United States - 06156
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Aetna Pharmacy Claims
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Since october 7th i started the claim on my fathers life insurance he passed away in sept. sent in what i needed to claim it always getting the run around been calling every two weeks since then. They do not reach out to update you You have to call them. two weeks ago they stated claim was approved- and a check will be cut. I call due to not receiving two weeks later they tell me it was denied and i have to fill out more paper work to make the claim. This is unacceptable to take 6 months to claim life insurance my father paid for to take care of his family...
After being contacted by Aetna sales and accepting a PPO plan that included prescription drug plan I realized...
On August 12 my husband was admitted to area hospital for a diabetic wound on the back of right leg and bilateral edema.Prior to his discharge it was determined that he was in renal failure and dialysis was needed.After his first or second dialysis treatment both arms became swollen.Also both knees.I was informed by his doctor that dialysis caused his gout to flare up.He was in so much pain that he screamed when you touched him.He was unable to walk or feed himself.I decided to send him to a area nursing and rehabilitation facility to regain some of the mobility in his hands and legs.He was admitted on August 16.It took the rehab facility until August 28th come up with a care plan.On August 29, I was informed that he was being discharged on the 31.Your company decided he wasn't doing enough to qualify for continued treatment. I was told that I could file a appeal. After speaking to your appeals department.I was informed that Peer to Peer conference was required. The facility informed me that Friday at 6pm they unable to contact anyone for a conference.That following Tuesday morning I was informed that the appeal was denied.When called your corporation to find out who they had did the Peer to Peer with
No one could give a valid explanation. That Monday was the Labor Day holiday. So I know there was no conference. While at the facility my husband's condition worsened. He now had a wound on his coccyx and bilateral heel wounds .All of which was seeping.Iwas I told by his dialysis nurse that he his protein levels was too low for him to heal properly. Also he was in so much pain he could not sit due to his coccyx wound.He was sent to another area hospital for wound care.At that time I requested he be evaluated by their emergency room.Since his ability to speak was now mainly yes or no answers.He was admitted .He now has wound vac on his coccyx and his leg wound.The heel wounds are healing but not enough for him to walk yet.And his swelling has decreased in his joints.He is still unable to feed himself .When I requested he be sent to another nursing or rehabilitation center for additional treatment. Your company denied him admission. I spoke to Amy at your corporate office.She informed me he doesn't qualify for rehabilitation due to his condition. Because he is unable to sit without aid.How is he suppose to sit with a machine attached to his coccyx. And regain use of his hands and legs without proper rehabilitation. I was told to apply for Medicaid for him.But since he recieving his pension and social security pay.His income is too high to qualify for it without putting all his income into a Miller Trust account. Prior to applying for Medicaid. Since your company is refusing to pay for any more services .I have no other place for him to get proper treatment while applying for Medicaid. I am unable to care for him at home.We live in a second floor apartment.which was not problem for my husband prior to this. But impossible now.I also work a full time job.And take my handicap son to his part time job. Home health will only cover limit amount of hours.Am I to leave him alone during those times.I also have some health issues that limits my mobility. So bringing my husband home is not a valid option. Since your company refuse anymore nursing facilities. And I can not bring him home without jeopardizing both his health and mine.Personal pay is not a option. I will already lost half of my household income in order to get him qualified for Medicaid. If I have to use my income as well.My son and I would soon be homeless and car repossessed. Neither one could get to work.I
want someone to call me from your headquarters and explain why I am being put in this difficult position. His prior authorization was so short that nothing was done to aid in his recovery before he was cut off.Now you are denying him any additional services. The letter we receive when this plan was activated by Mittal in 2017.Stated we could decline this plan but with cause a potential forfeit of other services from Mittal.It also stated the Aetna had Medicaid plans.What plans and is my husband able to get them in his condition. Is your profit margin so much.That you are willing to bankrupt me allow him to die from lack of proper care.I sure you don't really care.
So I'm sure there will no reply from your company.But please make sure your CEO get a copy of this.I want him to know how his company is making there billion dollar profits.
I filed for Short Term Disability in February. W0007 23001 Charles M. Michalak My claim was initially...
filed for a Short Term Disability claim. My Doctor's diagnosis and observations support my claim, yet Aetna...
My wife was deined coverage my Aetna. Once I received a bill from the doctor's office in March I reviewed the EOB's and contacted Aetna. I was told I would need a letter of "Medical Necessity" stating this work was in conjunction with the breast lesion removal and biopsy. The doctor's office sent a letter to Aetna stating this on 3-22-18, Aetna received the letter 4-3-18 with their confirmation number [protected].
On 4-6-18 I called Aetna and was told that they had the letter and the claim would be reprocessed based on the information. I did not think to get a confirmation number that day. I was told 5 to 7 days to reprocess.
On 4-16-18 after no response from Aetna I called again. I spent a half hour on the phone while they looked for documentation. I was told the claim had not been sent back for processing but they had all the necessary documents and it would be reprocessed. Aetna CNF #[protected].
On 4-23-18 I called again as I had no response from Aetna. Again I was told the claim had not been sent back for processing. I spent another 45 minutes on the phone while the documentation was found again. I was told it would be sent back. Aetna CNF. #[protected]. Then the representative that I was talking to said " but call back in two days and ask to speak to a supervisor".
So on 4-25-18 I called and spoke to a supervisor for another 45 minutes. The claim still had not been sent for processing and I had to explain the entire narrative again. He spent time to again gather the documentation and he said he was sending it to " Complaint and then Reprocessing" and it would take until May 10th to resolve. The CNF # yesterday was [protected] and he gave me a case ID number [protected].
On May 23rd I called to try and get some resolution or information and at that time I was told that the claim was in Appeals and would be resolved by May 23rd. I said what happened to the 10th. I was told the records they had did not say May 10 anywhere.
After having extreme congestion and a bad cough for over 10 days, I called Teladoc. I paid $40 to be yelled at by a doctor and essentially, to be told I am trying to get medication. When I told him last time I felt this way, I went to the Minute Clinic, they gave me a Zpack and I felt better, he told me they did me a "disservice" and I shouldn't have been giving a presciption. He was rude and insulting and I hung up the phone and cried. I will be telling everyone I can not to use this service. 12/3/17
Trying to see about buying st disability. Was told I had to do that during my enrollment. I should not have...
My employer changed to Aetna from Humana on Jan 1, 2016. Since then, 9 out of 10 claims are denied for various reasons: need more medical records, wrong codes, not a covered benefit (when it is), etc.
One denial for annual blood labs in Feb 2016 was denied as not a covered benefit. When calling in (17 phone conversations in total) I was usually told the charges were added to my deductible. They never were.
By August, I was able to show them the claim was never added to the deductible and that they should reprocess the claims. They did not stating I was beyond the 180 days to appeal. I was left with $700.00 of labls to pay for out of pocket.
It is not a lot of money except that I became permanently disabled in November 2016 with an incurable and untreatable condition in the United States. (Some foreign countries have approved treatment for my neurological progressive disease). Fortunately, I began receiving SSDI a few months ago.
Fast forward to Jan 2017 - Aetna is denying claims to manage my symptoms. They claim they never received my medical records even though my physician sent them with tracking. When I called in today, the representative said the records were not received. When I stated I had proof that they did receive the records, she said they weren't scanned into their system until 5 days later, 1 day after they closed the claim.
Instead of matching up the information and paying the claim, they did NOTHING until I called today 12 days since their receipt of the requested information. Concurrently, they have been reimbursing for my physical therapy (after many delays, denials, requests for more information) at 70% instead of 90%!
After requesting to re-process at least 20 claims at the higher rate, I asked what can be done to make sure the reimbursements going forward are corrected and was told by the member concierge, "I don't handle claims but they should pay it correctly next time." I let her know there is no logical reason to think they'll get it correct "next time" when they've had 20 PT visits to get it right so far.
I am so sick, live alone and resent having to spend hours on the phone each week to beg for services for which I pay (via my former employer as part of long term disability). Though I am dying a slow death, I am sure the emotional frustration and fatigue from Aetna is going to speed up my departure from this world.
Seriously, they are reprehensible!
Since June 2016 I've been having shoulder issues which my doctor believes may be a torn rotator cup. Aetna...
Aetna is a rip off. I had a previous miscarriage as the baby was missing part p of chromosome 12 (12 p dilution). The next pregnant the dr suggested i do a cvs test which then showed mosaic of chromosome 12 (23 Q mosaic). As it was the same chromosome the dr suggested we do a micro on my husband and I to rule out the possibility that we may have it. Aetna is now refusing to pay for it which costs $10, 000 because their code shows experimental. This is a rip off. For a test this expensive they should have pre authorization at least or maybe use their brain and read the history to know that this was a needed test not experimental...
Aetna is HANDS DOWN the worst company I have ever had the displeasure of dealing with! Not just the worst...
I retired from Owens Corning in 2006 that had provided life insurance while I was working. In 2008, per my...
My Daughter lives in Cold Spring Kentucky, she has health insurance (aetna) thru Kentucky medicaid. She has been in and out(mostly in) of the hospital for the past week due to adhesion's on her small intestines that are obstructing her bowel which results from Crohn's disease that she was diagnosed with over a year ago. Her Doctor recommended an operation that would require removing "the bad" sections of her small intestines (adhesion's) that would eliminate the obstruction to her bowel that could otherwise become a life/death situation. Everything was in place for this operation to be performed on 04/13/2016 at St. Elizabeth hospital in Northern Kentucky. This morning as she and other family members were literally on our way to the hospital, her Doctor calls her to inform her that her Kentucky medicaid "aenta" will not pay for this necessary, crucial, urgent operation. My Daughter had to physically, mentally, emotionally prepare for this day just to be turned away because Kentucky Medicaid will not pay for it? What does this insurance pay for if it will not even pay for someone to have a procedure done that can give them quality of life? This is an outrage! She is a 32 year old woman with three small children who depend on her. The insurance company originally said that they would cover this operation, and literally the last minute, on our way to the hospital she gets a phone call telling her to turn around and go back home because they decided at the last minute, they aren't paying for it. This is totally unacceptable and something really needs to change. This company needs to be investigated, their practices/competency is deplorable! My Daughter's health and life are at stake here. ~Thank you for your time, Sheila Loga
july 17th 2013, i was set for back sugery.14 hours before showup time at the hospt.i received a call statting...
Having a terrible time with Aetna with getting prescriptions. They just lie every time you talk to them. I finally got one to admit that the doctor had sent in a request and they had denied it after they kept saying the doctor hadn't submitted anything. I had the denial in my hands from them and told her that and she finally after a long silence said "Oh I see he did submit it and we denied it. It isn't covered on your plan".
I told her it was on their formulary and she said yes it is but your "employer specifically chose to exclude that drug"!!!
What employer goes through and picks and chooses specific drugs not to include in their plan?
They also are trying to get away with not paying for a pre-approved investigative procedure by saying it may not be covered under their pre-existing condition policy. Its a procedure to find out if I have something so how could I have already been diagnosed? Also that clause does not apply in group coverage when you've been continuously covered. They want a 3 page questionnaire filled out. Who was your prior policy with? YOU, AETNA What is the phone number? YOURS, etc. etc. Just a delaying tactic.
They customer service reps are rude and appear ill informed about their own product and their own policies.
My daughter has dependent coverage on my health insurance through my employer. In March of 2013, she became...
My medical follow-ups were refused, because Aetna failed to pay my existing claims. I contacted Aetna on numerous occasions and their representatives said the claims were satisfied. However, Aetna’s online resources reflect that the claims are not paid. Also, I’m refused medical follow-ups and being contacted by collection agencies for non-payments. The collection agencies forwarded this information to the credit bureau. Presently, I need medical attention & medication, but worried about accumulating additional unpaid claims. Aetna is causing me more medical problems and anxiety by refusing to satisfy the claims in question.
Being at age of 69.5 Aetna approved primary care physician directed me to get a shingles vaccination. His office doesn't keep the vaccine due to storage requirements. He said to go to a pharmacy to get the vaccination. I went to Kroger where I have had prescriptions filled for one time use (maintenance med.s require Aetna mail order). I got the $200 vaccination and Aetna denied claim stating Kroger wasn't approved as a provider. Perhaps it's due to me being a working senior on an employee plan they are handling my claim in this manner.
They are the rudest when you finally reach someone. They lied to me, and told me that my claim was approved, ONLY AFTER I told them that my reason being out was a nationwide LAW, so what was the hold up? I have been out of work, and without pay for 6 weeks now, and still no paycheck. So, 3 days later, I called to check on the status of my check, and there was NONE. So, I once again spoke to someone, and she said that they just approved it today. So, that where the lie comes in.
I bet that they would cut off my insurance if I didnt pay them, so where the heck is my money? Its Dec, and Christmas and I have depleted my savings account to live off of, hey, I didnt ask for breast cancer, you know, and the law states that if you get a masectomy that reconstruction is part of your treatment. I applied for this on Oct. 19, and now its Dec 13, and I have no money still.
HOW PATHETIC>AND SLOW>AND RUDE.