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8.07.2007

Aetna is paying for my ultrasound!

I just received an email from the Aetna representative assigned to my case opened through my employer regarding the ultrasound they refused to pay for, and they have agreed to pay for the ultrasound! (see previous posts).

The 20-week ultrasound occurred back in May, and I opened a dispute with my employer in July, after resubmitting the claim and filing a written dispute with Aetna. Here's the text of my last email to my Aetna representative, after they informed me that they would provide me with financial counseling, so I could pay the bill myself (um, no thank you)....
I have no intention of paying for the sonogram myself. From my discussion with the business office at ::sonogram provider::, Aetna has never paid for a sonogram with them and this sounds to me like it needs to be resolved between Aetna and ::sonogram provider's:: service providers and/or billing department (I'm sure there is some type of business relationship there, as ::sonogram provider:: is considered an in-network provider). The fact that this practice has gone on this long sounds like Aetna has no intention of paying for sonograms, despite what their plan documentation says and what their CSRs tell the insured who call.
Here's what I received today from the Aetna representative...
We were successful at reaching ::sonogram provider:: and we secured information over the phone that was not originally submitted. Based on the added medical documentation, we are reversing our original determination. The ultrasound has been deemed medically necessary and appropriate and therefore a covered expense under the terms set forth by the plan design.
I'm still not happy that it took 2 1/2 months for them to pick up the phone and call the ultrasound provider, but I'm glad they FINALLY agreed to pay. It was a lot of rigmarole, and I hope Aetna realizes that the dollar value of the resources used to resolve this dispute likely cost them much, much more than the dollar amount of the dispute itself.

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Comments on "Aetna is paying for my ultrasound!"

 

Anonymous Hazzard said ... (9:19 AM) : 

This kind of thing just makes me angry. I had to have an emergency procedure at 2:00 o clock in the morning a couple years ago. Somehow the insurance company believed I was supposed to get prior approval for the procedure. I was in no condition to seek approval at 2:00 am and I'm sure they wouldn't have been there to take my call. It took months to reason with them and finally get them to cover it. I think they make it this hard because they know a percentage of people won't be this persistent.

 

Anonymous Anonymous said ... (7:14 PM) : 

Hi, I'm in New Jersey and we just recently had the same problem. My 20-week was in May too, then we got the "statement of benefits" claiming that the procedure had been denied as "experimental." They then claimed that the patient is not responsible for the bill unless I signed something in advance stating that I would be (I don't think I did?)

Then today, we got a letter from the hospital stating that they have been trying to get Aetna to pay for 55 days now and no response, so I don't know if Aetna is denying it or just ignoring them.

If you get this comment, could you email me? mjsmoller@yahoo.com. I'd love to know more details of how you escalated it, what documents you needed, etc. so we can take the same steps. Like you, I have no intention of paying.

 

Blogger SavingDiva said ... (3:30 PM) : 

Congratulations on being so persistent!

 

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