I was reading some questions about Aetna's DMO and how ppl are being overcharged. My husband's plan is DMO; we can go to anyone on the list. Found mostly "dental groups" within the DMO program. Meaning a gazillion dentists are employed there as well as "specialty" DDS's . I read on my husbands insurance that Root canals are 100%' referral required, which I got from my PCD. Upon finish of just the RT, i was charged 96.00. Aetna's website shows they paid the Dentist 100% ; so why did the dentist take 96.00? They had to have their butts set on fire to send Aetna a pre treatment letter. I never got that. I got a half estimate of what to expect but the numbers aren't matching up. I have to get my final crown on this RT(been a month now on one tooth) and I refuse to pay what I already did. I hope they don't get ticked after all they probably have 1000 dollars more than they are supposed to have from one tooth. (quoted 1000 per tooth on RT, crown post and whatnot) I think I paid that plus Aetna paid out 1000 as well. Damn, Im in the wrong business. lol Should I take this one step up and write to the Atty. General of my state? Consumer affair fraud dept.? (state : NJ) I think we are being charged for stuff clearly stated to be 100% paid by Aetna. This dental group IS in the list for DMO.
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First turn your Aetna card over and call the member service number. Speak to them and have them explain why you are charged what you are charged and tell them all the payments you have made to the insurance.
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