Guaranteed Healthcare

My wife, Stacy, recently gave birth to our beautiful baby boy, Cole (see attached picture from a proud new father). During the pregnancy, my wife was required to submit blood samples for state-mandated genetic screening. Thankfully, the results came back satisfactorily. Unfortunately, the insurance claims did not…

Beginning in March 2008, I began receiving bills to pay $162 for expenses associated with the genetic screening tests. In the “Insurance Paid” column of this invoice, I noticed that my insurance provider, Aetna, had paid $0 and that I was responsible for the entire $162 bill. Assuming this was some sort of error in the billing process, I contacted the California Department of Public Health (with whom I was finally able to connect after 6 or 7 phone calls) to inquire whether my claim had been submitted to Aetna.

They informed me that it had (twice) and that I should contact Aetna customer service directly. According to the Aetna customer service representative with whom I spoke, the California Department of Public Health is an out of network provider. The Aetna representative informed me that I needed to meet a deductible of $300 before they would pay for any medical expense claims associated with out of network providers. So, any Aetna member with our insurance plan (Open Choice PPO) is on the hook for CALIFORNIA STATE-MANDATED genetic testing because one of the largest Departments of Public Health in the United States is an out of network provider!

To say that our health care system is in a state of utter disrepair would be an understatement… I’ve forwarded this message to Senator Dianne Feinstein, Senator Barbara Boxer, Representative Jackie Speier, and GuaranteedHealthCare.org. I’ve also filed a formal appeal with Aetna requesting a sincere apology and full reimbursement of the $162 paid out-of-pocket to the California Department of Public Health. I’ll let you know what, if anything, I hear back. Sincerely, Andy