Friday 11th of August 2017 01:33:30 AM
I'll start by mentioning that it is 11 days past my group health insurance effective date. It was supposed to be active on December 1st, 2017. It is now December 11th and we still haven't been "entered" into their system. Therefore, my family and I "do not exist" in Aetna's world, nor does any medical professional recognize that we have health insurance. I have never heard of any insurer ever doing this to their customers.While waiting, I had to pay for two doctors' visits (full price since no insurance was "in effect" and we couldn't get the negotiated rate). Okay, I can deal with that and will file it when/if we are activated at Aetna. The straw that broke the camel's back was when I had to pay full price on my son's medication -- around $700. My patience was gone at that point. I called customer service (again) who wouldn't help me because "I wasn't in their system." After about 6 different phone calls and 4 hours of my time, they finally routed me to someone in the Rx insurer department.I had a simple question -- When my plan and member information FINALLY gets entered into their system, is it possible that the medications my son took were going to require a pre-authorization. I just wanted to be prepared since these pre-authorizations can take up to 10 - 15 business days from the time you have to send it to the doctor for initiation. I didn't want to fork out another $700 for the following month.The customer service (National Accounts) lady was very rude -- she wouldn't let me get a word in and interrupted constantly. I have never been treated like that by any customer service rep I have ever spoken with. She was very stern with her voice. I got her name and department, but somehow lost it over the following weekend. I wanted to file a complaint. I was angry at myself for losing it. The lady told me that no one would answer my question because the member information was not in the system. She refused to route me to anyone that might help.I understand that. I just wanted to know if it was typical for them to require pre-authorization for the medicines. I asked to be routed to someone in Rx to talk with anyway. She kept saying with a firm voice "No." Her reasoning... It could have been one of two Rx insurers -- Aetna or Optima Rx. I had a simple solution - Give me the number to both centers and will ask both of them. It would still give me some idea. She still said "No." After demanding that I have her full name and department, she finally gave it to me.Again, I know that when/if we get entered into their system, I can file the claim individually and perhaps get my money back. But, I was told by the pharmacist that since I didn't get a pre-authorization, Aetna/Optima is not required to pay the claim. A pre-authorization is required before obtaining the drugs -- and Aetna was known for doing this.I don't know how I will react if it happens. I will appeal, but who knows how long the appeal process will take and even if it would be overturned. I have some say-so whether or not my company will decide to change carriers for the next plan year. I assure you, I will do everything in my power to ensure this happens -- regardless of costs. NEVER, NEVER, NEVER will I use Aetna again and I would encourage the same for others if they have a choice. Also, if CVS acquires Aetna, then CVS will never receive a dime from me either. I hope this helps someone.