Consumer Alert: Arizona woman gets doctor's bill for 100% covered visit

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by Gary Harper

Bio | Email | Follow: @GaryHarper3TV

azfamily.com

Posted on August 24, 2012 at 6:30 PM

Updated Friday, Aug 24 at 4:52 PM

PHOENIX -- Annette Wilt cherishes her kids and of course their health.  So she makes it a priority to take all three of them to their doctor for their annual wellness visit just to make sure they stay healthy.

"You try and keep them healthy and happy," Wilt tells 3 On Your Side.  "It's hard to get by these days but we do the best we can."

So Wilt made the appointments with the same physician she's been taking them to for years now.

"I told the office I just needed to get a regular check-up and whatever shots they need for school," Wilt said.

Wilt said the wellness checks for all kids were supposed to be covered 100% by her insurance company, Aetna, plus there was no deductible.

But although Wilt thought she had to pay zero out of pocket, she found out otherwise when the doctor's office billed her nearly $150 on her credit card that they had on file.

"The next thing I knew, there were three debits from my checking account for $46.96 each which I wasn't anticipating," Wilt said.

Confused, Annette contacted Aetna, thinking there must have been a mistake.  And this is what the insurance company told her.

"Your doctor charged you for osteopathic manipulation and they pulled up the description on it and it's basic chiropractic services," explained Aetna.

Wilt was floored, claiming she'd always taken her kids to the same doctor and he's always done the same exam, including osteopathic manipulation.

However, this time it stood out separately on a bill and it was always included in previous wellness checks.

"He cracked their back. He did the same thing he's done every other check-up, he did look at their back and crack their back but I didn't know that was chiropractic services," Wilt said.

Wilt said she was frustrated. She couldn't understand why she was being billed for something that was usually covered.

"Are you saying that I have to know to tell a pediatrician when I take my kids in not to touch their back," she wondered.

Aetna said the "Osteopathic Manipulation" or the "back cracking" that her kids had is not considered part of their routine wellness visit and since Wilt is under a different policy from year's past, then it's very likely her current policy just doesn't cover it.

That's bad news for Wilt  Her doctor's office won't waive the charge and Aetna says they're not responsible.  

"Once again we have one pointing fingers at each other and the only one affected by it is me," Wilt says.

Aetna said physicians should always notify consumers when something is outside the parameters of a routine exam. 

By the same token, consumers should look through their insurance handbook to make sure what things are covered before they arrive at the doctor.

 

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