Monday, January 19, 2015

When All Else Fails, Call the CEO's Office at Your Insurance Co.

I make no secret about it: I test my blood sugar a LOT.  Hypoglycemia unawareness is a big reason for this, but its also how my HbA1c's are as excellent as they are.  Insurance companies would like to limit how many you can use because its a big expense line for them.  But I look at it this way: one trip to the Emergency Room for a hypo I couldn't tell was happening would erase any savings they got for denial of a few test strips.  Over the years, I've had a number of different insurance companies, including United Healthcare, Wellpoint/Anthem, EmblemHealth of New York and Aetna.  I cannot say enough bad things about Anthem.  They suck, and bad service to patients is part of the company's DNA.  They simply don't give a shit about patients, only the employers who buy their services.  United Healthcare has, in my opinion, consistently been better at service.  They have their own unique differences, but nothing insurmountable.

I never had Aetna before last year, I migrated from United Healthcare (whom I was relatively pleased with) because my employer switched PEOs and with that came a new healthplan.  For the most part, I've had no major issues with Aetna.  Sure, their formularies are slightly different and I had to switch meter brands yet again, but the policies themselves work in a similar manner and were relatively straightforward.

Shortly after Thanksgiving 2014, I placed a refill order for my testing supplies.  I had one refill remaining, but my endo was submitting a new script in December so I didn't anticipate any issues.  True, on December 1, 2014, we had a new "plan year" and there were some minor modifications to the formulary (some items required pre-certification that did not require them previously), but I wasn't expecting a major change, and I had all of the things I needed to do ready, including the order, pre-certification, payment, etc.

As of Thursday, January 15, 2014 and I still haven't received my fucking test strips.  Not only that, by my supply is now dwindling.  Throughout the last month, I've spent more than a few hours on the phone with Aetna, Aetna Rx Home Delivery, Appeals and others.  I was most pissed off when Aetna Rx Home Delivery told me to speak to appeals, transferred me there, and then appeals told me I had to speak to Aetna Rx Home Delivery, who had just transferred me to them.

Last Friday, I'd had enough.

I was doing everything I was supposed to, going through the proper channels, I'd provided everything I needed to, yet no decisions, no denials, no explanation of benefits, no answers and no test strips.  I think placing an order 2 months ago was more than enough time, so I did something I'd heard about but never had a reason to try it: I called Aetna's corporate headquarters number in Connecticut (I've driven by there a hundred times so I know where they're located) and I told the receptionist that I needed to speak to the President.  When she asked who was calling I gave her my name and the reason I was calling.

Within a minute or two, I was speaking with a department by the name of Corporate Office Complaints.  They handle calls when people call the CEO and try and reach that person, and they are often much better trained than a typical call center employee is.  The person I spoke with had heard it all before, and she was very pleasant.  She took all of my information including everything I had experienced and explained to every department at Aetna, then gave me a complaint number to save just in case I needed it again and her direct line.  Because it was Friday afternoon, I didn't expect much to happen.

However, this morning, I received an email that my Aetna Rx Home Delivery order for test strips was being shipped today.  Not "in process" or "pending" but "shipped".

After two months of an endless back-and-forth, my situation (at least for this order) had been resolved.  The lesson I would impart you with is that people who call the President and/or CEO's office usually get taken care of.  These departments are set up so the CEO never hears about the crap that goes on underneath him.  But these executive office complaints can save you lots of hassle and get things done that should otherwise be working but somehow aren't.  Make no mistake: you need to have done everything you're supposed to or they can't help you.  If you didn't get a precertification from your doctor, they really can't help you, as you need to get that stuff first and make sure you don't have anything outstanding on your end.  But they can make things happen when no one else in the company wants or is willing to assist.

Update, January 20, 2015: My order arrived today (finally).  See the picture below!


2 comments:

David Edelman said...

I love this approach, Scott. Thanks for sharing - it never hurts to go straight to the top! (A Better Business Bureau complaint can have a similar effect if it's deceptive behavior.)

Unknown said...

Happy #dblogcheckday my Friend. Hope to hear more from you soon.

Yours,
AmyT