My wife and I are insured by Aetna through her employer. When our policy started in January we started going through the fertility testing process. When checking out our account we noticed an ambulance charge in my name by a provider in the midwest (we are in MD, have never lived outside MD). Never received this service – never ridden in an ambulance in my life!
After several calls with Aetna and the provider and several weeks the claim was finally removed. This process has made it incredibly difficult to understand where we stand with our deductible and outstanding balances over the past couple months.
Not two weeks later and an ambulance claim from the same provider shows up on our account. We contacted HR and benefits rep at my wife’s employer who suggested we report as fraudulent activity. We submitted the false claims to Aetna Special Investigations Unit. The reply to our fraudulent report simply stayed we need to give the provider another chance to correct this before it can be submitted as fraud.
What are our options? I am not confident that this won’t keep happening, and have no idea whether or not our deductible has been met. Would seeking some sort of legal action or guidance be overkill?
submitted by /u/gdsprt
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My wife and I are insured by Aetna through her employer. When our policy started in January we started going through the fertility testing process. When checking out our account we noticed an ambulance charge in my name by a provider in the midwest (we are in MD, have never lived outside MD). Never received this service – never ridden in an ambulance in my life! After several calls with Aetna and the provider and several weeks the claim was finally removed. This process has made it incredibly difficult to understand where we stand with our deductible and outstanding balances over the past couple months. Not two weeks later and an ambulance claim from the same provider shows up on our account. We contacted HR and benefits rep at my wife’s employer who suggested we report as fraudulent activity. We submitted the false claims to Aetna Special Investigations Unit. The reply to our fraudulent report simply stayed we need to give the provider another chance to correct this before it can be submitted as fraud. What are our options? I am not confident that this won’t keep happening, and have no idea whether or not our deductible has been met. Would seeking some sort of legal action or guidance be overkill?
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