Medical and Health Services Manager?

My health insurance company lied to me about my benefits?

• In the summary of benefits my people services manager gave to me when I was deciding on my health care plan, it says that Aetna covers up to 80% on "Contraceptive drugs and devices not obtainable at a pharmacy". Yet when I try to go and get an IUD (Intra-Uterine Device) they say they don't cover it. What's the deal? Now why am a paying these people $80 a month from my paycheck? Anyone here had this happen to you?

• Answer:

  Try and get your hands on a Certificate of Insurance (sometimes called an Evidence of Coverage document) that lists ALL of the policy's provisions; a Summary of Benefits chart isn't complete. Look in the Exclusions section to see if IUD's are excluded from coverage, even though they're considered contraceptive devices. Then, check the Covered Services section and read the actual verbiage regarding this benefit. If you see nothing that substantiates Aetna's denial, you should send it a written appeal; you may also be able to ask your state's insurance commissioner for help at this stage (some states require you to appeal first). Have you called the service center number listed on your membership card to ask why this isn't being covered? It's possible that it's a mistake, or that your health care provider used the wrong code on the claim form. I hope this helps! UPDATE: I read your additional comments. If you're being charged a deductible before the device is covered, see if this is because you attempted to get the device from a "non-participating provider." You may not have this deductible if you go to a participating provider (this is a health care provider that has a contract with Aetna).