we are now into my ninth month of aetna saying my therapist, who is in-network according to their own website when i chose that marketplace plan, is out-of-network.
Replies
I worked at Baylor in residency United Health Care said my Baylor MD was out of network when our baby was born. After getting them to admit they were wrong, I got a bill for half of the prior bill. When I called again, they said they didn't know I was also appealing the baby's part of the bill.
sep 2, 2025, 5:58 pm • 0 0 • view
Top contender for worst major healthcare company My personal favorite was discovering Aetna didn't even have a pediatric anesthesiologist in-network on the entire northern half of the Houston metroplex (roughly 3.5M people, no doctors in-network)
sep 2, 2025, 5:25 pm • 1 0 • view
Anesthesiologists are big on not being in-network for anybody, so when you get surgery by an in-network doctor at an in-network hospital you still get a surprise out-of-network bill. Psychiatrists are another specialty where don't take insurance (or the ones who do aren't taking new patients.)
sep 2, 2025, 5:35 pm • 1 0 • view
"Well, you see sir the provider page on our website may not be up to date." "OK, so why don't you update it?" "Well, you see sir the provider page on our website may not be up to date."
sep 2, 2025, 7:24 pm • 0 0 • view
😡Grrrr!
sep 2, 2025, 5:24 pm • 0 0 • view
Well, we're now into the 5th year since Trump promised he'd release his "tremendous health care plan sometime prior – hopefully, prior to the end of the month." in Aug 2020. So hopefully that will be out soon and all of this will be worked out.
sep 2, 2025, 5:25 pm • 1 0 • view
I had the same experience with Kayser and my gynecologist before replacing my IUD. Their web page still has her on their web page even though I reported the issue.
sep 2, 2025, 5:26 pm • 1 0 • view
Do they practice at multiple locations?
sep 2, 2025, 5:27 pm • 0 0 • view
no, she has her own practice
sep 2, 2025, 5:35 pm • 0 0 • view
I’m actually a medical biller and although I’m not sure how much I can help, I’d be happy to try!
sep 2, 2025, 6:09 pm • 1 0 • view
so I think what aetna did is put my provider on their in-network list when they actually have her billing affiliate on their in-network list and that billing affiliate stopped being in-network on aetna for people on individual policies like me, unilaterally, in january
sep 2, 2025, 8:25 pm • 1 0 • view
what i should have done, immediately, is file change of life status whatever and get a new plan. instead i switched to a plan that costs 3x as much as my old one & still doesn't cover the thing i switched to it for
sep 2, 2025, 8:26 pm • 1 0 • view
I’m not sure how much your therapist’s biller or billing affiliate has communicated with you during this. But if you’re receiving Explanations of Benefits stating she is not in network from Aetna, look for an NPI number. You can lookup the number to see whether that belongs to your therapist.
sep 3, 2025, 12:59 am • 0 0 • view
Or to her billing affiliate. If it belongs to the billing affiliate, you can get your therapist’s NPI using a name search. Then use that NPI and contact Aetna to see if she’s in network on an individual level. If so, I’d ask her biller if they can try billing using her individual information and go
sep 3, 2025, 12:59 am • 0 0 • view
from there. Unfortunately, that’s about the only suggestion I have. I hope this made sense and that this situation gets straightened out for you soon. Dealing with insurance sucks. FYI, this is a link I recommend for searching for the NPI. npiregistry.cms.hhs.gov/search
sep 3, 2025, 12:59 am • 0 0 • view
oh we've gone well past that. I guess the NPI they have assigned to her is not her actual NPI, it might be the one belonging to the payment processor (which, to insurance companies, is basically the provider since it's who you pay and it;'s who they pay)
sep 3, 2025, 1:08 am • 1 0 • view
You are not alone
sep 2, 2025, 8:16 pm • 0 0 • view
ah, the fond memories of having a toothache then going to the dentist listed on the site and oh its out of network but your tooth hurts so you pay cash anyway
sep 2, 2025, 5:20 pm • 2 0 • view
remind me why eyes and teeth are not covered by medical insurance? I feel pretty connected to them.
sep 2, 2025, 5:58 pm • 1 0 • view
nobody ever managed to explain that one to me. oh yeah, on that note, it was entirely separate dental insurance that i was never able to use since i lost my job at the time.
sep 2, 2025, 6:07 pm • 0 0 • view
Deny, delay, deflect, defend. Or, "how Aetna keeps their shareholders wealthy".
sep 2, 2025, 5:56 pm • 0 0 • view