Here I am again…Aetna Medicare

I don’t know how to link my original post but in short, horrible misquotes and several grievances. I thought I was getting somewhere back in April. Submitted my grievance to Medicare and Aetna called me the next day.

My issue was researched and I was encouraged by the senior analyst to go ahead and submit an appeal, which I did. A week after submitting and several calls later, I find out that I won’t get a decision under June 3rd and “S” is assigned to my case. Ok, cool. I know it’s a process.

June 2nd, I get a call from “D”. Nothing has been worked on in regards to my case. Supposedly “S” had an unexpected medical leave and, the day before my decision is due is the day they decide to contact me.

Ok, well… now I explain everything to “D” and he’s going to work on my case.

I’ve called several times to speak to “D” or anyone in the grievance department and have gotten member services calling me back asking how they can help…I’m running in circles.

It’s now July 5th.

Oh, and… a prior-auth was submitted for my medication along with a tier exception. The prior-auth was approved but the tier exception was not. Even though both wanted the same information- why I need this medication and not others on their formulary list. Mind you, I’ve been through over 10 years of medication trials and tried everything on their list. How does it get approved one way and not the other when they’re asking the same information.

I called the original analyst person. I left her a voicemail expressing my displeasure and explained, I require a call back by Thursday morning and I will be filing another formal complaint with Medicare.