Got an FEHB Aetna Paper Claim to file? Don’t Ask Ann!

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(Update 7/01): Aetna’s social media department (@AetnaHelp) contacted me via Twitter about 45 minutes after this post went live on Twitter.  We are in contact and working through the pharmacy claim.

(Update 7/15): Aetna’s social media department (@AetnaHelp) notified me via email that they located and processed the pharmacy claim.  The check is being mailed to my home address.

I’ve been receiving a rash of crummy customer service lately.  It’s either a run of bad luck or I have the gall to expect an actual product or service when I pay for it.
My latest food fight is with a pharmacy claim for $505 that Aetna has either ignored or misplaced.

I’m approaching my family’s deductible (spent ~$2600 YTD out of a $3,000 deductible), so I’m a bit suspicious.

Here’s the details:

May 1st:  I filled a $505.12 prescription for one of my dependents at the local Target Pharmacy.  I used my Aetna Health Member Card to verify my eligibility for the prescription.

May 20th: In reviewing my claims history on the Aetna Website, I noticed that the claim had not posted yet.  I called the 888-238-6240 Aetna number on the back of my member card and asked what to do. Aetna told me to download the claim form off the website and fax it in.

June 13th: I filed a paper claim for the prescription by downloading the ‘Commercial Prescription Drug Claim Form’ off of the Aetna Member website. Per the form’s instructions, I faxed it in to 888-472-1128.

June 24th: I called Aetna to ask if they received my paper claim- They did not.  The conversation went like this:

G: I faxed in a pharmacy claim, dated 5/1 for $505.  Have you received it yet?

A: No, we haven’t.  I don’t see it in our system.

G:  I faxed it in to the 888-472-1128.  Is that the correct number?

A:  No, it isn’t.  Where did you get that number?

G:  It’s on the top of the claim form that I downloaded from your website.

A: Sorry, that’s not the correct number.  The correct fax number is 859-425-3371.  You can fax in the old form to the correct number, just make sure it has your member number and the pharmacy receipt/instructions attached. We will email you the correct medical and pharmacy paper claim forms.

G:  Ok, thanks.  Any chance that Aetna can post the correct forms on its website?

A: We’ll look in to it.

Later that day I received the email from Aetna, but it was encrypted 6 ways from Sunday, to the point that I had to try 2 different computers and 3 different browsers to open it.  I finally opened it and got the ‘correct’ forms.

The ridiculously encrypted Aetna email with BLANK BOILERPLATE FORMS reads like this:

Dear Aetna Member,
RE: W**** *****
Attached please find the information you requested from Aetna Member Services.
 
This email may contain personal health information that is sensitive. Aetna considers personal information to be confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as our own company privacy policies.

The federal privacy regulations require us to keep personal information about you private, to give you notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. If you would like additional information or if you have questions regarding this notice, please contact Aetna’s Legal Support Services Department by mail at 151 Farmington Avenue, RT65; Hartford, CT 06156; by phone at 860-273-8600; or by fax at 860-907-3017. Include your name, phone and fax number. You may also obtain this notice in full by visiting the Privacy Information page on our website.

If you have any further questions, please contact Aetna Member Services by calling the telephone number on the back of your ID card, or log on to www.aetna.com and select “Aetna Navigator” and “Contact Us”.
Sincerely,
Aetna Member Services

*Note this email box is not monitored. It is outgoing email service only. The information contained in this email is applicable as of the date of this transmission. Please be advised this information is regularly updated and therefore is subject to change.

Disclaimer: This email contains information some or all of which may be proprietary or legally privileged. It is for the intended recipient only. If you are not the intended recipient, you must not use, disclose, distribute, copy, print or reply on this email.

Since Aetna can’t afford the bandwith or labor to post the correct forms on their own website for their members, I’ve taken the liberty of posting the pharmacy claim form here and the medical claim form here.

Aetna has bodged this pharmacy claim for one of the following reasons:

• It’s a deliberate ‘glitch’ to keep me from reaching my deductible (least likely)
• The loss of my pharmacy claim was an unfortunate accident (possible)
• Aetna is incompetent in handling claims (likely)
• Aetna has a deliberately confusing manual claim process to prevent reimbursement (most likely)

I’m going to call back in next week to check on the fax- If not received I will step it up and send the claim via registered mail.
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