Aetna Specialty Pharmacy is charging me $3, 098.01 for a Synagis shot my son never received (I have proof that they have the medication) and $140 for an in-home nurse visit that never happened.
Last year during insurance selection, Aetna was no longer a choice for medical insurance. I selected Kaiser and then contacted Aetna, Sherwood clinical, and our doctors to inform them of the change.
Aetna claims that on 1/14/2008, the "patient" approved that they send the Synagis medication to Sherwood Clinical (who would send a nurse to the house to administer the shot). Did I forget to mention that my son was 1 year 3 days old at the time?! How could he have approved delivery of the medication? He couldn't even talk! When I mentioned this to them, they said that the person that put in the entry may have been talking about someone else in the household. The truth is that they never received approval and made an entry that was an out right lie.
Aetna's next claim was that they sent the medication to Sherwood Clinical. When I contacted Sherwood Clinical, they informed me that they did receive the medication, but after reviewing their records (which showed that I told them about the change in insurance) they called Aetna to find out how to return the Synagis, and returned it via UPS (I have the UPS Shipping Receipt and the name of the person at Aetna Specialty Pharmacy who accepted and signed for the meds). Aetna claimed that they don't accept returned medicine. But when presented with proof that they did accept it, they backpedaled and said that they destroyed it. Lies on top of lies, and once again--why am I being billed for medication I never receieved, which they have and probably re-distributed to another patient.
I received the first bill in April, and spoke with a representative on 4/24/08. An investigation was supposed to take place and I was supposed to be told of the results. The only thing that happened was I received another bill.
So, I called the Reimbursement Department (6/12/08)--again provided them with all of the information--again, and was told that the case would be resubmitted to Quality Assurance for investigation, and someone would contact me with the results--again.
All that happened was that I received another bill in the mail, which not only has the $3098.01 charge for the Synagis, a $140.00 charge was added on 4/25/08 (the day after my initial call to Aetna Specialty Pharmacy), for a nurse visit that NEVER happened (Sherwood Clinical will attest to this).
I've done my due diligence:
I informed the insurance company, the doctor, Aetna Specialty Pharmacy, & Sherwood Clinical of the change in insurance.
I did NOT give Aetna Specialty Pharmacy approval to deliver the Synagis to Sherwood Clinical.
My son did NOT receive a shot from Aetna (Kaiser provided him with his January Synagis shot at the Kaiser Facility (a little late--1st weekend in February)).
I have the UPS Shipment Receipt which shows that the Synagis was shipped to Aetna Specialty Pharmacy and signed for by one of their employees.
So, why am I being billed for medication they STILL have, and for a nurse visit that never happened? I'm sending a copy of this letter to Clark Howard and the Chairman & Cheif Executive Officer of Aetna, Inc.
At this point, the payment is 90 days past due. So not only do I need them to stop trying to bill me for medication they still have, I'll need them to remove whatever entry(ies) they've placed on my credit report.
I'm sending this letter hoping that getting the word out will generate enough conversation that someone will take interest and tell me can be done to help me out of this mess.