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.
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.