Thanks in advance for any help! My son had a neuropysch exam and testing done about 18 months ago. Our insurance company (Aetna) paid the claim. Now, Aetna has reached out to the provider saying that Cotiviti Healthcare has performed an audit and has determined that the procedure was not medically necessary as he didn’t meet “medically necessary conditions” and are requesting payment for the nearly $4,000. Is this something that we’re going to have to pay? Or is there a way to go about getting details on why he didn’t meet the specific conditions? We are in MA and this is a high deductible plan that I get through work. Thanks for any advice!
Edit: I found out about this when the provider emailed me saying the insurance company contacted them asking for a refund. Not sure why they wouldn’t contact us directly?
submitted by /u/SoxFan8765
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Thanks in advance for any help! My son had a neuropysch exam and testing done about 18 months ago. Our insurance company (Aetna) paid the claim. Now, Aetna has reached out to the provider saying that Cotiviti Healthcare has performed an audit and has determined that the procedure was not medically necessary as he didn’t meet “medically necessary conditions” and are requesting payment for the nearly $4,000. Is this something that we’re going to have to pay? Or is there a way to go about getting details on why he didn’t meet the specific conditions? We are in MA and this is a high deductible plan that I get through work. Thanks for any advice! Edit: I found out about this when the provider emailed me saying the insurance company contacted them asking for a refund. Not sure why they wouldn’t contact us directly?
submitted by /u/SoxFan8765 [link] [comments]Read Morer/HealthInsurance