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When my kids were little, Aetna denied every claim from my Peds Dr under $100 hoping ppl would think it wasn’t covered and pay out of pocket.
EVERY claim. My kids had chronic ear infections & strep throat. I had a huge stack of Explanation of Benefits showing the denials
When my kids were little, Aetna denied every claim from my Peds Dr under $100 hoping ppl would think it wasn’t covered and pay out of pocket.
EVERY claim. My kids had chronic ear infections & strep throat. I had a huge stack of Explanation of Benefits showing the denials
When I called to find out why the claims were denied, I was told they didn’t know. That only the processors knew. I asked to be transferred to the Claims Processing Department.
I was told that wasn’t possible because they had no phones in the department. 😯 Yes, NO phones.
I was told that wasn’t possible because they had no phones in the department. 😯 Yes, NO phones.
Having to submit the claims 3 times cost the practice quite a bit. Another was to depress claims. If it cost more to file the claim than the reimbursement then there is no reason to file the claim.
One day I found out Aetna was withholding payment. Six figures. Money needed to pay the salaries of the office staff.
Why did Aetna withhold the payment? They wanted to renegotiate the contract they had with the practice. Mid year.
Why did Aetna withhold the payment? They wanted to renegotiate the contract they had with the practice. Mid year.
They wanted the practice to accept a payment schedule lower than Medicare. This’s illegal. They did it anyway
They were no longer accepting Aetna
I wrote an email to my boss abt it. He used the same Peds practice. It turns out that 75% of the ppl with kids at my job site do too
They were no longer accepting Aetna
I wrote an email to my boss abt it. He used the same Peds practice. It turns out that 75% of the ppl with kids at my job site do too
He escalated it. It went all the way to the top.
Human Resources found out that an Oncology practice had the same problem.
Eventually they made the determination that because Aetna was not paying the claims, we were uninsured. They allowed us to change policies midyear.
Human Resources found out that an Oncology practice had the same problem.
Eventually they made the determination that because Aetna was not paying the claims, we were uninsured. They allowed us to change policies midyear.
An Aetna PR person came for Q&A sessions. Trying to limit the damage.
I attended a session and asked why they deny every claim under $100. He said “We don’t deny every claim under $100”
Me: I have a stack of 300 EOB forms that shows you do deny claims under $100.
I attended a session and asked why they deny every claim under $100. He said “We don’t deny every claim under $100”
Me: I have a stack of 300 EOB forms that shows you do deny claims under $100.
His jaw dropped to the floor. He did expect to be challenged and was prepared for it.
I turned around and left. I heard the door open & close behind me. Another employee caught up with me and said, his daughter had major health issues and he had the same stack of EOBs.
I turned around and left. I heard the door open & close behind me. Another employee caught up with me and said, his daughter had major health issues and he had the same stack of EOBs.
Most ppl changed Aetna was dropped as an option the next year
Score one for consumers
Aetna was banking on the fact that most ppl wouldn’t notice & most didn’t. This only came to a head because they over played their hand by withholding payment & I’d made friends with my Ped Dr
Score one for consumers
Aetna was banking on the fact that most ppl wouldn’t notice & most didn’t. This only came to a head because they over played their hand by withholding payment & I’d made friends with my Ped Dr
Insurance companies take advantage of people too sick to fight them. As a standard practice they deny every claim they think they can get away with.
They love the word “experimental”. They label everything they can as experimental. They label accepted treatments as experimental.
They love the word “experimental”. They label everything they can as experimental. They label accepted treatments as experimental.
Every health insurance plan has a stipulation that they will not cover experimental treatment. But they decide what’s experimental.
That’s one major flaw in @SenSanders #MedicareForAll bill. It specifically excludes anything “experimental”.
That’s one major flaw in @SenSanders #MedicareForAll bill. It specifically excludes anything “experimental”.
The problem with excluding “experimental” treatment is that Big Pharma and the Healthcare Lobby fund much of the research done. But their goal is to make profit not provide care.
When most of the members of the Boards of associations like the Infectious Disease Society of America have their research funded by Big Pharma, the Healthcare & Insurance Lobby, new treatments are rejected when put forth for consideration as an accepted treatment.
Some treatments don’t lend themselves to double blind studies.
A treatment may be a serious of different medications with the protocol tailored to the patient. The meds taken, for how long, what combinations, etc.
Ins won’t pay even tho the treatment has a hit success rate.
A treatment may be a serious of different medications with the protocol tailored to the patient. The meds taken, for how long, what combinations, etc.
Ins won’t pay even tho the treatment has a hit success rate.
As shown in the video, the label can prevent someone with diseases like ALS, MS, Lupus, Parkinson’s, etc from receiving proper care.
It also prevents that population from benefiting from new treatments/medications that are safe but may not be fully vetted for their condition.
It also prevents that population from benefiting from new treatments/medications that are safe but may not be fully vetted for their condition.
Same is true for people who are out of options in a life and death situation. They are prevented from accessing treatment that may help them because its experimental.
Insurance companies deny coverage in other ways.
I have been taking a medication for 10 years. It’s always been covered no problems.
Last year we had new health insurance. Caremark was the only drug plan offered.
They showed a limitation on some of my medications.
I have been taking a medication for 10 years. It’s always been covered no problems.
Last year we had new health insurance. Caremark was the only drug plan offered.
They showed a limitation on some of my medications.
With 1 medication, the limitation was on the number of pills It came in strengths of 100, 200, 300 & 600
The limitation was 6 tablets per day. No matter the strength. So 6 of 100 or 6 of 600. Ludicrous right?
I took 300 during the day but 1200 at night I couldnt get enough 300s
The limitation was 6 tablets per day. No matter the strength. So 6 of 100 or 6 of 600. Ludicrous right?
I took 300 during the day but 1200 at night I couldnt get enough 300s
But with the medication I had been taking for 10 years, the limit was 84 tablets for a 25 period every 30 days.
I take it four times daily. Every day. That works out to 120 tablets. For 30 days.
Before choosing my healthcare plan, I called to find out about the limit.
I take it four times daily. Every day. That works out to 120 tablets. For 30 days.
Before choosing my healthcare plan, I called to find out about the limit.
I asked about the cost. They told me it would be $2000/month. 😮
But I knew they were lying to me. As I said, I’d been taking it for 10 years. I know what insurance had been charged. It was a generic. At most $100.
84 works out to 3.3 per day. Not enough.
But I knew they were lying to me. As I said, I’d been taking it for 10 years. I know what insurance had been charged. It was a generic. At most $100.
84 works out to 3.3 per day. Not enough.
To get my full dosage, I have to have the pharmacy put the 84 thru my insurance and pay for the remaining 36 out of pocket. The 36 cost me $10 last month, not $2000
I can’t get the next refill for 30 days. 84 for 25 days literally means 0 for 5 days & you can only fill every 30
I can’t get the next refill for 30 days. 84 for 25 days literally means 0 for 5 days & you can only fill every 30
I 1st it filled at CVS because I was supposed to get the cheapest prices because Caremark is the provider
But they would only fill for 84 every 30 days. They deducted one from the number of refills. So a full refill was deducted even tho I only got part of the prescribed amount.
But they would only fill for 84 every 30 days. They deducted one from the number of refills. So a full refill was deducted even tho I only got part of the prescribed amount.
My neighborhood pharmacy (inside my grocery store) fills the entire 120 pills. In 15 minutes.
Now Aetna is buying CVS.
Now Aetna is buying CVS.
But it’s not just health insurance that’s a problem
Long Term Disability Insurers and SSA (SocSec Disability) do the same thing Delay by denying. Hope the person gives up and goes away
They take advantage of people too sick to fight back
Denials are automatic for silly reasons
Long Term Disability Insurers and SSA (SocSec Disability) do the same thing Delay by denying. Hope the person gives up and goes away
They take advantage of people too sick to fight back
Denials are automatic for silly reasons
If your employer offers the option of purchasing additional LTD, opt out. The insurance company collects your premiums with no intention of paying out.
Standard Insurance (headquartered in Portland) is both the biggest and the worst.
Don’t let commercials for AFLAC fool you.
Standard Insurance (headquartered in Portland) is both the biggest and the worst.
Don’t let commercials for AFLAC fool you.
If you do need to file a claim, get a copy of the plan from your Human Resources Department. Read it. The contract they sign on your behalf usually benefits the insurance company and there are major stipulations you need to know about.
Social Security Disability 🤔 recommendations on how to navigate that could fill an entire book
Know your rights Document everything. Don’t let their questionnaires trip you up. “Examples” they give are used as reasons to deny. Attending church 1x a month was a reason for denial
Know your rights Document everything. Don’t let their questionnaires trip you up. “Examples” they give are used as reasons to deny. Attending church 1x a month was a reason for denial
In general, when dealing with insurance companies you should do the following:
Read ur policy incl specifics on treatments
Document every phone call & every contact
Don’t give up
Ask for a supervisor if u aren’t satisfied
Contact the State Insurance Commisioner if necessary
End
Read ur policy incl specifics on treatments
Document every phone call & every contact
Don’t give up
Ask for a supervisor if u aren’t satisfied
Contact the State Insurance Commisioner if necessary
End
This story isn’t just about Aetna. All the companies cheat us in whatever ways they think they can get away with.
It isn’t about healthcare to them. It’s about profit. Even if they have to violate (or rewrite) the terms of the contract we or our employer has with them.
It isn’t about healthcare to them. It’s about profit. Even if they have to violate (or rewrite) the terms of the contract we or our employer has with them.
