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» LymeNet Flash » Questions and Discussion » General Support » Medical Insurance HELP!

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Author Topic: Medical Insurance HELP!
kelmo
Frequent Contributor (1K+ posts)
Member # 8797

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We just received a letter stating Aetna had discontinued coverage of my daughter (who is over 18) on January 1, 2007.

When my husband talked to HR last year, they stated they needed a "certificate of disability" to prove that she couldn't attend school full time (12 hours).

We jumped through the hoops, and she was denied SSDI. She is now trying to carry nine hours. It's her limit.

They have deducted insurance from my husband's paycheck for the past year, reimbursed the doctor over the past year, and when I called Aetna, they stated she was covered the entire year.

This is bogus. My husband will be talking to his HR rep today about this.

Has anyone had this happen where you had to pay for reimbursed costs for a year when you thought you were covered?

I will have to go back to get another job to pay the medical expenses they will want to get reimbursed for.

What can be done?

Kelly

Posts: 2903 | From AZ | Registered: Feb 2006  |  IP: Logged | Report this post to a Moderator
bettyg
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kelmo, did you get my newbie package earlier?

in back of it is the DISINISSUES, disability insurance issues, web site has wonderful info on filing to WIN SSDI benefits, etc.

go here and sign up; they do NOT have a user-friendly board like us to talk 1 on 1!

There are links to helpful websites found by clicking on 'Links'
on the Disinissues website or by going directly to
http://groups.yahoo.com/group/Disinissues/links

There are many more links, as well as advice and "useful" messages
in the Files area of the website. Go to
http://groups.yahoo.com/group/Disinissues
and click on Files.

after you've signed up and get confirmation or whatever, then you can post.

just copy your post there and ask!
**************************************

2 other things I'd do:

contact Sen. John McCain's Ariz. office staff since he's YOUR senator; and also the house rep for your area. you have to sign a RELEASE OF INFO, but they can look into things for you. Some places are intimidated by them.

they can NOT speed things up, but those folks have to give them MONTHLY REPORTS on what is going on!


other thing to contact Arizona Insurance Commissioner, the watchdog over health/life insurance in your state.


Do you have a question about a insurance company not paying on a claim or reinbursing you? If so you will need to fill out a complaint form on line at

www.iid.state.az.us

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pab
Frequent Contributor (1K+ posts)
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Did you fill out the certificate of disability?

My son is 21 and unable to go to school. Our insurance gave us a form to get filled out by his LLMD. It was a really simple form - only 3-5 questions.

The insurance company accepted the form. My son stays on our insurance. We fill out the form each year.

--------------------
Peggy

~ ~ Hope is a powerful medicine. ~ ~

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kelmo
Frequent Contributor (1K+ posts)
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That's what Human Resources wanted!! But, they wouldn't tell us where to get one! All they said, "we'll know it when we see it".

I will call Aetna tomorrow and see if they will supply one.

Kelmo

Posts: 2903 | From AZ | Registered: Feb 2006  |  IP: Logged | Report this post to a Moderator
kelmo
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I called Aetna today and guess what? The happen to have a certificate of disability. Everyone made sure they were so vague about where to get something like that.

Thank you Pab...if you hadn't told me, I would have insist they look for it. And I had to insist!

I've heard from someone else, that they also conveniently lose it when you fax it to them.

My daughter is almost out of medication. This had all better take place soon.

Kelly

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minoucat
Frequent Contributor (1K+ posts)
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I sent all my communications to the insurance company by certified mail as well as by fax. Having the delivery confirmation really helped in my battles with them.

Yes, our insurance (Aetna! Quelle surprise!) did try to deny pre-approved payments about 7 months into treatment.

We won out in the end but it took piles of paperwork, documentation, and persistence, and the whole thing took over 6 months to resolve. Maybe longer -- I've tried to suppress the awful memories of the stress and fear of that time. You have my complete empathy. Stick to it and fight fight fight.

--------------------
*********************

RECIDITE, PLEBES! Gero rem imperialem!
(Stand aside plebians! I am on imperial business.)



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kelmo
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Certified mail instead of FAX---BRILLIANT!

My daughter will need medication soon. I may have to use the county system to get those. She has already been approved, but we didn't want to use the medicare system. Felt that was for those who REALLY need it.

Well, she really needs it.

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bettyg
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yes, certified mail WITH RETURN SLIP; that's your evidence they received it!

each is a separate charge, but worth it!

good luck battling! [group hug] [kiss]

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kelmo
Frequent Contributor (1K+ posts)
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We sent our certificate of disability to our insurance on Tuesday, received a denial today (friday).

We plan to appeal. This is rediculous. There is no way my daughter can support herself. She is pushing herself to take nine credit hours of college, and they aren't accepting that.

I'm very depressed.

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minoucat
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kelmo -- insurance companies pretty much deny by reflex. Statistically speaking, from the numbers I've seen, at least 70% of the insured never challenge their first denial. Which means the insurance company has made money and relieved themselves of their financial obligations simply by sending a letter.

Another 70-80% don't challenge the second denial. And so on.

It IS upsetting to get into these insurance battles, as well as time consuming, frustrating, etc. But it's often well worth it. I never thought I'd win our appeals but I did. Sometimes you need legal help; sometimes not.

Best of luck. Chin up, and all that.

PS you might find some help in the Resources for dealing with insurance... link. I've just added a new link about insurance advocacy at Families USA Consumer Resources

--------------------
*********************

RECIDITE, PLEBES! Gero rem imperialem!
(Stand aside plebians! I am on imperial business.)



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kelmo
Frequent Contributor (1K+ posts)
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You've given me a ray of hope. It's been a hard evening. I have been so angry with the callousness of the system.

We are going all the way with this...not giving up.

Posts: 2903 | From AZ | Registered: Feb 2006  |  IP: Logged | Report this post to a Moderator
   

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