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An Update from Tallahassee

CartwheelsJust as I was finishing my nebs this morning, I got a call from an 850 area code – Tallahassee. I got so excited and dropped everything we were doing. The news is beyond good, but best digested in bullet points.

  • Aetna responded to them that I rec’d my booklet now (we have) and that I did request it on Jan 2 and mid-Feb (we did).
  • Aetna admitted that we did not get proper notice of the plan changing according to law.
  • Aetna admitted that we did not get a choice of new plans to choose from – but that was because it was supposed to just be a new ID card.
  • Aetna’s wording of the issue regarding my Rx costs made it sound like we were not the only ones in the system who were affected because it was an issue with a group number.
  • Tallahassee was going to get a reimbursement for us for any costs had we purchased Rxs at the improper rate (we didn’t).
  • They also said we can’t really get any compensation for our 20+ hours arguing with Aetna reps.
  • Tallahassee said they have been receiving numerous complaints similar to ours now, but ours was the most eloquent and cut to the chase, so ours led the way to the problem. They are auditing and attempting to contact everyone in the group who has these medications to assist them.

I feel like a champion for the little guys out there now. He thanked me for getting this info to them to help so many people. He said Aetna is a very responsive company when contacted and are more willing than most companies to respond well.

I told him that we confirmed that I had a grandfathered plan with a $5M lifetime max and asked him his professional opinion if it was smart to stay on that. “Absolutely,” was his confident reply. I asked him if I jumped to UnitedHealthcare if I’d be going from the pan into the fire and he said that if I did that, Tallahassee has no regulatory control over them because they are out-of-state insurers  – and it would actually be Golden Rule as the company. He said for the $640 we will be paying for my plan alone starting next month, I have an excellent plan that I should never consider ditching for another.

At the end of the call, I told him about my Twitter storm and the responses we got back. He said that is most likely the same department that Tallahassee deals with: the resolutions department. They are the ones who either give direct answers or solve problems efficiently.

David: 1 – Goliath: 0

Comments

  1. Gotta love it when the system actually works. Great job, Jesse!

    Now, if only the Facebook system worked so I could sign in that way to post this. I guess I’ll be a guest. 😉

  2. YES! So glad that you guys stuck through it all. Dealing with health insurance is truly one of the worst parts of CF (ironic, considering how unpleasant the rest is!).

  3. Erintaylor8284 says:

    Well done! I hate you had to spend so much time and energy to get it done, but atleast you made a difference! I hope the audit you have spurred helps a lot of patients with their isssues! I have United…so far we’ve had no real issues, but the ones I have had have been dealt with correctly and timely – thank God! Proud that you stuck to your guns…AWESOME!

    Erin Taylor
    Orlando