A local college offers its students health insurance through Aetna and one particular student has this Aetna policy as 1° and HMA as 2°. The student health plan stipulates that after $500 has been paid out to any providers within a specific field of medicine Aetna will no longer act as 1° which is the case with this particular student.
Claims submitted to Aetna have resulted in denials with an EOB stating Aetna is not the 1° and omitting any reference to already paying out $500. Submitting claims to HMA results in a denial and an EOB with verbiage about not being 1°. Over the phone HMA tells me they need something in writing declaring when and to whom Aetna paid out the $500. Aetna reps adamantly refuse to provide any such documentation and point the finger back at HMA saying they should contact provider services with the student health plan and request the information.
HMA refuses to contact anyone, however, they suggest a possible solution which is to have the patient call Aetna's member services for the student health plan and request a letter from Aetna identifying when and to whom the $500 was paid. The patient sends the letter to the provider, who forwards it to me, and I fax it to HMA.
My questions are:
Is it really necessary to get the student involved in this process? Are there alternative paths to get these claims paid which do not burden the student?
It has been a long time since I was a student and recall less than I probably should, but I do remember enough to realize this is something a student should not have to deal with.
