#fuck aetna

[digzmania]

Aetna intentionally denied multiple pre-authorization requests for my upcoming surgery with the SOLITARY purpose of delaying it until it was too late to schedule a surgery date in 2024. I was scheduled to have the 3rd of 3 surgeries on 27 NOV 2024. My remaining Out of Pocket MAX for the 2024 year is down to $509, and Aetna wanted to be able to put more of the financial burden (Deductible and reset out of pocket ax) back onto me. My doctor submitted pre-authorization requests on 30 OCT 24, 08 NOV 24, and 12 NOV 24. Each time, Aetna came up with a new and unethical reason to deny or delay their approval. On two separate occasions, AETNA cancelled the requests internally, and outright lied as they tried to claim that my doctor's office had withdrawn the requests. Only when pressed in a three way call with Aetna and my Doctor's Scheduler on the phone did they admit that teh cancelled requests were their doing. Then they asked for a new request submission, claiming that it was not a "Denial of Service." Next, they denied service stating that my doctor and surgical center were "Out of Network." not only are both "IN NETWORK," both are considered Tier 1 Preferred by Aetna, as stated on Aetna's own website provider listing. After more than a month of phone calls, clarification requests, cancelations, re-submitted requests, transfers to various Aetna Departments, my request was finally approved on 06 dEC 2024... AFTER my originally scheduled date had past, and ONLY AFTER Aetna fully realized that it would be too late to schedule a surgery date by 31 DEC2024, at which time all deductibles and fees due from me reset all over again.

At no time were any of these delays out of a concern for my health, wellbeing, or safety. Aetna had one goal at purpose... delay, deny, depose for the purpose of saving Aetna money and costing me thousands $,$$$. I'll not even go into all of the details about denial of service for procedures already performed... like authorizing cervical fusion surgery and paying for the fusion plates, but denying payment for the screws used to fasten the plates in place...

[tj-crochets]

Hey y’all! Aetna (the worst health insurance company I’ve dealt with) denied my doctor’s Prior Authorization Requests for my inhalers, so I could use some help.  What do you know about appealing health insurance coverage decisions in the US? I think there’s something about asking who made the determination and if there were doctors involved, but I can’t remember the details.  Additionally, do you know how to determine when your open enrollment period is? I am at this point wanting to get away from Aetna as quickly as possible, but apparently even if I am paying the premiums myself out of pocket I can’t get blue shield until it’s an open enrollment period??? I don’t really understand that because I know I’ve seen forms asking like “which of your multiple health insurances are you using for this” so I thought you could have multiple forms of health insurance if you wanted. Health insurance makes no sense and I deeply resent everything about this. Especially Aetna. Resenting the fuck out of Aetna tbh

[thedyke]

i feel like i’ve grown so much recently. like i’m on a year and a half of fully supporting myself and not living with family, i’m finally trying to make decisions that help me in the future, i’m staying on top of my med refills… 24 will be a good year!!!

[truthwithlight]

hey fellow cripples if you can DO NOT USE AETNA FOR YOUR INSURANCE... [pt: do not use Aetna for your insurance]

this is a load of fucking horse shit. i've been fighting with my insurance for FIVE WHOLE MONTHS [pt: five whole months] to get my AS medication approved. they keep canceling my prior auth. yeah. canceling. not denying! just straight up deleting it and not telling anyone

they tell us we don't have specialty pharmacy coverage, so we talk to our insurance guy and he tells us yes we do it's in our plan! then they tell us cvs isn't a pharmacy in their network! THE INSURANCE IS LITERALLY AETNA CVS [pt: the insurance is literally Aetna CVS]???

they keep directly lying straight to my rheumatologist's medical assistant's face about how the PA process works when half her job is getting PA requests done! i've been living off of sample injectors for the last five months, my doctor is almost out of samples, and the manufacturer has informed them that they're not making samples anymore. the insurance is well aware of this and (before april when they stopped covering that as well) kept telling me to just take humira. i cannot take humira! i get severe injection site reactions! they also know this! it's in my notes!!!

we've sent in appeals, we've gotten both every pa submitted and the appeals expedited, and there's absolutely no word from aetna. just a silently canceled document or "yeah the higher ups aren't budging, sorry, here's [number you've called like 5 times that gets you nowhere]" we get a different story from every single person we talk to

i'm sick of this, my mom is sick of this, my DOCTOR [pt: doctor] is even sick of this, and i just want to be treated like an actual fucking human being and not a case number no one at aetna wants to deal with.

i've been holding myself back from making this post because surely it'll get resolved, right? surely i'm just being bitchy, right?

well my last straw is today when they sent me yet another message saying cvs isn't in their pharmacy network (bullshit) and told me it had to be filled by a local pharmacy i'd never heard of. we call said local pharmacy and they inform us that they're a family owned compounding pharmacy and cannot fill expensive specialty prescriptions like this without LITERALLY GOING BANKRUPT [pt: literally going bankrupt]

the medical assistant we keep having to talk to says that in all her years of having to work through stubborn insurance, she's never had an experience this bad. no patient has ever had this much trouble getting a relatively common prescription filled.

literally the worst experience of my life, it's beyond degrading to be treated like you're the problem because some executive somewhere is deciding that it's better for you to be crippled and in bed all day than approve a single prescription

[subversivecynic]

Today in "things that should radicalize you"

Retrieved Mom from LTC and she came home. They gave her 10 days worth of the meds and said good luck, just tell ss that you discharged and you will receive payments again starting October.

One of the 12 meds she is on one is $1800, another is $1500, and a third is $600. I don't know what the rest are because they haven't processed them yet, but 3 of those are name branded.

The facility, upon discharge, did not offer transition to home or help restarting her insurances.

So to tldr, they sent her home to us with zero money, zero coverage, and a bill that's about 1 month income for her kids to continue to have access to her heart meds, insulin, and dementia meds.

[the-voice-of-night-vale]

I'm a medical biller, and Not only does UHC deny care based on an absolutely dogshit AI model, but they also basically reject every single office visit above level three (office visits are split into 4 levels based on time and/or complexity(99212-99215)) and force you to resend them because they don't believe that you should actually be billing "that high" (any office visit in which you discuss a prescription is automatically eligible for at LEAST 99213, oftentimes it's 99214) (and then a lot of the time they reject it again for "duplicate" :))))

Unfortunately most insurance companies are dog shit in general, and a lot of the time those of us who are covered by our empoloyers don't have a choice (and marketplace plans are EXTREMELY expensive) but if you have the choice, yeah. try not to go with them (of course, change healthcare also happens to own a ton of insurance carriers besides uhc)

UnitedHealthcare, the largest health insurance company in the US, is allegedly using a deeply flawed AI algorithm to override doctors' judgments and wrongfully deny critical health coverage to elderly patients. This has resulted in patients being kicked out of rehabilitation programs and care facilities far too early, forcing them to drain their life savings to obtain needed care that should be covered under their government-funded Medicare Advantage Plan.

It's not just flawed, it's flawed in UnitedHealthcare's favor.

That's not a flaw... that's fraud.

[gingersnapwolves]

You know what since I’ve got a ton of new followers because my post on puberty blockers took off and people apparently want to see me rant, I’m gonna get up on my soapbox for a PSA for tumblr’s aging userbase.

Do not! Get! A Medicare Advantage plan!

Tell your parents not to get one. Tell your aunts and uncles not to get one. Tell your friends not to get one.

Why is that, you might say? Kouri, what is a Medicare Advantage plan, you might say?

tl;dr Medicare is the government healthcare plan for Americans of a certain age or with certain disabilities. It is owned, administered, and operated by the government. You are entitled, if you wish, to outsource your Medicare and have your policy run by a commercial group, such as United HealthCare, Cigna, Aetna, et cetera.

Here’s how it works: For everyone who signs up for, say, a plan that rhymes with Figna Medicare Advantage, Medicare gives Figna a certain amount of money and says ‘use this to take care of this patient’.

You can see where this is going, right? Figna says ‘sure boss! *wink nudge*’ and then shoves as much of that money into their own pockets as possible, and they do that by finding excuses to NOT pay for your medical care.

Medicare Advantage plans are pushed and marketed heavily. They’ll call you. They’ll set up stands in your PCP office to try to encourage you to buy in. They will say things like ‘with Medicare, you have to pay a 20% coinsurance, but with us you only have a 10% coinsurance’ and completely neglect to tell you that having a smaller coinsurance only matters if they approve the fucking care that you need, which often they won’t (while Medicare would have) and if your doctors are willing to accept it, which often they don’t (while they do accept Medicare).

Is Medicare perfect? Absolutely not! I've got my share of bones to pick with them. But simply put:

Medicare is government administered. It is a service. It costs the government money, which is why the GOP is always trying to cut funding to it. Medicare Advantage is corporately administered. It is supposed to make money. Which gives them incentives to deny your care and fuck you over that Medicare simply does not have.

Do not. Get. A Medicare Advantage Plan.

[unicornbeck]

Welp. Our insurance now charges us more than 5 times our last year’s copay for being seen in Immediate Care.

It was $15. Now it’s $80.

Our insurance company’s name starts with “A” and rhymes with Etna. Fuck them and fuck the American Health Care System.

[frasermints]

because they drug test upon offer of employment and with reasonable suspicion. as much as i love costco they're still fucking cops. if issaquah and company can't get with the program, don't expect your local warehouses to.

costco should sell weed i want to smoke kirkland signature strain

[tj-crochets]

I am once again in insurance hell, so let me reiterate: Aetna is the worst health insurance company I’ve ever had to deal with. Avoid it if you can. 

[strinak]

oklahoma is fucking with the state version of medicaid (soonercare) and making it a managed care system (??) and it's stressing me out bc only one of the three choices has "we cover this but not this" brochure and re: the brochure they don't cover shit? but also all three are "contracted to provide the same level of care"

[crookedheir]

The juxtaposition between how well my MCAS symptoms are managed on medication and how awful my symptoms are as/after it wears off is wild. For like 3 weeks a month I’m lulled into a false sense of security and then WHAM, I’m in hell.

[fellthemarvelous]

Deny. Defend. Depose.

It is clear to those of us that live in America, the only people we truly have on our side are ourselves. The ruling class has made it clear we don't matter to them.

Luigi Mangione was arrested and happened to have every single piece of evidence on him that law enforcement was looking for, including the parts for the ghost gun, inside his backpack (that he also got rid of in Central Park containing the Monopoly money???). Either he was trying to get caught or that evidence was planted. And when he was being forcefully pushed into the jail, he hollered back to the press about "injustice" and "being an insult to the intelligence of American citizens and our lived experiences."

The people have now turned against corporate America and the CEOs and billionaires are fucking terrified. Nothing the news stations are saying to us are changing our minds. The American people have finally united over this issue and there is no going back for us. Whoever did kill Brian Thompson (and theories abound on the game The Adjuster is playing because no one plays Monopoly alone) exposed the very real divide that exists between every day citizens and the extremely wealthy. Things were easier for them to control when they were able to divide us, but now that we are aware of how uncertain our future is in America and seeing just how little we matter to the people who take our money, we have realized that we have more in common with each other than the people who control every aspect of our lives. We are waking up.

There isn't one person in this country who hasn't been a victim to the predatory scam that is private health insurance. Medical debt is the leading cause of bankruptcy in America, and many of us are one ambulance ride or hospital stay away from homelessness. We all know people who have died because the insurance company denied them the treatment they needed or waited until it was too late for an approval of a medical claim to matter anymore.

Recently, I decided to be tested for autism and ADHD. Not life-threatening or anything, but my life is still in shambles and I want to know if I'm going untreated for something else. Before being tested though, I was informed that the insurance company (Aetna) has said that they were going to cover the full cost of the testing I was having (which was six hours of testing by the way). She even made sure several times that they were, in fact, going to cover it in full and they said yes.

The same day that Brian Thompson, CEO of another horrible healthcare company, was murdered in broad daylight, I received a call from that doctor's office with the woman telling me that Aetna was now telling her they never agreed to cover my testing and that they are going to bill me for $1600 (where the hell am I supposed to get that?) and she is fighting them, but considering our lives don't matter to the people who tell us what healthcare we are and are not allowed to receive, I don't think they will feel compelled to change their minds because they are bloodsucking parasites who only care about lining their pockets while I don't even have $6 lying around, let alone $1600!!

Corporate America leeches off our taxes. They take and take and take and we see nothing in return. They raise prices on insurance coverage and then deny us the very coverage that we pay for. They poison our food, price gouge our poisoned food, and then force us to pay for the treatment we get when the food makes us sick. Corporate America profits off of our hard work, our taxes, our health, our lives, our deaths.

I don't know if this will reach a larger audience or not, but I wanted to talk about it on Tumblr because this platform seems to be a crossroads for every type of creative soul. I initially brought up this idea on TikTok earlier, but I want to see if it can get traction in other places as well since I have fewer than 3,000 followers on TikTok (and I have seen a small few express interest in my idea in the hours since I posted the video.)

We're busy being lectured by politicians and the news media because while they are clutching their pearls at what happened to Brian Thompson, the rest of us do not give one single flying fuck about what happened to him. As CEO of a for-profit health insurance company, he signed off on denied claims and death for those of us who struggle to make it from one day to the next. The sicker you are, the poorer you are, the more they force you to struggle and pay. The love to deny coverage because regardless of whether we live or die, they already have the money we are forced to pay them.

I don't condone murder at all, but I also don't care that he was murdered because he was guilty of murdering so many more people in this country through legal means because it's profitable. The CEOs are scared and there are wanted posters with their names and faces popping up in places. Every CEO of every healthcare company is guilty of murdering Americans and they continue to go unpunished for it because "it's just business".

So (if you've read this far) all of this previous rambling is to say that I keep thinking about how I want to make an impression. I want to continue upsetting the billionaires and the CEOs because corporate America is full of murderers who are legally allowed to decide whether we live or die based on which outcome will give them more money.

I have thought about the idea of creating a wall/constructing a wall somewhere as an art piece or something (making a statement) that will somehow honor the memory of people who died because insurance denied them care.

I know I definitely want it to say something along the lines of "In memory of those murdered by for-profit healthcare systems in corporate America". Something blatant. Loud. Something they are forced to look at every single day. Somehow. The wall could have images of those who are gone, or names of the person who died with the name of the insurance company responsible for their death underneath. Just something to make it clear that we see them for what they are. Something to avenge those who were sacrificed so billionaires and CEOS and shareholders could brag about record profits. Something that shows the whole world that American citizens are waking up to who the real monsters are.

The Adjuster (whoever he is or is not) has fanned the flames of revolution in America. He managed to unite us in a way I can't even recall before. It's not over. We know what happened to Brian Thompson was just the beginning, and corporate America only just now realized how much we actually hate them. A single shooter has sparked an awakening in America that is starting to snowball into something much bigger.

So if there is anyone out there who might be interested in collaborating on something like this, please let me know. I know we are all tired and demoralized and we have no money. I want to make a statement though, and I love doing that through art or writing. Collaborating with other people who have been through this same shit will also probably help us unite even more.

This is a watershed moment in American history.

In the words of Kanan Jarrus, Jedi Knight,

"There is a future for us. One where we're all free. But it's up to us to make it happen."

[sooptea]

Saw that some folks don't know how American Private Insurance Works, so I wanted to show some real life examples of how mine works. For transparency I do not use United Healthcare (I have had them in the past), my numbers are from the insurance I have which is called Aetna; and the plan I use is available through my employer (so if I quit or get fired, I lose my insurance).

So, in my experience. Copays (the amount of money you owe upfront for an appointment) varries depending on what doctor you're seeing. I have to pay this every time I see a doctor, and if I do not have an FSA/HSA card then I have to pay with one of my personal cards.

For a Primary / Family Doctor $30 USD -

For a Specialist (Physical Therapy, Therapist, Orthopedics, literally any specialty doctor) $60 USD -

Urgent Care $75 USD -

Emergency Room $300 USD -

And where does that leave me, 6 months into my year plan (because this resets to Zero every time the plan renews)?

What Does that mean? That means if I went to a hospital today and had to stay overnight, I'd be responsible for $2,422.16 USD before my insurance would cover anything. And I would have to spend another $2,135.40 USD before they would 100% cover the cost. If I needed any surgery, any care, anything that gives a bill, I am responsible for it until I meet those "goals"

But the fun part? I don't know what that would mean for my primary care doctor visits after I meet my out of pocket maximum, because I have NEVER met either my deductible or my out of pocket maximum. Not because I didn't have expensive bills! But because they never fucking applied. Because all of this still hinges on you being IN-network. So if you go to a doctor that's out of network, those numbers are different! They're higher.

I did 13 sessions of physical therapy about 1.5 months ago. That was $780 dollars for the copays. Plus an extra $77.84 because of one of the things I was billed for was not covered with my insurance. Oh yeah, even if you go to an in-network doctor there are procedures that aren't covered by your insurance even if they're necessary. If they were out of network I would have been responsible for a total of $3,885 additional dollars on top of my $780 I paid in co-pays. And that would not have counted towards my deductible. It would have been towards my out-of-pocket max.

I have to look up local doctors in my town to make sure they are in network, people have to look up HOSPITALS to make sure they are in network. Our system is fucked up. I have had reoccurring chest pains since childhood that they can't figure out why, and anytime I get a flair up I have to figure out if I want to take the risk of it being a heart attack or not because it costs $300 to be seen by the emergency room (because urgent care cannot help with chest pain). When my father had a grand mal seizure and possibly hit his head, I as a teenager had to figure out in a moment of crisis if I needed to call 911 or not. Because my father is epileptic with a different type of seizure (partial complex) and while he had frequent episodes, he had not had a grand mal seizure for over 12 years at that point, and I didn't know if we could afford the ambulance. That was one of the most terrifying moments in my life, point blank, made worse because of how fucked up our insurance system is.

[oysters-aint-for-me]

i’m so upset bc my antidepressant that works really well and basically saved my life, well, the prior authorization expired after a year and so my doctor had to send it in again. stupid, but no real big problem. aetna approved the medication pretty quick and sent my doctor a fax saying so and also sent me a letter saying so and also the CVS website says my insurance has approved the medication. however when i go to the pharmacy it still has “needs prior authorization” stuck to it and we can’t seem to get rid of it so i can’t get my antidepressants and it’s starting to really affect me and i’m getting really depressed again and im scared and i just want my stupid meds for my stupid brain but some fucking computer somewhere has some stupid fucking wire crossed and no one seems to be able to take responsibility for it or fix it so i’m stuck without the meds and i don’t know what to do anymore at this point. no one knows what the problem is. also now you can’t just call CVS, wait on hold for 20 min, and talk to someone, oh no, nothing that simple, now you have to leave a stupid fucking voicemail and wait for them to call you back which they WONT DO because i’ve talked to them plenty of times in the past where they’ve said “we’ll call you back with that info.” AND THEY NEVER HAVE, THEY NEVER DO, THEY NEVER WILL. which means i have to go there AGAIN tomorrow and wait for half an hour while the pharmacist tries to get a human representative on the phone only to find out “we have no record of a prior authorization” like please just kill me now

[mercury-waters]

The UnitedHealth CEO shooting takes have all been made, but I do think that even beyond the core that healthcare should never ever ever be private or for profit, it's kind of crazy the scheme that all these companies are allowed to get away with.

When I was fighting with my insurance to cover my top surgery (Aetna), I couldn't find the number to actually call my insurance. There were two different numbers on my insurance card to call, and NEITHER of them called Aetna, they called third-party companies that Aetna paid to give me plan information or to complain to (to no avail). These were the only numbers I could find, not just for this, but also later when the company suddenly started denying the asthma inhaler I've had to use several times a week since I was 6, and other things.

The entire situation was fucked top-to-bottom, but that additional layer, which is pretty standard across most healthcare, is buck-wild to me. If you are going to fight me tooth and nail to stop me accessing benefits *THAT I PAY FOR*, there should be a fucking law that the company itself actually has to tell me to my face. You don't get to hire underpaid call-center workers to do it. Your company has to hire its own workers, who, if they get fed up with their own company's bullshit, can strike on behalf of the goddamn general public to get their shit in line.