I believe that a Psychiatry doctor within my Aetna Network is no longer licensed or have an active license in Texas. He has a NPI and Medicare number and part of multiple insurance networks. But, I cannot find an active license for Texas and Aetna actually says that they do not verify if a doctor is still licensed?? This is not good! Would you assume that a doctor is active if he's a part of a network?

I have a health plan with Aetna, and for specialist office visits, the copay is $65. For outpatient diagnostic testing, there is no charge, no copay, and no deductible applied. I went to my specialist's office for a blood test with a nurse, without seeing the doctor. A few weeks later, I received a bill from the doctor's office showing that I owe $65. I called my doctor's office, and the finance department said they billed using CPT code 36415, which is correct. Then I called Aetna, and a representative said, "Because the lab is an in-house lab at my specialist's office, if I go to a doctor's office for outpatient diagnostic testing, the $65 copay applies since I received a service from the provider." Is this correct? I had blood work done at other specialists' offices last year without seeing the doctor, and I wasn't charged the $65 copay. Did Aetna change their terms this year? Has anyone had a similar experience? Is it normal for Aetna to categorize diagnostic testing done in a specialist's office as a doctor's visit?

Update: Thank you for all the responses and suggestions. This is my first time ever dealing with insurance so was a little confused. I believe I have figured out what the issue was. I was seeing an in network gynecologist and they requested I get an ultrasound. The gynecologist had me scheduled with the hospital but said I can cancel and find another provider to try and find a cheaper place. I found an imaging clinc that says online that they take Aetna and so I scheduled with this place. They took my insurance information and I called them 3 times prior to my appointment to confirm the price of the service. They had stated the service was $245 every time I called and that I wouldn't owe anything more then that. I went to the clinic and before getting the ultrasound done again asked about the price. They said it would be $245 and so I swiped my card. I asked again if I would get another bill later and they said no that this is all that I would owe. I did the ultrasound and before I left I had them print the bill. They printed it for me and it shows that the good faith estimate was $245, which is what I paid upfront. A month later I received a bill from the clinic for $400 and upon checking the insurance claim I see $400 going to deductible and another $401 saying "pending or not payable" with my total share being $801. It seems my insurance is not covering anything. I had no idea that they would not cover anything or that this place was "out of network" as it literally says they take Aetna. I was reassured multiple times that the $245 was all that I would owe. I told them many times that I would cancel my appointment if there is the possibility that I would be charged more. The good estimate bill doesn't even show the actual price of the procedure nor how much my insurance would cover. I am so mad. How do I debate? Do I file a complaint? It also seems like my insurance is unaware that I've already paid $245. Please help!!! Another $800 bill on top of the $245 is insane.

My Aetna plan will be removing Miebo from coverage in the new plan year effective 7/1/25. This drug is the only FDA approved drug proven to treat the evaporative component of dry eye disease. There recommending I switch to Restasis , which is a good drug, but only treats the production of tears and not evaporation. Since there is no generic and no FDA approved alternative , are there any legal actions I can consider, or the plan can just do whatever they want and I’ll need to find another company that will cover the plan. The drug is about $800 a month, and while I can make it work, I would prefer for it to be paid for. I could also attempt to back door the European Version EVOTEARS from Germany for $20 a bottle.

I got a MRI done two weeks ago. When I scheduled the appointment the staff told me they didn’t know the amount to be billed since my insurance is a high yield deductible and no copay. They mentioned that if I want to pay out of pocket without using my insurance it would be $500. Fast forward I received a processed claim from Aetna saying that I need to pay $920 and that the X-ray company billed them $1,200. Is there any way to reverse this? I feel scammed by both the X-ray company and Aetna. Can I fight back a processed claim?

Hello, I have Aetna insurance and my daughter was prescribed to go for hypoallergenic formula. I spoke with agents, doctor office submitted required docs and they received a fax saying it’s covered. They directed me to Coram where I can order fomula. Coram and Aetna coordinated and determined I’m covered at 100% Now, in my Aetna app the claim is denied and my share is $6536. I have not received a bill from the provider(Coram). I’m panicking Please tell me if I owe the above amount?

I have aetna cvs hmo. On the app it says I spent zero towards my out of pocket max which is not true since I went to an in network urgent care yesterday and spent $5 for my copay! Once the out of pocket max is met, then insurance covers all medical costs. Also when it says that my insurance will cover 100 percent for all medical services that are covered..when it says covered does that mean covered as in network providers?

My husband had a emergency surgery for his appendix on February. We just received his EOB and it says denied because the provider didn't pre authorized the service and that we shouldn't be billed for it. The bill is $37,000. Our insurance is through Aetna. What does this mean? Do we really not owe anything? Or will the hospital still bill us? TIA Unable to call insurance since they are already closed. Edit: The hospital is in network.

I don’t know if this is the right flair, so I apologize if it isn’t. I’m 26F living in Florida. This is my first time trying to navigate health insurance, so my parents helped me find a plan that would let me keep my doctors and cover my prescriptions (major ones being my neurologist and migraine prescriptions, which are only brand-name). My pharmacy called and said they needed one my prescriptions authorized, so I called my neurologist’s office to have them authorize it. My insurance just took effect this month, so I was also going to update it with the office. We did a search on the Aetna CVS Health portal and my doctor was listed as being in-network, but I was informed that they aren’t. They take Aetna, just not my policy. Because they’re not in-network, they can process the authorization. I guess the online portal isn’t accurate… or maybe something is lost in translation? Is there a definitive way to find providers that will take my insurance? Does anyone else even have any experience with the policy in general?

I live in Texas and have seen the reports about BCBS. I have Aetna insurance, purchased through Marketplace, and today I found out that my primary care provider, physical therapy, and pain management specialist are no longer in-network although they were a week ago. My PCP did not even know that the contract with Aetna was no longer valid - she found out while trying to set up a referral for me. Is this a fluke or is something bigger going on with Marketplace insurance?