Aetna - I Drew a Line in the Sand

[easysurfer]

Helping my sister who dual qualifies for medicare and medicaid this year. Having to figure out what medical services falls under which seemed confusing to me so I had her sign up for a plan under Aetna that covers services for both.

So, met with Aetna assigned case workers to come up with plan. Communicating with Dr. about some services when ran into a snag. For three times now, Aetna couldn't get her properly assigned to her PCP. As a result, things are delayed. Frustrating that each time, I called member services (can't make the change by a website) and made sure they verify to PCP. They say something like ,"Yes, all done, effective immediately" only for me to find out later a different doctor gets assigned as PCP .

I drew a line in the sand. I messaged the case worker (who doesn't have much power to do anything about getting this fixed either) saying if this isn't fixed by end of month or sister gets assigned another wrong PCP, I'm considering throwing the towel and changing insurance provider.

Makes me wonder now, is this just me or an Aetna thing. Googling reviews and comments online, looks like several have Aetna horror stories.

I'm almost hoping Aetna messes up again so I jump ship. Will be back to square one, but maybe blessing in disguise .

 

[Jerry1]

I'm almost hoping Aetna messes up again so I jump ship. Will be back to square one, but maybe blessing in disguise .

Best of luck with your struggle. I wonder though, seems like starting over can only be a blessing if there are really other options in your area. Are there?

 

[easysurfer]

Best of luck with your struggle. I wonder though, seems like starting over can only be a blessing if there are really other options in your area. Are there?

Thanks. Yes, there are other options. Would have to start again in square one though, like meeting face to face with case managers.

I'll wait awhile with my line in the sand, but have an itchy trigger finger to switch.

To be fair, so far other parts like time to reach someone was good. No long wait time on hold and the case managers didn't totally ignore questions.

 

[pb4uski]

....I drew a line in the sand. I messaged the case worker (who doesn't have much power to do anything about getting this fixed either) saying if this isn't fixed by end of month or sister gets assigned another wrong PCP, I'm considering throwing the towel and changing insurance provider. ...

You might get more response by doing one of the following.

1. Write a complaint to the CEO or President of Aetna. Where I used to work, any complaints to them would get special handling by more experienced people who were in a better position to make changes happen.

2. Threaten to complain to the state insurance commissioner. Companies hate to see complaints and if they fail to fix it and you do make a complaint, the state insurance department can rattle their cage to get the change you need made.

 

[easysurfer]

Okay, just called the client enrollment (of the state, not Aetna). I'm the authorized person that can help require changes on her behalf.

In her case, good news because she's on both medicare/medicaid she can change plans anytime. No open enrollment applies.

I'm the type of person that likes to give folks a chance for redemption, so I'm giving til end of month for Aetna to get the PCP update done. If not done by then or if they get the change wrong again or if in the future they give crappy service, then like that old Bob Dylan song, "I Feel a Change Comin' On" .

 

[Another Reader]

Is the PCP really on their list? Is the office within the requisite number of miles from her residence as required by Medicare? If not, they may just be assigning one that meets their requirements when you call and not explaining what they did.

I had an insurance company claim I had not elected a PCP and assign me to a doctor whose primary language was not English and whose office was located in a neighborhood in which I would not park my car. When I told them I had had the same PCP for over 10 years and the instructions were not to enter one on the annual enrollment form, they eventually relented. The telephone conversation might have included a suggestion that this would be elevated to the insurance commissioner as well as the contracting retirement system if not successfully resolved immediately IIRC. Lots of noise about not changing until the next open enrollment period, but a correction letter arrived a couple of weeks later.

 

[easysurfer]

Yes. PCP is on their list. I made sure to tell them to verify and they read off the doc's name and address. Doc is only about 10 miles away from sister. Office is in different county. But if a person isn't allowed to get a PCP in different county only 10 miles away, that really doesn't sound right.

 

[Car-Guy]

Makes me wonder now, is this just me or an Aetna thing. Googling reviews and comments online, looks like several have Aetna horror stories.

I'm almost hoping Aetna messes up again so I jump ship. Will be back to square one, but maybe blessing in disguise .

I'm not sure if it's a Aetna thing or not since I've only had Aetna insurance for many years now (not by choice - company insurance). Saying they suck is being kind to the extreme.

Trust me, your hopes that they mess up again will likely be answered, soon.

 

[easysurfer]

...

Trust me, your hopes that they mess up again will likely be answered, soon.

That's the best news I heard all day .