Friday, March 14, 2008

Memo to Aetna: PLEASE Learn How to Use a Scanner

Following up on my earlier post about Aetna claiming that information was missing from a form that I had submitted to them.

I finally got in touch with my doctor’s office to ask them about the problem. I spoke with the office manager, and she was very surprised by Aetna’s assertion, as the form that they had given to me was a standard 1500 form… used throughout the medical industry for this type of claim. All pertinent information should have been on this form.

So, I re-followed-up with Aetna. I explained the situation to the gentleman with whom I spoke. He asked me to hold while he pulled up the file and looked into the situation. And guess what? Yet another AETNA SCREW UP. It seems that the information WAS on the original form… but when Aetna scanned the document into their system, they mis-scanned it… cutting off the vital information. Yes, it was yet another AETNA ERROR. THANKFULLY this gentleman with whom I was speaking was sharp enough to notice this error… as opposed to the woman with whom I originally spoke, who cited only the fact that the information was missing and that I’d need to re-submit the form. So, the gentleman on the phone was kind enough to call the doctor’s office directly to request that they fax a new form to them.

And so, my wait begins anew. This process started nearly EIGHT WEEKS ago. Any guesses as to how much longer this is going to take? On second thought, don't answer that question. The answer may prove to be too depressing.

Tuesday, March 4, 2008

Ask or Ye Shall Wait


On January 16, I mailed to Aetna two claim forms for doctors' visits that were NOT covered by Aetna (what a surprise!).

About two weeks later, one of the two claims showed up online as having been received and submitted. The other was not mentioned.So I waited. And waited. And waited some more.Fast-forward to March 3: I called Aetna. After waiting on hold for about 10 minutes, I spoke with a representative. I explained the situation to her, and upon her investigation she discovered that the claim was “on hold.” It seems that the form was missing the doctor’s tax-identification number and diagnostic code… and therefore Aetna was unable to process it.I asked why I hadn’t been contacted about this. I t was explained to me that an “explanation of benefits” should have gone out to me 21 days (THREE WEEKS - the standard amount of time that Aetna waits to send out such an explanation) after the last time that an Aetna representative “touched” the account… which had been on January 31.

Now, if my math skills are of any use, then the “explanation of benefits” should have been mailed to me on February 20… or, about TWO WEEKS AGO. The woman on the phone said “oh, it’s likely already in the mail on its way to you.” Yeah, right. A single piece of paper, folded in three, takes two weeks to travel to Rhode Island. NOT EVEN AT CHRISTMASTIME does it take that long!Of course, I called the doctor’s office to share the tale with them… and they pointed out that the diagnostic code was RIGHT THERE ON THE ORIGINAL FORM.

If I hadn't called, this whole thing would have remained in limbo. And why does Aetna wait THREE WEEKS before informing its subscribers that it won't be sending payment due to a problem with the submitted forms????

Anyway... now the process begins anew. I can look forward to waiting several more weeks for Aetna to get its act together.

Aetna sucks.

Saturday, March 1, 2008

Here... Just Bite Down on This Bullet

WARNING for all Aetna subscribers who are planning to have a colonoscopy or an endoscopy in the near future: if you will require general anesthesia as opposed to conscious sedation, then... well... uhhhh... well... YOU'RE OUT OF LUCK. It's true, Aetna members: Aetna will no longer cover general anesthesia for these procedures. It's conscious sedation... OR NOTHING.

Don't believe me? Then please read the words directly from our friends at Aetna:

Are you planning to have a colonoscopy in the near future? That’s great – because this is a very important cancer screening procedure for people ages 50 and above that can easily save your life.

You may have heard that we were changing the way we will cover sedation services during colonoscopies and other routine endoscopic procedures. We have some important updates to share with you.

We have decided to delay the start of our new policy until gastroenterologists who now rely exclusively on monitored anesthesia (which requires the presence of an anesthesiologist) have time to transition to alternative forms of sedation that will be available in the near future. These alternative forms of sedation, like the moderate sedation that our policy has always covered and will continue to cover, can be given to you by the doctor performing the procedure.

We are delaying this policy for two reasons. First, in some parts of the country, doctors now routinely use monitored anesthesia care (which requires that two doctors be part of the procedure instead of one). In some cities and surrounding areas, many gastroenterologists do not offer their patients moderate sedation at all for endoscopies. Because of this, in some places our members may not be aware of the alternatives available to them, or might have trouble finding a doctor who will manage the sedation services without an anesthesiologist.

Isn't that nice? Yet another blanket policy. And once again, the needs of the patient are completely irrelevant in the eyes of Aetna. I think that we can count this as reason number 7512 why Aetna is the worst insurance company IN THE WORLD.

Wednesday, February 27, 2008

This is a Recording

Earlier this month, a friend of mine sent two prescriptions to Aetna to have them filled by Aetna's mail-order pharmacy.

Last week, he received a phone call from Aetna. Well, sort of.

You see, his phone did ring... and it was a call from an Aetna phone line... but there wasn't actually another person on the other end of the phone. Instead, upon picking up the phone he was treated to a recorded message, which went something to the effect of...

"Hello. This is Aetna. We have received your prescription. However, due to a problem, we will not be able to fill your prescription. If you need more information, please call us."

How's THAT for top-notch customer service? We have your prescription. We can't fill it. Goodbye. As if a pre-recorded message isn't bad enough, the message itself is quite the piece of work: IF you need more information???? Which high-level Aetna genius approved such an outrageous insult to our intelligence?

Sleep tight, Aetna customers; the prescription's in the mail. Then again, maybe it's not.

Wednesday, February 13, 2008

Aetna Sucks

Welcome to the site that is devoted to exposing the worst health-insurance company in this country, Aetna.

If you've got an Aetna horror story to share, then send it to us at, and we'll publish it here for the entire country to read.

The Price Is Right... Wrong... Right... Wrong... Right

A recent fun-filled pharmacy experience to share with you:

After I received a prescription from my doctor...

1. I checked the medication on the Aetna website to (a) ensure that it was covered, and (b) confirm the cost. According to the Aetna site, the medication would cost $40.00 at a retail pharmacy.

2. I then went to a retail pharmacy to have the prescription filled. At that time, the pharmacist informed that, according to their Aetna information, my cost would be $240.00.

3. I took the prescription back and called Aetna on the next business day. At this time, Aetna informed me that the pharmacy was mistaken, and that my cost would be only $40.00, as it stated on the website.

4. After work that same I returned to the pharmacy. Once again, however, the pharmacy told me that they would have to charge me the $240.00 rate, per Aetna.

5. So, I took back my prescription so that I could print out all of the screens from the Aetna website... screens which would verify that I qualified for the $40.00 rate.

6. Upon presenting this paperwork to the pharmacy, I spoke with the pharmacist... who informed me that Aetna was giving me incorrect information. To aid in my plight, the pharmacist offered to call Aetna on my behalf.

7. The pharmacist was able to get nowhere with the call, unfortunately. By this time, I could not wait any longer for the medication, so I ponied up the $240.00 out of my pocket. Oh, by the way - my old health insurance used to charge me only $30.00 for this same medication.

8. But wait - there's more: I called Aetna YET AGAIN on the next day. The person with whom I spoke assured me that the retail pharmacy was in error... and to verify this, the person offered to transfer me to Aetna's pharmacy department.

9. Upon speaking with someone from Aetna's pharmacy department, I was told that... my retail pharmacy was CORRECT all along, and that I had to pay the $240.00 up front.

Yeah, Aetna's great. I sleep well at night knowing that my health-care management is in their capable hands.