PCP Continues to NOT submit my referrals and I keep getting bills due to Aetna failing to pay

Last year, I had an inconclusive mammogram, and my PCP referred me to get a second mammogram and ultrasound if that was still inconclusive. I had both done and thankfully, everything was okay. However, I was slapped with a 2,000+ bill from the care provider because Aetna wouldn't cover it due to "no referral." I went back and forth between my PCP's office and Aetna for over 8 months… my PCP said that "referrals are in the system, and it is fine, and we don't need to submit the referrals because they're in the system," and Aetna said, "There are no referrals and they need to submit them."

I finally worked with a patient advocate for this year's mammogram (and ultrasound because it was likely I'd need to get one with my breast tissue as it is), and she assured me that they sent in the referrals to Aetna before my mammogram and ultrasound this time and all should be okay. They also comped my 2,000 bill but said that would only do it this one time.

Well, it's been two months since my procedure, and I just got a bill for 2,000!!! I also had to see an ENT for dysphagia last week and noticed on my Aetna claims page that I also owe 900 dollars for THAT appointment to whom I was also referred (and had an order put in on My Chart).

I'm furious. I've never had these issues until I changed jobs and insurance to Aetna. I don't even know where to start with this — I don't understand why this keeps happening, and I have no idea how to prevent it. I can't keep begging my PCP's office to submit referrals every time I have to see a specialist because I already did that for my mammogram this year, and I am still being denied!

If anyone can provide help here on what I can do so that I don't have a logistical and financial nightmare to deal with for months every time I need medical care, I'd really appreciate it.

submitted by /u/SilverCirclet
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