01) I filled a prescription for Tresiba insulin pens:
02) 1 box contains 5 pens @ 300 units per pen, total units per box 1500 units.
03) Co-pay for 30 days = $47.00
04) Co-pay of $47.00 divided by 30 days 1 day = $1.60. (2 days = $3.20, 3 days = $4.80)
My prescription:
On July 07, 2017 I had a prescription for 2 boxes of Tresiba insulin pens I was charged and I paid $141.00 co-pay.
This is how Aetna calculates the co-pay for my prescription:
a) The 2 boxes total contained 3000 units of insulin.
b) 3000 units divided by 48 units = 63 (rounded) days
c) For 3 days I was charged a full month co-pay of $47.00., where I should have been charged $4.80 for a total of $98.80 for the 63 day supply of insulin. The difference is $42.20.
I have been cheated out of $42.20 each time I had this prescription filled; multiply that amount by 20,000, customers and amount comes to $844,000.00; 10,000 customers will equal $422,000.00. I HAVE TO WONDER HOW MANY OTHER SENIORS ON FIXED INCOM HAVE THEY DONE THIS TOO??
(Please keep in mind that the customer number could be well above the number I have given as an example and the amount could be well above $42.20.)
That I am sure the $42.20 is not being paid to the pharmaceutical companies, so where would all this money be going if not to Aetna and I am sure Aetna is not paying taxes on (not declaring this as income, since it’ coming in under co-pay payments). This fraud only pertains to per-packaged medication.
I was made aware of this issue by sheer accident. Aetna never tells its customers how they calculate pre-packaged medication. WHY?
If you purchased a 12 oz. cup of coffee for $4.00, and realized that you were only given 3oz. of coffee, and the server would not return your $3.00 for the additional 9 oz. or give you 9 oz. of coffee. What would you do?
You would have to call it FRAUD, DECEPTION, SWINDLE, a CON and a SCAM.
To my knowledge there is no other industry or business that charges its customers like this in the United States of America? I certainly never agreed to pay Aetna $47.00 for 3 days of medication. This is a fraud allowed by MEDICARE and we have no one to help us.
This is what is happening to Aetna customers (and there may be other insurance companies doing this as well). As a result of Aetna’s SCAM I have been pushed into their GAP, which means I paid $395.79 co-pay where I use to pay $141.00. Ask how many other people have been pushed into this same position, I know I am not alone.
Furthermore why is Aetna cheating senior citizens; retired seniors receiving Social Security (no COLA in 3 years), and others relying on medication to keep them ALIVE. WHILE THE C_O ARE BRING IN EXCESS OF 1 MILLION DOLLARS YEARLY? Where is this overage going? Who is the money going too?
Ask:
1) How many customers are affected?
2) How much money is involved?
3) How has Aetna been applying this income (coming in as co-payments) on their accounting books?
4) How many years have Aetna been collecting this income?
5) How much if any of this income has taxes been paid on?
I am retired from working for the state of Alaska and have gueranteed worldwide medical care through AlaskaCare. Aetna has the contract with the state of Alaska to administer "AlaskaCare" health insurance. By the Alaska Constituion(Article VII, Section 7), my retiree benefits cannot be diminised and this includes heath care. AlaskaCare guerantees worldwide medical care. Aetna was awarded the Administrator contract by employees of the State of Alaska Department of Administration/Division of Retirement and Benefits, even though Aetna does not offer worldwide medical coverage to Alaskacare members and has refused to honor the wolrdwide wording of AlaskaCare by not offering worldwide coverage through their Aetna Global Benefits unit.
Not only has Aetna, its employees and employees of the State of Alaska been involed in contract fraud, thet have violated federal statutes, including but not limited to the following:
1) The Interstate Commerce Act of 1887, Title 49USC(McCarran-Ferguson does not apply)
5) 42USC , Capter 175, (b)(4)(H) and 42USC(b)(4)(E)(i) , Essential Health Benefits Requirements
6) Employee retirement Income Security Act of 1973, 29USC, Cahpter 18
7) Health Insurance Portabilityand Accountability Act of 1996, Public Law 104-191
8) Public Health Service Act, Section 2793
9) Patient Protection and Affordable Care act of 2010, Public Law 111-148
10) And all laws both State of Alaska and US Federal government statutes that deal with fraud.
The state of Alaska and its Administrator of AlaskaCare, Aetna Inc, have denied me medical treatment for a most possibly life threating condition. Since I have been denied my rightful medical care, I will be focusing on reporting the above violations of federal law to the proper federal governmnet agencies.
After 19 years of membership with AETNA life insurance in CT , through my employer and after retirement due to disability, they disqualified me claiming I can do some kind of sedentary work. They ommitted medical information of my main specialist for about 19 years and disqualified me based on their own nurse consultant against a 20 years experienced doctor who specializes in my medical condition. The case was reported to CT State Insurance Department and AETNA missed to submit them the 9 pages medical report that indicated I was permanently and totally disabled. The CT State Insurance Department terminated the investigation claiming they found no violation to CT laws by AETNA . In reality there afrent laws in CT thay restrict Life insurance companies and allow them to do all these unfair and bad intend actions. No one will gieve me a life insurance after 19 years being ill and disabled. The employer ( City of Hartford ) also ignored AETNA's unfair action as it will also save them money .
AETNA has used same methods with former co-workers just to eliminate them, as consumers get older and after charging the City of Hartford large amounts for coverage and after long periods of times . In this case this policy was terminated after over 19 years when the consumer got older and his medical condition was worse. In the beginning years they accepted medical information from same specialist doctor but suddenly they became actively requesting more medical information, medical notes , even requested visits and tried to bring their own doctor toperform evaluation on consumer. Every year they began pursuing to terminate the case and denied the case even when the doctor indicated there was a pernament and total disability. Their final report was based on notes that will not involve doctor who diagnosed total and permanent disability. They disregarded the doctor's opinion that they have accepted all the former years . They have disqualify me membership purposedly and planned even when it was an obvious conflit of interest . The CT Insurance Department did nothing to protect the interest and rights of the consumer. The office of Protection and advocacy for people with disabilities also denied me any consultation . Since it is needed a special attorney to fight this cases and since disabled people lack finanantiall means they do get away with abuse. AETNA and the CT State Insurance Department seem to be a real rip off to consumers as well as the Office OPPD. Policies in the State of CT seem to be just in paper and not enforced. CT need legislation on restrictions for Life Insurance companies as well. If you have gone through something similar please write your story and contact me via this web site
How do you get information to appeal the denial of a health insurance claim?
If you read the letters they send you, they're required to give you "evidence" they've collected so you can fight your denial. And wouldn't audio recordings be considered evidence?
First, allow me to quote from the letter Aetna sent us when they denied a claim in July, for services rendered in May. It's under the headline "Access to relevant information."
"At your request, we will give you free of charge access to copies of all documents, records and other information about your claim for benefits, including the specific rule, guideline, protocol, or other similar criterion that was used in making the decision ..."
So we were told repeatedly -- in phone calls recorded by Aetna -- that a meningitis vaccination at MinuteManClinic of Texas would be covered. We were a little wary, because sometimes they say it's covered and it's not, so we really made sure. We called both the clinic and we called Aetna and of course we presented the insurance card at the clinic on the date of service and they all said it was covered.
Except it wasn't.
They want their money now, and I want the tapes. I want the audio files because it will show beyond a shadow of a doubt that they told us repeatedly it was covered. Now I'm getting collection notices from MinuteManClinic -- I knew this would happen -- while the "second level appeal" is ongoing. What does Aetna say about that? Sorry, bro. Pay it.
Meanwhile, not only will Aetna not give me the audio files -- the "evidence" I need to fight my denial -- they say that we can't record their phone calls even though they can record ours.
Aetna Inc. Reviews
I have contacted Aetna to cancel my service with them and they continue to pay for my health care from my doctor!
I have coverage already that takes care of this but they pay it and then charge me for the copay. They refuse to listen to my plea to them!
01) I filled a prescription for Tresiba insulin pens:
02) 1 box contains 5 pens @ 300 units per pen, total units per box 1500 units.
03) Co-pay for 30 days = $47.00
04) Co-pay of $47.00 divided by 30 days 1 day = $1.60. (2 days = $3.20, 3 days = $4.80)
My prescription:
On July 07, 2017 I had a prescription for 2 boxes of Tresiba insulin pens I was charged and I paid $141.00 co-pay.
This is how Aetna calculates the co-pay for my prescription:
a) The 2 boxes total contained 3000 units of insulin.
b) 3000 units divided by 48 units = 63 (rounded) days
c) For 3 days I was charged a full month co-pay of $47.00., where I should have been charged $4.80 for a total of $98.80 for the 63 day supply of insulin. The difference is $42.20.
I have been cheated out of $42.20 each time I had this prescription filled; multiply that amount by 20,000, customers and amount comes to $844,000.00; 10,000 customers will equal $422,000.00. I HAVE TO WONDER HOW MANY OTHER SENIORS ON FIXED INCOM HAVE THEY DONE THIS TOO??
(Please keep in mind that the customer number could be well above the number I have given as an example and the amount could be well above $42.20.)
That I am sure the $42.20 is not being paid to the pharmaceutical companies, so where would all this money be going if not to Aetna and I am sure Aetna is not paying taxes on (not declaring this as income, since it’ coming in under co-pay payments). This fraud only pertains to per-packaged medication.
I was made aware of this issue by sheer accident. Aetna never tells its customers how they calculate pre-packaged medication. WHY?
If you purchased a 12 oz. cup of coffee for $4.00, and realized that you were only given 3oz. of coffee, and the server would not return your $3.00 for the additional 9 oz. or give you 9 oz. of coffee. What would you do?
You would have to call it FRAUD, DECEPTION, SWINDLE, a CON and a SCAM.
To my knowledge there is no other industry or business that charges its customers like this in the United States of America? I certainly never agreed to pay Aetna $47.00 for 3 days of medication. This is a fraud allowed by MEDICARE and we have no one to help us.
This is what is happening to Aetna customers (and there may be other insurance companies doing this as well). As a result of Aetna’s SCAM I have been pushed into their GAP, which means I paid $395.79 co-pay where I use to pay $141.00. Ask how many other people have been pushed into this same position, I know I am not alone.
Furthermore why is Aetna cheating senior citizens; retired seniors receiving Social Security (no COLA in 3 years), and others relying on medication to keep them ALIVE. WHILE THE C_O ARE BRING IN EXCESS OF 1 MILLION DOLLARS YEARLY? Where is this overage going? Who is the money going too?
Ask:
1) How many customers are affected?
2) How much money is involved?
3) How has Aetna been applying this income (coming in as co-payments) on their accounting books?
4) How many years have Aetna been collecting this income?
5) How much if any of this income has taxes been paid on?
I am retired from working for the state of Alaska and have gueranteed worldwide medical care through AlaskaCare. Aetna has the contract with the state of Alaska to administer "AlaskaCare" health insurance. By the Alaska Constituion(Article VII, Section 7), my retiree benefits cannot be diminised and this includes heath care. AlaskaCare guerantees worldwide medical care. Aetna was awarded the Administrator contract by employees of the State of Alaska Department of Administration/Division of Retirement and Benefits, even though Aetna does not offer worldwide medical coverage to Alaskacare members and has refused to honor the wolrdwide wording of AlaskaCare by not offering worldwide coverage through their Aetna Global Benefits unit.
Not only has Aetna, its employees and employees of the State of Alaska been involed in contract fraud, thet have violated federal statutes, including but not limited to the following:
1) The Interstate Commerce Act of 1887, Title 49USC(McCarran-Ferguson does not apply)
2) 18USC, Chapter 96, Section 18, Raceteering Influence and Corrupt Organizations.
3) Sherman Anti Trust Act, Section 2
4) Clayton Anti Trust Act, 15USC, 12-27
5) 42USC , Capter 175, (b)(4)(H) and 42USC(b)(4)(E)(i) , Essential Health Benefits Requirements
6) Employee retirement Income Security Act of 1973, 29USC, Cahpter 18
7) Health Insurance Portabilityand Accountability Act of 1996, Public Law 104-191
8) Public Health Service Act, Section 2793
9) Patient Protection and Affordable Care act of 2010, Public Law 111-148
10) And all laws both State of Alaska and US Federal government statutes that deal with fraud.
The state of Alaska and its Administrator of AlaskaCare, Aetna Inc, have denied me medical treatment for a most possibly life threating condition. Since I have been denied my rightful medical care, I will be focusing on reporting the above violations of federal law to the proper federal governmnet agencies.
After 19 years of membership with AETNA life insurance in CT , through my employer and after retirement due to disability, they disqualified me claiming I can do some kind of sedentary work. They ommitted medical information of my main specialist for about 19 years and disqualified me based on their own nurse consultant against a 20 years experienced doctor who specializes in my medical condition. The case was reported to CT State Insurance Department and AETNA missed to submit them the 9 pages medical report that indicated I was permanently and totally disabled. The CT State Insurance Department terminated the investigation claiming they found no violation to CT laws by AETNA . In reality there afrent laws in CT thay restrict Life insurance companies and allow them to do all these unfair and bad intend actions. No one will gieve me a life insurance after 19 years being ill and disabled. The employer ( City of Hartford ) also ignored AETNA's unfair action as it will also save them money .
AETNA has used same methods with former co-workers just to eliminate them, as consumers get older and after charging the City of Hartford large amounts for coverage and after long periods of times . In this case this policy was terminated after over 19 years when the consumer got older and his medical condition was worse. In the beginning years they accepted medical information from same specialist doctor but suddenly they became actively requesting more medical information, medical notes , even requested visits and tried to bring their own doctor toperform evaluation on consumer. Every year they began pursuing to terminate the case and denied the case even when the doctor indicated there was a pernament and total disability. Their final report was based on notes that will not involve doctor who diagnosed total and permanent disability. They disregarded the doctor's opinion that they have accepted all the former years . They have disqualify me membership purposedly and planned even when it was an obvious conflit of interest . The CT Insurance Department did nothing to protect the interest and rights of the consumer. The office of Protection and advocacy for people with disabilities also denied me any consultation . Since it is needed a special attorney to fight this cases and since disabled people lack finanantiall means they do get away with abuse. AETNA and the CT State Insurance Department seem to be a real rip off to consumers as well as the Office OPPD. Policies in the State of CT seem to be just in paper and not enforced. CT need legislation on restrictions for Life Insurance companies as well. If you have gone through something similar please write your story and contact me via this web site
How do you get information to appeal the denial of a health insurance claim?
If you read the letters they send you, they're required to give you "evidence" they've collected so you can fight your denial. And wouldn't audio recordings be considered evidence?
First, allow me to quote from the letter Aetna sent us when they denied a claim in July, for services rendered in May. It's under the headline "Access to relevant information."
"At your request, we will give you free of charge access to copies of all documents, records and other information about your claim for benefits, including the specific rule, guideline, protocol, or other similar criterion that was used in making the decision ..."
So we were told repeatedly -- in phone calls recorded by Aetna -- that a meningitis vaccination at MinuteManClinic of Texas would be covered. We were a little wary, because sometimes they say it's covered and it's not, so we really made sure. We called both the clinic and we called Aetna and of course we presented the insurance card at the clinic on the date of service and they all said it was covered.
Except it wasn't.
They want their money now, and I want the tapes. I want the audio files because it will show beyond a shadow of a doubt that they told us repeatedly it was covered. Now I'm getting collection notices from MinuteManClinic -- I knew this would happen -- while the "second level appeal" is ongoing. What does Aetna say about that? Sorry, bro. Pay it.
Meanwhile, not only will Aetna not give me the audio files -- the "evidence" I need to fight my denial -- they say that we can't record their phone calls even though they can record ours.
Outrageous.