Preparing to Send an Appeal (or Dealing with Health Insurance, part 4)
Thursday, a week and a half ago (the day after the last post) I got on the phone with the health insurance people and went over many of the different issues I was experiencing. The first person explained to me how to access all the information online, so I apologized for not realizing that all my info was so available and went to check it out. (The URL for his is: https://member.aetna.com/MbrLanding/login.fcc?TYPE=33554433&REALMOID=06-36d8cb4d-4ac1-44c7-b12d-a80fba4b718e&GUID=&SMAUTHREASON=0&METHOD=GET&SMAGENTNAME=$SM$VpTDdQeU7wjYENtpG34SqCD6x1pnyGMS%2fwM1025WQGa5dTTcHQxurw%3d%3d&TARGET=$SM$https%3a%2f%2fmember%2eaetna%2ecom%2fMbrLanding%2fRoutingServlet%3fcreateSession%3dtrue .)
The site could be nice. It's very well laid out and easy to navigate. However, the details for the medical claims leave something to be desired. If I look at the details for the "Hospital Incidentals" for my big operation, it has two different places which say "Your Responsibility" at the end of the table, but they have two different values. I called Aetna up again and asked about this discrepancy. Of course, the lady on the other end had to put me on hold, then go figure out what was going on. All the details were naturally not on the page. They were covered in the Explanation Of Benefits (EOB). There's a link to View/Print the EOB, so I clicked on that. I got the following message:
"Your Claim Explanation of Benefits (EOB) is not available. We will send you an email when your EOB is ready to view/print. Please use Email Options on your Personal Profile page to update your email address, if necessary."
Great. My EOB isn't ready to view yet. It's small wonder I haven't received any of these in the mail aside from the one that I had in my hands (covering the Otolarynologic foundation bill). I asked the lady why this feature wasn't working online for me, and she had no idea (she was completely nice, as people always are). She said the best thing for me to do would be to send me another copy of all the EOBs. (Another? I hadn't gotten them the first time!)
She suggested that I file an appeal, using the grounds that I'm a grad student on a limited income. She said to first wait until I had the EOBs in front of me, then file. I received them on Saturday. I have more questions on them (which I'm about to call and ask) but I'm running quickly out of time. I am leaving for Germany for a summer internship on Wednesday and as far as I know, I won't have a phone or Internet access in my room there. Meanwhile, my credit rating is certainly going to continue to plunge!
Okay... calling now...
... at least, I will be when I find a working phone here...
That was very unhelpful. Apparently once you exceed the maximum benefits for a surgery, Aetna also stops performing any negotiations on your behalf. Thus, instead of negotiating down my $4,167 bill (usually they're capable of negotiating it down to 60% or so) they left it as is and forwarded it on to me. Since doctors and hospitals usually expect this round of negotiation with insurance providers, that initial price is often jacked up. Awesome.
The same is apparently true with my $14,000 bill. The insurance company applied its contract with them, but, since the bill went over $5000, the limit of cost was breached and negotiations were not employed.
Now to call Argent and see if they can get the Pathology people to send me a bill (since I still haven't gotten one). I got the voicemail box from the Argent people. I left them a message, though I will likely try calling them back.
Who is next? Oh, I need to ask the Boston Medical Center about the Anesthesia charge showing up on one of my bills. I don't know what this is for, since I already dealt with the actual anesthesia bill and paid my part for that.
Hmm, that line rings and just keeps ringing. No hold, no machines, just ringing. I'll wait until 2 so that lunch breaks are all done.
More later :-\
The site could be nice. It's very well laid out and easy to navigate. However, the details for the medical claims leave something to be desired. If I look at the details for the "Hospital Incidentals" for my big operation, it has two different places which say "Your Responsibility" at the end of the table, but they have two different values. I called Aetna up again and asked about this discrepancy. Of course, the lady on the other end had to put me on hold, then go figure out what was going on. All the details were naturally not on the page. They were covered in the Explanation Of Benefits (EOB). There's a link to View/Print the EOB, so I clicked on that. I got the following message:
"Your Claim Explanation of Benefits (EOB) is not available. We will send you an email when your EOB is ready to view/print. Please use Email Options on your Personal Profile page to update your email address, if necessary."
Great. My EOB isn't ready to view yet. It's small wonder I haven't received any of these in the mail aside from the one that I had in my hands (covering the Otolarynologic foundation bill). I asked the lady why this feature wasn't working online for me, and she had no idea (she was completely nice, as people always are). She said the best thing for me to do would be to send me another copy of all the EOBs. (Another? I hadn't gotten them the first time!)
She suggested that I file an appeal, using the grounds that I'm a grad student on a limited income. She said to first wait until I had the EOBs in front of me, then file. I received them on Saturday. I have more questions on them (which I'm about to call and ask) but I'm running quickly out of time. I am leaving for Germany for a summer internship on Wednesday and as far as I know, I won't have a phone or Internet access in my room there. Meanwhile, my credit rating is certainly going to continue to plunge!
Okay... calling now...
... at least, I will be when I find a working phone here...
That was very unhelpful. Apparently once you exceed the maximum benefits for a surgery, Aetna also stops performing any negotiations on your behalf. Thus, instead of negotiating down my $4,167 bill (usually they're capable of negotiating it down to 60% or so) they left it as is and forwarded it on to me. Since doctors and hospitals usually expect this round of negotiation with insurance providers, that initial price is often jacked up. Awesome.
The same is apparently true with my $14,000 bill. The insurance company applied its contract with them, but, since the bill went over $5000, the limit of cost was breached and negotiations were not employed.
Now to call Argent and see if they can get the Pathology people to send me a bill (since I still haven't gotten one). I got the voicemail box from the Argent people. I left them a message, though I will likely try calling them back.
Who is next? Oh, I need to ask the Boston Medical Center about the Anesthesia charge showing up on one of my bills. I don't know what this is for, since I already dealt with the actual anesthesia bill and paid my part for that.
Hmm, that line rings and just keeps ringing. No hold, no machines, just ringing. I'll wait until 2 so that lunch breaks are all done.
More later :-\
posted by Kyle at 10:33 AM
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