My partner recently had several (about 10) physical therapy visits at an in-network outpatient hospital. My belief was that these visits would cost her $20 per visit and the remainder would be 100% covered by Aetna PPO, because that is what my benefits book says when I look up physical therapy services. Aetna has processed all of these claims to deductible instead, and she is now on the hook for more than $1,000.
When I asked them why they processed to deductible they said it was because the place of service was an outpatient hospital instead of a physical therapy rehabilitation center. When I re-read the section on rehabilitation services, the only mention of place of service was for cognitive rehabilitation services. It does not mention place of service at all for any other rehab services.
I plan to fight this on principle, but I was wondering if anyone has any tips or experience with appealing something not because it was denied but because it was processed incorrectly?
submitted by /u/dangbrist
[link] [comments]My partner recently had several (about 10) physical therapy visits at an in-network outpatient hospital. My belief was that these visits would cost her $20 per visit and the remainder would be 100% covered by Aetna PPO, because that is what my benefits book says when I look up physical therapy services. Aetna has processed all of these claims to deductible instead, and she is now on the hook for more than $1,000. When I asked them why they processed to deductible they said it was because the place of service was an outpatient hospital instead of a physical therapy rehabilitation center. When I re-read the section on rehabilitation services, the only mention of place of service was for cognitive rehabilitation services. It does not mention place of service at all for any other rehab services. I plan to fight this on principle, but I was wondering if anyone has any tips or experience with appealing something not because it was denied but because it was processed incorrectly? submitted by /u/dangbrist [link] [comments]Read Morer/HealthInsurance