• Report: #1050908

Complaint Review: Aetna

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  • Submitted: Tue, May 14, 2013
  • Updated: Tue, May 14, 2013

  • Reported By: furiousataetna — Tampa Florida
Aetna
Internet USA

Aetna Lied about coverage then denied claim for cancer patient's wig Internet

*Author of original report: thanks for your opinion

*Consumer Comment: Did you read ALL the information in the physical copy

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 In December of 2012 I was diagnosed with breast cancer. I was told with all certainty that I would lose my hair when I underwent chemotherapy which would start mid January 2013. I had heard through friends that sometimes health insurance companies will cover the cost of a wig. I called, asked and was told Yes, they cover 90% of the cost of a wig for cancer patients, up to $500 max. I asked what I needed to do and she said simply go to a wig store, purchase it, and go to the aetna website for a claims form and then mail it with receipt for reimbursement. I was happy and did so. On January 5, 2013, I purchased a wig at a local store.

Upon completing the claim form, I had questions. The form asked for codes that I knew nothing about. I called Aetna (Call #2) and she said that to list the name of the wig store on the receipt and that was all I needed to do. I did so. Mailed it. Heard nothing back for a month or more.

Called Aetna (Call #3). I was told that the claim was not processed because it lacked a code number of some sort. He said that it was a small detail and he could easily fix it right then and submit it again and I should get a check within a couple of weeks. Waited another month-no check.

Called again (Call #4). Was told well actually your claim was denied because you didn't use an in-network wig provider. This was the VERY first time I heard of this stipulation, and absolutely did not know Aetna had even a list of wig providers. I would have Happily gone to one of your wig providers if in fact I had been told there was such a list. When I originally called regarding benefits I was certainly NOT told to go to one in-network to receive those benefits. Now, I am out $500. I most definitely would not have spent $500 on a wig if I had known I would not be reimbursed for it. I foolishly thought that Aetna was sympathetic to a cancer patient losing their hair.

I have appealed this once before and was only repeated the policy of using an in network provider. My problem is... I NEVER WAS TOLD THERE WAS SUCH A THING AS AN IN NETWORK WIG PROVIDER.  In fact, I was told the opposite.

Additionally, upon looking at the list of providers for wigs for Tampa (after I was out $500 and my claim was denied), there was only one store. It was not primarily a wig store and had only a handful of colors and styles. Certainly not going to work.  

Ultimately I was reimbursed around $43 for the $500 wig.

 I am here to say that Aetna representatives are not aware or do not understand their In-network Wig Provider policy. They are obviously not telling customers about it and are leaving cancer patients with hefty bills that they are originally told they would be reimbursed for. A shame- and on such a sensitive product for a cancer patient.  

Aetna shafts cancer patients and takes NO responsibility for the erroneous information they tell customers. Who is the only one hurt when a rep tells the customer incorrect information?  The customer and Aetna does not take any responsibility for the words that their reps say.


This report was posted on Ripoff Report on 05/14/2013 01:11 PM and is a permanent record located here: http://www.ripoffreport.com/r/Aetna/internet/Aetna-Lied-about-coverage-then-denied-claim-for-cancer-patients-wig-Internet-1050908. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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#1 Author of original report

thanks for your opinion

AUTHOR: furiousataetna - ()

You seem like a person who would love to argue online about this for days so...thanks for your response. Just asking them to take responsibility for their reps. And yes, a company is responsible for what their reps tell their customers-that's their job. It is that succinct. 

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#2 Consumer Comment

Did you read ALL the information in the physical copy

AUTHOR: Tyg - ()

 Im sorry to hear about your cancer. And I can take a small amount of solace that you are getting treated. However the biggest mistake ANY insurance policy holder can make is to assume that the ppl who sell it know EVERY single line of information in YOUR contract. There could have been a policy change internally that prevented you from being able to get your monies back. I would seriously give some consideration to both the ppl you have been talking to and to the contract that you signed with them.

First of all the ppl you would be talking with are simply ppl in a call center. They probably have a "working" knowledge of the insurance company policies, but dont know every line by heart. It is highly unfair of you to hold these ppl to this standard when even you yourself do not follow this standard. You as the consumer had the responsability to not only read, but understand all aspects of your insurance coverage.

You are actually very very lucky that your insurance reimburses you anything. Most insurance companies consider a wig a "luxury" item. You dont need hair to exist. A wig is a personal defence against any sort of social stigma. It does nothing to further your actual health. It simply makes you feel better about what your going through. As you have stated, the list of "approved" wig dealers you would have been reimbursed for, didnt meet your definition of "pretty" or you would have returned the first wig and gotten one from that store.

Oh its also nice to see that you refuse to take responsability for your own policy issues. Must be nice to blame someone else. However, from the tone of your post, it sounds like you must blame others as a normal.

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