HMO Coverage for Child

[kencyber]

I signed up for a company-sponsored insurance group plan through Aetna insurance (HMO plan) here in San Diego. The enrollment form that I filled out, lists my wife and daughter as having the same primary care physician. This physician is a specialist in internal medicine.

We believed that our pediatrician that we have been seeing was our daughter's primary care physician. It is only now, after 8 days of hospital visits, 2 emergency room visits and numerous check-ups that the doctor has called us to tell us our primary care physician is wrong.

I have contacted the insurance company and my human resources department to try to get this resolved but to no avail. The insurance company indicated that all of my hospital bills would not be covered and now they want me to fax a copy of the enrollment form. I have reason to believe that most of the bills have already been paid by my insurance provider. Should I fax this form or would it just give my insurance provider reason to deny my benefits?

 

[cbg]

I'm confused. Did you list the pediatrician or the internal medicine specialist on the enrollment form? If it was the internal medicine specialist, why did you believe that the pediatrician was the primary care physician? Am I missing something?

 

[kencyber]

I guess I enrolled my child with an internal medicine specialist but after talking to my wife I thought that we had my daughter signed up with her pediatrician. So you could say that the mistake was definitely mine. The troubling thing is that nobody notified us of the error after numerous doctor and hospital visits.

The identification card for our daughter only has the doctor's phone number and does not list anything else such as the doctor's name or address.

 

[cbg]

Who was supposed to notify you? And how were they supposed to know it was a mistake?

 

[kencyber]

And who is cbg and what do those letters stand for? Is it in your nature to ask lots of questions? Are you qualified to answer any questions in this forum?

Nevermind, I will figure it out myself

 

[cbg]

Kencyber, I'm trying to help you but I don't understand where you're coming from. And yes, as a matter of fact, after 5 years of working for a managed care company as a service rep and 15 years in Human Resources, I think I am qualified to answer. The reason for the questions is to get information that I need to answer your question accurately.

I don't understand who you think was responsible for telling you that there was an error. The insurance company? Your employer? The doctor's office? Likewise I'm not sure how they were supposed to know that you wrote the wrong doctor's name down. I'm not being sarcastic; I'm asking what I think are relevant questions, sincerely.

If you don't want my help, fine. If you do, perhaps you might help me help you by answering the questions?