Aetna review: Here we go again — months of prescription denials and prior authorization runaround

I am updating my review because, unbelievably, I am dealing with Aetna over my medication again.

My previous experience with Aetna was already bad enough. I dealt with prescription denials, repeated phone calls, administrative runaround, and prior-authorization issues. At one point, I was told that a prior authorization was what was needed, only to continue running into problems after the requested paperwork was submitted.

Now, after temporarily losing my insurance because of unemployment and getting coverage again, I am right back in the same situation.

I have been taking this medication for nearly 20 years. My doctor has now been trying to resolve the current coverage issue with Aetna for roughly two to three months. Prior authorization paperwork has been submitted, yet coverage for the brand-name medication continues to be denied. My doctor’s office has repeatedly tried to deal with this, and we still do not have a workable resolution.

What makes the situation even more frustrating is that there is currently a shortage affecting the extended-release medication I take. Because of availability, my options for obtaining the extended-release medication are already extremely limited. The immediate-release alternative is not equivalent for me and does not work the same way for my treatment.

So now, after almost two decades on this medication, my doctor and I are spending months dealing with an insurance company over continued access to the formulation that has worked for me.

This is exactly what made my previous experience with Aetna so infuriating. Members are told to follow the process, so we follow it. We’re told to have our doctors submit prior authorizations, so they submit them. Then the authorization is denied anyway, more paperwork follows, more calls have to be made, and eventually the patient has to personally step in and fight over something their physician has already been trying to resolve.

At this point, I will be documenting every denial, every authorization, every call, every reference number, and every communication between Aetna and my doctor’s office. I intend to use every appeal, external-review, complaint, and regulatory process available to me until I receive a clear written explanation and this issue is properly addressed.

If Aetna believes the brand-name extended-release medication I have taken for years should no longer be covered, then I want the exact reason in writing. I want to know what coverage criteria were applied, what information from my physician was considered, why the prior authorization was denied, what alternatives Aetna requires, and exactly what evidence is necessary to overturn the decision.

Patients should not have to spend months fighting their insurance company after their doctors have already provided the requested information.

This is not my first experience with Aetna creating unnecessary obstacles around my prescriptions. Unfortunately, after everything that happened previously, I am now dealing with it all over again.

I will update this review as the appeal and complaint process continues.

Sincerely,

One extremely frustrated Aetna member