- Report: #740858
Report - Rebuttal - Arbitrate
Complaint Review: SRC (Insurance) an Aetna Company Aetna Affordable Health Choices
SRC (Insurance) an Aetna Company Aetna Affordable Health ChoicesP.O.Box 14079 Lexington, Kentucky United States of America
SRC (Insurance) an Aetna Company Aetna Affordable Health Choices Strategic Resource Company The home of disappearing faxed claims. A place where employees are trained to give conflicting information about benefits, mislead about faxed claims not being received. Lexington, Kentucky
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My husband and I are "covered"-and I use this term rather loosely-by SRC. One thing that I noticed that when we went to the pharmacy to pick up prescription medication the costs out of pocket were exactly the same as if we did not have insurance. To investigate and research our benefits I contacted SRC directly where I was informed that our plan didn't cover prescription medication like some other insurance companies do, our coverage provided us with a 70% reimbursement of out of pocket costs.
In order to process a claim, we had to fill out a form containing the name of the medication, cost, doctors name and pharmacy where it was purchased at. I filled out the forms I was directed to immediately and faxed over to the number provided. We thought that the process was easy enough and upon filling out the claims we faxed the forms to the number provided. The first claim was faxed to SRCat the end of December 2010.
We continued to fax other claims to the number provided and didn't think anything of it and continued to wait for the reimbursement. Well, time passed and our child-like naivet was quickly debunked when we called in the beginning of March to receive an update from SRC on all of our claims sent to them. At that poins we were informed- much to our surprise- that me faxing the claims was a waste of my time as my plan with SRC didn't in fact (according to him) provide a 70% reimbursement unless the medication purchased didn't have a generic counterpart. As a reply to me stating that this information was contrary to the information we received in December the gentleman on the other end claimed that we were misinformed. He also stated that regardless no faxes for prescription reimbursement were ever received by SRC. At that point I ceased faxing any claims to SRC since my "insurance" didn't cover pretty much all of the medication that I had purchased.
Fast forward to May 17th when my husband contacted SRC to once again go over our benefits. He spoke to a lady (he didn't obtain the name) who informed him of all the benefits we had and were covered by, one of which states that we were available to receive 70% reimbursement for all of our medications-information contrary to what we were told in March. The employee my husband was speaking to informed me that we should fax any and all prescription claims that we had from December 2010 up to May 17th and continue to fax anything obtained from now on.
On May 17th I faxed the now plethora of prescription claims (I have a chronic condition that requires me to purchase medication on a monthly basis). The claims were faxed to the number provided. On May 18th I contacted SRC claims department to confirm the receipt of the claims I faxed. At that time, after providing all the information ranging from the ID number to the fax number we were faxing from. After all of that I was informed that no fax of any sort was ever received by SRC in their automated system from which any and all faxes are retrieved. On a daily basis, starting on May 19th, I continued to fax the claim forms to the various fax numbers I was given by the many different employees. Each and every day from May 18th to May 26th we were given the same answer as before stating that no claims were received by SRC under that ID number or from the fax that we were faxing the claims from. This game continued until I spoke to a lady who stated that I should fax the forms directly to their desk. I faxed the forms to the number provided and continued to call asking the status-please note that was never able to speak to the person who directed me to fax the forms to them. FInally on the 27th of May when I called for yet another follow up I was informed that the fax was received by the person I was asked to fax the forms to directly. I was informed that claims should be processed anywhere 3-10 days.
Let us, once again, fast forward to June 14th of this year when I once again contacted SRC for an update on my claims. To no surprise I once again spoke to a totally different person. That person told me that none of my prescription claims were going to be reimbursed (we were due around $1400). Imagine yet another shock on my part when the employee informed me that I maxed out on my benefits for the year as our benefits only covered $2500 for any prescriptions, doctors visits, tests, etc. That was information that we were never given-not when my husband spoke to a SRC employee on the 17th when she went over each and every benefit provided to us per our policy. Not a single person I spoke to when attempting to follow up ever mention that I was not going to get a reimbursements because I maxed out on benefits. I asked the person with whom I was speaking to transfer me to the individual who informed me to fax the claims to directly. I was informed that I could not be transferred because they were in a different area and potentially unavailable. I asked to speak to a supervisor and was informed that supervisor was unavailable. The employee did offer to send an email asking that I wished to be contacted. At that point I was frustrated and confused and agreed to the email and ended the conversation.
In my personal assessment I noticed that each and every person we spoke to had a different explanation of what our actual benefits were, each and every person spoken to since December of 2010 could somehow not find any of the plethora of faxes we sent to SRC. Somehow every single of our claims entered a black hole (as another person filing a ripoff report mentioned). Each and every single employee was unable-or not trained-to transfer me to the same person we spoke to on another occasion. It seems that SRC is not very big on continuity of care.
We feel that we were ripped off by SRC and were mislead on coverage and claims received. We might not be able to get our monies due to us by SRC but maybe this report and many others can inform any potential customers of SRC's tactics and absolute inadequacy as a customer based company. Other insurance companies deny claims that are quite expensive and extensive, this company seems to keep their fingers crossed that we, patients, do not go to doctors, receive any tests or buy any prescriptions as those claims are too much for this particular insurance company to pay or reimburse. I think that I'm better off not having coverage since I am paying out of pocket anyhow. Dropping SRC would actually save money as there would be no monthly payment for coverage.
This report was posted on Ripoff Report on 06/14/2011 08:32 PM and is a permanent record located here: http://www.ripoffreport.com/r/SRC-Insurance-an-Aetna-Company-Aetna-Affordable-Health-Choices/Lexington-Kentucky-40512-4079/SRC-Insurance-an-Aetna-Company-Aetna-Affordable-Health-Choices-Strategic-Resource-Compan-740858. 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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