Thursday, September 10, 2009

one of many recent health insurance emails


Dear Ms. Robin:

Thank you for using the Aetna Navigator website to contact Aetna Member
This is in response to your claim question on you for 04/10/2009 for the
amount of $8,844.35 from _____________.

The above claim was processed towards your in-network benefit deductible
of $300.00, and then paid at 80% leaving your patient portion of 20%.

The total patient responsibility is $1,106.74 including the $300.00
deductible. The insurance paid the amount of $3,226.99.

Please refer to your plan summary of benefits which covers outpatient
hospital services at 80% once the $300 individual deductible is met.
Outpatient diagnostic, x-ray or lab services are covered at 80% once the
$300 deductible is met.

Our records indicate that ______________ participates with
your plan of benefits and the negotiated allowed amount for your service
was $4333.73.

The adjusted amount of $4510.62 (the difference between the submitted
amount of $8844.35 and the negotiated allowed amount of $4333.73) is a
provider write-off. You are not responsible for this amount.

We have processed your request for an Explanation of Benefits for you
for the 04/10/1009 date of service from ___________________.
You should receive a copy in the mail in 5-7 business days. You may
also print an electronic copy of your Explanation of Benefits from your
Aetna Navigator secure member website.

The electronic Explanation of Benefits looks exactly like your paper
EOB. Both versions include service date, provider name, bill expense,
amount not covered, remark code (if applicable), etc.

If you have questions, you can reach Member Services by (blah blah blah).

Internet Response Team


Okay, for starters, whoever you are that's writing me back, I understand that you are just a person, like me. But right now, I feel like I'm dealing with crooks -- not you personally, but AETNA. "$8,844.35," "$4333.73," all these numbers you're telling me, they all could've just come out of nowhere for all I know, because nobody told me any of these figures before I went in for that MRI. Do you understand how unfair this is?

So what I need you to do is to please kick this issue up to a higher department at AETNA. Because I have a real problem with the way AETNA is conducting this matter, and I'm not going to let this rest. I am very involved in advocacy and healthcare issues and the way Health Insurance companies conduct their business, and I need my own issue resolved satisfactorily.

Thank You,



Thank you for using the Aetna Navigator website to contact Aetna Member

This is in response to your claim question on you for 04/10/2009 for the
amount of $8,844.35 from ________________________.

Your claim has been paid according to your plan benefits.

You may use the "Estimate the Cost of Care" option on your Aetna
Navigator. You may do so by mousing over "Take Action on Your Health",
then clicking on "Cost of Care". Here you will find the average
contracted rates for procedures such as a MRI. Another option is to
contact Aetna prior to services performed. Provide us with the
physician or hosptial information and the procedure that will take place
and we can provide you with the necessary pricing information.

If you have questions, you can reach Member Services by logging on to and selecting "Contact Us". You may also call
the toll-free number on your member ID card.

Internet Response Team


Yes, but it is too late for this information now that I already have a bill for over $1,000. Aetna needs to have a much clearer protocol in place regarding the cost of medical procedures. My cardiologist told me I needed an MRI. I had no idea I would have to ask AETNA how much this procedure costs before telling my cardiologist "yes, I will take your advice to have this potentially life-saving test you are telling me I need." I have never before had such problems with any insurance. As I say, this whole correspondence needs to be made available to a much higher department than Member Services, because this is a big problem, AETNA's lack of a followable protocol for its members who pay so much money for AETNA's coverage.

I need better customer service, better answers, better corporate accountability from AETNA.


then i printed this all up and sent it to the ceo at aetna's corporate HQ with this at the end of the letter:

What I am getting at here is the fact that your company purposely makes your policies vague in order to, in your opinion, justifiably give your clients figures for what you are and are not deciding to pay for procedures. But it is not justifiable. I had no idea I would have to pay over a thousand dollars out of pocket for a necessary MRI, and if this is the case with your policy, you need to send your customers warnings regarding the possible out of pocket amount, because, as I know your corporation knows, the layman does not understand things like this. Your company needs to get a social conscience.

Because of your purposely vague policies, I now have to prove to Cedars Sinai that I am unable to pay this money, being that my whole household is unemployed, and hope they write me off as a charity case. But that is not why I am writing to you.

I am writing to you because you need to put a more user-friendly protocol in place, ASAP, to stop ripping off your clients. There is NO WAY it would occur to someone, after being told they have to have a necessary medical procedure, that they have to first "use the 'Estimate the Cost of Care' option on [my] Aetna
Navigator. [I] may do so by mousing over 'Take Action on Your Health', then clicking on 'Cost of Care'" to find the "contracted rates for procedures such as a MRI," as your customer service representative belatedly informed me.

What is your excuse for all of this?

why am i telling you all this? a) unfairness is, unfortunately, my obsession, and this whole thing feels unfair to me and b), i really do think that these companies try to confuse us on purpose, and it's not right.


  1. It sounds as though the responses you were receiving were generated form letters that answer questions based on key words that appear in your email. This is even more frustrating since when you pay all this money & they cant even hire a real person to answer your queries.

  2. yeah,,, i've been down this road before, unfortunately (apparently, at ER's these days, the physicians [you know, the doctors you see for half a second, because it's nurses that do the grunt work at ER's]ALSO bill you, in addition to yr co-pay, but nobody at the hospital gives a heads up about that beforehand -- this is an example of one health insurance issue i've spent hours bitching out about). I'm gonna have to get my blood pressure up about a million times trying to get through to someone how unfair it is to be bills after the fact for shit with no warning beforehand until finally i make it to someone with some authority who tries to brow beat me into paying, but since i never have the thousands of dollars they're trying to get, i end up brow beating them into writing me off as a charity case instead of harrassing me with collections companies instead. it's all such bullshit. sometimes i get bills for like ... the lab my bloodwork was sent to doesn't participate in my insurance so now i owe, like $121.24. how did it become the norm to send people invoices out of the blue? without any protocol in place about like, telling us we're going to get billed. it's not like i requested that particular lab to do my bloodwork. these people are total, complete crooks.