Can I submit a medical claim after paying up front?

[charis]

My husband accidentally paid a provider directly out of pocket for service without it being submitted to our Aetna insurance first.  I'm not sure why the provider did not submit the claim, but here we are.  Can I take the receipt and submit the claim myself to get reimbursed?  I couldn't find anything on the Aetna website/forms concerning this.  Or do we have to go back and ask the provider to submit the claim and reimburse us?  I'm concerned that we might never be reimbursed for this and/or that it would count toward our deductible.

[raven2963]

It is against regulations for the provider to keep both your payment and the insurance companies.  Call them and requested them to submit the claim for you. 


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[charis]

It is against regulations for the provider to keep both your payment and the insurance companies.  Call them and requested them to submit the claim for you. 


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That is what we will likely do.  I don't think the provider try to keep both payments, but I was thinking it would be quicker if I could do it myself, since we've already paid.  I guess I'll just have to accept that it might be months before we get any money back.  It's been my experience that if a provider doesn't have any incentive to submit the claim, it can drag out.

[ringer707]

I have done something similar to this with acupuncture with Aetna before. The acupuncturist did not accept insurance, but my insurance covers Acupuncture. I paid out of pocket for my visit and had him print me a receipt with the relevant billing codes for insurance. There is an Aetna claims form you can print out and mail or fax in. It was a little tough to find on the website, if I remember correctly. They reimbursed me for some of the cost, not all. Not sure if it had anything to do with me submitting a claim afterwards and the acupuncturist not doing it, or if they just don't fully cover the cost of that type of visit.

[charis]

I have done something similar to this with acupuncture with Aetna before. The acupuncturist did not accept insurance, but my insurance covers Acupuncture. I paid out of pocket for my visit and had him print me a receipt with the relevant billing codes for insurance. There is an Aetna claims form you can print out and mail or fax in. It was a little tough to find on the website, if I remember correctly. They reimbursed me for some of the cost, not all. Not sure if it had anything to do with me submitting a claim afterwards and the acupuncturist not doing it, or if they just don't fully cover the cost of that type of visit.

I was able to find the form, but it looks like we'll need to take it back to the provider to fill out a portion and sign.  It's possible the provider does not take insurance, as in your situation, so I'll try that first.

[ringer707]

If it's the same form I had, I think it said the provider had to fill it out or you could attach a receipt with the relevant information. I did not have the provider fill it out and only filled out my portion and attached the receipt and they still paid me.