While I was a student at the University of Connecticut School of Social Work, we were required to have health insurance. If we didn’t have insurance on our own, we had to buy it through the school and the only option was Accident/Sickness Insurance from Aetna Student Health. It was fairly inexpensive – $870 for one person for a year. But the coverage was awful.
I’ve recently been dealing with Aetna concerning $500 in medical bills they won’t pay. I made four calls to customer service and talked to four different people. I was told a couple of different things before learning what was really going on: first I was told that I hadn’t reached the $5000 benefit limit and the customer service representative didn’t know why the bills weren’t being paid. She said she would re-submit them and get back to me. When I called back because I received another bill from my doctor’s office, showing these same bills had not been paid, I was told that I had reached the $1000 benefit limit. I finally found out that Aetna Student health will only pay for three doctor visits per accident or sickness, leaving me to pay the rest. Then I called my doctor’s billing office to let them know this and, out of curiosity, asked how many visits Aetna had paid for. The billing clerk checked her files and told me that only one visit was paid for. So I had to call Aetna again and speak to another person who agreed that Aetna had only paid for one of my doctor visits. He said he would look into it and call me back (I’m still waiting for his response).
I think the health insurance system is designed to force you to be persistent if you want to find out why a claim isn’t paid. Otherwise you just give up and pay the bills that you may not even be liable for. What will probably end up happening is that Aetna will pay for three of the visits and I’ll end up paying for the rest. This is unfortunate because these visits took place between 3/08 and 8/08 and I’m just finding out that I owe money to my doctor. I don’t know if it’s because the doctor’s office billed late or because Aetna took a while to process the claims, but it left me thinking that the doctor visits were covered and all I had to pay was the co-payment. Instead, I’m left with a bill for $500 and a feeling of disgust with the bare bones “coverage” I received from Aetna Student Health.