So in 2019 my wife and daughter were covered under Emblemhealth through her employer, but she was paying like 250 per paycheck. I got a job in July of that year with Aetna coverage where i was only deducted 26 per paycheck for full family coverage.
In October of 2019, she went to a podiatrist with our Aetna card. They took the card, insurance covered it, or so we thought, and she got the care she needed.
Flash forward to 2020. We got a bill from the podiatrist. Apparently they saw that she was also covered by emblem, so Aetna was refunded what they covered, and emblem denied the claim. We did not know this could happen since neither of us know much about this shit.
Now i am trying to send the bill to Emblem as i was advised, get the “explanation of benefits” form from Emblem, send that with the bill over to Aetna so they can cover the bill.
My question is, whats the explanation of benefits form look like? Isnt it that regular form that explains what is covered and for how much? Like this one? https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/plans/individual-and-family-plans/plan-documents/2019/Individuals%20and%20Families/summary-of-benefits-and-coverage/EmblemHealth-Gold-Value-D-Summary-of-Benefits-and-Coverage.pdf
We are trying to reach emblem but if thats all i have to send AETNA then i can do that without talking to emblem, which sucks ass by the way.
submitted by /u/ARC1019
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So in 2019 my wife and daughter were covered under Emblemhealth through her employer, but she was paying like 250 per paycheck. I got a job in July of that year with Aetna coverage where i was only deducted 26 per paycheck for full family coverage. In October of 2019, she went to a podiatrist with our Aetna card. They took the card, insurance covered it, or so we thought, and she got the care she needed. Flash forward to 2020. We got a bill from the podiatrist. Apparently they saw that she was also covered by emblem, so Aetna was refunded what they covered, and emblem denied the claim. We did not know this could happen since neither of us know much about this shit. Now i am trying to send the bill to Emblem as i was advised, get the “explanation of benefits” form from Emblem, send that with the bill over to Aetna so they can cover the bill. My question is, whats the explanation of benefits form look like? Isnt it that regular form that explains what is covered and for how much? Like this one? https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/plans/individual-and-family-plans/plan-documents/2019/Individuals%20and%20Families/summary-of-benefits-and-coverage/EmblemHealth-Gold-Value-D-Summary-of-Benefits-and-Coverage.pdf We are trying to reach emblem but if thats all i have to send AETNA then i can do that without talking to emblem, which sucks ass by the way.
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