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Aetna and The Rawlings Company LLC Seek to Reduce Your Disability Benefit

Attorney Stephen JessupAuthor: Attorney Stephen Jessup

Have you received a mysterious letter from Aetna with The Rawlings Company LCC emblazoned across the top?

We recently received letters on Aetna letterhead, referencing our clients’ claims for disability, which start with: “Aetna Disability administers disability benefits under the group plan sponsored by your employer. We are requesting your cooperation in providing some additional detailed information about your claim, because we believe it may be the result of an accident or injury for which a third party (another person, organization, or insurer) may have some liability.

So what does this mean? To put it simply Aetna is trying to find creative ways to say you may owe them money!

Offsets and Other Income

If you are on claim for long term disability benefits under an ERISA governed group long term disability policy chances are your policy allows the insurance company to reduce your benefits for “Other Income.” The most common example, and maybe one you have experienced, is Social Security disability. Essentially, if “someone” is paying you money for your disabling condition, the insurance company is going to reduce their obligation to you and possibly request a repayment of a prior overpayment.

Another lesser known example of “Other Income” is the proceeds of any settlement or judgment resulting from the actions of a third party that contributed to your disability. For instance, if you were involved in a motor vehicle accident and because of your injuries you filed for disability under your employer’s disability policy and you receive settlement proceeds or a judgment at trial, your insurance carrier could be entitled to repayment of the money already paid out to you.

The Rawlings Company LLC

Pursuant to their website, The Rawlings Group is the “recognized leader in healthcare subrogation services field.” On the main page of their website they boast: “MAXIMUM RECOVERIES FROM THE INDUSTRY EXPERT for the services we provide, The Rawlings Group has an unbeaten record of recovering more money for more health plans than any other vendor.” (Subrogation is the legal doctrine whereby one person takes over the rights or remedies of another against a third party)

A simple search in Google reveals not so flattering information from individual insureds claiming to have been harassed by The Rawlings Group, medical procedures not being covered and vague implied threats of unknown proceedings.

What’s this mean for you?

Honestly, we are not quite sure yet. For one client in which we received the Aetna/Rawlings Company letter, the nature of the disability stems from a cancerous tumor from over 5 years ago. Hardly a case that might be the result of the actions of a third party! This leads us to believe that maybe this is a shot-in-the-dark form letter being sent by Aetna to see if there is a way for them to further lessen their financial obligation to provide you benefits under your group disability policy.

The disability attorneys of Dell and Schaefer quickly sought clarification as to the nature of these letters as we did not feel comfortable having our clients sign what we consider overly broad authorizations allowing some a company that is not mentioned anywhere in the plan documents, to collect whatever information they want. To date we have not received any response from Aetna as to our inquiries.

If you have received a letter from Aetna with indications of The Rawlings Company wanting to investigate your claim, please feel free to contact Attorneys Dell and Schaefer.

There are 64 opinions so far. Add your comment now.

Amy Vierra:

I received a letter from The Rawlings Group on behalf of my insurance company HealthNet. They indicated “that HealthNet recently processed a claim for the patient (me) listed above. According to your HealthNet contract, when a member is injured through the act of another person and is entitle to recovery from a third party, Health Net is entitle to reimbursement if the member receives any recovery for the medical expenses”, etc.

The strange thing is, I have never heard of and have never received an EOB for the dr. referenced in this letter. I did have a trip to the ER on the date referenced, but it was for an infected tooth and I have already paid the doctor that I received a bill from and an EOB from. What do you think is going on here?

Attorney Stephen Jessup:

Amy,

As indicated in the post, Rawlings Group is a subrogation company that has apparently been hired by HealthNet to recover payment from another source for some alleged treatment received. I would recommend you contact HealthNet to inquire as to the reason for the letter and to inform them that you have never treated with the doctor they referenced.

Sara:

I have received an “audit” from Aetna and Rawlings Company asking me for Newborn information, date of birth, address, and my current coverage carriers and phone numbers. I no longer have Aetna coverage (it ended 9-30-12, and I did have a baby during that time, 8/12).

Am I legally obligated to provide this information considering I haven’t had aetna insurance for over a year? I’m not going to just hand over my personal information unless I have to!

Attorney Stephen Jessup:

Sara,

It appears that they are contacting you with respect to a health insurance matter that I would presume has already been paid by Aetna. I would suggest contacting Aetna in writing to determine why you are receiving the notice. I did just that with respect to my client’s long term disability claim and never heard another word from Rawlings.

Nate:

Our 1 year old son fell down some steps and had an ambulance trip to the hospital. I have since received a subrogation form to complete. It was an accident, pure and simple. I’m concerned they will go after the home owners to recoup expenses. What should I do?

Attorney Stephen Jessup:

Nate,

I would advise you to contact a personal injury attorney as this is stemming from an accident as opposed to a disability claim.

Xcamote:

My daughter fell of her scooter on a public sidewalk. The reason was due to extremely uneven lifted pavement, it happened at night where street lights where not working and it was difficult to see. I went to the emergency room, everything went through normally, but now I’m receiving letters from Rawlings requesting the settlement amount from the city before they can come up with a figure of what I owe. I ask them over the phone what I owe them and they tell me they cant disclose that until I report my settlement amount. I haven’t filed a claim with the city yet because they are asking me for medical debts I incurred but Rawlings won’t tell me. Can they do that? Sounds suspicious to me.

Attorney Stephen Jessup:

Xcamote,

You will need to consult with a personal injury attorney as to your rights. Our experience with Rawlings Company, as noted in the article is purely with respect to claims for disability insurance benefits.

Michael M.:

I recently sought pain relief in the form of a cortisone shot in my right elbow for an injury I received 16 years ago related to a fall from a tractor trailer I was legally employed to work on. I also sought a 2nd medical opinion from the same orthopedic surgeon during the same visit for an old dislocating shoulder injury from 7 years ago to which I had an MRI done at the doctors request. Neither one of these injuries had anything to do with Aetna at the time they occurred. Now I am being harassed by the Rawlings Company and I would very much like that to stop ASAP. I receive monthly letters from Rawlings with a threatening tone if I do not respond. I wish the HIPA laws could be leveraged against Aetna for sharing our information to a 3rd party company without our consent. I’m sure there is fine print on some Aetna document I signed that may or may not have contained the word “subrogation”. At the time I signed Aenta’s agreement forms I had no idea what that word even meant.

Attorney Stephen Jessup:

Michael,

Is Aetna your long term disability carrier or health insurance carrier?

Randy:

I also received numerous letters from The Rawlings Company (TRC) asking me to provide them with what I consider to be private, personal information. With all the scams going on today I didn’t respond, as I felt if it was legitimate then Aetna would be contacting me themselves about this and not some second-rate collector of sorts. I constantly receive bogus letters and emails from such people all claiming I “have” to provide them with this or that, so naturally I thought TRC was just another scammer among many. Aetna is my primary health provider but I am disabled with a progressive neurological disease and because of this my clarity of thought isn’t what it used to be, and with all the scams among us anymore I felt this was just another attempt to get personal info. Since my initial “survey” I have received a total of FIVE surveys all claiming that I HAVE to release my info to them, and in simple terms, if I don’t give them whatever they want it will constitute failure to comply with Aetna under the terms of my plan. I have received other similarly worded threats like this over the years from scam outfits so I was hesitant to even contact them about this because it’s difficult for me to speak anymore. Why hasn’t Aetna at least informed their client base they’re using some third-party money collector of sorts (TRC) and that it’s okay to deal with them? Just performing a simple internet search of these people doesn’t paint a very appealing picture so why would I be inclined to release my information to them when even Aetna hasn’t informed me of their partnership with them?

Attorney Stephen Jessup:

Randy,

I would agree with you and seek confirmation from Aetna that Rawlings is in fact an authorized representative of the company as it relates to your claim.

Michael M.:

Hi Stephen,

Aetna is my primary (only) health insurance carrier. Unlike Randy in the last post, I have received confirmation that Rawlings is authorised to represent Aetna. However I did not solicit the services of Rawlings and I feel threatened by Rawlings as I am not comfortable with this process.

Attorney Stephen Jessup:

Michael,

I would discuss your concerns with an Aetna representative. Rawlings sole purpose is to see if someone else is liable for payment of services. If they find said source it saves Aetna money.

Michael M.:

I understand what you’re saying Stephen and I have already had that discussion with my Aetna representative. I am not interested in protecting Aetna’s interests. I pay for their service. I do not expect to have Aetna share my private information with a 3rd party “collection agency” on behalf of Aetna for Aetna. Nor do I intend to cooperate with Rawlings. Regardless of who is liable. In my case no one is liable for my injuries so they would not need to worry in the first place. All they did was upset me when I learned what the subrogation process is. I am sadly disappointed that the US government does not protect ordinary citizens from the invasive nature of subrogation. I guess I don’t understand how the HIPAA laws are supposed to protect people because both Aetna and Rawlings have obviously found a successful way to challenge it or they would not be harassing people like they do.

Josefine:

Hi Stephen,

I recently received a letter from the rawlings company asking me to fill out their questionnaire. I had an accident (slip and fall) two years ago and won the injury claim ($300.000). Last year, I signed up with Aetna and then this year I had another surgery done that had to do with my accident from two years ago. Now I got the letter from Rawlings. Do you think if I fill it out and tell them about winning my injury claim I will have to pay Aetna back for this recent surgery? Can they do that? Aetna pre-authorized the surgery. Thank you.

Attorney Stephen Jessup:

Josefine,

I am not sure how your health insurance policy reads but there may be some right to subrogation by Aetna. I would suggest you review your health insurance policy and possibly contact Aetna for clarification.

Brendan S.:

I am getting harassed by Rawlings Company LLC. What happens if I just ignore them?

Susan H.:

Hi, I am insured with Aetna through my husband, and I am on Social Security Disability. Now, the husband has been getting letters from Rawlings saying that Aetna Traditional periodically requires info from our members to update our records and ensure accurate claim payments.

I do not feel comfortable in giving my Medicare ID#, which is my SS# and if I’m receiving SS benefits (I do not have Part B, just Part A) as it’s not of their business. What are my options at this point? Would appreciate any suggestions. Thank you.

Attorney Stephen Jessup:

Susan,

Aetna does use Rawlings to investigate claims to determine if there is a right for subrogation under the policy (if someone else is responsible for your disability that may have to cover part of the cost). I appreciate your concerns and would recommend that you contact Aetna in writing to vocalize same to verify if in fact they have hired Rawlings to perform any activity as it relates the Aetna claim.

Brittany M.:

I received this letter and filled out the questionnaire online. Oops! I had a hemorrhagic stroke due to an AVM bursting and I have been going to rehab for months to recuperate… then I received this letter. I checked the ongoing illness box but I have also applied for a critical illness stroke claim. Is there a chance that they will want that money paid back to Aetna when I had no injury or accident?

Attorney Stephen Jessup:

Brittany,

Is your Aetna policy of disability or health insurance benefits?

Netlace:

I have received three request from Rawlings for gathering key information for Cigna. My husband talked with Cigna and they said they do not use this company. They said discard it. I am concerned because after a search there are many with this same thing. This is something that needs looked into. Is this not fraud? It is signed Sincerely Cigna.

Attorney Stephen Jessup:

Netlace,

If Cigna has advised you that they have not authorized Rawlings to work on their behalf then I would not communicate with them. You may also want to file a complaint with your state insurance commissioner on account of Rawling’s actions.

Robert V.:

I have also been receiving letters from Rawlings. I have been on long term disability for 2 years having recently gone through an Aetna review of my claim. Aetna told me I still qualify for disability, then a week later the first of the Rawlings questionnaires showed up. I was injured in a fall at home, will Aetna go after my home owners insurance if I put this info on the letter?

I am with Brendan S. and also would like to know what will happen if I just ignore the letters.

Attorney Stephen Jessup:

Robert,

Aetna will certainly look to obtain the information. However, I do not know if there would be any type of subrogation right against your homeowner’s insurance for your injury. Has Aetna directly asked you questions regarding the homeowner’s insurance?

Robert V.:

Aetna has never asked any questions concerning my homeowner’s insurance or how I was injured. They have only asked questions concerning my medical eligibility.

Attorney Stephen Jessup:

Robert,

I don’t believe that they would be able to go after the homeowner’s association as the accident/injury was on account of your actions and not those of a third party. You can certainly inquire of Aetna as to who Rawlings is and why they are contacting you. Aetna may advise you to take no action with them.

Jeff:

Stephen,

I have been contacted several times by the Rawlings Company and not sure what to do. I have a bad back and subsequently had an epidural shot to help with the pain. It seems as though that playing sports and being extremely active in life has taken its toll on me but that is it. Every once in a while (like once every 5 years) it flares up and I need to get some treatment for it. Is this something that I need to disclose to them?

Attorney Stephen Jessup:

Jeff,

Is Rawlings contacting you within the context of a disability insurance claim or for purposes of health insurance?

Pat K.:

I work in HR. One of our employees received a letter from the Rawlings Company LLC with the Aetna Logo asking for a series of personal information including SSN. They threaten to deny any future claims if the form is not filled out! I scanned and sent a copy to Aetna who apparently has no idea who The Rawlings Company LLC is! I also call the number on the letter – 888-258-8060 – only to get a vague answer. In my opinion this is an attempt to defraud or gather personal information for some sort of financial gain.

In case I am wrong, however; can you please contact me and let me know if our employee is in fact obligated to fill out this form?

Thank you for your time and input.

Attorney Stephen Jessup:

Pat,

If Aetna is disavowing any knowledge of Rawlings Company as it relates to your employee I would be very hesitant to provide any information until such time Aetna directs it.

Pat K.:

Thank you Stephen. I finally spoke with someone at Aetna who confirmed that they own the Rawlings Company. I spoke with Rawlings and informed them that our employee was not covered under any other medical insurance plan and that was the end of it (the employee never had to fill out the paperwork).

Thank you for your help.
Pat

Attorney Stephen Jessup:

Pat, you are most welcome.

Kyle Valentine:

Mr. Stephen Jessup,

My wife received the Aetna/Rawlings letter asking for any information about a 3rd party. My wife has been going to a chiropractor for several months due to hip and lower back pain (possibly from being a Sous Chef and standing for 10 hours a day/ 5-6 days a week), but we have not attempted, nor intend to do any type of workman’s compensation claim or disability claim. Should we just ignore this request? It is asking us to complete the questionnaire and mail it or call Rawlings to complete it. We don’t feel comfortable authorizing ANY of her information to a third party.

Thank you in advance for your time and assistance.

Terrie:

I received one of these letters about a steroid shot for a home accident I had last year. We have insurance through Aetna, but our “company” is self-insured, essentially they only use Aetna to process the bills, so this leaves me really suspicious as it seems counter to our self-insurance. Your thoughts?

Attorney Stephen Jessup:

Kyle,

I would not suggest that you ignore the request. I would recommend you contact Aetna to first determine what the nature of the request is and express your concerns with regards to privacy. If you do not have a claim for disability or worker’s compensation then I am assuming Aetna is likely investigating based on health insurance claims and are attempting to find a way to make someone/thing else responsible for the claim.

Attorney Stephen Jessup:

Terrie,

Rawlings might be looking into whether Aetna would have subrogation rights if your homeowner’s insurance might be responsible to cover the injury. I would recommend you contact Aetna to discuss the nature of the letter and why they are sending it to you.

Alisha:

My husband received an audit letter from Rawlings from Aetna asking all sorts of questions about either of us being on long or short term disability and or receiving Medicare. I have a neurological condition and have since 2010, it is not related to a accident and isn’t anyone’s fault. I finally got disability and Medicare to help us out since I am unable to work at all… Before I received this letter they have sent me around 30 since 2010 asking if any of my claims are associated with a accident I have sent all of them in and told them it was not! But this is my first letter like this. I’m a little concerned because when my husband was in a bad car accident (at no fault of my husband’s) Aetna covered the costs of the medical expenses only to turn around and take the insurance settlement we got from the guy who hit my husband. We paid them every last bit of the settlement, we got to pay for his medical bills since it’s an ERESA insurance plan. I am really worried they will now try and make me pay for the surgeries and procedures I have got even though it has nothing to do with an injury and no one was at fault. It’s a neurological disorder I will have for the rest of my life… will they keep trying to go after me?

Is this something I need to get a lawyer about, so we aren’t constantly harassed? Do I need to fill this audit forum out? Or should I take it to someone and if so who? Or should I wait it out? They try and refuse every claim that comes their way. Right now I am in the middle of trying to get a surgery that they have denied since March (!) even though I have completed all of the criteria to get the surgery. They keep sending out the same letter requesting the same stuff that my doctor has sent in 10 times… can they keep doing this? I would rather not have to pay lawyer fees but I don’t want to get harassed over everything we go to the doctor for, either! :( It’s very frustrating to see every claim being denied, even if it was pre-authorized!

Attorney Stephen Jessup:

Alisha,

First and foremost I would contact Aetna to get clarification as to what Rawlings’ role will be in your claim. I am not sure if your concern is with respect to a health insurance policy or a disability insurance policy. If it is for the former it could be that Aetna has hired Rawlings to determine whether Medicare should have paid any of the bills.

Alisha:

The health insurance with Aetna is through my husband’s employer and he has more then 100 people at his work so medicare would be my secondary insurance. So the way everything is billed out is first Aetna then medicare. I am worried about two things, they try and get medical bills already paid for to be reversed and try and say I owe put of pocket or medicare does. Or drop me from coverage because I do have medicare now. (Since they cover a portion then it go was to medicare to cover 80% of the balance that was unapid. Also can they try and up our rates because I am getting long term disability through social security. (it has nothing to do with an accident and I never filed a claim or got an money from being hurt except for me being on disability.)

The reason I worry is from what they have done in the past. They have already sent out paper after paper asking if each claim was from an accident and I have explained it is now from any type of accident. So now I am wondering if since it’s not from a accident and I fought to get disability and fought to get medicare they will now fight to take me off the insurance or make our rates higher or even worse try and make me pay bills they already paid.

Sara:

I filed a lawsuit with an attorney after a car accident. Now the case has settled. I got a schedule of distribution of the settlement money. My attorney has listed her fees and then there is The Rawlings Co for $12,000 distribution monies. I knew nothing about the Rawlings Co. Doing the attorney’s work. Is this legal I should be paying both of them. Don’t you hire an attorney to do your subrogation?

Attorney Stephen Jessup:

Sara,

You need to discuss this situation with your attorney. Rawlings most likely worked for your healthcare provider to assert a lien on the proceeds of your settlement to pay back your insurance company for services provided in light of the accident. Most health insurance policies contain such subrogation provisions.

Jackie:

I was in an auto accident in Feb 2014. Aetna is my medical insurance and has The Rawlings Company handling my claims. The auto insurance company has settled with my attorney however the Rawlings Company is failing to process my final claim for 7 months now. I wish I knew what to do about this.

Attorney Stephen Jessup:

Jackie,

Your personal injury attorney (if you had one) should have resolved this matter as part of the settlement. If you were represented I would recommend you contact your attorney’s office.

Amy:

I had leg pain and received a series of physical therapy treatments over the past several months. I paid my copays and my insurance company (Aetna) paid for the treatments. However, I received one mail from Rawings Company on ‘behalf’ of Aetna today asking me to fill out some questionnaire (on paper, online or over the phone). All the questions are looking for if a third party is responsible for my pain. I’d like to seeking advice from you in terms of my next steps:

1. Can I ignore and don’t respond? Would it impact my insurance? It is not clearly stated that what would happen if I don’t respond. But it is very obvious that they are urging me to respond ASAP.

2. If I have to respond, what shall I tell them? I don’t think there is any third party involved. It is just an arm pain. To be honest, I don’t feel comfortable having any interaction with them, and I really question their credibility.

I look forward to your advice!

Attorney Stephen Jessup:

Amy,

If you don’t respond they will most likely keep contacting you. Rawlings is most likely trying to determine if they can go after somewhere else to pay the medical bills (such as if there was a car accident claim pending). If your injury/condition is not on account of the actions of a third party I doubt they would have any further involvement.

Nancy:

I received a letter today from Rawlings indicating aetna paid a claim on my behalf and needs to find out if another party is responsible. As the date of treatment had many components, I decided to call the number listed to find out the exact claim the are referring to. I was bombarded with a never ending recording about winning a free Medical Alert button, possibly a $100.00 Walmart gift card, and even a free weekend in the Bahamas! I hung up, and went to Aetna’s web site to report it and said if they want information of this nature they will need to call me themselves. Why do I have to waste my time with crap like this when the information they were asking for was already given to Atena, pre-op!

L. Cox:

Rawlings is sending threatening letters to my son, a minor child, over a claim last year with Aetna. I have told them to send a letter addressed to me directly, as his parent and guardian, and I will happily answer it. They refuse and the threats keep coming. What are our rights in this situation? I am not comfortable answering a legal letter that is addressed directly to a minor child. Nowhere on the form is there a way to identify who is filling out the form (ie parent or guardian).

HA:

Stephen, nice of you to provide input for all these folks.

The letter my wife received from Rawlings in regards to Aetna Audit is just a form letter. She has Medicare Part A and disclosed it to HR. They also ask where she works on the form. Really information they should already have. I think it best if one gets the form requesting general private information. They should have Rawlings contact HR and deal with general info through the company. I doubt the procedure I had would not raise any red flags. Therefore, I think letters like these general ones are sent out when a payout is over a certain amount and there is qualifying age criteria. They are grasping for straws and playing hit and miss and sure they find ways to save a company money.

Attorney Stephen Jessup:

L,

I am sorry that I do not have an answer to your inquiry. The inquiry is most likely due to some medical treatment received- for whatever that may have been. As a minor under your health insurance, I am assuming, you are ultimately responsible, so you should be able to resolve the matter with Aetna yourself.

Attorney Stephen Jessup:

Thank you for your input Harold.

MD:

I was injured at work and filed a worker’s compensation claim under the FECA (I am a federal employee). I just received a letter from TRC. Am I obligated to respond to this?

Attorney Stephen Jessup:

MD,

You will need to consult with a Worker’s Compensation attorney to determine your obligations.

Greg D.:

I hurt myself working out. I was bench pressing at my gym (where I am a member) when I accidentally tore ligaments in my shoulder. I received a letter from Aetna asking if I was planning to file a lawsuit against anyone or if any third party was responsible and what happened. I filled out the form they sent saying that I hurt myself so I wasn’t suing anyone. I ended up having surgery to fix my shoulder. I am a 32 years old medical student and the surgery was 100% curative so the injury didn’t affect my schooling and I don’t work. Aetna paid their part of the coinsurance and I am making monthly payments for my part of the coinsurance. Now I just received a letter from the Rawlings Company that is almost identical to the letter I received from Aetna 8 months prior. I just called Aetna and they told me that they can’t discuss what the Rawlings Company’s role is in the situation except that they were hired to collect more information on the incident. Aetna told me that they were trained to not answer my questions and to tell me to refer to the Rawlings Company for these types of questions. I told Aetna that I would not be contacting any third party and that I would be submitting a letter in writing to Aetna requesting the role that this company will play in my claim that has already been processed. I know when I signed up for the gym membership that I also signed a contract saying I would not hold them responsible for any injuries sustained on their property. I am worried that if I make any formal statements to this company that they could somehow come after me or the gym. Is this something that could happen? I know if Aetna can somehow find a way to make me pay for my surgery they certainly will. Do you think they would be more inclined to back off if I got an attorney to write the letter or is this something I can handle on my own? Or would you suggest that I just fill out the same information again to Rawlings like I sent to Aetna and not worry about sending Aetna a letter?

Attorney Stephen Jessup:

Greg,

Rawlings is exploring rights of subrogation under the health insurance to see if the negligence of a third party resulted in your injury, which would then allow them to go after the coverage of that third party to recoup what Aetna paid. It would seem that there is no third party negligence and chances are you signed waivers when joining the gym waiving liability if you were to injure yourself. If there is no third party who is liable for your injury your health insurance would foot the bill.

A. Saenz:

I had surgery to fuse my c-5 an c-7 in 2010. The result of the surgery was that I had a titanium plate placed on my vertebrae. In March of 2013, 3 years after the original surgery I was rear ended by a driver under the influence. The injury was catastrophic in that the plate that was placed in my neck at the time of the c-5 c-7 fusion broke from the impact. The resulting injury damaged my left arm leaving it numb with a loss of motion and muscle mass. The Workmen’s Compensation Division of my Police Agency denied any payments and benefits stating that it was a prior injury, and as of yet not paid any of my medical expenses. I have received monies from my Under Insured Motorist policy and the suspect’s liability insurance. I paid all the bills and and settled with all of the all the medical practioners that treated me. I received a letter from the Rawlings Group and have not responded due to the fact that the former Third Party Administrators falsified documents that were sent to the State of Texas Workmens Compensation Division. The State of Texas Department of Insurance investigated and found that the documents were false. I don’t owe anyone a dime since I had to pay all of my expenses my self. Why should I respond to Rawlings Group Questinaire.

Attorney Stephen Jessup:

A. Saenz,

As we only handle claims dealing with disability insurance, you will need to contact a worker’s compensation attorney in Texas to discuss your situation.

Thomas G:

My wife 83 years old was sent for a CT Scan with contrast at the local hospital. Technicians after trying numerous times to inject the contrast into her forearm did the test without it but had severely damaged the vein in her arm. When she came out from the test they had an ice pack and a towel wrapped around her arm told her to use the ice and take aspirins for the pain. During that day till the next morning her arm continued to swell and the bruising extended from the tips of her fingers to her armpit. Next morning we returned to the hospital and the ct area where they had a doctor look at it and they sent us to the emergency room at the same hospital. Having been to this hospital before my wife’s information was already in the system and after explaining what the circumstance were they sent us into a room. after asking numerous questions they sent us to a room for a doctor to see her and after 4 hours in the room with no treatment for the arm although they took 8 vials of her blood to test. When all the tests came back negative (everything in the normal range) the doctor said use ice and aspirin for the pain and sent us home. while checking out the woman told me that my copay was $50 and I explained to her that the injury was caused by the hospital and I felt that no payment was needed. I refused to pay. Now I have received form letter From the Rawlings Group representing Aetna. What do you suggest? Thank you.

Annonymous:

I had a surgery and Aetna paid it’s share and I paid mine. I have received at least two letters on Aetna letterhead with Rawlings name on the top right corner with questions regarding third parties (accident, work related injury and injury on somebody’s property). I was not happy that Aetna shared my private/possibly protected health information with Rawlings so, I ignored them. Now, I have received another one more of the same form threatening with “further action”. I am thinking of forwarding future threats to my states attorney general and medical board. What is your advice?

Attorney Stephen Jessup:

Thomas,

Aetna is going to look to have the hospital pay for the treatment. As you have indicated a third party caused the injury resulting in treatment you may need to cooperate with the Aetna process.

Attorney Stephen Jessup:

Annonymous,

You can contact Aetna to discuss your concerns. They are seeking sources of subrogation to pay for the services that you received.

Charles:

Hello Mr. Jessup,
I have gotten 3 letters from the Rawlings Company in regards to a CT I had done on Dec. 23 2014 for a Hernia that has been on my stomach since 2009. The Hernia is a result from surgery that was done on my stomach to repair what was call a scar break. The surgery was performed in Germany and was paid for by German health insurance. I moved back to the US in Sept. 2014 and decided to have a CT performed to verify if it was life threatening. The CT concluded that the hernia is not life threatening and surgery was not needed and was left up to me to decide if i wanted to have surgery to repair it. Its not an injury from an accident, as the questions on the letter are asking. What should I do. The third letter is kind of threatening and worried that they will cancel my Insurance and want me to pay back the money that they paid. I am still paying an out of pocket amount of $700.

Attorney Stephen Jessup:

Charles,

They are trying to determine if a third party is responsible to cover the cost put forth by Aetna. If there was no accident causing the initial issue then answer as such. You can also contact Aetna directly to discuss with them your concerns.

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