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Insurance company health provider problem

Seven On Your Side
August 5, 2011 7:45:09 PM PDT
A woman was caught in the middle between the insurance company and a health care provider.

A Queens woman got stuck with a big bill, she couldn't possibly afford.

"The pain I have now is deep sharp pain goes down my back," Linda Nieves said.

3 Slipped discs and six surgeries haven't kept Linda Nieves down.

She works full time as a mailroom supervisor for a major bank, but when her back started bothering her recently, her doctor sent her to physical therapy and a chiropractor to address it right away.

"Now I get hit with a bill of $4,500, I don't have money to pay it," Nieves said.

That's $4,505 after going to this in-network medical center her insurance company Aetna recommended.

Her claim for multiple visits was denied because Aetna claimed New York Medical and Diagnostic Center didn't submit her paperwork on time.

"Aetna's saying they didn't receive it," 7 On Your Side's Nina Pineda said.

"That they didn't receive it, that it was 120 days late," Nieves said.

The clinic provided copies of mail logs and written correspondence to prove the paperwork was submitted , but at the same time put Linda in collections for not paying her bill.

"And it's on my credit report and I sent all the paperwork," Nieves said.

7 On Your Side went to the facility to see how Eyewitness News could help.

The clinic immediately removed their patient from collections and requested her credit report be wiped clean of the debt.

But the center still couldn't get Aetna to pay for the physical therapy and chiropractic care.

The insurance company also added it never received a referral.

"And I told them, 'How do you treat someone if you don't get a referral? Why would you keep treating them?" Nieves said.

"They usually don't let you in the door without a referral," Pineda said.

"Exactly, and I it gave to him," Nieves said.

"Who do you blame in all this?" Pineda asked.

"It's like the clinic, the clinic, they're saying that they submitted it right, but Aetna's saying that they didn't," Nieves said.

7 On Your Side appealed to the insurance giant directly, resubmitting all the documentation.

"Nobody wanted to listen to me and finally I got 7 On My Side," Nieves said.

Aetna informed Eyewitness News that errors occurred between the care provider and their vendor which processes claims, stating their member Linda should have never been billed and is not responsible to pay that $4,505 and apologized for all the difficulty she experienced.

"Thank you so much for working on this case, thank you so much," Nieves said.

"We just want you to get better," Pineda said.

CONNECT WITH NINA PINEDA AND 7 ON YOUR SIDE

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