How I can get justice on how AETNA INSURANCE threated me on re-inbursement???

Question

I have contacted AETNA before i filled my reinbursement thru phone on toll free. The lady that attended my call asured me that I can file even I am just a beneficiary since all the receipt is under my name and was spend in my country when i give birth to my young son to an american citizen who is the primary member. They made me do all the paperworks and filled it online. since I m here in the middle east. I have couple of emails secure doc, emails and phone calls from internet that proves that they are aware of me filling it. they told me they wil wire to my the money and i gave them all bank info and scan of receipts. I have gone thru all this and turn out they paid direct to the father of my kids back in the US. He spends the money and never give it to me now my debts and promisory notes back in my country still outstanding. If aetna didnt assured me that they will pay me I will not go thru all this ****. ( sorry for this word) I feel i was fooled and maybe ratial descrimination.

Answer 1

Here's the reality check - insurance companies SAY one thing and DO another. Anytime any reimbursement is due to the patient, it goes to the guarantor (main policy holder) on the insurance. That's just how they do it. Otherwise, it would be a bookkeeping nightmare of trying to keep track of the information of spouses and other beneficiaries on every single Aetna policy - there are hundreds of thousands of them, if not millions. It's not racial discrimination - they do it to everyone. Don't go all Al Sharpton here, it's not necessary.

You can not go after Aetna - you don't have a leg to stand on because the insurance is not in your name as the main policy holder. You need to go after the father of your children for payment. You would have a better chance of winning if it were to go to court - you can prove YOU sought the care, YOU paid for it up front, but HE got the money. There's a large enough paper trail for that.

EDIT: (After your edit)

It's not c**p from Aetna. That's their policy. Suck it up. They need legal papers to prove that you're the custodial parent of the minor child and that it's a legal edict in writing that when you lay out payment for medical care and therefore you are entitled to the reimbursement. Otherwise, who's to say that ANYONE can just call (or email) Aetna and ask to be paid for claims? If the way YOU think Aetna should pay out were their policy, then what's to stop me from calling them to get your payment sent to ME? Exactly.

Answer 2

When a reimbursement is due to a patient, insurance companies always reimburse the main policyholder .*

I'm sorry you weren't aware of that, but unfortunately there isn't much you can do about it with Aetna.  They followed proper procedure on their end.

Any legal action you take would need to be against the father of your kids for spending the money that he should have passed on to you.  And I hope you're able to get your money back - its not fair that he spent it!

* The only exception to this would be if there was a Qualified Medical Child Support Order (QMCSO) on file that stated that a minor child's reimbursement should go to the custodial parent.  If you have one of those court documents on file with the insurance company, then you may be able to pursue action with them.  However, I suspect that you don't have a QMCSO, since you don't live in the US.