Thursday, February 3

Insurance: Gotta Hear It To Believe It

Every now and then you hear a really classic explanation/policy/law that really takes the cake. Guess who's got the cake today . . . haha. Here we go.

Recap: while pregnant, I suffered from (rare) pregnancy-induced asthma. My ob referred me to a pulmonologist for a full battery of tests. The bill: $846.37. Insurance, however, kept denying the claim pending "more information from physicians." In the meantime, the pulmy sent us to collections and we paid up to keep our credit report clean. Now, we are seeking reimbursement personally from insurance. (These tests were from October of 2003. 15 months later, we're still getting the run-around.)

The original statement was that the insurance (Aetna) would need proof of prior continuous insurance coverage to approve the claim. Read the previous entries and you'll see why that route is impossible. I realized, however, that Aetna is treating this as a pre-existing condition rather than pregnancy-related. If they acknowledge it is pg-related, they are obliged to pay up in full without proof of prior coverage. So I tried that tack.

Well, in order to confirm it is pregnancy-related and not pre-existing, they are requesting medical records from various physicans to ensure that I have never before been treated for asthma. Apparently they have been sending out "requests for information" to "two physicians." I wanted to know which two, so I could call their offices and gently remind them to please get that information in the mail ASAP.

"I can't tell you," the Aetna lady replied.

Apparently it would violate federal law to tell me which of my OWN doctors they want more information from. I pointed out that obviously, 15 months later, these offices have dropped the ball or Aetna is using incorrect addresses or or or or . . . I'd like to verify, myself, that the doctors have received these requests and are formulating a response soon.

She still can't tell me.

Well, what do I do now? I wanted to know. I have a finite amount of time before Aetna can deny the claim permanently. I find it ODD that TWO doctors are ignoring these requests. I smell a rat, frankly.

"Well, you can try to call the doctors yourself," she said, "and ask them to forward the relevant records to us."

"WHICH doctors?!" I wanted to know.

"I can't tell you," she repeated.

I asked if she could tell me what KIND of doctors they are-- obstetricians? Pulmonologists? Rheumatologists? (Due to some chronic health issues I have seen a boatload of doctors-- I don't know which two they might have chosen, or why.) I was hoping to narrow the field. Nope, can't tell me. Okay . . . if I guess their names, can you tell me? Nope.

So now I am waiting for two doctors to reply to another plea from Aetna to forward my records. Which two? Don't know.

I even got on the phone and called a few myself. All, naturally, deny receiving any requests for information from Aetna.

I think, my friends, that the $846.37 and I are permanently parted.


At 10:51 PM, Anonymous Anonymous said...

This happened once to me when I got my wisdom teeth out-- the incompetent new intern took 6 tries to hook up an iv.

When the credit agency ladies called I explained the entire thing to them and gave them some numbers to call and *they* worked everything out for me.


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