Don't believe Aetna phone support-Preauthorized treatment denied!

[Anonymous]

Long story short....Went to doc for allergy testing. First time for this. His office called Aetna (Group HMO) to confirm coverage for the treatment.
Aetna phone rep stated covered, deductible/co pay applies, no preexisting exclusions!!! Have documents and testimony from the office to confirm.
CLAIM DENIED...PREEXISTING! I appealed. Lost appeal 1, went for 2nd appeal. Hearing supposed to be scheduled and was. Problem...I was never notified of
the hearing date and time!! Now their saying..."opps, our phone support people aren't perfect"!
Filed complaint with state.
The misrepresentation by the Aetna phone rep cost me $1,400!

[Anonymous]

This is ridiculous! So, they pre-authorized you, giving you full permission to have the test and appropriate coverage. And now they reneged? Absolutely unacceptable. I'm sorry you had this happen.

[Anonymous]

Sorry, OP, but you're likely going to lose. pre-authorization isn't a guarantee of coverage, especially in connection with pre-existing conditions.

The best thing about the ACA is the pre-existing condition exclusion is gone.

[Anonymous]

We get it, insurance companies suck. But you don't need to keep posting this story over and over again.

[Anonymous]

If you didn't get a letter or email or something from their website, it wasn't preauthorized.

[Anonymous]

I had a similar experience with Aetna this past June. According to our benefits, my son is supposed to have unlimited occupational therapy services for habitual services. The OT department and I both called Aetna for pre-authorization of services. After going for two months, Aetna claimed because he is not diagnosed with Autism or Down Syndrome, they did not consider his condition to be habitual. Stuck us with a bill for $400 in services. We got documentation from his therapist and his pediatrician that stated the services were not for rehabilitative purposes. My son was born with his condition and needed occupational therapy to gain life functioning skills. We filed 3 rounds of appeals and eventually won. His services, however, were interrupted for 4 months while we went through the appeals. Unfortunately, after winning the appeal Aetna came back and claimed my son's benefits would expire on his birthday because he would be turning 19. My son was turning 9 not 19. Took another two weeks to fix that fiasco.

Bottom line, Aetna sucks. Get another insurance plan at open enrollment if you can.

[Anonymous]

I have had the same problem with aetna. My daughter continues to have speech therapy covered, but at the end of june last year, they decided that her OT was not covered retro back to April 1. I have no idea how to fight this. We tried getting new prescriptions for the OT with different dx, but nothing worked. Her therapist was nice enough to "write off" the fees for us, but now she's not getting OT. I can't afford it.
Now...after her developmental doc ordered a micro array chromosome test, and it being pre authorized over the phone at their office, then again over the phone to me the next day, it was denied. The test is $2700! I never would've done it if it wasn't covered. They continue to give us the run around. They told us to have it billed under a different procedure and dx code. We did that with the lab. Denied again. We called and spoke to a manager. She told us there is nothing she can see as to why it was denied. She said she'd look into it and call us the next day. She cI alled back, and said the underwriting dept (I think) deemed it "experimental testing", and these are not covered. So of course I got a letter from the ordering doctor that this is a standard of care, needed to determine future dx and treatment. Now I'm getting calls from a collections agency.
Do I need to contact an attorney? I already have a special needs child, I don't need this...

[Anonymous]

Anonymous wrote:If you didn't get a letter or email or something from their website, it wasn't preauthorized.[/quot

A pre-auth must me done through the mail. You must get it in writing from your insurance company. Good luck.

[Anonymous]

Appeal, appeal, appeal

They randomly deny, figuring a large % of people will just give up.

2:00, if you can, hire an attorney to write a letter for you.

[Anonymous]

Anonymous wrote:I have had the same problem with aetna. My daughter continues to have speech therapy covered, but at the end of june last year, they decided that her OT was not covered retro back to April 1. I have no idea how to fight this. We tried getting new prescriptions for the OT with different dx, but nothing worked. Her therapist was nice enough to "write off" the fees for us, but now she's not getting OT. I can't afford it.
Now...after her developmental doc ordered a micro array chromosome test, and it being pre authorized over the phone at their office, then again over the phone to me the next day, it was denied. The test is $2700! I never would've done it if it wasn't covered. They continue to give us the run around. They told us to have it billed under a different procedure and dx code. We did that with the lab. Denied again. We called and spoke to a manager. She told us there is nothing she can see as to why it was denied. She said she'd look into it and call us the next day. She cI alled back, and said the underwriting dept (I think) deemed it "experimental testing", and these are not covered. So of course I got a letter from the ordering doctor that this is a standard of care, needed to determine future dx and treatment. Now I'm getting calls from a collections agency.
Do I need to contact an attorney? I already have a special needs child, I don't need this...

Maryland Attorney Generals office. They helped me win a 20K fight.