Quote:
Originally Posted by Shelley
Hey guys,
I am having treatement on left frozen shouler that has been developing other problems including some TOS pain.
My employer switched from a PPO plan to a POS open access plan with Aetna and there have been some issues because Aetna's computer program screwed up the group number. Because of this programming issue they are not paying my doctors and telling them I have no insurance coverage when I do. If the docs actually call they see that I do have insurance but when claims are submitted they are denied.
This has been going on for 2 plus months now and its getting ridiculous and Aetna does not know how to fix the problem and I am getting the runaround. These docs want to get paid and they are looking to me for payment. One is even going to collections becasue he does not care what insurance says.
Is there someone that I can report them to? Should I consult a lawyer? Will a threat like that even carry any weight?
Any help is appreciated.
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Ok, let me get THIS STRAIGHT. CUz this stinks to high hell, to me, and not you, Shelley, the insurance company.
First, you have some injuries to your left shoulder and possibly TOS (vascular or neuro?) Neuro TOS is one of the hardest and costliest work comp claims.
So firstly, if these injuries were caused by your work, they are supposed to be paid by a work comp insurance company - not a "PPO".
That's what I need to know, otherwise, I am not getting this story straight in my mind yet. And Shelley, while my pain is not sky-high, I'd like to help some.
God bless.