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Aetna Sucks

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blondy28
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Aetna Sucks

Post by blondy28 on Sat Feb 10, 2018 10:53 pm

My husband's company switched to Aetna from BC/BS effective December 1.  At the time the two things that really pissed me off about it is that 1) my PT is not in-network, and 2) my husband's company decided that they would no longer be reimbursing us 70% of the $5,000 deductible.  Right now, I'm wishing those were the only two issues.

In spite of CVS having bought Aetna, their drug prices SUCK.  I've actually been printing coupons from GoodRX for our prescriptions, which is saving quite a bit of money off the Aetna-negotiated prices, but when you use those coupons, whatever you pay does NOT get applied to the deductible.  I have a very expensive procedure that my doctor thinks will be THE most effective treatment for me, since everything else we've tried has had little impact, but I'm not going to do it until I meet the deductible, because I don't have $5,000 to shell out at once.  I thought I'd meet the deductible with an office visit here and a prescription there.  But that doesn't appear it's meant to be.  And as a side note, I checked the price of these same prescriptions when I had them filled at Walgreens under BC/BS, and their negotiated cost was less than GoodRX, so we never needed coupons and all of our prescriptions were applied to our deductibles.

So Friday, Gab gets the car stuck in a mound of snow at the end of the driveway after the plows had come through.  I'm the only one home so I go out to try to dig her out.  On my first shovel of snow, my back went into full-on spasm and locked.  People with back problems should not try to shovel snow.  Couldn't move last night, and spent most of the night on a heating pad and shoving advil down my throat.  Woke up today in worse pain.  Virtually unable to walk.  When we switched to Aetna there was a meeting to review their very strict requirements on which facility you should be visiting for medical attention.  If you went to the ER, for example, when you should go to Urgent Care, or if you went to Urgent Care when you should have gone to their walk-in clinics that are located inside CVS stores, they would deny your claim.  So I went to their website and reviewed all the information.  The walk-in clinic did say they handle "strains", so I called CVS to see if I should be going there.  They said that since I have a history of back issues (bulging/herniated discs, epidurals, trigger point back injections), that it was more involved than just an ordinary strain, so they suggested Urgent Care.  I called Urgent Care, gave them my whole story, and told them that I know that they only have X-ray machines and no other more advanced imaging machines, but that I do have an MRI from 6 months ago, so I could bring my results if that would help.  She put me on hold and came back and said "We will NOT give you opioids so do not come here.  We won't treat you".  Huh?  I had said nothing about opioids.  I said "well, the last time I had this problem with my back, they gave me a medrol pak (steroids) and muscle relaxants, so I had assumed that's what you would have proposed".  She said "well, don't come here.  We will not see you.  Go to the ER".  I said "I can't go to the ER.  Aetna has very strict requirements for going to the ER, and THIS isn't one of them."  She said "well, try another Urgent Care location then, but we won't see you here."  WOW.  With no other options, I called the on-call doctor at my pain management  group.  I apologized profusely, since they make it very clear that emergency service calls are not meant for having prescriptions filled.  The PA who I was speaking to was very understanding, and as expected, he called in a medrol pak and flexeril for me.  And once again, it's more expensive than the GoodRX price, so we will be using the GoodRX coupon for these prescriptions too, so they also won't get applied to our deductible.  Aetna's price on Medrol is $30.  GoodRX is $18.  Walgreens with BC/BS was $14, and it was applied to deductible.

In December, I had to go through a precertification process with Aetna to get botox injections for migraines.  They approved it, and I had the injections.  They processed the claim, and covered the botox drug, but they rejected the $1,005 in doctor's fees....on a PREAPPROVED procedure.

Aetna fucking sucks.  We've only been with them since December 1, and it's been a nightmare.
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SoxIlliniRob
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Re: Aetna Sucks

Post by SoxIlliniRob on Sat Feb 10, 2018 11:53 pm

Way better than single payer.
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sharpy
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Re: Aetna Sucks

Post by sharpy on Sat Feb 10, 2018 11:57 pm

They all suck. I wish I had the power and the persuasive personality to convince the entire country to NOT buy any health insurance. If nobody had health insurance, and no doctor, hospital or pharmacy was going to collect a dime, National Health care would be passed in six weeks.
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blondy28
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Re: Aetna Sucks

Post by blondy28 on Sun Feb 11, 2018 12:28 pm

SoxIlliniRob wrote:Way better than single payer.

Did you read the article about the woman who was having severe abdominal pain and had a high fever.  Her mother, a nurse, told her to go to the ER because it sounded like appendicitis.  Turned out she had ovarian cysts, so her insurance denied the $15,000 ER bill because her condition wasn't actually life threatening.  Having had that meeting when we first changed insurance, where they explained that we HAD to go to the proper facility to be treated, I made darned sure that I didn't go to the improper facility.  What do you do when the urgent care people say "We won't treat you....go to the ER".  I understand that people are freaking out about prescribing/over prescribing opioids, and I imagine that when someone says "I have a history of back problems" that that might be a red flag that someone has an addiction that was due to legitimate chronic pain, but I've never heard of someone actually being told "don't come to our facility, we'll turn you away at the door"...especially for something that there are other treatments for...like the one I've had.  If I were actually looking for pills, couldn't they just have prescribed the steroids and muscle relaxants and denied pain killers if I had asked for them?  I've never heard of anything so ridiculous as being told "don't come here, we won't treat you".
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SoxIlliniRob
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Re: Aetna Sucks

Post by SoxIlliniRob on Sun Feb 11, 2018 12:38 pm

blondy28 wrote:
SoxIlliniRob wrote:Way better than single payer.

Did you read the article about the woman who was having severe abdominal pain and had a high fever.  Her mother, a nurse, told her to go to the ER because it sounded like appendicitis.  Turned out she had ovarian cysts, so her insurance denied the $15,000 ER bill because her condition wasn't actually life threatening.  Having had that meeting when we first changed insurance, where they explained that we HAD to go to the proper facility to be treated, I made darned sure that I didn't go to the improper facility.  What do you do when the urgent care people say "We won't treat you....go to the ER".  I understand that people are freaking out about prescribing/over prescribing opioids, and I imagine that when someone says "I have a history of back problems" that that might be a red flag that someone has an addiction that was due to legitimate chronic pain, but I've never heard of someone actually being told "don't come to our facility, we'll turn you away at the door"...especially for something that there are other treatments for...like the one I've had.  If I were actually looking for pills, couldn't they just have prescribed the steroids and muscle relaxants and denied pain killers if I had asked for them?  I've never heard of anything so ridiculous as being told "don't come here, we won't treat you".

And yet, there are those who will defend this bullshit to the death.  Usually, those defending it are those who would never have to endure what this lady endured or what you endured.  For example, my Pam and I are insured through her Verizon job with BC/BS.  BC/BS would NEVER, EVER give us a hard time about ANYTHING, because if they did Pam would complain to HR about it and if enough others did the same, BC/BS would lose that massive contract with Verizon.  So basically, we are virtually assured of not having to ever endure any of this shit as long as Pam remains at Verizon or some other large company such as AT&T or Sprint.  Most people in our shoes don't want single payer because we don't see beyond the ends of our noses in terms of how the marketplace is affecting us, and how our coverage works.  Just seems to me that if enough people pondered the hardships our fucked up system is causing nice people (along with you, LOL), or if they had to endure what you endure for just a few months or a couple of years, they would think differently about it all.  I can't imagine ever having to consider the financial implications of seeking treatment I need.  We just go get treated for anything.  Knee hurts?  MRI.  Shoulder hurts?  Therapy.  Foot hurts?  XRay.  Foot not getting any better, get a minor procedure.  $25 copay for the doctor consult and maybe $100 for some anesthesia that was higher than what my insurance covers.  And that's it.  It's not a reasonable way to deliver healthcare for me to have that, and you to have what you have.
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cream919
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Re: Aetna Sucks

Post by cream919 on Sun Feb 11, 2018 3:56 pm

My heart truly goes out to you Blondy and the many health issues you've contended with...I think you know that. 

That said, I think you ought to switch political allegiances and, in the future, support only GOP candidates when you step inside the voting booth. Rest assured they're on this health care mess like a house on fire and better days are ahead for all of us. NEVER forget the bold words and calm assurances we got from our beloved president who promised a health care program "like you wouldn't believe" It's going to be "UNBELIEVABLE!!!!!!"  cheers cheers cheers cheers cheers cheers

A hearty thank you to all of the deplorables who voted for this carnival barker/shaman. I wish I was a businessman who could conduct business with them. Dumb fucks will believe anything you tell them.
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alohafri
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Re: Aetna Sucks

Post by alohafri on Mon Feb 12, 2018 9:03 am

cream919 wrote:

A hearty thank you to all of the deplorables who voted for this carnival barker/shaman. 

Wrong board.  tongue
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SoxIlliniRob
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Re: Aetna Sucks

Post by SoxIlliniRob on Mon Feb 12, 2018 9:20 am

Blondy, you'll enjoy this new piece of reporting in Forbes.  Can't imagine you think single payer would be better than this awesome system....

https://www.forbes.com/sites/robertglatter/2018/02/11/former-aetna-medical-director-admits-to-never-reviewing-medical-records-before-denying-care/#4579a73935e5
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blondy28
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Re: Aetna Sucks

Post by blondy28 on Wed Feb 14, 2018 8:22 pm

SoxIlliniRob wrote:Blondy, you'll enjoy this new piece of reporting in Forbes.  Can't imagine you think single payer would be better than this awesome system....

https://www.forbes.com/sites/robertglatter/2018/02/11/former-aetna-medical-director-admits-to-never-reviewing-medical-records-before-denying-care/#4579a73935e5

This doesn't surprise me in the least.  I just sent it to the owner of my husband's company.

I understand that Aetna had no control over what the urgent care people did.  I just couldn't let it go.  I thought perhaps the information that was communicated to the doctor that resulted in her refusing to treat me was miscommunicated, so I wanted to speak to her personally.  The woman who I spoke to Saturday actually answered the phone, and I recounting our conversation Saturday and asked her to explain why they would deny treatment.  She said "well, you had all those back surgeries so we felt your case was too complex".  Huh?  I said "I never said I had back surgery.  I have NEVER had back surgery.  I said I had herniated and bulging discs and that's why the CVS walk-in said that they weren't the proper place for me."  Then she said "you said you wanted advanced imaging..."  Um, no I didn't!  I said that I know urgent care facilities typically only have x-ray machines and I asked if you wanted me to bring my MRI results from last summer.    She ultimately basically admitted that they thought I was drug seeking.  I said "how?  When you said 'we won't prescribe opiates for you' and I said 'I don't expect you to.  They typically prescribe steroids and muscle relaxants'.  She said 'we wouldn't prescribe steroids, either'"  WHAT?  That's total bullshit.  Of course you would prescribe steroids!  Do you know how many times my asthmatic daughter has been prescribed steroids at an urgent care facility?  I even found a Yelp review for this place from a guy who went in for back spasms!  Trust me...I get it.  I get that you have to try to weed out drug seeking patients, but holy shit, all I did on the phone was literally list my current ailment and any history that may apply...nothing more, nothing less.  The only thing I could think that was going through their heads was that I advised that CVS told me that their walk-in clinic was not the appropriate place to treat me, so they assumed I was rejected because I was drug seeking.  This whole medical  system in our country is a shit show.
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sharpy
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Re: Aetna Sucks

Post by sharpy on Wed Feb 14, 2018 11:12 pm

This whole medical  system in our country is a shit show.

I keep hearing how its the greatest in the world ...

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