Rich's complaint:
November 04, 2013

Insurance Company: Aetna
Coverage Type: Health Insurance

• Underwriting - Premium Too High
• Underwriting - Refusal to Insure
• Underwriting - Cancellation
• Underwriting - Nonreneweal
• PolicyHolder Service - Inadequate Service
• PolicyHolder Service - Incompetent Employees
• PolicyHolder Service - Delays/No Response
• Claim Handling - Denial of Claim
• General - I feel abused by this company

I have had health insurance with Aetna since 2009. This is an individual policy. Every year the premium ratchets up 15-20% Currently, it is an obscene 1178 a month. The annual deductible is 2500. After the deductible is filled, they charge a 50% co-pay to a maximum of 17000. So, in about four years, I have paid close to $40,000 in premiums. Aetna has yet to pay one claim.
Recently, I have had a claim for a very expensive drug. I have also had some major claims where I have surpassed the deductible. My doctor sent a prescription for me to my local pharmacy. The drug is a specialty drug. It costs 3700 a dose. The local Walgreens sent it over to there Specialty Pharmacy division. After two weeks of phone calls with Walgreens, they advised me that they were ready to ship upon payment. I gave them a credit card number. They did not ship the drug to my doctor. I called them back. They told me that Aetna called them at the last minute. They instructed Walgreen's to fax the prescription to the Aetna Special Pharmacy. The price to me from both pharmacies was about the same $3700 for a single dose. It was apparent to me that Aetna wanted to handle the prescription because of the high mark-up on it. They took an additional two weeks to get ready to ship. Again, I needed to supply a credit card to pay for the drug up front.
I got the drug. The good news is that the treatment was successful. Two weeks passed. I got absolutely no paperwork from Aetna Specialty Pharmacy. I needed the paper work,of course, to send back to Aetna with the claim for reimbursement. I called several times and explained I needed a printed receipt specifically for filing a claim. They eventually relented and mailed a receipt. The receipt had minimal information on it. I figured that since it was all within Aetna, no problem.
I faxed the claim form and receipt to Aetna in Phoenix, Arizona. Twenty-six days later, I get a form letter from Aetna denying the claim. The reasons given were my member id does not have prescription coverage, and the receipt did not have enough information to process. The receipt prominently displays several 800 numbers to call.
I got on the phone with Aetna member services. I wasted an hour explaining the situation to one customer service rep after another. Five in total. At one point, someone picked up the phone and announced she was the switchboard operator, how might I help. I asked for a supervisor. She transferred me to yet another customer service rep who asked me to identify, for the fourth time on this call, with my id number, full name, birth date and address. I asked her if she was a supervisor. She replied, "no". I explained the problem to her again. I again asked for a supervisor. She transferred me to yet another customer service rep, who again asked for ID, full name, birth date and address. I explained the problem again. She placed me on hold for eight minutes. She came back on and politely told me that there wasn't anything she could for me and she didn't know what I should do. She sounded frustrated with her job and the whole situation.
For now, I am preparing to file an internal appeal with Aetna. I am al so contemplating getting legal help. I feel that Aetna has breached the contract and need to forfeit the premiums to date back to me.

0 0

Tweet