So i go to an in network walk in clinic and...

[wayliff]

I recently went to an IN NETWORK walk in clinic that belongs to the Sarasota Memorial Hospital. (This walk in clinic is listed in the Aetna navigator as in network)

When I was visiting the room, I specifically asked if they took Aetna and they said they did and I made my co-payment.

I signed all paperwork that was necessary, like other walk in clinics I?ve been to and other doctor?s offices.

When I got my bills, I got a bill from the hospital and in addition one from the physician as well.

The bill from the hospital gets covered by the Insurance however the physician is out of network and therefore I am responsible for the full amount.

When I walk into an emergency room or walk in clinic or something similar, they really cannot expect us to ask the hospital, the nurse, the physician and all the staff if they are within the network to make sure everything is covered.

I feel pretty much like I walked into a trap and they got me ? I signed the paperwork (FINE PRINT) trusting the in-network hospital and Aetna navigator and then I get hit with a bill that is not covered.

The unsuspecting consumer gets it?and it sucks.

 

[Gulzakar]

You could always file a grievance, but since it wasn't an Emergency, you're SOL. It's the duty of the insured to know what's covered.

All you had to do was call the number on the back of your card, ask Aetna if the name of the clinic is covered, and then take it from there.

 

[jagec]

Originally posted by: Gulzakar
You could always file a grievance, but since it wasn't an Emergency, you're SOL. It's the duty of the insured to know what's covered.

All you had to do was call the number on the back of your card, ask Aetna if the name of the clinic is covered, and then take it from there.

The clinic WAS covered. But it seems that one of the doctors that worked there wasn't, if I'm reading it right.

Health care in this country is good quality, but they REAM you on bills.

 

[DBL]

Did you call the clinic and explain the situation? I'd say you have a reasonably strong case. IF they give you a hard time, why not speak with Aetna since they list the clinic as being covered. It seems to me that you were not given correct information and you probably should not be responsible for that.

 

[wayliff]

I have filed a complaint with my HR department and with the insurance Company. I called the biller and they simply said i need to pay.

Yes the clinic was in the network...the doctor who took care of me was not.

 

[wayliff]

Originally posted by: Gulzakar
You could always file a grievance, but since it wasn't an Emergency, you're SOL. It's the duty of the insured to know what's covered.

All you had to do was call the number on the back of your card, ask Aetna if the name of the clinic is covered, and then take it from there.

Even if it is the duty of the insured...i'm sure that if you're feeling sick all you want to get is past the paperwork as fast as possible to get treated.

I looked up the clinic in the Aetna's navigator website and it shows as in network...as well as I asked in the clinic.

 

[jiggahertz]

Originally posted by: wayliff

Originally posted by: Gulzakar
You could always file a grievance, but since it wasn't an Emergency, you're SOL. It's the duty of the insured to know what's covered.

All you had to do was call the number on the back of your card, ask Aetna if the name of the clinic is covered, and then take it from there.

Even if it is the duty of the insured...i'm sure that if you're feeling sick all you want to get is past the paperwork as fast as possible to get treated.

I looked up the clinic in the Aetna's navigator website and it shows as in network...as well as I asked in the clinic.

Yeah, that sucks. My GF had emergency surgery last summer. The ER accepted her insurance but the surgeon who performed the surgery did not.