Customer Service Issues

Posted Mon September 11, 2006 3:06 pm, by MA L. written to Aetna U.S. Healthcare Inc.

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Medical coverage is very expensive today. As consumers we pay a great deal of money into a system that is not always customer-centered. As an insurance provider, I am hoping you can help me to resolve a service issue I encountered with your company recently.

I have had Aetna HMO coverage since July of 2005 for me, my husband and our son. Presently I am 7 months pregnant with our second child.

Over the past year that we've been covered, I've been fortunate to have been healthy and have needed very few Dr. visits or prescriptions outside of routine well checkups or an occasional flu bug.

However, my pregnancy has not progressed as smoothly and the stress of that is now being compounded by the lack of help I am getting in obtaining service and supplies through you.

I was diagnosed recently with gestational diabetes by my physician. In addition to now having to see a Diabetic Coordinator and making some modifications to my diet, I was also provided with a glucose meter and instructed to test my blood sugar 7 times per day. She wrote a script for the strips and lancets my monitor would need and I left to have them filled.

Figuring the logical place to obtain my supplies was my local pharmacy, I stopped at CVS and submitted my prescription order. I was told by the pharmacist that there was some kind of discrepancy with my birthdate in the system and that they (CVS) would need to contact you (Aetna) to verify my coverage.

The pharmacist then asked if I could return the following day to pick up my supplies. Since I had approximately 1.5 days worth of sample strips and lancets that came with my meter, so I figured that would be alright.

On my way home from the pharmacy, I contacted Aetna Member Services myself to verify my birthdate and to make sure my specific monitor was covered. The rep I spoke with confirmed that my birthdate was listed correctly in the system and that my supplies for the monitor would be covered as a Tier 2 item at $25 co-pay or a 3 month supply for $50 via mail order.

Since I only had 1.5 days supplies on hand and it was crucial that I continue monitoring my blood sugar, I told the rep that I would prefer to just get the supplies through the pharmacy and not save the $25 by doing mail order right now. The rep indicated that would be fine, but to keep in mind the mail order for the refills.

When I arrived at CVS Saturday morning to pick up my supplies, you can imagine my shock when the pharmacist informed me that Aetna did not cover Diabetic supplies on my plan and that just one month's supply would cost me over $300.

I did not have $300 to pay for this out of pocket, so I contacted the Aetna Pharmacy services number provided by the pharmacist.

The first rep was of little help. She indicated that the supplies for my particular monitor was what was not being covered and that I would need to go online myself and look up my coverage to determine another unit that was under formulary and have my Dr. re-write the script.

I told her I didn't believe that should be my or my Dr's responsibility to research this and could she contact the Dr to let her know what options were available. She refused, so I asked to be transferred to a supervisor.

I was then transferred into a voice mailbox that announced in a female voice it belonged to the Pharmacy Services Supervisor, but provided no name or any way to transfer back to a live person. I did not leave a message.

After contacting my physician, I called back to Pharmacy services and was connected to Ebony, who informed me that, to her knowledge, the testing supplies are almost never covered under pharmacy and that they were probably covered under my medical coverage instead, but she did not know how to get the supplies submitted to the proper area.

She tried in vain to help me find some way to get the coverage waived, at least temporarily, before finally telling me I would have to wait until Monday to contact Member Services to find out just what was covered and what I would have to do to get my supplies. That would mean 2 days with no way to test my blood sugar.

So first thing this morning, I contacted Member Services again and spoke with Carol who finally explained that my diabetic supplies would be covered under Durable Medical Equipment as opposed to pharmacy and that I would need to contact a DME vendor to determine if they carried the type of strips and lancets my monitor required.

I would also need to order the supplies since there did not appear to be any vendors in my area where I could pick them up right away.

Carol provided me with the names and phone numbers for 3 vendors, 2 of whom did not carry my brand of monitor or testing supplies and the third carried no diabetic supplies at all. Again, I felt put out having to do the research work that I believed should have been taken care of by your service reps.

I called back (AGAIN!) and spoke with Melissa who added another 2 vendors to my list. After finally contacting Byrum Healthcare, I was told they had my brand of strips and lancets, but it would take 24 hours just to verify all the information with my Dr.and with you and then another 3-5 days via UPS Ground to ship the supplies from Indiana to where I am in Ohio.

That means that I will be without the ability to test my blood sugar, all total, for a whole week. This concerns me because even though I am following my diet, my physician has no way to know if this is effectively managing my condition because I can't provide her with the data for my blood sugar levels. This is a problem because it could result in severe problems for both my unborn baby and myself if left untreated this late in my pregnancy.

While the majority of your reps were at least pleasant to deal with, the lack of real help available frustrated me more than I believe was necessary.

I would suggest taking steps to make your service more customer-focused and less labor intensive.

I find it unacceptable that there is no one available from 8 pm Friday until 8 am Monday. Most issues don't present themselves during "regular business hours" so how can a member get the help they need if there is no one there to help them when they need it?

Your "voice activated" automated phone system is a nightmare to navigate. I have never been told that others have a hard time understanding me, but I had to repeat myself at least 3 times each time I called before the system understood me and transferred my call.

I also find it inexcusable that the responsibility for hunting down vendors and making sure that my coverage was verified basically fell to me. If your representatives had all the information, wouldn't it have made more sense for THEM to contact the vendor and/or the physician and coordinate this, rather than pawning this chore off on me?

This whole experience, to me, was far more complicated than it needed to be. I got conflicting information, when I got any help at all, and was not only expected to know find out the terms of my policy myself, but to do all the work of coordinating and securing my coverage myself. There HAS to be an easier way to accomplish this.

I have never had to write to an insurance carrier before to complain about customer service, so I am not really sure what my expectation should be to rectify the situation.

I guess, bottom line, I need to know that you take my concerns seriously and that steps will be taken to address these lapses and make the system easier for the customers to use and access. While I realize it is important for consumers to be engaged in their healthcare and coverage, doing this much legwork is a bit ridiculous.

I look forward to hearing back from you soon.