Monday, September 22, 2008

Answer to Prayer

Ok I have a love/hate relationship with health insurance. Our health insurance is through Aetna. I picked them because they are an HMO which means I have only copays and know what I'm going to pay before stepping into the building. I had a horrible experience with BCBS. Basically the air ambulance was not in-network so instead of my helicopter ride being covered all the way, we ended up with a $10,000 bill. I was so not happy. One thing I also love about Aetna is that they have the best dental coverage of all the plans we have to choose from. We don't have any in-network dentists but if I call every 90 days to get a pre-authorization, then our dentist is covered. Now let me tell you, every since the helicopter incident I now keep a notebook. In this notebook I write down every time I call Aetna. I write teh date, time and the rep I talked to. Then I write down exactly why I called and Aetna's answer. Yes it sounds over the top but the only way I can make sure my procedures are covered. Anyway, Pablo had a bridge put in over 4 months ago. I called a week before his appt and got our dentist preapproved. Well turns out Aetna screwed up. They gave me preapproval and not Pablo. So I had to call back and give all the info from my first phone call. The rep said he fixed it and back dated it. Well last week I got a call from my dentist office saying the claim was denied again. I was so mad. Aetna has denided serval of my claims lately. Not sure why but they have. So I called and get this. They claimed that I never called for pre-authorization. So I explained the first mess-up in not covering Pablo and covering me instead. They found that and turns out the rep missed backdating it by one business day and that is why the claim was denied. So I explained that a mistake had been made. They actually told me they had no record of my call. Oh I was so mad. So I asked them to appeal it. Thank goodness for that notebook. I had the day, time and rep I talked to the very first time. So they told me they would put the appeal in but to not bank on it being covered. I called back the dentist office and explained what happened and they were as mad as I was. I also had to ask if the claim is denied what do we owe. Get this, if Aetna doesn't pay the claim we would owe $3,000. This year we picked up a 2nd dental insurance because we knew we would have major dental work done. So between our two dental insurances we were only suppose to pay $500. So talk about shock just thinking about paying that huge chunk. Anyway, I got the mail today and there was a letter from Aetna. I knew right away it was a decision about my appeal. Turns out that they are actually going to cover the brige!!!! I didn't explain why but I have it in writing that they will pay their portion. Praise God. You do not know how much I have been stressing out on how to find $3,000!!!! I must have sounded mean enough on the phone when I put my appeal in. Who knows, I'm just so happy they are going to pay for it. You do not know how often I have to call this company and fight with them over claims. But so far they have covered everything. And I've gotten pretty smart on insurance information!!!!

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