My autistic 4 yo was referred to pediatric occupational therapy last year by his pediatrician. We went weekly for about 8 months. Aetna denied coverage of the last 7 visits, saying that our sessions exceeded the number of visits on the referral. I spoke to an Aetna agent on the phone who informed me that the provider should have told me that we ran out of visits/needed a referral, but they did not and continued to schedule us regardless. Our EOB for these sessions says that we’re not required to pay, but the hospital with the OT clinic just sent us a bill for the first 4 denied sessions at a whopping $665 per visit and I’m sure that the bill for the last 3 sessions isn’t far behind, which will come to about $4445 after the co-pays we paid at the time of the visits.
I’ve called my son’s pediatrician’s office to see if they could backdate a referral as a last ditch effort to get the visits covered, but I’m wondering what else I should do. I’ve never dealt with a situation before where our insurance company says we shouldn’t pay but the provider says we should. I’ve called the hospital billing office but they’re bogged down with calls right now and took my name and ph. number to call me back in 1 business day. Any advice?
edit to add, if it’s relevant: We’re in Virginia on an EPO plan (I think, no out of network coverage w/ PCP and referrals required).
submitted by /u/alkanechain
[link] [comments]
My autistic 4 yo was referred to pediatric occupational therapy last year by his pediatrician. We went weekly for about 8 months. Aetna denied coverage of the last 7 visits, saying that our sessions exceeded the number of visits on the referral. I spoke to an Aetna agent on the phone who informed me that the provider should have told me that we ran out of visits/needed a referral, but they did not and continued to schedule us regardless. Our EOB for these sessions says that we’re not required to pay, but the hospital with the OT clinic just sent us a bill for the first 4 denied sessions at a whopping $665 per visit and I’m sure that the bill for the last 3 sessions isn’t far behind, which will come to about $4445 after the co-pays we paid at the time of the visits. I’ve called my son’s pediatrician’s office to see if they could backdate a referral as a last ditch effort to get the visits covered, but I’m wondering what else I should do. I’ve never dealt with a situation before where our insurance company says we shouldn’t pay but the provider says we should. I’ve called the hospital billing office but they’re bogged down with calls right now and took my name and ph. number to call me back in 1 business day. Any advice? edit to add, if it’s relevant: We’re in Virginia on an EPO plan (I think, no out of network coverage w/ PCP and referrals required).
submitted by /u/alkanechain [link] [comments]Read Morer/HealthInsurance