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 complaint 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.
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 till 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 big shot 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.
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 Synagis (costs about 2500 per shot) and the shots were to be given between Nov and April. These shots prevent bronchitis in preemies. 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-authorization processor not inform the doctors office or the member. We have restarted the paperwork and Starmark says they haven't received the papers. My doctor's 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!!!
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 disc. 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.
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 Aetna 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 women's health issues. Shame on you Aetna!!!
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.