About 10 years ago, I enrolled in Aetna. Ever since then, I have ran into the same situation over and over again. It has nothing to do with the ACA because this has been going on forever and a day. If I knew then what I know now, things would have been easier.
Whenever I was looking for a doctor, it was a huge fiasco. I will tell you right now that life was easier without insurance because the doctors make it difficult for you to use it. Like all insurance companies, there is a list of doctors that you can go to. When I called Aetna to make sure the doctor was in network, they referred me to the doctor. The doctor wasn’t sure so they referred me back to Aetna and then Aetna would refer me back.
Why would they do that you ask? I had the same exact issue when I had Blue Cross Blue Shield. I did nothing, but play phone tag. It should be as easy as setting up an appointment, but when you have insurance it is not that simple. Then I had the same issue with Cigna. I even called Cigna to see if Primary Health was in network or not, I even called Primary Health. They both said out of network. Two months after the appointment, I found out they were in network.
I am going to tell you the secret on how to resolve this issue if you have not figured it out already. The trick is knowing who your network is and this will make most of the troubles go away. If you go out of network, typically you pay higher. You get lower coinsurance or none at all. It doesn’t matter whether you have a PPO or HMO plan. It matters what network you have. It drives me crazy when a provider states, “Well, we take PPO plans.” NO!! They have to be able to answer whether they are in a specific network because the insurance coverage is different when they are not contracted with that network.
Knowing this would have saved me the copious amount of phone calls and headaches. If you have insurance and want to go to the doctor the first thing you need to know is who your network is. Typically it is on the insurance card. Then you can look for doctors to go to. Last, your only responsibility is to call the doctor and ask, “Are you contracted with this network.” If they do not know, it is THEIR responsibility to call the network and ask if they are contracted with them. It has nothing to do with knowing what your coverage is and it has nothing to do with the insurance company. It has something to do with the doctors knowing who they are contracted with.