Complaint Review: Aetna Health Insurance - Open Access - Minnetonka Minnesota

I happen to be experiencing almost the identical situation. What is extermely disturbing to me is that I researched the plan in depth and ultimally chose it because of the convenience of the formulary and the fact that I spoke with numerous representitives at almost every level. All reps that I spoke with assured me that they ran my information through their system as if I were placing a new order and all of them assured me that there would be no problem what so ever. 

What frustrates me the most is that all of their online documentation and personal plan information pertaining to my program clearly stated and to date; states that there is no issue in receiving my pain medication through the Home RX Service. 

I received a call from their head pharmacist the following day who informed me that they no longer send Class 2 medications via Home RX. She stated that they implimented that procedure over a year ago and that there are NO exceptions. I commented that I had chosen the plan two months ago and that there was nothing that indicated that the medication was not available via Home RX. I commented that I felt that it was unethical and illegal not to have made any updates to the online information as well as my personal plan benefits. 

She then commented that if my doctor did not know where I can find a local pharmacy to fill them; that she had no business writing the prescription. My experience with the Service Representatives was basically amicable; however; all of the pharmacists that I spoke with were extremely RUDE. The only hope in the situation is that they will pay for the medication the if you can find a local pharmacy to order it for you. 

When I expressed that they had been misleading prospective members and current members by leading them to believe that a service existed when it had not been available for over a year she blew a fuse. I informed her that the fact that they are creating an illusion that a service or benefit exists when in fact it does not; is grounds for Illegal Business Practices, Fraud, and Subsequently a Class Action Suit of Epic proportions. 

She then had the nerve to tell me that there was a way of obtaining it through the Home RX Program but that she was not going to instruct me how to do so because I would probably broadcast it to the world and that she was not going to allow that to happen. 

She then expressed that an individual who received those medications through the program had to fall within a "certain criteria". I asked her if they had a copy of my medical records or if they had spokent with my Doctor. She neither had access to my medical records, did not want to look at my medical records, and ABOVE all; she refused to speak with my Doctor. 

When I asked her; how then could she possibly know that I did not fall under the elusive category she beligerently told me that it did not matter anyway because she was not going to allow the pharmacy to fill it. She then put on the act as if she cared; and asked me if there was anything else that she could do for me. Before I had a chance to asnswer; abruptly hung up on me.

You are ABSOLUTELY right on the mark in assessing that a "Class Action Suit" is begging to be initiated before we see anything at all being resolved in this matter!!! I spoke with a department head with the Insurance Commision and she stated that based on our conversation surrounding the details of this scenerio; too many people are being "Baited" into beleiving that they are entitled to a benefit which does not EXIST. The company is using their literature as a manipulative tactic to recruit and secure members under false pretense.

She adamently instructed that anyone else experiencing this scenerio with this company should complain and broadcast it on every level and arena from the Insurance Department, B.B.B, FDA, All applicable govermental agencies, the corporate offices of the company themselves, and even the Media. The list went on and on. Anyway, I have taken enough of your time but I would like to thank you for sharing your information; not just for my sake but for the sake of all the patients who are enduring and will continue this kind of insanity. 

One voice may not seem to make a difference but MANY voices will. Our government was supposed to have been established by the people and for the people. If we remain silent then we lose our right to complain in order to make a difference; and we deserve what we get by not asserting our rights and priveledges as individuals, patients, and American Citizens. 

Thank you for refuleing and resparking my desire to make a difference by sharing your circumstances!!! 

Respectfully Yours,

Enough Is Enough 777.......

FDA approves drugs for certain uses. Sometimes doctors use drugs for conditions that FDA has not approved them for. Migraines are often treated with cancer pain breakthrough medications because they feel it works better than imitrex or the other migraine medications. Most health insurers will not cover this type of usage unless the physician can justify the use for the condition. Aetna gave you an out by asking your to have the doctor contact them to explain the medical necessity of the prescribed medication. It is up to the doctor to explain to the insurer the necessity of the medication since it is being used for an unapproved treatment. Most times the carrier will go along with the provider's recommendation as long as it is medically sound and necessary. Did you talk to your doctor about requesting approval from the carrier?