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Aetna Claim Collections/Reporting Question

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Aetna Claim Collections/Reporting Question

Hi all,


Back in November I refilled a prescription thinking my old employer's insurance was still active.  Come to find out, it wasn't active anymore and I received a bill from Aetna for nearly $4,000 a week ago.  The bill said to pay as soon as possible to avoid collection efforts.


I have gone back and forth with Aetna, and Walgreens is trying to help find another way to cover the copay.


I called Aetna again to ask how long I have to either pay or have Walgreens resolve the issue before the debt is sold to collections.  The rep from Aetna then said "I am required to inform you that we will not send this particular bill to collections and your credit will not be affected."  I asked her to clarify and she repeated herself.   I said that I intend to pay the bill somehow, but what is keeping someone from not paying the bill if it won't be sent to collections. She replied "nothing, I guess." 


So, my question is...does anyone have a similar experience with this or any experience with insurance claims not being sent to collections?  I'm assuming they still are going to try to get their money somehow right?  I definitley do not want any negative marks on my credit report.


Any insight would be so greatly appreciated.


Thank You!!

Message 1 of 4
Credit Mentor

Re: Aetna Claim Collections/Reporting Question

Hi and welcome to the forums 


Okay, let's break this up, medical can get a bit complicated ( I do have experience)


When insurance is inactive, they don't pay, most pharmacies adjuncate claims on the spot. Walgreens certainly does. 


Did you lose coverage retroactively because I don't see anyone walking out of pharmacy without paying in  full, paying rx copay (or percentage depending on drug tier, or  insurance paying in full.  


Walgreens wouldn't be working with them unless they paid then recouped payment. 


Aetna wouldn't be sending you a bill if they paid, tWalgreens would if recoupment happened.

Aetna would send you EOB, two actually.

One for payment, one for corrected claim. 


So, how did you walk out without paying if insurance was inactive on the day you went to pick up your medication? 


Message 2 of 4
Not applicable

Re: Aetna Claim Collections/Reporting Question

Thanks for the reply.   This whole situation is confusing for me so thanks for bearing with me.


So I left my job in October, and was taking a job with a new company in November.   I was under the assumption that my insurance stayed active for 30 days after leaving my job when in reality it only stayed active through the end of the month.   My insurance at my new company didn't kick in for 30 days after date of hire.


During this in between time, I needed a refill on a medication.  (One mistake of mine was assuming that an authorized refilll meant insurance would cover this refill).  So I submitted for the refill.  I do also have a copay assistance card from the manufacturer of the medication, which is used to cover any cost left over that insurance wouldn't pay.


I'm not sure what happened, but I walked away paying the usual $35 copay for the meds.  Leading me to believe everything was fine.


Aetna explained to me that they likely hadn't received notification from my employer that I had left the company yet, so they approved the medication.

Message 3 of 4
Frequent Contributor

Re: Aetna Claim Collections/Reporting Question

In this situation it would be Walgreens that you owe the money too, not Aetna, since they would be recouping the paid amount from other claims that Walgreens are filing. The corrected claim, if it has not been actioned yet, will reverse the transation.


I also do not understand what's going on here.


Can you post the snail mail communication with all personal data stipped out? And also the Exaplantion of Benefits from Aetna if you have it?

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Message 4 of 4
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