Coverage Confusion

I'm in process trying to determine coverage for an outpatient medical procedure in Virginia and can't clear answers from either the insurance company (Aetna) or provider whether it will be covered in-network. The medical group (VCU) itself is confirmed in network with Aetna.

I had to cancel my initial booking at location A/ to be performed by doctor A when Aetna told me that although the doctor was in-network, he was not in network at that location. I was advised what locations were in-network, and rebooked accordingly at location B/ and was assigned doctor B (doctors are seemingly assigned to procedures at random/ per availability), but am now told that doctor B is not in-network at location B, though is at location A, and that doctor A is actually in-network at location B.

The medical group is an administrative mess (they've admitted as much to me) and doesn't seem to be able to answer any in-network/ coverage questions. Aetna customer support doesn't seem much better (I've been told different coverages/ answers by different reps at different times).

Questions are:

– Do you expect this is just administrative confusion and that similar procedures/ doctors with the same medical organization are actually covered in-network across locations?

– Any tips for effectively escalating this with Aetna? I asked for that on a recent call, but haven't received the escaled call back after a week. I did reach out to my office's insurance broker as well who has helpfully reached out to their Aetna rep/ Provider Relations and is awaiting a response.

– Any tips for escalating this with the provider? I don't expect any success here, but I'm curious if there are any questions I can ask that might help clarify.

I can try to rebook matching in-network locations/ doctors, though frankly I don't trust Aetna's information at this point, and rebooking would push the date back even further.

Any help is appreciated!

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submitted by /u/tabaplar
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