Wednesday, February 22, 2012

Adventures with Aetna or, "Why Aetna Sucks"


I have been taking Benicar for nearly eight years, with excellent control of my blood pressure. It was covered by Aetna last year. Now, however, I find that it is not covered under this miserable excuse for an insurance plan. Denied for no better reason than I have not tried two other approved medications, losartan and diovan, before being prescribed Benicar, never mind that I had been taking Benicar for years
I was told...by an Aetna representative...that all I needed was for my physician to send in a pre-certification stating I have been taking this medication for years and the prescription for Benicar would...be...approved. I was assured...by an Aetna representative...that the prescription would be approved. Today (February 16th), I found out that the prescription was denied. I was not informed of this by any party, either my physician's office or Aetna.
In the phone calls to Aetna following this revelation, I was told by and Aetna representative that my physician need only submit a pre-certification to Aetna, which his office did…twice. Furthermore I was told, explicitly, by the Aetna representative that the prescription would be approved. In the phone calls that followed, the customer service supervisor denied all culpability on the part of Aetna for the misleading statements to the effect that the medication would be approved with no further ado. Secondly, Aetna, nor any other insurer for that matter, has any business questioning or inserting itself in the decisions regarding treatment options as discussed between a physician and a patient.
I have been taking Benicar for years with no side effects and effective control of my hypertension. Changing medications at this point is unwarranted from a medical standpoint and would require a period of dosage adjustment and titration to effect which could have consequences for my health and well being. But my health and well being are, apparently, of no importance. Aetna’s policy in this matter poses unnecessary burdens on physicians in that Aetna representative state the matter can be resolved by a fifteen minute phone call to Aetna’s pre-certification department. As you may well know, given the volume of patients primary care physicians see on a daily basis and the added burden of meeting the documentation requirements of multiple insurers, this is completely unrealistic. The process seems designed to serve as an impediment to patients seeking redress for these unjustified denials of coverage than to address the patient’s needs.

4 comments:

Hawkeye Fierce said...

Word. To your entire post. But especially this:

Secondly, Aetna, nor any other insurer for that matter, has any business questioning or inserting itself in the decisions regarding treatment options as discussed between a physician and a patient.

My fun ride with Aetna has included allegations of prescription drug abuse based on their erroneous records and denial of doctor ordered diagnostic scans. Bonus prize: the mass they refused to scan turned out to be cancer.

Aside from the fact that insurance companies are legalized racketeering, it is outrageous for the input of persons so wholly uninterested in my health to be allowed to have bearing on the maintenance of my health.

No words of wisdom. Just saying I feel your pain, bro.

Sinistrality said...

I am going through the same thing with Aetna and Benicar. As far as I am concerned,Aetna is practicing medicine with out a license. How dare they decide what medication I should be taking when they do not even check with my doctor as to why I take benicar. I have tried many other hypertension drugs before I switched to Aetna through my employer. . Benicar was the only one that works. My Mother had the same problem with various drugs for hypertension and Benicar was the only one that worked for her. I believe heriditary plays a part in my sucess with Benicar. To make matters worse, Aetna covered Benicar for three years before starting to play games with my health.

Sinistrality said...

I am going through the same thing with Aetna and Benicar. As far as I am concerned,Aetna is practicing medicine with out a license. How dare they decide what medication I should be taking when they do not even check with my doctor as to why I take benicar. I have tried many other hypertension drugs before I switched to Aetna through my employer. . Benicar was the only one that works. My Mother had the same problem with various drugs for hypertension and Benicar was the only one that worked for her. I believe heriditary plays a part in my sucess with Benicar. To make matters worse, Aetna covered Benicar for three years before starting to play games with my health.

Anonymous said...

I recently received a letter from Aetna saying that they will not be covering Diovan next year under their Medicare Part D. I have been on this medication for many years and suddenly they just pull the rug out from under my feet. I can't take most medications because they either don't work or bad reactions, such as allergies.It's about time the medicare offers a prescription drug plan DIRECTLY through medicare, not through these insurance companies, that only stuff their own pockets with our tax dollars.