Last Tuesday, I received a call from Aetna because they saw my post from the previous eventing and wanted to get my issues resolved. I really appreciate this and I am very happy that I got their attention after 3 months of phone calls, but sad that it took a nasty old rant to get their attention. In fairness, I will update the good with the bad and as always. . . . the truth too!
I am still awaiting written confirmation but the person at Aetna that I have been working with says that they cleared up the date correction issue that I had with the claim that was sent in with the wrong date of 7/31/2009 instead of 8/31/2009. Thank goodness, one thing is out of the way! It's funny how it took 3 days to fix it after my blog post. Prior to that it was three months of phone calls and frustration!
They still have not cleared up the out of pocket maximum issue though. They say that even with the date resolution claims included above that I am only at about $1300, which is a long way from the $400 they previously told me, but still short of the actual amount I paid and have receipts to prove it. So, I am hoping that can be cleared up quickly since I have the receipts and documents necessary. Also, I'm getting past due notices from 3 doctors, who have been understanding, but I am not sure how long until they decide the want to escalate it. I hope this matter can be cleared up before it affects my credit in a negative way.
I have a appeal hearing scheduled for tomorrow. It's a conference call that I get to call into to present my case. This is for the appeal for more therapy coverage for Chianna, and was already scheduled prior to my blog post last week. I just hope that talking to a committee of people will help my case and I hope they see that I have been treated wrongly by Aetna giving me wrong information and the "insurance run around". Bottom line for my appeal, 2 different representatives from Aetna told me that Aetna would approve more therapy if her pediatrician wrote in a letter stating it was medically necessary, and Aetna still denied the coverage after this letter was sent in.
I feel like behind the scenes there is the scene from The Incredibles movie when Mr. Incredible was working as an insurance adjuster and he was not allowed to approve any claims. I hope that is not really the way it is, but that sure has been the way I have been made to feel. Just sick of being told one thing and then they do another, or being told multiple different things in answer to the same question.
Wish me luck and I will keep you all posted! Thanks so much for reading!