Wednesday, July 29, 2009

Thanks for nothing, Aetna

So, as part of their marketing-to-our-captive-audience campaign, Aetna has been spamming us with sending around glossy four-color booklets every so often during our pregnancy. They have information on how to stay healthy, what to watch out for and so on--nothing I couldn't get from reading the front covers of all the parenting magazines in any good newstand, but if that's what Aetna needs to do to spend our premiums make themselves feel good, OK.

The one we got today had tips for what to with a newborn, what are dangerous symptoms and what are normal activities for them. Aetna doesn't use quite the same language as I do, but I guess that "endlessly crap green lakes of fire" isn't a description that everyone would find useful.

Now, I know that Aetna has money to burn on these tracts because they sure as hell aren't spending it on our pregnancy. Since week 20, which is almost 20 weeks ago now, they have refused to pay for our initial ultrasound. You know the one--it's the standard one where they check for Down Syndrome, spina bifida, extremity development, organ development and all that other stuff that's kinda nice to know not only for parents but also for the doctors who will deliver the baby.

So I found it of particular interest that the centerfold--yes, a two-page, foldout spread--in the latest spamphlet they sent us was a lovely photo of a couple cuddled up around and smiling over a beautiful ultrasound of the baby they're expecting. Must be that Aetna licensed that photo from another insurance company that actually covers pregnancy, or perhaps one that actually pays for what it promises to pay for in their plan description, or maybe even one that has a shred of humanity and common sense buried deep in its sclerotic bowels.

Thanks for nothing, Aetna.

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9 comments:

  1. Hey, and while we're at it: Does Aetna track you by your Social Security number? In violation of federal law? Thereby increasing the problem of identity theft?

    Just checking.

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  2. They don't mention that in their glossy brochure.

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  3. And in your formal, written appeal---feel free to enclose a photograph of Mama looking at that page of the pamphlet, and perhaps you could photoshop some word bubble coming up from the baby bump... "Mom, it's too bad we've got Aetna. They won't cover sonograms to make sure I'm healthy!"

    .....I'm just kind of mean spirited like that.

    Bet your ass that Sheplers is getting a picture of Gage is his Cavender's boots.

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  4. They only cover ultrasound if she is pregnant. They probably need 18 months of past medical records to see if the real cause for the weight gain is pregnancy or just over eating.

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  5. L-P: Love those boots. Hate that Sheplers (lack of) customer service.

    CAGirl: Actually, the hang up is that they only cover ultrasounds during pregnancy for certain purposes and diagnosing pregnancy isn't one of those purposes.

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  6. Having processed insurance claims in my past life, I'll give you my Official Professional Opinion: I'll bet either the doctor's office on their claim, or the claim processor when handling the claim, put the wrong diagnosis code so that it's being denied. There's no way that procedure isn't covered.

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  7. Amama: Aetna is so particular about what diagnosis codes are used that our ultrasound office had us sign a statement that we would pay if Aetna refused payment. This is not their first parade. Also, Aetna has a long history among people I've spoken with of refusing first and then only paying when a claim is appealed. My guess is that they view insurance payments like those Best Buy refunds--they offer them, hoping most people won't go to the trouble to get them. Did I mention how much I dislike Aetna? I've never gotten worse service from a health insurance company. Ever.

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  8. Well, those forms are pretty much SOP at any doctor's office, but it sounds like they take it a bit more seriously and with good reason.

    I got laid off from Prudential before they were bought by Aetna, about 5 or 6 years ago. I've heard nothing good about working there, either.

    OTOH, could be that their claim processing software sucks. We had a lot of problems with that at HealthNet before mgt. got their act together and fixed all the bugs. It's kind of scary how complex all that is, and what dumb mistakes happen because of it.

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  9. We're really caught in a pissing match between skunks--the doctor's office doesn't want to give in, rightly so, and post an incorrect diagnosis just to receive payment. Aetna refuses to recognize the standard code for the standard diagnosis. This is where some goddamned gov't regulation, or the threat of it, would do me, and other consumers some good. Somebody needs to crack some heads together, and no one of us individually will get that done against a multibillion dollar conglomerate.

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