Aetna insurance is messed up?

Question

My dad has been in overseas for tha past 2 years.When he made his 2 week visit 6 months ago, for the first time he used his Aetna insurance.He went to the IC Laser Eye Care at Bensalem to simply get an eye examination.The doctor gave him a prescription to get glasses but he never did that because he had to leave the U.S. So just today we get a phone call from their office saying that we owe $400. I called the office, but they said to call the insurance company. I then did that and I asked them what this payment was about, they named 3 things one for "office consultation" $200, one for "visualization" $100, and he said something that starts with the letters "gonoes__"(sorry dont know the rest)I have absolutely no idea what theyre talking about. By the way, they then told me to call back the doctors office and that he's "responsible" to pay for this. Please tell me what I should do to get out of this mess because my dad did nothing more than to get his eye examined which only cost $20...

Answer 1

Don't take the word of the insurance representative. Insist that they send you an itemized bill that details exactly what they say you owe them and what the doctor billed them for. Then take the printed bill to the doctor and ask him to explain the charges he billed the insurance company for, and why. Usually the problem is mixed up records or incorrect coding of procedures. If they won't budge, write a registered letter to the insurance company disputing the charges. Include a copy of the policy that specifies what they charge for an eye examination, and have your dad send a written letter, notarized if possible, detailing that on such and such date he received only a routine eye exam and that no further action was required. If possible, he should schedule another examination with a different doctor so that he will have undisputed evidence that whatever the first doctor charged for, there was no need to do.

Answer 2

I'm sorry you've encountered this insurance nightmare. I've been there, and done that . . .

You need to call Aetna back, and take down the name of the person with whom you're speaking, as well as the date/time. Questions to ask:

1) Verify with Aetna that your father had vision insurance coverage on the date of treatment.
2) Once step 1 is done, ask for details on what the vision coverage actually covered, and how that doesn't map to the bill you received.
3) If you don't receive answers to your satisfaction to step 2, escalate the issue to that person's supervisor, and take that person's name. Continue to escalate -- and take names -- until you have satisfaction.

The bottom line is that if your father was covered by Aetna for vision insurance, there should be no reason for them to not to pay the charges, less the co-pay. I wish you all the best . . .

Answer 3

This is probably an oversight by your previous employer, or Aetna. Regardless, when they realize the error, they can go backwards and cancel the insurance when it was supposed to stop. They will take their money BACK for claims paid on your behalf. This means that any provider will then be owed by YOU for treating you. If you have prescriptions that you filled after the insurance should have stopped, you are responsible for that as well. The best case for you is that when the cancelation happens, it will not be for the Oct 15'ish date.

Answer 4

If you already recieved a bill from the doctor you may want to ask them what you need to do to dispute the charges. They usually have an address that you can write to and explain why you are disputing the charges.

The above advise on contacting the insurance and finding out exactly what was billed, what the benefits are and why the claim was not covered is very good. Definitely ask for a supervisor and threaten to file a complaint if you have to! Also definitely get an itemized bill!

Good luck!

Answer 5

I was strongly considering signing up with Aetna now i'm not to sure. Are you sure Aetna was in that Doctors office network?