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

by IFadmin

Urgent Help Needed: Confusion Over Double Insurance (Kaiser/Aetna)

I’m 19 years old and started working at Costco in July 2024, which is my first job that offers health insurance. I was automatically enrolled in health coverage without realizing it, and now that the opt-out period has closed, I’m stuck with it. I live in the DMV area and my insurance is with Aetna.

Before this, I was on my father’s Kaiser Permanente insurance provided by Home Depot. Without my parents knowing, I began using Kaiser’s services in October 2024 to access online therapy and psychiatric appointments, which led to my ADHD diagnosis and medication prescription. Unfortunately, my family is not supportive of my mental health treatment.

Recently, when I tried to book an appointment with my therapist, I was denied. It turns out Kaiser has been denying coverage and directing claims to Aetna since October 2024, resulting in unpaid claims for about six 15-minute sessions at $250 each. While these therapy sessions are in-network for Kaiser, they are considered out-of-network for Aetna.

Additionally, I’m facing a bill for an annual check-up with my primary care physician at Kaiser, which lists $834 in lab work. I suspect this is due to Aetna denying coverage, but I’m puzzled as to why the bill is going through my father’s insurance.

I’m really confused about how this coverage is working and how to navigate the communication between the two companies. I would greatly appreciate any guidance on where to begin and what questions I should be asking them. I can’t get new medication prescriptions without more therapy sessions, and I’m feeling the impact already.

Here are a few questions I have:

  1. Am I going to have to pay for the therapy sessions out of pocket? Will any payment be transferred from Aetna to Kaiser since Aetna is denying coverage? Or will neither cover it?
  2. How will this double coverage work throughout the year? What steps should I take to ensure I’m covered?
  3. Will I need to go through re-evaluation to get new medication refills?
  4. Most importantly, what essential questions do I need to ask to clarify my situation? What should I inquire about from each provider?

I realize some of these questions may require specific details about my coverage, but any guidance you can offer would be incredibly helpful. I’m juggling full-time college along with 30 hours of work each week, and I’m feeling overwhelmed by all of this.

Thank you to anyone who can provide assistance—your help means a lot to me.

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

  1. First off, I’m really sorry to hear about the situation you’re in. Dealing with health insurance can be incredibly confusing, especially when it comes to double coverage. Here are some steps and questions you can utilize to help navigate this:

    Understanding Your Coverage

    1. Contact Both Insurance Providers:
    2. Call Aetna: Explain your situation, including your prior coverage with Kaiser. Ask them why they are denying coverage, especially for in-network services.

    3. Contact Kaiser: Make sure they know you have Aetna and discuss any coverage they can provide based on that, given that you have been consistently using their services.

    4. Questions to Ask:

    5. For Aetna:
      • Why is coverage being denied for therapy and lab work?
      • What is their process for handling overlapping insurance plans?
      • Are there specific providers that Aetna would cover for mental health services?
    6. For Kaiser:
      • Can you clarify why you’re being billed if Aetna is denying coverage?
      • Is there an appeals process for the denied claims?
      • How can they coordinate with Aetna to cover your costs?

    Managing Costs and Claims

    1. Payment Responsibility:
    2. It’s possible you might have to pay out of pocket if neither plan covers the sessions due to the overlapping coverage. Confirm with both insurers about your obligations.

    3. Find out if you can appeal Aetna’s decision, especially if the services were initially considered in-network under Kaiser.

    4. Annual Check-up:

    5. Clarify with Kaiser what specific lab work is being charged and whether Aetna has a different approach or gets billed differently for the annual check-up.

    Prescriptions and Future Appointments

    1. Medication Refills:
    2. Ask your therapist if they can facilitate a temporary provision of your medication as you sort this out. They might know your situation and be able to provide guidance.
    3. Discuss with Aetna whether you need a new prescription or a new diagnosis on file for continued medication.

    Follow-Up and Next Steps

    1. Organize Your Information:
    2. Keep records of all your interactions, including dates, names, and any claim numbers.

    3. Create a timeline of events so you have a clearer picture to refer to as you communicate with both providers.

    4. Other Considerations:

    5. Look into the possibility of using a “primary” insurance and what that means for coverage and billing. In many cases, one insurance might take precedence over another.
    6. If you feel overwhelmed, consider reaching out to your college’s health services; they may have a caseworker or advisor who can help.

    Emotional Support

    Finally, please remember you’re not alone in this and it’s okay to seek support. Talk to someone about what you’re going through—whether that’s friends, family, or a counselor. Your mental health is important, and it’s crucial to care for it during this stressful time.

    By taking these steps, you should be able to clarify your coverage and find a path forward. Good luck, and I hope things get sorted out soon!

    Reply

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