Meritain Health

Meritain a subsidiary of Aetnaallows its members to see Aetna providers.

But, on the other end of this, they have paid me perhaps 10% of bills submitted.

Calling them for assistance goes like this:

Me: Hi still you havent paid me, why?

Them: (long convoluted reasons)

Me: can you tell me what steps to take to be paid for my services?

Them: (nonsensical phrases that involve no actionable plan)

Me: I need to speak w a supervisor

Them: (puts me on hold 3 times. Total call time 40min) no one is available, theyll call you later.

Me: what is your supervisors name?

Them: I dont know

Me: youre telling that you dont know the name of your supervisor?

It goes on like this for awhile.

. It all started with signing up for Delta Dental in late June.

Our dentist only accepts Delta so I signed up for it and sent in my July payment coupon along with a check. A few weeks later I received a letter saying that Meritain had gotten the July payment but that I needed to send in an additional 64.43 for the added cost of Delta/ cost increases. They said for prompt attention so I sent in the check right away. That would have been July 24.

I even mailed it from Denver so it might get there earlier.

Today I went in to pick up my prescription and was told that my husband and I have no coverage! We both called Meritain and were told different stories but basically that until Meritain cashes the check, we have NO COVERAGE!

I have been sending in the coupons for Meritain/ Cobra for the past year on time each and every month. There is no reason to cancel our insurance based on 64 dollars I didn't know I needed to pay due to the increase. What if we had an accident or heart attack?

Nowhere in the letter informing me that I owed additional monies did they say we would be completely without insurance until they got the check!

Nowhere do they allow you to pay online or by phone! I understand "Old School" but this is highly unfair to deny coverage based on a decidedly archaic system with no flexibility nor kindness. Cobra is rather like the Wizard of Oz, no one has their number and the only way to communicate with them is through 48 hour turn-around emails.

Don't even get me started on Delta Dental because they are another entity from Meritain but Meritain signs you up for Delta. My husband made the fatal mistake of attempting to go to the dentist this month.

We had no way of knowing we weren't signed up but it turns out that it was more than the dental... until today.

Meritain, Cobra, and Delta all need to coordinate so that each company isn't blaming the other for mistakes.

I have dutifully paid each and every month. If Meritain wants to paid the correct amount when you make changes, then why don't they tell you to call instead of sending new coupons weeks later?

I had an Aortic Valve Replacement done that was preauthorized and approved. Meratain then reversed the authorization after the surgery was completed with no valid reason other then "not enough information provided".

The surgeons provided bucket loads of information, numerous supportive tests, echocardiagrams, and all that was needed to support severe aortic stenosis. I was a high risk patient and could not have open heart. The only alternative was for transcatheter aortic valve replacement or to rapidly move to a critical risk of stroke or complete heart failure or the valve becoming completely blocked. Meritain literally reversed their decision while I was admitted and the surgery done.

It appears that I am now faced with a fight about a surgical process that has clear-cut standards that all legitimate and ethical insurance companies use. All of my physicians and surgeons are shocked at this denial after giving approval. It seems I can't rely on Meritain to give a good authorization first time around. I'm a fighter though and I intend to put up a good fight.

I'm paying a lot for this insurance.

If you have Meritain Health, be careful. They are not honest, ethical, or knowledgeable concerning the procedures they review.