Not understanding why my medication isn’t being paid for [USA] [25 y/o]

So I’ve ran into a very frustrating and complicated situation and am looking for advice.

Some backstory:

Like my chart at the bottom indicates, I was on my parents medical coverage all of last year, technically until 10/30/22. I say technically because I started a new job on 10/31/22, this job offered medical plans to employees, however I didn’t actually enroll in a medical plan through them until very late last year (~12/29/22).

Despite this, I have been made aware that all insurance coverage via this employer is backdated to your start date, being 10/31/22. So I’ve come to understand that my parents insurance plan actually became secondary on that date.

Why this is a problem:

I routinely get what I would consider extremely expensive medical care for my chronic illness. This treatment is typically ~$11,000 every 6-8 weeks. I usually pay hardly anything out of pocket thankfully, but because of this insurance switcheroo, my provider has let me know I may be responsible for the majority two of my bills, this is because while they have paid the admin costs for the treatments, my new plan is declining to pay the part of the claims responsible for the cost of the drug (95% of the total cost)…

From what I’ve been told, this is because there was no precertification/preauthorization under my new plan, for the drug itself. I don’t understand why this is an issue because I already had preauthorization from my provider on another AETNA plan… To my knowledge this is basically just the doctor saying that I actually need said drug, and I’ve been on it for 8 years at this point…

I had two of these treatments “improperly” and am responsible for the payment of the drug administered on these dates.

– 11/7/2022: I had this treatment before I had even elected a medical plan with my new employer, so to my knowledge it was processed correctly to where I wouldn’t have to pay anything. HOWEVER, when I elected medical coverage with my employer on 12/29/22, this claim had to be reprocessed because it retroactively made my parents plan a secondary according to Aetna.

I have no idea how I could have handled things any differently other than just.. not getting my treatment because I switched jobs? To my knowledge at the time, I was only on my parents plan at the time of treatment. I didn’t have any other insurance. Now they are telling me I have to pay because at the time I was on insurance I didn’t even buy yet? So frustrating…

– 1/6/2023: No authorization for the drug.

What I have done now:

I haven’t received any treatment since 1/6/2023 and my provider is not scheduling any further treatments until this is all sorted out.

2/22/23: I have called Aetna and appealed both of these claims, citing all the information I’ve shared here. They said it can take 30-45 days to hear back though.

I have also called my employer healthcare plan advocate, they did suggest another solution. Supposedly I could ‘back out’ or ‘delete’ my healthcare coverage through the employer. This would force all the claims up until this point on their plan to be processed under my parents again, except as primary. Can anyone confirm if that is a real thing?

My only concern with this solution is that I went to the emergency room, using my employer’s insurance as primary, on 1/25/23. The total bill was $5,512.50 and I did not have to pay anything out of pocket or any co-pay. I’m concerned about how this claim will be reprocessed under my parents plan if I elect this option to back out my employer coverage. I’m pretty sure the place I went is not in network under my parents plan but is under the employer one.

So that sums up where I’m at up until this point. Looking for any practical advice, actionable solutions, or really anything to help me get this sorted out so I can 1) start getting the medical treatment I need again and 2) hopefully not be set back 10’s of thousands of dollars.

DatesPlan(s)1/1/22-10/30/22Solely on my parents medical coverage, Aetna10/31/22-presentPrimary: Aetna through my employer, Secondary: Aetna through my parents