LymeNet Flash: Insurance Director Never Looked at Patients Records Before Denials

This is topic Insurance Director Never Looked at Patients Records Before Denials in forum General Support at LymeNet Flash.

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Posted by Tincup (Member # 5829) on :

Uh oh Aetna! Bad, bad, bad and you got caught.

Anyone who had Aetna insurance or any insurance and who was denied coverage should review this article for possible avenues for remedies in your own case.

http://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

Posted by Lymetoo (Member # 743) on :

Can you imagine?

Posted by TrekCoord (Member # 48888) on :

I think (although I can't prove) that there is a check list and someone with a GED is just checking the boxes.

"Aetna, the nation's third-largest insurance provider with 23.1 million customers, told CNN it looked forward to "explaining our clinical review process" to the commissioner."

I'll bet - [shake]

Makes me question the reliability of every other insurance company and their policies concerning treatment.

Posted by Rumigirl (Member # 15091) on :

I have been fighting insurance companies denials, refusals to Preauthorize, etc., etc. on and on into the sunset for decades. They will get away with whatever they can, however egregious the denials are. It takes soooo much blasted time!!

And they are all crooks, basically.

Oxford "reprocessed" all my IVIG claims for last year, claiming that I owed a $50 co-pay per visit, in spite of the fact that my Certificate of Benefits clearly says there is no co-pays for Home Infusion.

I have been fighting it for many months, and they still keep saying that they "processed it correctly." No, they didn't.

So, tonight I spent a ton of time on making a complaint to the state Attorney General's office, when I happened on something on the state AG's website saying that they had a huge case against Oxford

over the last 2 years for Oxford refusing to pay thousands of patients Home Infusion claims! And here they are still at it, in spite of having to pay those claims, pay a huge fine, and reprocess everyones claims. Crooks!

Health care insurance should not be for profit!

I still have a lot of work to do on this blasted set of claims. I'm so sick of it.

Posted by hiker53 (Member # 6046) on :

Rumigirl, Keep at it.

I filed a complaint with our state's attorney general about being overbilled and won back over $6000.

Posted by Rumigirl (Member # 15091) on :

Wow, hiker, good for you!! It takes so much time and persistence! And I constantly have multiple wrong medical bills that they are dunning me for. Quite a lot of it is insurance not covering what they should.

But also, so many entities are wrongly billing me for things I don't owe, that is, billing something as surgery, and therefore charging way more money, when it isn't surgery.

So many hospitals, doctors offices, etc, have their hands in my pocket or in the insurance company's pockets, which, ultimately is my pocket. Endless battles.

But this doctor's testimony is really bad. I am not surprised at all, though.

I spoke to the state AG's office today about my complaint, saying that I saw the case the AG's office had against Oxford for not paying for any patients' home infusion claims. The guy I spoke about my case said, "What else is new?"

I recognized his voice and remembered his name, and he recognized my voice, because I've had to make so many complaints over the years----some of which the insurance companies still managed to not respond to. Maddening.

I need to spend my time trying to heal myself, not waste my time on this stuff, but I have to deal with it.