Insurance denying in network claims
Hello, I currently have an Aetna marketplace plan and am having some issues with some claims. I visited a provider back in February twice for a follow up visit. I checked the provider database and it stated the doctor was in network. The claims were then sent to my insurance who denied them because the provider was out of network. I then called and have spoken to a customer representative three times over the phone about these claims. I mentioned that the claims were billed as out of network but that the provider is in network and if they could reprocess them as in network. They put me on hold to check and then they proceed to tell me that the provider is in network and that it was a mistake on their end. They then tell me that the claims will be reprocessed and to wait. The issue is that the first time I spoke to someone about this on the phone was March 20th he told me it would take five business days. I waited more than the five days the claims were still showing up as denied. I called again on April 12th the person told me that I would have to file an appeal and that I would be sent the paperwork through email never got it. I then called on April 15 and spoke to the same person I had spoken to on April 12 and he told me that the claims were showing up as in process and to wait 7-10 business days. I’m getting worried that I will have to pay the bills because more time is passing and am not sure I am doing the right thing as this is my first time going through this. Yesterday I just decided to print out an appeal form and fill it out along with all the documents and sent it to Aetnas fax number. Any advice or guidance on what to do from this point on?
submitted by /u/kipipip
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