Referral issue?
I have Aetna HMO. My primary doctor has referred me to 5 different specialists and all of them were paid by the Insurance but the last one. Aetna claims that they never received the referral and refuse to pay. My primary doctor tells me the specialist should have requested the referral, the specialist tells me the primary doctor should have sent the referral. Aetna tells me that I should have made sure the referral was sent to the insurance company and that it's all in the benefit book. This is the first time I have HMO and never received a benefit book. Is there anything I can do?
Thank you.
Update:It's too late for a referral now. It took Aetna almost 2 months to deny the claim.
Comments
WEll, it's probably not too late for the doctor to do a referral now, to cover it. Call Aetna, ask them exactly what has to be done. I'm sure they'll ask for a referral from your doc. Then call him, and say, hey, I need this!! He shouldn't squawk about it.
Probably not. Ultimately, it is the patient's responsibility to make sure the specialist referral has been obtained.