Need Advice Urgently — Double Insurance Confusion (Kaiser/Aetna)

by IFadmin

Urgent Advice Needed: Confusion with Double Insurance (Kaiser/Aetna)

Hi everyone,

I’m 19 years old and started working at a local Costco in July 2024. This is my first job that offers health insurance, and I didn’t realize I was automatically enrolled — a mistake on my part, I know. I live in the DMV area, and my insurance is with Aetna.

Before this job, I was covered under my father’s health plan through Kaiser Permanente, provided by Home Depot. Without my parents’ knowledge, I’ve been using my Kaiser benefits since October 2024 for online therapy and psychiatric appointments, which are covered under their plan. I’ve been diagnosed with ADHD and have been prescribed medication; unfortunately, my parents are not very supportive of mental health treatment.

Recently, I tried to make an appointment with my therapist, but I was denied. It turns out Kaiser has been denying coverage for my therapy sessions and deferring the costs to Aetna since October 2024. The unpaid claims have accumulated — I’ve had about six 15-minute sessions billed at $250 each. Even though the therapy is in-network for Kaiser, it’s considered out-of-network for Aetna.

To complicate matters further, I received a bill for an annual check-up with my primary care physician at Kaiser, totaling $834 for lab work. I suspect this is also due to Aetna denying coverage, but I don’t understand why the bill is coming from my father’s insurance.

I’m feeling utterly confused about how to navigate this double coverage and would appreciate any guidance on how to proceed. I need to ensure I can get the care I require, as I’m already feeling the impact of missing therapy sessions.

Here are some questions I have to get started:

  1. Am I going to have to pay out of pocket for my therapy sessions? Can the payment shift from Aetna to Kaiser, given that Aetna is denying coverage? Will neither insurance pay?

  2. How will my double coverage work for the rest of the year? What steps should I take to make sure I’m covered?

  3. Will I need to be re-evaluated and re-prescribed to get refills on my medication?

Most importantly, what fundamental questions should I ask to get clarity on my coverage? What should I inquire about with each insurance provider?

I understand some of these questions may be difficult to answer without more specifics about my coverage, but any guidance in this complicated situation would be greatly appreciated. I’m a full-time college student working 30 hours a week, and I’m feeling quite overwhelmed.

Thank you so much to anyone who can help — it truly means a lot!

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One thought on “Need Advice Urgently — Double Insurance Confusion (Kaiser/Aetna)”

  1. It sounds like you’re in a really challenging situation with your health insurance and mental health treatment. Here’s a structured approach to help you navigate this confusion:

    1. Understanding Your Coverage

    • Contact Both Insurance Companies: Reach out to both Aetna and Kaiser Permanente. Have your Member ID ready for both plans. Ask them specific questions about your coverage:
      • Confirm the status of your coverage under both plans.
      • Ask why your therapy sessions are being denied by Kaiser and how Aetna factors in.
      • Understand what your benefits cover under each plan and especially what is considered in-network vs out-of-network.

    2. Questions To Ask Each Provider

    • For Kaiser Permanente:

      • Why are my claims for therapy being denied?
      • Is my mental health treatment covered under my father’s plan, and are there any specific steps I need to take to file a claim?
      • Can I still access services under Kaiser even with dual coverage?

    • For Aetna:

      • Why is Aetna deferring coverage to Kaiser, and what does that mean in terms of billed services?
      • How does Aetna handle situations of dual coverage?
      • What steps should I take to ensure I am accessing the appropriate services covered?

    3. Therapy Sessions and Medication

    • Payment for Therapy Sessions: It’s likely that if Aetna denies coverage, Kaiser may not cover those charges either since they are treating Aetna as the primary insurer. You may have to pay out of pocket unless you appeal the decision. Ask both providers about the appeals process.
    • Refills for Medication: You may not need to be re-diagnosed, but it depends on the pharmacy and the specific guidelines of both insurers. Ask your therapist if they can provide a prescription or if you can get a telehealth appointment to avoid repeating the diagnosis process.

    4. Future Steps

    • Manage Your Coverage: Keep a record of all communications with both insurance companies, including dates, times, and names of representatives. This will help if you need to escalate your case.
    • Seek Assistance: If it feels overwhelming, you might consider asking for help from your college’s health services or a legal aid organization that specializes in insurance issues.
    • Explore Financial Options: If necessary, look into any financial aid programs or reduced-cost options for mental health services until you can sort out the insurance mess.

    5. Emotional Support

    • Seek Support: Since you’re already feeling overwhelmed, it might be helpful to talk to someone about this outside of therapy—a trusted friend or family member, or a college adviser. They might help you keep perspectives and manage your stress.

    This situation can be confusing and frustrating, especially while balancing work and school. Take it one step at a time, and don’t hesitate to lean on available resources for support. You’ve got this!

    Reply

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