Friday, March 5, 2010

Insurance Update

I am pulling my hair out over this insurance crap!!!!
Yesterday afternoon I get an email from the Aetna dept who is working on the case about the out of pocket maximum issue and they say that the reason they have that we did not meet the out of pocket with them is because on the days that Chianna had 2 therapies, the therapy place should have only charged us one co-pay!!! He says I have a $300+ credit that the therapy place owes me.
It does not make any sense whatsoever! It's two different therapies: speech & physical therapy with 2 different therapists. Not that I WANT to pay more, but it just makes sense that would be 2 co-pays. To make matters worse, if I knew that were the case, I would have insisted that she had speech and physical therapy on the same day the 2nd time during the week or an hour of therapy instead of 30 minutes, which often does not seem like enough. The schedule was: Mondays: speech and aqua therapy, Wednesdays: physical therapy and Thursdays: speech. The reason why we didn't have them on the same day was because the therapists didn't have openings, but if that were the case, then I would have treated the situation differently. It was already an inconvenience to go there twice, but it also broke things up for Chianna, so I didn't really protest to it.
I had some questions about it and should have known that something was "off" when she started OT at this other new place, because there, she gets 1 hour, and it is only one co-pay of $50, where as if she went 2X per week for 30 minutes each, it would have been 2 co-pays = $100. I had just chalked it up to different places do things differently or whatever. So, I am stuck in the middle and seemingly getting screwed every which way here!
Of course, I got the email from Aetna after 5 yesterday and the therapy place was closed, so I had to sit and stew about it all night long. I called the therapy place first thing this morning but had to leave a message, the office manager wasn't there.
I am hoping they make good on this. It even further complicates EVERYTHING! I owe them money, besides the credit that I now evidently have, and I am grateful they have worked with me and not insisted on payment while I work everything out with Aetna, but at the same time, she should have been getting hour long sessions rather than 30 minute ones!
Until I talk to the therapy place and get everything straightened out, I don't know what to think and what is right. I don't know whether the therapy place screwed up (intentionally or not) or whether Aetna didn't clarify the terms of service to them. Certainly no one clarified it to me, I never received anything from Aetna regarding the therapy coverage and what I was entitled to get etc. etc. Maybe it is in the giant book of fine print, and I guess that's my fault for not reading it, if it is there. The only thing that Aetna told me is that I get 60 consecutive days of coverage and that it is $50 co-pay per visit. They didn't say how long the visits are or anything like that. The therapy place had told me that Aetna had a restriction on how much therapy Chianna could have was one hour max per day that they would cover. And it turns out, that at the therapy place, the co-pay was not $50 because of a deal they have with Aetna my co-pay responsibility is less and varies. I originally had paid them $50 per visit for about 2 months until the therapy place realized it was wrong and issued me a credit. Last year, the payments were $37 for PT, $43 for Speech and $47 for Aqua. Now this year it is $37 for PT and $50 for speech.
My insides feel twisted and my head hurts! When I got the email last night, I didn't know whether to scream or cry! I was really upset about it, because of how it complicates all these issues even further.

I have to say that I am very happy that Aetna has finally figured things out and got back to me about it, but I still have to throw in there that if this were figured out sooner, it would not have ballooned into such a problem with a domino effect on other things, including my level of stress!
Next week, my dad and I are meeting with a rep from ADP and looking at different insurance plans from Aetna and different insurance companies so that we can see which is the lesser of the evils and go with that one. That is one aspect that I feel lucky and have some control over, my dad & I make the decision of what insurance we carry for our company, so at least I am in control of one thing!

Just keeping my readers, friends, family & commiserators up on the events. I hope to have more details hashed out by the end of business today!

If you are reading this for the first time, this is only a piece of the puzzle and the drama that we have been put through. You can see details on this whole insurance debacle with Aetna on my blog: and if you would like to help, feel free to link to the blog and share my story with anyone and everyone who will listen. I am not just doing this for me and my family, I am doing this for all the families who have been wronged by Aetna and other insurance companies who make it their policy to deny claims in hopes you will not notice, make it hard enough to fix problems that they hope you will give up, and state incorrect things over the phone just to get you to shut up and hang up and then they do not stand behind what was said.


Anne said...

OMG Shari I need a drink after just reading this, I can't imagine having to actually deal with it!!! I sure hope this all gets worked out for you soon!!!

Tammie said...

I'm with Anne. I need a drink & so do you my friend! Pop rock martinis are on me. Name the night!

I really hope that Aetna & the therapy place get their act together. Even though Aetna is "working" with you, I still believe the media needs to be involved to get them moving. As for the therapy place, it sounds almost as if they were working with the info they got from Aetna.