Legal Question in Insurance Law in Texas

I recently received a medical bill for two prescriptions purchased about a month ago. I just graduated and was on a student medical plan. I called my university's insurance office earlier this year to ask about referrals and at the time was told that my insurance would end on the 18th of August. I made sure to pick up my final prescription before that date. I went to get them on the 14th and 16th (two different medications) and was told to return later as only part of each could be filled. When I returned I paid my typical 30 or so dollars and was not informed that I would be charged more than that. Several weeks later I received a letter from Aetna saying I owed the full amount (one of the prescriptions is pretty expensive). I called and was told that although I was given incorrect information I still had to pay the full amount. I really can't afford this I haven't touched the medication and didn't want to open them until this was solved. Is there anything that can be done? My mom has asked a pharmacist she knows and was told that usually they will let the customer know at the time of pickup if the amount was approved or not. In my case that didn't happen and now I'm expected to pay for it. If I had known I wouldn't have bothered picking them up.


Asked on 9/29/10, 8:38 am

1 Answer from Attorneys
Robert Stephens Stephens & Stephens

Write Astna a letter and tell them they are estopped (Yes it is spelled estopped.) from denying payment since you relied on their representation to your detriment. Send a copy of your letter to the State Insurance commissioner reporting them. One more reason the National Healthcare bill is good. It will stop a lot of this behavior.

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Answered on 10/06/10, 5:55 am


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