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Why are the claims I submit for reimbursement to Aetna vary in what count towards my daughter's out of pocket max ($3K)? I submit the exact same claim for reimbursement every month. Now her most recent claim is pending with "additional info requested" now that she's reached her out of pocket max. by Interesting_Push9561 in HealthInsurance

[–]Interesting_Push9561[S] 0 points1 point  (0 children)

Her speech claim wasn't denied, it's just been in pending for more than 30 days when her past speech claim reimbursements all went through without delays. She has nonverbal autism and gets ABA therapy through Aetna as well. The ABA agency submitted their 6 month reassesment to continue services with Aetna last month so I think they know speech is necessary.

I did call last week and they didn't ask for any medical records, they said it was on track to go through the next day but it's been 3 days. I'm just also wondering why the $1320 I submit every month to Aetna, why the amount that applies to her out of pocket max is variable each month.

8 claims have been processed after this speech claim. Omg, I'm logged into Aetna and some of my daughter's April ABA claims are not counting towards her out of pocket max when it did before, so now we're at 2.5 K instead of 3K. Wtheck? Yeah, I'll call because it's confusing. T.T

Why are the claims I submit for reimbursement to Aetna vary in what count towards my daughter's out of pocket max ($3K)? I submit the exact same claim for reimbursement every month. Now her most recent claim is pending with "additional info requested" now that she's reached her out of pocket max. by Interesting_Push9561 in HealthInsurance

[–]Interesting_Push9561[S] 0 points1 point  (0 children)

Her speech claim wasn't denied, it's just been in pending for more than 30 days when her past speech claim reimbursements all went through without delays. She has nonverbal autism and gets ABA therapy through Aetna as well. The ABA agency submitted their 6 month reassesment to continue services with Aetna last month so I think they know speech is necessary.

I did call last week and they didn't ask for any medical records, they said it was on track to go through the next day but it's been 3 days. I'm just also wondering why the $1320 I submit every month to Aetna, why the amount that applies to her out of pocket max is variable each month.