or directly to the insurance company. Don't know which. If voiceoff was sending her payment to her husband's work, I'm wondering if that was by choice. Was she given the option of the independent admin. Is it different in each state? Shouldn't be since its a federal law.
Anonymous on 01/10/2010:
Thanks Nohandle.
Nohandle on 01/10/2010:
Sheriff, It's been that way as long as I remember as far as editing a review. I've complained in the past when someone posted a review that he later decided to change after the comments began being posted. One in particular was a member lashing out at the citizens of the US because he was angry with U-Haul and he lived in Canada. We began to respond and by the time he finished editing his review it appeared we were picking on him. At one time most OP's would usually at least make changes within the reply section of his review for clarification and not change the review.
voiceoff on 01/10/2010:
I do not mind if both my reviews are side by side as I did not change my review but clarified what I wrote so any new people reading it would not be mistaken about it, as you seem to have been. In fact there are still other relevant facts that are not included, but I did not want the issue to be bogged down with cicuitous routes.
The point here is that my original check was NOT put through for at least a month and I did not get my card for some time after that. I DID call and email repeatedly about this. THEY dropped the ball. But they have no consequences for doing so. Only I am suffering. That is why there is a LAW. To make people have a conscience. But some still won't. They did not post my check and are saying it was late. It was timely and as you indicated they HAD to have known they were receiving these checks so anyone with an iota of concern would have called to say sonething about that. AETNA claims I can be reinstated as long as they say so. BUT THEY have not as yet. Leading me to believe they do not want to rectify this even though it is in their power to do so. That is what is recommended by the Labor Dept wgich represents the Federal Govt to make sure people have coverage if they are within the eligibility of COBRA. Also the State Insurance Commission would want it enforced. How many vtimes must I say that I called and called and they were unavailable.
Sympathy should not evaporate if they lost my check and did not notify me of any cancellation pensing so how should I think that.
The sympathy is that bureucracy will dictate a human life's needs being denied rather than common sense being used. Seems the Law was passed to make sure we have covergae whether is its economically good to do so for Aetna or the firm my company works for. Financially there is motive to cut people out and the Law keeps that motive form being used.
But you are right. It is the firm who hires their people so is responsible for what they do, petty or otherwise. The company can be sued for all medical bills resulting from not reinstating me.
voiceoff on 01/10/2010:
I have a lot of typos a spelling errors but am not being allowed to edit this at this time. I also wanted to reword some sentences as previously the edit option allowed this I was not particularly careful, expecting to edit.
Please do not imply I edited my original to cover up anything but rather to address what you said was confusing. When a person writes, they know all the facts, but give some, so it is somehow lost to them that it is not as clear as they think.
I appreciate your sympathy and it was not wasted as the sympathy is for now being in a neverland and sea of bills without knowing where to send it and more Drs appointments which I have no way of paying without insurance. I was NOT late and if it was lost in the mail ( I do not know), it should be corrected anyway.
Pro consumer I do not know what you noticed but I can be reinstated and should be and I did not send my checks late so they should not deny me coverage by saying so. It can be rectified. I shouild not be stranded with no hope.
Anonymous on 01/10/2010:
Something as important as COBRA payments in the future it would be in your best interest to send them return receipt requested. This will save you any further grief, at least when it concerns receipt of your payments.
voiceoff on 01/10/2010:
Yes I guess there was reason to make this a law. I will send all future payments that way, God willing.
I think two changes are needed with this law.
1. notification of pending cancellation to the person who will be affected ( NOT THE ADMINISRTATOR ONLY).
2. Choice to send to the insurance company directly, elimination another source of clerical error and layer of potential problems.
voiceoff on 01/11/2010:
Guess what? I got cancelled check showing that I HAD paid the very month I was cancelled bu Aetna. Tom morn I will call and send proof. I hope that will do it.It was NOT late. It was on the first of the month yet that same month it was cancelled anyway.
voiceoff on 01/12/2010:
I just learned that there is usually another middle company ( not Aetna and not the company with the employees)who administers this so there is proof that the checks were received from other than the company who is obligated by law to provide Cobra. But that was not the case here.Conflict or covenience, this would have been caught right away.
voiceoff on 01/13/2010:
Yesterday Aetna said they were doing everything to reinstate me immediately as soon as possible. Today they have no record other than I was cancelled back then. They told me to call the "administartor," but that is the person who put in the cancellation even though I sent my cjecks and the month it was cancelled it was cashed. She has no care in the world that I can be wiped out without insurance. IT IS DEFINITELY a conflict of interest when the company obligated by law can ( yes the law had to be made cause otherwise no one has a conscience, clearly) simply get out of the law by claiming a payment late , ignoring the payment altogether, and having no reason to notify the individual that they are not coverered (by law). One with a drop of consideration would do so. But humans and people are not one and the same.COLD HEARTED administrators are "saving" the company money ( when the company would follow the laws but for them).They are as rude and disrespectful as they have the power to be. THIS IS THE HEIGHT OF DISREGARD FOR ANOTHER. Aetna says they would easily and readily reinstate me, and it came from the administrator who willfully and with disregard PUT IN TO HAVE ME CANCELLED, so clearly it is this administrator I am now supposed to appeal to? Probably will do it again in amonth for spite as I see this. Spite cause of my divorce which is none of her business but she took sides here and kicked me off. Some people cannot have power as it goes to their head and they are so petty and disrespect others and justify it. What a world we live in when the needs of someone are diregarded even though the insurance company would gladly reinstate.
They say I am rude. Rude people are still covered by COBRA so that is no excuse.
The Department of Labor is supposed to represent the little guy but I think they often just go along with the company rather than insisting the law be abided by. It's my life but just a job to some. Common sense needs to prevail.
DebtorBasher on 01/13/2010:
I hope you're keeping record of the names of the people you're talking with.
voiceoff on 01/13/2010:
The prior Aetna employee was professional and nice and gave me his first name and ID number.
He can't install me as it comes from the host firm ( a conflict of interest if ever there was one).
I don't know if the Department of Labor can tell this errant firm that they they must reinstate but if Aetna is willing and I paid all months why are they not doing so? A clerical error gets someone off the hook from following COBRA LAW? Congress would not approve of that. Either they deliberately put in that cancellation ( I am thinking so more and more) or did so in error. Clearly it was NOT my intent to be off of it as I sent my monthly checks so it was not I who was remiss. There is such a run around no one wants to do anything kind any more they all want to get away with the most they can and are proud of that. Yes. So upsetting and in a minute it could be fixed but they want their pound of flesh. Pretty please do not put me in a position of being financially wiped out in case I have an accident." WHOA how can anyone be so unprofessional about this very serious job?Yes I have the ID number and was told they had to access a computer and deny my coverage for this to occur. It came from the firm not the Insurance company. An administrator should not be the same as eth firm. They just IGNORED my payments and my calls and claim I was NOT on top of it. RIGHT. I was not on top of people who input my cancellation knowing full well I had been paying for it as directed.
There is a place for such people..
voiceoff on 01/14/2010:
Coincidentally it turns out the case of missing payments is not uncommon when the company is also the administrator and need not notify of cancellation. A lady told me ( I did not tell her my case it was a coincidence she brought this up about herself) that she worked at a company that is publicly sold on stock market and that she was laid off and applied to COBRA. Her check was also lost or never received or late and she was not notified of her cancellation until she submitted a claim that was denied.
In her case it was also no middle man. company and admin were one and same. Again, accidents do happen but the "no need to notify of cancellation pending" part is inexcusable.
voiceoff on 01/17/2010:
So there are usually three separate companies to be clear to others. Company, middle administartor, and insurance company.
But sometimes it is only two and therein is the rub. If it is two and the $ goes to the insurance company it is bestter than to the company because then the insurance company would be obligated to write re a cancellation. But the biggest problem is no need for the company to even bother letting the person know they are pending a cancellation. And believe me many who do this administration couldn't care less if someone loses coverage based on a clerical error on their part.
voiceoff on 01/17/2010:
Sheriff, dan said it was rare to send to the company but is is actually quite common. And Moms disagreed with Dan.
voiceoff on 01/31/2010:
Still working on this. Labor dept has it now. Insurance company agrees to reinstate. This is not the FIRM but an individual in the firm that has been digging their heels in and causing me pain for no reason. Denial is like murdering someone financially as there is no way I can pay costs of medical. I am sure it can be done easily but they can't admit this is wrong.
voiceoff on 01/31/2010:
I have now even written to my senator to help. I think she will be the one to do so as she makes the laws and knows they are there for a reason and wants them followed. I am still praying for this very week. I have $900 of health costs accumulated I can't pay now.
lisa on 08/04/2011:
why are there appeals if no one is going to win - that is fraud....
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Starmark good at finding rules under which they can deny your benefits
Posted by on
CLINTON, IOWA -- My company switched to Starmark couple months ago. We had a twin boys who were early by 11 weeks. SInce they were preemies they were to get Synages (costs about 2500 per shot)and the shots were to be given between Nov and April. These shots prevent bronchitis in premeeis. My old insurance company paid for the shots Nov through Jan and I am trying to get the authorization for shots of Feb and March 10 and I am still waiting for the authorization from the company and it's already April. Since last two months they keep pushing me and the doctors office around to complete some paper work. They have very complex system of meeting RX. They outsource their Prescriptions services to Wellpoint. Wellpoint outsources Pre-authorization services to another unit. Wellpoint also outsourced some of the special medicines to another company called Precision RX. To get an answer we have to call all the layers (at least 4) and then you get a vague answer saying that Pre-authorization was given but not used (by Precision RX) and Pre-authorization is valid only for 24 hours. I can't believe why a pre-authorization would be valid only for 24 hours. IF it's so then why not the Wellpoint Pre-authorizatin processor not inform the doctors office or the member. We have restarted the paperwork and Starmark says they haven't received the papers. My doctors office says they have proof of sending the Fax and the confirmations. Since Starmark insists that they have to get the papers again, we faxed them one more time. I am already on tag for shots for one month. Since Starmark is dragging its feet I may have to pay another month shots out of my pocket. Starmark SUCKS!!!
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LRayala on 05/05/2010:
After this review was posted, I had emailed my company's HR/Finance folks. One of the more considerate team members at my company took it up with Starmark Sales Manager who is turn had ensured that the medicine (Synagis) was issued within a week. If not for the intervention by my Company Managers and initiative by Starmark Sales Manager, it was probably not possible to get them to pay for the medicine.

I am hoping that Starmark will pay for the medicine issued by CVS Caremark during the transition phase.
LRayala on 07/11/2010:
Just wanted to update, I had sent the bill for the medicine issued by Caremark during transitioning of my old carrier to Starmark and they have reimbursed me the cost of medicine. However, they did deduct the copay of $400 for each child. So, I ended up paying $800 for one month's medicine. Under my old carrier (BCBS) I didn't have to pay a single penny. So, it is bad but not as bad as I had to pay the entire bill of $5600. Starmark have at least realized their mistake and try to correct the mistake and they seem to be interested in addressing customer complaints
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StarStarEmpty StarEmpty StarEmpty Star
Benefit Not Available in Area
Posted by on
Rating: 2/51
DAYTON, OHIO -- Our benefit booklet states we have 100% coverage for MRIs, etc. if done in a stand alone office.
Sounds really great, right??? Well, there are no stand alone offices in our area even though many are listed in the benefit handbook. When I called Aetna for a name that would qualify for the 100% coverage I was given a name that doesn't even exist any longer, it's now owned by a hospital. Looking further I found all listing were incorrect, either the number was disconnected or it wasn't even the correct office. When I filed a complain w/Aetna I received a letter stating they do not guarantee coverage for all areas and I could file a complaint with Washington, DC. Truly felt filing with Washington was going to be a waste of time but, did it anyway. Yes, it was a waste of time. Response was about the same as Aetna and if I wish to further appeal I can file in Federal Court. NO THANKS, why waste time with something that is impossible to win.

Before selecting Aetna insurance you may want to call providers in their benefit booklet just to see if you will have the coverage promised.
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Unpaid Claims and Refusal to Pay for Necessary Treatment
Posted by on
COLORADO SPRINGS, COLORADO -- My health insurance is Aetna, however Principal pays the bills using Aetna guidelines. Last December I contacted Principal to get benefits quoted for chiropractic care and physical therapy. I was told that they will pay $500 total for chiropractic care, and physical therapy is unlimited with a $20 copay per session. The chiropractor I go to is part of a wellness clinic that has a physical therapist, massage therapist, and doctor as well. When I spoke to the representative, I was told that they would pay for physical therapy at the chiropractor's office as long as the doctor's office coded for physical therapy. The representative said that I might need a note from the doctor saying that my treatment was medically necessary. When I went for the treatment, I agreed to submit the bills myself to Principal because this office has had problems in the past with Principal. After I sent in the bills with the note of medical necessity, my claims were denied saying that my treatment was not medically necessary. I stopped my treatment because I did not want to accrue any additional bills. Three months later my primary care physician sent me to physical therapy at the hospital and had an MRI done of my neck. We then found out I have several bulging discs in my neck, and severe degeneration. This is now 6 months after my treatment started and 3 after it stopped. The insurance company is no longer denying my coverage because of the lack of medical necessity. Now they will not pay because they said they do not pay for physical therapy at a chiropractor's office. I am now stuck with over $13,000 in medical bills that my insurance refuses to pay. I more than likely will have to file for bankruptcy now. On a side note, they finally paid the $500.00 for the chiropractic treatment. My second issue is my pain doctor wants to do a radIowave ablation to the nerves in my neck. I had the test done which proved the treatment will work for pain reduction. My insurance company is denying coverage saying the treatment is experimental because of the herniated dics. Ironically, this is the main reason for the treatment. Because I cannot get treatment, I am probably going to have to apply for disability at 33 years old. The insurance companies are playing God with our health, and it's not right. I suffer in severe pain everyday of my life because of my insurance company.
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Anonymous on 11/10/2009:
Typical insurance company. They collect your premiums and never want to pay anything back.
Anonymous on 11/10/2009:
I've learned the hard way to never take the insurnace company's word for anything. It is always best to check your certificate of coverage to find out what they will or will not cover. Check your certificate. If the services you had done were in fact a covered benefit, contact your states department of insurance and file a complaint. The insurnace company will move quickly once they get a notice from them.
BEJ on 11/10/2009:
You did not specify if your insurance was PPO or HMO. HMO want you to use their providers and do not pay when you don't. PPO's are different.When you called the insurance company to see if they covered physical therapy did you initially ask them if they covered the place you wanted to go to. Just because they cover a treatment--sometimes they have preferred providers they want you to see. If the treatment is considered experimental for that diagnosis--they may not cover it at all. You need to check your policy and see what is covered.
JR in Orlando on 11/10/2009:
To summarize: 6 months ago you go to a chiropractor/physical therapy.For 3 months you submit no bills or letters of medical necessity, as inferred from the fact you quit treatment 3 months ago, when you submitted those items and were denied. That would be three months after you started. So you ran up $13,000.00 worth of physical theraphy bills during this three months before coverage was determined. Did you ever think maybe the very first week you should have sent a letter of medical necessity and bill to see if they would pay it? Them saying some procedure fits under the policy does not mean they approve that treatment FOR YOU, or FOR THAT DOCTOR.

Also, anytime there is a verbal agreement, you should follow it up with a written letter, sent certified return receipt requested.
ShelbyRoo on 11/11/2009:
I appreciate the feedback. Here's a quick response to some questions -
My insurance is a PPO
My booklet shows that I have 100% coverage for physical therapy - it does not state that I can't have it at a chiropractor's office
The chiropractor's office is in the network - the insurance company are the ones who referred me to them
My insurance company does not give anything in writing. They'll say you don't need preapproval, but then after the procedure they might not pay. I tried to get something in writing for a surgery I had, and they refused to send me anything in writing.
I was working with the chiropractor's office the entire time I was in treatment. They told me they ended up submitting the bills. That was incorrect information given to me by their receptionist. Every week I would check to see how things were going, and was told it's fine. Then I find out from their billing department that everything was not fine. I worked with my HR manager for months going back and forth with the insurance company. We sent them everything they requested. I did do my due diligence on this. The simple fact is the insurance company doesn't want to pay, so they're not going to.
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Aetna Insurance Policy Denied To Pay For Pre-Screening Test
Posted by on
BUFFALO, NEW YORK -- I'm 36 yrs old and had my first mammogram on November of 2008. Our Aetna insurance policy paid $340 for the test 100%. In February 2009 Aetan decided to reverse the charge and not pay the claim.

My Aetna insurance policy will not cover routine baseline mammograms for anyone under the age of 40 yrs!

The AMA recommends that all women between the ages of 35-40 have at least one baseline mammogram before the age for 40 for pre-cancerous screening etc. I cannot believe Aetna would deny women the right to have this screening???

As a result I filed an appeal and provided a letter of medical necessity from my physician and Aetna still denied my claim again.

Aetna is a lousy insurance company that does not care about womens health issues. Shame on you Aetna!!!!!
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yoke on 04/14/2009:
We have just switched to Aetna and I hate it.

Did you get a referral from your primary care for the mammogram? I have never had to get a referral before, with any other insurance company, but Aetna wants one, we just found out.
Hubby has been having knee problems. He went to the doctor who sent him on to an orthopedic. That doctor wanted to do an MRI. Aetna denied the request. The doctor had to fight Aetna to get it approved. Hubby is having knee surgery in a month.
Anonymous on 04/14/2009:
First, women have no 'right' to mammograms. Aetna set their criteria for mammography coverage and explain it in their policy documents. If people would read them, instead of pitching them or tossing them into the bottom of their desk drawer, there would be no unpleasant surprises. It is not an issue of women's health is a typical attempt to force everyone into the same box. There exist other paths to that box.
Many physicians screw up coverage for their patients by failing to get procedures pre-approved. They write letters of medical necessity AFTER the procedure and appear to 'hope to get lucky' in getting paid. There are many legitimate reasons for a woman outside of Aetna's age eligibility bracket to have a mammogram. If those reasons are carefully stated by the physician, the claim will be reviewed and probably be paid. This is particularly true if the procedure was ordered because it will 'almost certainly' prevent a more serious and expensive medical condition down the road. 'Screenings' do not meet that level of 'certainty'. (I doubt Aetna would cover a PSA 'screening' in the absence of other diagnostic criteria for a young, otherwise healthy male.) Simply put, if 'screening' appeared in the letter or the doc failed to carefully itemize the great risk involved in NOT doing the procedure, the claim would not be paid. I am a huge critic of health insurance practices, but this one falls squarely on the shoulders of the doctor and the patient. It most certainly is not a matter of Aetna's failure to soberly consider women's health issues. Sorry so needed to be said...I hope it explains how this works.
Former Aetna Subscriber on 01/22/2013:
The patient certainly does have the 'right' to any procedure. Aetna collects premiums for patient coverage. In this case they did approve the procedure and paid, then recinded the payment. Patients don't get that opportunity.
ginny on 02/04/2014:
This is my second time with breast cancer..Stage 2 and now Stage one. Aenta will not cover my mammograms and other tests, I fight with them every luck
I have to pay and pay.....the reps. on the phone are not trained very well and offer me uneducated answers. they are a joke company and are not running a tight ship!
For now I am stuck with them, but beware .....don't get cancer , you will be in the poor house!!!
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Charged more than non-insured person because we have insurance
Posted by on
MINNEOLA, FLORIDA -- I had to take my 13 month old son to the emergency room because he fell with the handle of a spatula in his mouth and bled profusely from his nose. Luckily by the time we got there, it stopped bleeding. We stayed 2 hours. The doctor finally arrived and looked in his mouth with a flashlight, and pronounced him fine.

We have private insurance through Aetna because this is $83/month vs. $400 per month to add him at my work and $900 per month to add him at my husband's work.

When we got the bill, the doctor charged $209 to look in his mouth. Fine. Then they added on an "insurance adjustment" of $69 and the Amount to Pay stated $278. I called and asked if the "Doctor Charges" were $209, how could I possibly owe more? They stated that uninsured people would just pay the $209 but insured people pay a fixed fee that is pre-arranged with the insurance companies, and my insurance company's arrangement is $278.

I stated I do not wish to claim this on my insurance - I wish to outright pay the bill as if I had no insurance. They told me that is not possible because I obviously do have insurance and you can't elect after-the-fact not to use your insurance.

This sucks big time! Has anyone ever had this problem? I am afraid if I pay just the $209 it will be turned over to collection and hurt my credit record. Please advise.
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spiderman2 on 08/15/2008:
I don't understand why you would not want to use the insurance that you pay for.
yoke on 08/15/2008:
Do you have to reach a deductible before your insurance pays the rest?
It does seem unfair that you have to pay a higher price than someone without insurance.
jenjenn on 08/15/2008:
I believe the "insurance adjustment" should have been a credit and not a debit, leaving you a responsibility of $140. Did you receive an explanation of benefits from Aetna? If not, request one immediately. I believe the facility made a mistake on your account. This doesn't make any sense.
jbarber8 on 09/12/2008:
I did call Aetna, and the doctor. I thought it was an error too - since in the past the fee I have paid through insurance has always been lower than the total charge from the doctor, even when I had a deductible to meet. I found out that Aetna has negotiated a 'Fixed Fee' situation at our hospital. If you have Aetna insurance and you go to this emergancy room, you are going to pay $278, no matter what the actual bill is!

This should be illegal, or should be the actual doctor's charges whenever the actual charges are lower than the negotiated fee. Or should have a chance to 'opt out' but the problem is you don't know the charges until the emergency situation is long over.
sore on 01/07/2009:
I would advise you to avoid any further agony/anxiety.
I would make arrangements with the hospital or doctor's practice to pay a small payment each month (which they will agree to).
By going this route, you will avoid harassing calls and letters from collection agencies.

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