Back in 2007 I sold an Aetna Managed Care Open Access plan to a client. A $3000 deductible, 100% plan that has done exactly what it was supposed to do.
Back in December, 2013 my client had an accident and has seen an orthopod for treatment. She had already hit her deductible so the claim was paid at 100% ...... until now.
Seems Aetna reviewed the claim and said the doc was not in the Aexcel network. Maybe he is, maybe he isn't. Client called today and told me about the situation. I wasn't in my office. Didn't have access to her file so I promised to get back to her once I had more information.
I have sent an email to my client to get more details, including the doc's name and address. Also asked if she had any information from Aetna indicating they had changed her network.
I am not even sure if they can do that while the policy is still in force.
So basically I don't have all the details but something about this doesn't add up.
Back in December, 2013 my client had an accident and has seen an orthopod for treatment. She had already hit her deductible so the claim was paid at 100% ...... until now.
Seems Aetna reviewed the claim and said the doc was not in the Aexcel network. Maybe he is, maybe he isn't. Client called today and told me about the situation. I wasn't in my office. Didn't have access to her file so I promised to get back to her once I had more information.
I have sent an email to my client to get more details, including the doc's name and address. Also asked if she had any information from Aetna indicating they had changed her network.
I am not even sure if they can do that while the policy is still in force.
So basically I don't have all the details but something about this doesn't add up.
