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No Coverage - Aetna Review

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1.5 Overall Rating by

No Coverage

We haven't had any problems with just regular doctor visits being covered. However It's been quite a different story concerning coverage for our child born with Cerebral Palsy. He has a g-tube in his stomach thou which we feed him "Pediasure" liquid nutrition. It's what keeps him alive. None of the "in network" pharmacies such as Kmart, Target, Walmart etc. sell that product to consumers with an RX because it can be bought OTC. Pediasure and the tubing supplies is considered "Durable Medical Equipment" according to Aetna and is covered under our plan and yet they cannot find a medical supply/pharmacy that can furnish these necessities to us. One member service rep told us to go ahead and buy Pediasure at the store, keep the receipts, fill out the proper form, (which I insisted she send to me so I knew I'd have the right one) and we'd be reimbursed. It was denied!! Why? Because we used an "out of network" provider. The grocery store. When I stated that THEY told me to do that, they were very unsympathetic and basically said 'oh well, you'll just have to appeal the denial.' We wanted to use the pharmacy we had with our previous insurance but wasn't "in network". Aetna said to have our pediatrician fill out and fax a "transition of care" form to have coverage at that pharmacy for another 90 days. They said they didn't receive the fax from the doctor. So then I faxed it. Two weeks later, I checked and they didn't have a record of the fax. I faxed again. I've waited for 3 months and checked today. That's right, NO RECORD of the fax. We aren't rich. This Pediasure is $14.99 a six pack. Our son consumes 6 cans a day. If we couldn't pay for this ourselves and had to depend on Aetna my son would literally starve to death.

1.0 Coverage
3.0 Cost
1.0 Service
1.0 Claims

Aetna Ratings

  • 1.7 coverage
  • 2.3 cost
  • 1.3 service
  • 1.2 claims
  • 1.6 overall rating

Based on 210 reviews - 1 is lowest, 5 is highest

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