Aetna refused a contract with the specialist I’m seeing for CPTSD. She has helped me more in 3 months than I’ve been helped in 40 years of other treatment. She charges $120/session, which I’ve been paying since the insurance company pays nothing out of network until deductible is met. I called them and they are telling me that they’re only applying $93/session toward deductible each visit—not the $120 I’m paying. We pay them over $800/month and they pay almost nothing. I’m tired of getting screwed over. Can I sue them?
Probably not. You can take a copy of your health plan or policy and see an attorney. My guess is that $93 Is the most they will pay the type of specialist you are seeing, so they are applying 100% of what they would pay to your deductible. After your deductible is satisfied, theynwould still only pay th $93, and since there is no contract between the specialist and them, you would still owe the balance to the specialist.
My answer to your question is for informational purposes only and nothing contained herein is to create or imply an attorney client relationship. Also, my answer is based on South Carolina and Federal law only. In all cases involving legal matter, i always suggest that people consult a licensed attorney in their jurisdiction.
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