Recent comments

1. What we'd like to know is how the Blues handle claims when a beneficiary is insured by another commercial insurance company, e.g., husband and wife both working for different companies and insuring each other through their individual employer-sponsored group insurance policies. 2. In the case of spousal dental insurance, we know for a fact that AETNA UNDERPAYS by subtracting the payment of the primary insurer from Aetna's (secondary insurer's) so called "approved = allowed amount" flat fee. In other words, whereas a primary insurer might approve $1,000 for a procedure, but allow (and pay) say, 50% or $500---Aetna follows-up as the secondary insurer by (under) approving say, an unrealistic $501 flat fee for the selfsame procedure...and then allowing (and "paying") 100% of its flat fee or $501. This means that the beneficiary's dentist receives $1,001 (or at least the full charge of $1,000 for the procedure, as approved by the primary insurer)...right? Wrong! At this point, Aetna then subtracts the $500 paid by the primary insurer from Aetna's $501 "approved = allowed amount", thereby paying only $1 for the procedure---this, in total disregard for the fact that the dentist has charged the original approved amount (by the primary insurer) of $1,000. The preceding leaves the "double-insured" spouse (who thought he/she would be 100% covered) with an out-of-pocket debt to the dentist of $499, i.e., $1,000 (primary insurer approved amount) - $500 (primary insurer allowed amount @50%) = $500 balance - $1 (Aetna as secondary insurer's "approved = allowed" flat fee of $501 - $500 = $1) = $499 out-of-pocket debt to the dentist who has charged the $1,000 primary insurer's approved amount! 3. We'd also like to know if the Blues are truly insurers, or whether they simply administer insurance coverage for the employers of the beneficiaries. In other words, are the companies that hire the Blues in reality self-insured? 4. Naturally, we would like to know the same thing about Aetna and the companies that hire Aetna.