Question
Hello,
Last Februaury I was diagnosed with an ectopic pregnancy. I was under Aetna Individual Advantage, and they would not cover the office visits, sonogram and several lab (bloodwork) visits leading up to the diagnosis, though they covered all procedures after the diagnosis. I have been told that up until the diagnosis, my obgyn's office coded these things as a threatened abortion. I am responsible for these charges because miscarriage is considered a "maternity claim," which my policy did not cover.
I have managed to get one of the claims mitigated, where I pay the doctor what the insurance company would have payed them- never mind the $50 co-pay that I gave the office!
I feel that, coding issue or not, the entire event pre and post-diagnosis should have been covered. Is it ethically sound for me to contact my doctors office and ask for the codes to be changed? Should I contact the FTC? I feel that Aetna is acting unethically, as it is common sense that an ectopic pregnancy is life-threatening, and at no point is this type of pregnancy viable or considered a miscarriage. Thanks for your time.
Answer
Hi Claire!
Yes I would call your Dr's office and ask them to change their coding to be more accurate. Definitely worth a shot to get these bills paid.
And you can always appeal with Aetna........I would however start with the Dr's office changing code.
Good Luck!
Tricia
