Don’t understand Aetna’s Commercial Prescription Drug Claim Form – Help
Hi all, I recently switched from BlueCare (TN Medicaid) to Aetna after relocating to another state for graduate school and enrolling in my university's student health plan.
Unfortunately, due to my lack of familiarity with how medical insurance works, I didn't realize you had to update both the doctor and pharmacy of a new insurance policy, so I accidentally sent four months' worth of prescription claims to BlueCare, which won't cover them. I only found out about my mistake when they started sending letters stating my claims were denied.
I talked to Aetna about getting the claims resubmitted to them, and they told me to fill out a "Commercial Prescription Drug Claim Form" and submit it along with the receipts of the prescriptions. I have two questions about filling out the form, and here's a link to the document so you can see what I'm talking about:
https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/individuals-families-health-insurance/document-library/commercial-prescription-drug-claim-form-english.pdf
I know that I'm the "patient," but who is the "employee" mentioned in the boxes in the first section? I'm a private individual attempting to have my own prescription claims resubmitted to Aetna, so I don't understand what an "employee" or anyone besides me has to do with this in the first place. I can't find a different form online, and I was sent this form by two separate Aetna employees, or otherwise I'd think it was the wrong form. In the box where it asks why I'm manually filing these claims, one of the options is "emergency." The other two options are obviously inapplicable for me. What counts as an emergency here? Does it have to be physical, or do financial and/or psychological emergencies quality for consideration? I don't need the meds to stay alive, but I'm already facing severe financial strain because of a separate situation, and I fear the added negative effects on my mental health if I can't fix this.
Any other advice you might have is appreciated as well. Thank you!
submitted by /u/JareBear313
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