need to escalate a complaint on Aetna. how?

[Semidevil]

so we have been dealing with aetna for over a year now about abill. not going into details, but here is the situation:

we had a service done, which was supposed to be covered by Aetna(per the dr's office).
Aetna sends a letter giving partial coverage.
I call aetna, complain, and they refile the claim.

I recieve a bill with 0 balance, paid in full.!

4 months later, Aetna sends another bill. looks like they somehow tooktheir money back, and not provding full coverage.(maybe check was not cashed, I dont know how they got money back).

I call complain, they wont budge.

I call the dr's office, and the dr's office calls aetna.

dr's office calls me back saying the bill is now reduced by 75 dollars, but the reason they did not cover full was because of missing documentation.

I did everything on my part and sent in missing documentation and sent a email complainig to them, demanding they call me back by 7/19 for explanation for all this.

they emailed me back saying they will get back to me, but no phone call yet.

I want to escalate this. where can I take this? do health insurance have some kind of department of insurance that regulates them?

what do I do?

I tried to call their number and speaking with a superior but they all have voicemails!

 

[DrPizza]

The answer probably varies by state. In NY, if you can show that you diligently pursued everything and it was the Dr's office at fault, then you're not held liable for the bill (provided it should have been covered by the insurance company.) (My wife used to work in a hospital in the department responsible for all the insurance stuff.)

 

[Tiamat]

oh man... i hate aetna. They gave me this same bullsh1t over a 55k$ hospital bill. In my case, they purposely did not help with any of the paperwork which allowed them to claim they were missing documentation, namely my medical records. Lucky for me, they decided to cooperate just before I had started seeking legal consultation.

Good luck, they will drag their feet for as long as possible.

 

[DrPizza]

(Oh, I probably should add though, diligently pursued means jumping through hoops as you are now doing - you won't owe a penny in the end; if they ultimately decide to decline it, your Dr's office has to eat the cost. In general, they don't do that to often though - if they piss off Dr's, then Dr's stop accepting that form of insurance.)

 

[Analog]

I would pursue it through the Dr.'s office then the insurance company. Whenever you talk with someone, get a name and document who you talked to and when. If you have it in writing, then it will be hard for them to argue.

 

[RaiderJ]

Sounds like a case study off of Sicko. Sucks! Damn insurance companies.