Aetna is breaking me down

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First. let me start by saying I am a financial dummy and I never kept my checkbook up to date or anything so I probably deserve what's happening to me.

 I have student health insurance (I'm 40, obviously an older grad student) through chickering/ aetna. From the diagnosis (March)  Aetna played a game where they wouldn't call me back, denied I called, etcand all that. I spent thousands from then to now (double mastectomy, cont pain, etc) on copays and other fees. I gave my dad power of to look at my med care site so he could look at the website and my deductible. Now I have been told by my case worker (who I obtained after a woman with a clipboard walked into my room the day after surgery and told me I was only classified as day surgery) and I told a social worker"Aetna wants me to die." When I got my case worker at Aetna she told me I had been allowed 3 days in hospital (which I would have taken, but I hotfooted it out there afraid of bills). But they never called me before surgery or contacted me in any way to tell me this or anything else.

So finally the Aetna person tells me I have met my deductible and out of pocket in May (surgery). Now I keep getting fresh bills from the oncologist, pathologist, surgeon, and they are a lot, with Aetna paying, still, only the 80 per cent. I tried my caseworker who seemed to say that because the bills were only sent out now I owe them because they were incurred before I met the out-of-pocket (even though I met that in payments) and I should have waited to pay bills instead of paying them on time. So now I have paid and am expected to pay on. She told me also that Aetna would pay everything except for "office visits." What isn't an office visit?  I tried talking to my college health rep and the ceo of health care at my college. He told me I was using negative energy and was worried about my mental health because I emailed the Aetna rep that I wouldn't pay these new 1000s and I wanted to take my breastless self and jump out a window. But of course I've had to stop seeing my therapist on a regular basis for money reasons though he is working with me. Kind of ironic... Also Aetna is coming after him for money they say he owes them because he is an in-service provider (he is NOT). The CEO of health said I should focus my energy on my disfigurement instead of these payments.

but I do not want to ruin my husband's credit or mine, though that's less important at this point. My Aetna rep suggested I call all my providers who are billling me and beg them to reduce the charges and tell them "I am a poor student with cancer." I am, but I paid my part I though and it seems humiliating since I paid my max.

I've tried fighting but I'm totally beaten down. I went to the bank to (naively) get all my checks from last August to now (my coverage w Aetna began then ) but it would be a five dollar fee for each check. I'm just depressed all the time cause it feels like I paid what I owed and they still won't be fair. I try to be responsible and do what's right but this is where I'm at.

Comments

  • dreamwriter
    dreamwriter Member Posts: 3,255
    edited July 2009

    Have you considered getting a lawyer who is familiar with insurance companies and the way they operate.  A letter to your worker suggesting that you are investigating legal assistance may actually get you the results you want.  But you have to be ready to hire a lawyer if they call your bluff.

  • lizws
    lizws Member Posts: 1,892
    edited July 2009

    Get all your bills and all your payments.  Create a spreadsheet and do a complete audit of all accounts. Include date of service, fee charged, fee allowed, what insurance paid and what you paid.  Once you see where the money was used towards your deductible and out of pocket it will be easier to fight Aetna.  You can get complete printouts from your doctors and hospitals as well.  Be sure to review your EOB's also.  They will become a huge help in your fight. 

    Send me a PM if I can help further.

    Hang in there. 

  • O3132W
    O3132W Member Posts: 211
    edited July 2009

    Freakless69:  Have you thought of the Insurance Commision of your state.  Perhaps they can help as they are the state regulator governing private insurance companies.  Also, how about a letter to your state representative.  I have heard that they can be very helpful to individuals, especially if they are up for re-election.  Here in Indiana, people complain to our TV stations who when they shine the public light on unscupulas business make waves and things get done.  As hard as it might be, while you are facing the biggest challenge of your life with the least amount of strength, you must gather every bill and piece of medical papers for a battle you should not even have to think about.  So sorry that you have all this to face.   Shame on Aetna Insurance Company.

  • rreynolds1
    rreynolds1 Member Posts: 450
    edited July 2009

    I agree with Freakless69.  Insurance carriers will do anything to avoid bad publicity.  I would also contact the Attorney General of your state.  In Connecticut, he is a bear and went after 2 insurance companies a few years ago and boy were they sorry!  File a complaint with anyone you can such as your state Dept of Insurance, The Better Business Bureau, The Dept. of Consumer Protection.  I would also contact your local news station and see if they will investigate it and do a bit on TV.  I would write an article for your local newspaper on your experience. 

    Most importantly, do NOT let these issues interfer with your healing.  As long as you can get the treatment you need now, don't worry about how it will get paid.  We can't take our money with us when we die and your family wants you more than good credit.  These days not many people have good credit anyway.  Balance the upset with good influences.  Join a support group if you haven't already.  I was never a joiner but cancer changed all that for me.  Do meditation when you feel really frazzled.  It will center you and put your healing to the forefront. 

    God bless!

    Roseann

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