Healthcare Spending Accounts question

gumbybros · 04-18-2007, 06:43 PM

I don't know if this is company wide, but Aetna is the company that administers our Healthcare Spending Accounts (HCSA). I'm having a problem with terrible service and wonder if this is a problem for others. Slow to pay claims, paying only parts of a claim and giving no explanation, not responding to emails, etc. I asked my supervisor who might be a contact person within UPS to try to get this worked out. He made calls, and said believe it or not--no one. As far as he could find out, UPS wants as little to do with it as possible. Take complaints to Aetna. Talk about having the fox guard the henhouse! So is it just lucky 'ole me, or is Aetna just miserable to everyone?

toonertoo · 04-18-2007, 07:00 PM

They are miserable to everyone.
I had one claim that they kept tossing back and forth between BC/BS and Aetna, each saying the other should pay it. Finally ended up in court. HR used to be able to help but now with Hipa or whatever that privacy act is, they can only talk to the insured or the spouse if they are on the policy. HR does have the ability to kick them in the A**, though. After a month of trying to get it straightened out and HR tellling me they were working on it, and the two companies denying it, and me trying to work and spending an hour on hold trying to handle it, my husband called HR, told them he'd be there in the morning, he'd have coffe with them, do lunch whatever they do all day, and hang out til it got taken care of, and it got paid that day. Too late for me to keep it from court, now I have a judgement on my credit report. Talk about people not doing their jobs.....
I just got back an EOB, I had two lumps removed, they are only going to pay for one, seems I should have kept the other. Here we go again.

SeniorGeek · 04-19-2007, 07:34 AM

My favorite was a claim that Aetna refused because it was lacking some required information, and they said to correct it and submit it again.

It was refused again, with the reason listed as "Previously Submitted".

raceanoncr · 04-19-2007, 07:53 AM

Ha, funny! Seems to be universal.

Just recently was off for regular disability. Aetna "Claims Specialist (?)" wanted Dr. to send reports to Aetna. Dr. sent to Fax # on bottom of letter below "Specialists" name. "Specialist" (note how I keep using " marks on title?), called me and said was denying claim cuz Dr didn't send report. I called Dr and, well, this goes on and on...

After playing phone AND FAX tag for a number of wks, I faxed "Specialist" with names, dates, and second Dr report (ended up getting MRI and dianosed with, now get this, AVASCULAR NERCROSIS. Pretty impressive, yes? Basically means DOUBLE HIP REPLACEMENT). "Specialist" STILL says she didn't receive. (I feel if I coulda cut the phone line leading to India that I would've lost the call, know what I mean?)

I said, "I and the Dr sent to this FAX #!!!!!" She says, "That's not my FAX #, that's a diff department!" "Well, maybe this diff department can walk down the hall, or maybe in this case, swim down the Ganges, and HAND it to you". (Now, don't jump on this part. This ain't racist, but some facts just speak for themselves).

Shortening up the story, we all got the right FAX, report was sent in, with her original letter also being FAXED in with wrong FAX number highlighted. BAM! Approved! It's a miracle! A divine mystery!!!

spun · 04-19-2007, 12:11 PM

I propose a class action lawsuit. Let's get the ball rolling!

Sammie · 04-19-2007, 01:47 PM

Quote:

Originally Posted by gumbybros

I don't know if this is company wide, but Aetna is the company that administers our Healthcare Spending Accounts (HCSA). I'm having a problem with terrible service and wonder if this is a problem for others. Slow to pay claims, paying only parts of a claim and giving no explanation, not responding to emails, etc. I asked my supervisor who might be a contact person within UPS to try to get this worked out. He made calls, and said believe it or not--no one. As far as he could find out, UPS wants as little to do with it as possible. Take complaints to Aetna. Talk about having the fox guard the henhouse! So is it just lucky 'ole me, or is Aetna just miserable to everyone?

Welcome to the club, old buddy...

My husband has a slight hearing loss and wanted hearing aids just for use at home; to hear conversations better, for when we go to a play, a movie, etc. and Aetna couldn't figure out if they would help pay for them or not. So we bit the bullet and purchased a pair on our own. (Not cheap.)Thirteen months later the hearing loss center received a payment from Aetna in our behalf. I call that prompt.

Tooner, your situation is disgraceful.

Something else to watch out for, boys and girls; at least among UPSers here. And this could be coming to a theatre near you.

Aetna pulls the plug on UPSer's and their families when the
UPS employee is on vaca or dis/work comp for a couple of weeks or more. And all ya gotta do is beg, plead and threaten to get back on again. Would you believe that some folks accept this, don't fight back and pay a fortune for health premiums elsewhere? Unbelievable.

My husband was out for a while due to a nasty bout with a stubborn appendix and during this time I went to get a prescription filled for him. He was a 27 yr employee at the time and Aetna had removed our entire family from the pharmacy
computer. I approached H.R. at work the next day and right before my eyes they experienced a sudden attack of deafness, blindness and dumbness. I also made an appointment with the Wizard of Oz (district manager), who got a confession from H.R. that this is the new, improved Aetna.

One more thing, just be glad you teamsters don't have the clerical and management version of Aetna. You'd be jumping off a cliff about now.

beentheredonethat · 04-19-2007, 03:00 PM

Quote:

Originally Posted by gumbybros

I don't know if this is company wide, but Aetna is the company that administers our Healthcare Spending Accounts (HCSA). I'm having a problem with terrible service and wonder if this is a problem for others. Slow to pay claims, paying only parts of a claim and giving no explanation, not responding to emails, etc. I asked my supervisor who might be a contact person within UPS to try to get this worked out. He made calls, and said believe it or not--no one. As far as he could find out, UPS wants as little to do with it as possible. Take complaints to Aetna. Talk about having the fox guard the henhouse! So is it just lucky 'ole me, or is Aetna just miserable to everyone?

I'm in the same boat. I started seeing a chiro fall, the regular insurance covers it except for the 15 copay and I don't need a referral from a regular Dr. I submitted the copay paperwork I kept. They denied it since I didn't have a Dr's note for referring me to a chiro. I told them insurance doesn't require a Dr's note, so why would I need one to go to a Chriropracter. Second one. My wife gets a bill for our Dr's appt at an orthodontist. This is just a preliminary visit bill of about $250 bucks. Well the paperwork the Dr's office uses is blue instead of white. My wife made photocopies of all the receipts and sent the originals to the Aetna. We get a letter denying the Orthodontist bill since it's illegible. My wife calls up and has her copy with her. She talks to Aetna asking why it's denied. Turns out when they get paperwork they photocopy them and the people work off the imaged paperwork on their monitors. Then they store the paperwork. Well whoever was working the imaging computer set it a little dark, coupled with a blue background and the lady couldn't read it. My wife explained they had the original and the original was on a blue background. We asked if they still had original, she said yes, but wanted us to go to Dr's office (30 min away) and get another new copy on white background. We told her no way, that she can go to the original we gave and read it from the original. They bitched and moaned, but we finally got paid on that visit. Fortunately\Unfortunately we went over what we put aside in our HCSA so I never did work on getting the Chiro bill paid.

beentheredonethat · 04-19-2007, 03:02 PM

Quote:

Originally Posted by SeniorGeek

My favorite was a claim that Aetna refused because it was lacking some required information, and they said to correct it and submit it again.

It was refused again, with the reason listed as "Previously Submitted".

If it wasn't for the fact that this is true, and you're out money, this would be funny story for a stand up comic routine. I feel your pain. Welcome to a new and improved health care system. (Not).

gumbybros · 04-19-2007, 05:37 PM

I submitted claims for HCSA reimbursement for me, my wife, and son. They paid a couple of my claims and all of theirs. They paid my mileage but none of theirs. And didn't offer an explanation. After no reply to emails I called them. Their explanation: All submitted claims were paid. Mileage wasn't properly submitted. (I've been doing it that way for the last 4 years) So apparently they paid me mileage that wasn't done properly for claims that weren't submitted. "Nothing more they can do. Resubmit" The rep I talked to this time said mileage should be listed on a separate paper claim by claim with date, patient name, distance and amount due(per mile rate x miles).If anyone knows where this info is located on their web site that says that's what they want, plesase tell me. I couldn't find it.

mattwtrs · 04-19-2007, 07:47 PM

A couple of years ago I submitted all my receipts to Aetna(mailed them in). I get my check and they did not pay for my son's copays. After numerous phone calls they acknowledged they had received all the receipts and EOB's but could not explain the short pay. 2 month's later I was paid in full. This year I faxed everything in & got my HCSA check in less than a month.