Medical Insurance Hell

I regularly check my family’s Aetna medical insurance online account to match claims with the corresponding invoices to ensure accuracy. In November, I saw several claims for my husband, for medical appointments and tests that had taken place in September and October, which he’d never mentioned to me.

Staring at the computer screen, I started having a panic attack, because I could only come up with two scenarios for my husband undergoing medical testing without confiding in me: (1) something potentially serious, even deadly, was wrong with him, but he’d been trying to protect me until he knew his exact diagnosis or (2) he was going to hide his for-sure-deadly diagnosis from me for the duration of my high-risk pregnancy, to protect our surviving twin and me from additional stress.

I printed off his claims summary and, without freaking out, of which I’m tremendously proud, asked him about the appointments. He said he was healthy, he’d not been secretly seeing doctors, and he hadn’t even had routine appointments on the associated dates.

Knowing that my sweet husband might try to protect me, but wouldn’t outright lie to me, I cross-checked the dates with my calendar and realized that every single claim was for one of my appointments with the Center for Maternal and Fetal Health, my high-risk pregnancy practice.

So I printed off the complete summary of my husband’s Aetna claims, identifying each of my appointments that had incorrectly been submitted in his name. When I handed the claims summary to the receptionist at the Center for Maternal and Fetal Health before my appointment the following week, she assured me that she would pass it on to the billing powers-that-be.

I never received a phone call, asking for additional information, so I assumed the filing errors had been rectified. And from Thanksgiving to Christmas, I was in crazed organizing and jewelry-making modes, so I didn’t check our Aetna online account.

But then I received a bill, correctly identifying me as the patient, stating that I owed our 20% out-of-pocket portion of the cost of two November procedures. But I’d hit my $2,500 Aetna individual out-of-pocket maximum for the year in August, before my first appointment with the Center for Maternal and Fetal Health. Once I’d reached that maximum, Aetna started providing coverage at 100% for the remainder of the year, so I knew I shouldn’t be receiving a bill for any outstanding amount for 2009.

More on this tomorrow. Too tired to continue thinking and typing…

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