Off topic question - Insurance coverage......?

[Guest guest]

Hello everyone,

We are a family living in Michigan and are extremely

frustrated by the way our insurance company, Aetna is

treating us. Maybe someone in the group has been

through a similar situation and would be willing to

share with us what the next steps should be. Any help

or advice is much appreciated.

Here's the situation - Our son who has autism is

receiving services from an out of network provider

from Jan 07 and the first time around when we filed

claims under speech therapy, all of them were denied.

The reason was that speech therapy is not covered in

our plan. However on raising the issue further I

received a call from one of the officers at Aetna who

said that autism " might " be covered and we should send

in our diagnosis letters from doctors and any report

from the out of network provider for proof of

disability and treatment. This was all done almost 2

months ago. They are still not sure if autism will be

covered or not and every time I call the response is

that the committee is still reviewing our information.

In the meantime we have noticed that our other claims

from regular check-ups etc have been not paid in full

either. We are receiving bills from in-network

providers about unpaid claims or higher co-pays. If we

are receiving services from out of network providers

for myself or my husband, the claims are taking much

longer and the reasonable and customary prices are

significantly lower than what we paid out of pocket.

We have received services from the same out of

network providers for myself and my husband last year

as well and were paid based on what our out of pocket

expense was. On questioning this issue the response is

- the reasonable and customary prices are subject to

change from week to week.

So here are my questions -

1. Did anyone have luck getting insurance coverage for

autism? If yes please do share.

2. Did anyone encounter what we are facing right now -

copay increasing and reasonable and customary prices

decreasing after large sums of autism treatment bills

were filed for claims (and those are not covered yet).

Please let me know what you think.

Thanks,

Meeta

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