Retroactive claim denial ordeal
Since I changed my job 2 years ago in April 2021, I got an employer sponsored Aetna insurance switching from Blue Cross Blue Shield, sponsored by my previous employer. For two years I never had any issues with Aetna, as it covered all my doctors visits and medical services. Problems began when I got an email from Aetna in April 2023, claiming that over dozen of my previous visits and medical procedures would need to be covered by my old plan Blue Cross Blue Shield. This was nonsense, since I left my old job back in April 2021, and my old BCBS plan was terminated. I then called Aetna immediately, expressing my concerns that there must have been a mistake, and I was convinced my old plan BCBS was terminated. Aetna, however began contacting my doctors whom I visited between Summer 2021-Winter 2023. Aetna demanded refunds from my doctors for over $16,000 worth of claims. I started receiving letters and phone calls from doctors offices, stating that it was now my responsibility to cover for these refunds. While on the phone with my medical provider’s billing department, I was shocked to find out that my old plan with Blue Cross was suddenly re-actived in the system without me knowing. I was told this mistake created a conflict in the system showing two coverages BCBS and Aetna. A person from billing department recommended contacting Blue Cross Blue Shield and request a letter of termination of the plan. The letter served as a proof that BCBS coverage was terminated prior to obtaining Aetna’s coverage. I called BCBS to request a letter of coverage termination, and BCBS representative didn’t even speak to me. They said I must call to my previous employer’s benefits department, since the request to terminate plan needs to come from the employer. I called my former employer HR department and they admitted that the mistake was made and my health benefits and my old BCBS plan were erroneously reactivated. They assured me that they will open the case to cancel the coverage with BCBS retroactively, as it was a clerical mistake. Few weeks later, in early June, I followed up with BCBS directly and they said they didn’t receive a request to terminate my coverage. They also told me that my previous employer contacted them back in March 2023 with a request to reactivate my old coverage, without me knowing. Next, it took me multiple phone calls and a threat of a law suit to finally have BCBS provide me with a letter, correctly stating dates of coverage, ending April 30, 2021. I then provided this letter to Aetna, and Aetna assured me they will re-process all denied claims, resulted due to this error. Two months later, in July 2023, I received an explanation of benefits from Aetna, stating that same claims were again denied. I contacted Aetna again, sent them the letter from BCBS with dates of terminated coverage, and Aetna assured me they will fix the mistake and reprocess denied claims. Today, September 6, 2023, I received a ~$5000 bill from one of my providers. My health provider demands me to repay what was refunded to Aetna, for denied claims caused by this mistake. I’m very tired of battling this nonsense, and I would really appreciate any advice on how to resolve this ordeal. Thanks!
submitted by /u/MargoMargo86
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