What the Hell is Wrong with Aetna?

[FLM2]

Aetna made a decision, in Florida, to administer their new 2016 MAPD plans under Coventry and now tells all new subscribers (including those who had an Aetna plan last year and had to switch plans in Lee County) that they don't have Aetna, they have Coventry.

The only problem with this decision is that the plans filed with Medicare are AETNA plans, not Coventry. Nowhere in their plans for 2016, in Florida, is there a single mention of this-they have separate Coventry plans in certain areas and this has nothing to do with that.

I have clients in Lee County (Fort Myers) who are being denied benefits and told their doctors are out of network because of this deception, it is a disgrace. Several doctors offices have already said, 'we don't take Coventry' when they are clearly in the Aetna network and not every client will take the time to research this, they will just think their agent lied to them or something was changed.

I had a client call me today who has outpatient surgery scheduled for January 20th, it had been approved by Aetna last year for this date and now it is being rejected. When my client called Aetna, she was told, 'you have a Coventry plan, not Aetna' and your doctor isn't in network.

I suggested that my client call Aetna and tell them her next call would be to Medicare if the surgery was not approved, to recite the plan name 'Aetna Medicare Premier HMO' and plan number (which I gave her) and, if someone mentioned the word 'Coventry' again, to simply repeat this information over and over until the *** at Aetna connected her to someone who might help.

It's bad enough to pull this crap on an agent, we are equipped to handle it, but to do this to someone in their 70s facing surgery is just wrong, period.

 

[yogooglethis]

I was told they are having a " glitch" with Florida Aetna HMO members who where all migrated to the Coventry platform.Help desk are telling agents that this means a change in the Aetna network but that is wrong.what's changed is how providers now verify benefits .If providers use old Aetna method to verify they get a message saying they are not in network .The plan is still the Aetna HMO plan filed with CMS but renamed Aetna/Coventry - same benefits and network

 

[vic120]

I am a little confused by your post, Is the plan name still Aetna Medicare Premier HMO or is it now a different plan name and code?

If the 2016 plan is in fact the Aetna Medicare Premier HMO, Then shouldn't the Ins card indicate that?

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I was told they are having a " glitch" with Florida Aetna HMO members who where all migrated to the Coventry platform.Help desk are telling agents that this means a change in the Aetna network but that is wrong.what's changed is how providers now verify benefits .If providers use old Aetna method to verify they get a message saying they are not in network .The plan is still the Aetna HMO plan filed with CMS but renamed Aetna/Coventry - same benefits and network

Ahh.

Can't wait til Humana gets into the mix.

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[FLM2]

I was told they are having a " glitch" with Florida Aetna HMO members who where all migrated to the Coventry platform.Help desk are telling agents that this means a change in the Aetna network but that is wrong.what's changed is how providers now verify benefits .If providers use old Aetna method to verify they get a message saying they are not in network .The plan is still the Aetna HMO plan filed with CMS but renamed Aetna/Coventry - same benefits and network

It isn't renamed anything, it's just Aetna probably violating CMS rules.

Here is the front page of the Evidence of Coverage, is there a single mention of Coventry?

January 1 – December 31, 2016
Evidence of Coverage:

Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Aetna Medicare PremierSM Plan (HMO) (Open Access)

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2016. It explains how to get coverage for the health care services and prescription drugs you need. This is an important legal document. Please keep it in a safe place.
This plan, Aetna Medicare Premier Plan (HMO), is offered by Aetna Health Inc. (When this Evidence of Coverage says “we,” “us,” or “our,” it means Aetna Health Inc. When it says “plan” or “our plan,” it means Aetna Medicare Premier Plan (HMO)).


Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

This information is available for free in other languages.
Please contact our Customer Service number at 1 (855) 423-9420 for additional information. (TTY users should call 711). Hours are 8 am to 8 pm local time, seven (7) days a week.

Aetna has done something really wrong here, I can't believe that CMS would look very favorably on them misleading their subscribers like this.

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I am a little confused by your post, Is the plan name still Aetna Medicare Premier HMO or is it now a different plan name and code?

If the 2016 plan is in fact the Aetna Medicare Premier HMO, Then shouldn't the Ins card indicate that?

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Ahh.

Can't wait til Humana gets into the mix.

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It's not a glitch, it's a misrepresentation by Aetna and needs to be fixed or seniors are going to die because they are denied coverage or change doctors because they are told their in network doctors are not available and don't know enough to look into it.

 

[yogooglethis]

It isn't renamed anything, it's just Aetna probably violating CMS rules.

Here is the front page of the Evidence of Coverage, is there a single mention of Coventry?

January 1 – December 31, 2016
Evidence of Coverage:

Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Aetna Medicare PremierSM Plan (HMO) (Open Access)

This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2016. It explains how to get coverage for the health care services and prescription drugs you need. This is an important legal document. Please keep it in a safe place.
This plan, Aetna Medicare Premier Plan (HMO), is offered by Aetna Health Inc. (When this Evidence of Coverage says “we,” “us,” or “our,” it means Aetna Health Inc. When it says “plan” or “our plan,” it means Aetna Medicare Premier Plan (HMO)).


Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

This information is available for free in other languages.
Please contact our Customer Service number at 1 (855) 423-9420 for additional information. (TTY users should call 711). Hours are 8 am to 8 pm local time, seven (7) days a week.

Aetna has done something really wrong here, I can't believe that CMS would look very favorably on them misleading their subscribers like this.

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It's not a glitch, it's a misrepresentation by Aetna and needs to be fixed or seniors are going to die because they are denied coverage or change doctors because they are told their in network doctors are not available and don't know enough to look into it.

\
Seriously what is more likely:

One of biggest health insurance companies in the world buys Coventry and Humana specifically because they wanted to increase there share of government contract plans overtly violating CMS rules just so they trick their members

or


one of the biggest insurance companies in the world that recently bought bought 2 other companies having hiccups while merging platforms


as far as the name change you may want to ask one of your customers what it says on their 2016 correspondence they are getting from Aetna - it says Aetna Coventry Plan. sort of like what happened when UHC bought out Secure Horizons.They went from the name UHC MedicareComplete to SecureHorizons MedicareComplete insured by UHC to capitalize on the name recognition that SecureHorizons had established in the MA space.Once SecureHorizons was integrated in with the UHC medicare complete platform they dropped the SecureHorizons name in most areas.Not my first rodeo so i know its typical stuff in corporate mergers and acquisitions

 

[FLM2]

Seriously what is more likely:

One of biggest health insurance companies in the world buys Coventry and Humana specifically because they wanted to increase there share of government contract plans overtly violating CMS rules just so they trick their members

or


one of the biggest insurance companies in the world that recently bought bought 2 other companies having hiccups while merging platforms

as far as the name change you may want to ask one of your customers what it says on their 2016 correspondence they are getting from Aetna - it says Aetna Coventry Plan. sort of like what happened when UHC bought out Secure Horizons.They went from the name UHC MedicareComplete to SecureHorizons MedicareComplete insured by UHC to capitalize on the name recognition that SecureHorizons had established in the MA space.Once SecureHorizons was integrated in with the UHC medicare complete platform they dropped the SecureHorizons name in most areas.Not my first rodeo so i know its typical stuff in corporate mergers and acquisitions

It's not my first rodeo either and having Aetna/Coventry CSRs telling their Aetna members 'you don't have Aetna, you have Coventry' when they call in is inexcusable, particularly when the people calling in are seniors who don't necessarily understand the machinations of corporate mergers. It's also incorrect, they have AETNA plans, not Coventry regardless of how Aetna decided to administer these plans after they reviewed all of the plan documents and decided to enroll.

Mailing out documents with both names on it (if that's what they are doing, none of my clients have mentioned that to me) after the fact isn't nearly enough of an explanation, particularly when NONE of the information on the Medicare.gov website references Coventry, it isn't like Aetna purchased Coventry in October, it's been several years.

 

[yogooglethis]

It's not my first rodeo either and having Aetna/Coventry CSRs telling their Aetna members 'you don't have Aetna, you have Coventry' when they call in is inexcusable, particularly when the people calling in are seniors who don't necessarily understand the machinations of corporate mergers. It's also incorrect, they have AETNA plans, not Coventry regardless of how Aetna decided to administer these plans after they reviewed all of the plan documents and decided to enroll.

Mailing out documents with both names on it (if that's what they are doing, none of my clients have mentioned that to me) after the fact isn't nearly enough of an explanation, particularly when NONE of the information on the Medicare.gov website references Coventry, it isn't like Aetna purchased Coventry in October, it's been several years.

I agree Aetna's miscommunication or " glitch" as they call it to members and agents has been horrible and has caused many problems but the bottomline is it is still the same plan they choose to enroll in.

 

[FLM2]

I agree Aetna's miscommunication or " glitch" as they call it to members and agents has been horrible and has caused many problems but the bottomline is it is still the same plan they choose to enroll in.

The issue isn't that the plan is different, the issue is that my clients are being given incorrect information by Aetna/Coventry that can easily persuade them that either I lied about the plan and that their in-network doctor isn't covered under the plan as well.

It's already happened with one client (mentioned above) who is scheduled for outpatient surgery next week and now has been unable to get preauthorization for unknown reasons (the surgery was approved in December under the previous Aetna HMO plan), for someone in her 70s to have to deal with these kinds of problems isn't fair and it certainly isn't fair to me to have to not only explain this to every client that calls me but also deal with potential complaints to the DOI from clients who don't call me but call the DOI directly or call Medicare to complain and say I lied to them.

 

[yogooglethis]

The issue isn't that the plan is different, the issue is that my clients are being given incorrect information by Aetna/Coventry that can easily persuade them that either I lied about the plan and that their in-network doctor isn't covered under the plan as well.

It's already happened with one client (mentioned above) who is scheduled for outpatient surgery next week and now has been unable to get preauthorization for unknown reasons (the surgery was approved in December under the previous Aetna HMO plan), for someone in her 70s to have to deal with these kinds of problems isn't fair and it certainly isn't fair to me to have to not only explain this to every client that calls me but also deal with potential complaints to the DOI from clients who don't call me but call the DOI directly or call Medicare to complain and say I lied to them.

do a 3 way with member to provider and tell them aetna providers now verify through Coventry Provider Portal 1-800-847-3995.Aetna also has a special customer service number for Fl. Aetna HMO members who have been migrated to the Coventry platform 800-847-3995. Member ID # did change for 2016 so they need to give that one

 

[FLM2]

This is a heads up to other Aetna Medicare agents on the Gulf Coast who had members on 2015 plans that Aetna has moved to the Coventry platform without a new enrollment.

There is a really good chance you will not get paid commissions without raising holy hell-20 of my members have dropped off the face of the earth on my book and the local rep, who asked me for the list of members that all of a sudden showed up as Terminated on the Aetna book even though their plan had NOT been teriminated. then assured me in November that this would not happen, is now playing the 'I didn't know about this problem in November' card, that is never a good sign.

Aetna/Coventry broker services is closed today, they will be getting a call from me early tomorrow about this. I only found this out because my monthly Aetna Medicare statement is available today and only includes two renewing members, both on the PPO plan, not the HMO