Question
QUESTION: My husband, my 9 year old son and I went to check-up in different time between March to June, 09. My husband's health insurance, Aetna POS II, denied part of the payment from the blood test. We call Aetna, she said we had to respond of 10% medical and some of them they didn't cover. We told her we went to check-up was consider a routine and we don't know what was the doctor's send to the lab? She said my appeal time was over. My husband and my son still could appeal.
The Doctor's receptionist told us she would take care of it and until now the collector(Quest Diagnostics) call every week. I don't know is it the doctor doing something wrong (coding) or they should check the over before send to the Lab? We call Aetna, the doctor and Quest Diagnostics, they all said they were in the correct procedure. I belive something is wrong because my husband ask around by his co-worker, they didn't have this kind of problem.
I don't believed that my son only go for routine, regular check-up, the Quest Diagnostics charge him for $167.00. The total amount Quest bill us is about $850.00. Now I am afraid to see the doctor and go to the lab! Please help me to solve this problem.
Mei
ANSWER: Mei,
You don't state the reason why Aetna is not paying the entire bill. However, the first place you should look is to verify with them your lab benefits. Do they pay lab at 100%? Do you have to go to a specific lab in order to receive the most benefit? Is there a deductible?
After you determine what your benefit is and you feel that the claim was not paid as it should, then contact the insurance company (claims department) and ask them to adjucticate the claim again based on the fact that it was not processed/paid correctly.
Good luck
---------- FOLLOW-UP ----------
QUESTION: Thank you very much! Aetna don't pay part of it because it is 5% deductible consider medical. I got confuse what is medical and routine. We didn't expected when we went to routine check up, we had to pay that 5%. I concern may be the doctor or the lab billing the wrong coding, that is why Aetna don't pay for 100%. Will it be possible? What should I do? My husband's co-worker don't need to pay 5% when they go to routine check-up! Therefore I believed something is wrong in some way.
Please teach me how I can solve this problems.
Thank You
Mei
Answer
Mei,
You need to make sure that the blood work your husband's co-worker is getting is the same. If it is, is it possible that the co-worker has a different plan? you must compare apples to apples before you can determine if you claim is being processed incorrectly...or maybe the co-workers claim was paid correctly.
Good luck
