Insurance Claims

so i got a notice in the mail from Dekalb Medical which is where i went the last time i fell.  the notice stated that it had been 30 days and they hadn’t heard from Aetna as yet re:payment.  The balance on the account was somewhere between $1500 and $2000 (for a CT Scan) but when i looked at the bottom line “Pay this amount” it was 0.00 so i breathed a little easier.  well that prompted a call to Aetna to find out what the problem is!

First thing i did was check my claims online and sure enough i saw that it was denied – great!  Anyhoo, so i made the call.  Come to find out that it was denied because it wasn’t pre-certified (approved) by Aetna…and then the lady said if it isn’t pre-certified the only time it might be paid is if the doctor diagnoses it as an emergency.  So i said, “well it was an emergency – i’d fallen and was in the ER.”  i was told that since i was coherent I should have told the ER nurse/doctor to make sure and pre-certify the scan before anything was performed.  I told the woman that that was the dumbest thing i’d ever heard.  I mean who has time to think about those issues when u are in an ER and worried about whether or not you’ll come out in 1 piece or what they are going to tell is going on in that body.

while she was spouting off at the mouth, i continued looking at my claims and noticed yet another 1 was denied – the last MRI.  i asked her about that one – and again she told me that it wasn’t pre-certified.  Now that, i’m mad about.  The MSCA had no business doing it without it’s being pre-certified – they ALWAYS do it.  Now y they wouldn’t do that this year?  who knows! 

On the upside, i haven’t gotten any bills from either place (YET?!?)…so I haven’t gotten my panties in a bunch or putting on my armour to go to battlle with anyone – YET!!!