Aetna/Principal Complaint - Unpaid Claims and Refusal to Pay for Necessary Treatment
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.