Aetna, Inc.

Review: I started working for [redacted].com on January 26th 2015. In fact, I was already traveling (working) on Sunday January 25th to start orientation on the 26th from [redacted] to [redacted] said that Aetna should cover the prior few days to my start date since I needed to have the prescriptions for my travel and first week.

Aetna has denied my claim for prescriptions (birth control $130 and blood pressure $180) filled on 1/24 because I was traveling on 1/25 to start 1/26. Also they failed to reimburse for flu shot on 2/2 for $30. I did not receive my health cards until mid to late February 19th. Last, they are not covering annual blood tests that have always been covered by prior health insurance 3/3/15 for $84.35.

$425 approximately in out of pocket costs that should be covered by insurance. This is a very simple issue.Desired Settlement: I'd like to be reimbursed the difference of co-pay ($25 for [redacted]). I believe birth control and flu-shot should be covered in full along with the annual physical exam which included blood tests.

Business

Response:

Thank you for your inquiry received on 06/01/2015 regarding complaint # [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to Aetna’s Pharmacy Management department (APM) for assistance, and our records indicate the member’s effective date of coverage is 01/26/2015. If the member purchased medications prior to that date before her employment started, then there was no active coverage and the medications are not eligible for reimbursement.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Consumer

Response:

Review: [redacted]

I am rejecting this response because: I purchased prescriptions after my employment date of 1/26/15 including the flu vaccination. You have not paid me for the prescriptions purchased in February 2015 and the flu shot. I will continue to escalate this as now you have not paid for general annual blood tests in the amount of $90.