akoechlein
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Hi!
I've been working with a billing team on our ABA billing to Aetna. Prior to supplying services, we obtain an authorization for the 4 codes we bill (0364T/0365T and 0368T/0369T). The problem is this: Starting in October, Aetna has denied every claim for 1 out of the 4 kids for "Charges for Educational Services and Training is excluded from coverage under the member's plan". I've tried calling the Provider Relation department, and each time they claim that it was a misprocessing, and it would be reprocessed correctly to pay out (spoilers, the claims deny again). I'm filing a formal appeal today, and the parent is extremely worried that they'll be charged for all this service, which is fair enough.
My question is this: Has anyone else experienced this with Aetna? Our auths are always on the claims, and Aetna even admits they authorized the specific services, and haven't taken it back.
Thanks!
I've been working with a billing team on our ABA billing to Aetna. Prior to supplying services, we obtain an authorization for the 4 codes we bill (0364T/0365T and 0368T/0369T). The problem is this: Starting in October, Aetna has denied every claim for 1 out of the 4 kids for "Charges for Educational Services and Training is excluded from coverage under the member's plan". I've tried calling the Provider Relation department, and each time they claim that it was a misprocessing, and it would be reprocessed correctly to pay out (spoilers, the claims deny again). I'm filing a formal appeal today, and the parent is extremely worried that they'll be charged for all this service, which is fair enough.
My question is this: Has anyone else experienced this with Aetna? Our auths are always on the claims, and Aetna even admits they authorized the specific services, and haven't taken it back.
Thanks!