Nurse: We can't do that. You've got to come in and give me a urine sample. We're here til 4:30. Come in now.
Me: I can't get there before 4:30.
Nurse: Why? Do you live far away?
Me: I live in Celina.
Nurse: Ooh. That's far. You can't get here. Just go to any urgent care and they can fix you right up.
But what are the odds that I can go to any urgent care facility? I tried to login to the Aetna website to find out which ones I could go to but didn't have the patience to live through the "I forgot my password" routine so opted to phone them instead. (Time was of the essence!)
Aetna customer service told me that I could go to ANY urgent care facility. The young lady told me that the ER would cost me $75 and an urgent care facility would cost me $20. Aside from the obvious cost savings, it seems to me that you go to the ER when you are bleeding, have broken bones or are in serious pain. A bladder infection is annoying but it doesn't warrant a trip to the ER.
But while I was looking for an "urgent care near me", something kept nagging at me. Truth was, I just didn't believe I could go to ANY urgent care facility. So I called back. I spoke with someone different this time and I'm glad I did. I had to go with one that was "in network". And just let me say that Aetna has more than one network. I'm sure that creates an administrative nightmare for them, but I suppose it keeps people employed. There were no in-network providers in my zip code. Not a surprise. There's barely a grocery store in my zip code. (Give it a year or two, it will change!) But the choices being offered were Melissa (on the other side of the world), Lewisville (on the other side of the world and not even in the same county) and Frisco (about 20 minutes away - definitely the closest.) I took the number for the place in Frisco.
I called them only to find out that they were closing at 5:00 pm. By this time, I couldn't get there, either. I called Aetna customer service back for more options.
The other options got further and further away. It seems that if you are looking for an "urgent" care facility that you don't really want to drive over an hour to get there - even when you live in the boonies like I do. I asked why I couldn't go to one in McKinney. It was about the same distance as the one in Frisco. She asked if I'd like for her to get me an authorization to go to the one in McKinney.
Yes. If you can get it before they close for the day. They close at 8. I was starting to lose hope. Last year when I wanted to get an MRI without driving to another county it took them nearly a month to authorize it. Seriously. And I found out last week that after all that effort, they had denied payment to the facility that did the MRI.
I mentioned this to Mark, who was sitting across from me and the young lady at Aetna heard it. So now, instead of trying to get me an authorization to get medical attention that evening, she was telling me what happened a year ago.
Customer Service: The doctor never sent in the referral.
Me: The doctor referred me to someone who was out of network. I called you to find someone who was in network.
CS: But the doctor still has to submit the referral.
Me: Which doctor are we talking about? My primary doctor referred me to the specialist and the specialist ordered the MRI. Did my primary doctor need to submit a referral for the MRI?
It got completely confusing here. I still don't know how many doctors need to submit a referral for an MRI. But I do know that a year ago there was a month's worth of "to-ing and fro-ing" between Aetna, the doctors, and me. And that after all that someone still didn't get it right. And there are rules.
And apparently these same rules require that my primary care doctor submit a referral for me to go to an out-of-network urgent care facility. If my primary care doctor were available, I'd be going to him and wouldn't need an urgent care facility. Those are the rules.
I'm not sure what my exact words were. I think they were, "Do you know how stupid that is?" Then I was informed that I should have been informed about how limited the plan was before I signed up. Seriously, I was signed up by a salesman. The whole thing was great! Fabulous! Aetna's a great company but the deciding factor was that my primary doctor, my cardiologist, my dermatologist, my podiatrist and my gynecologist were all on the plan. I assumed that they would offer those other services, like imaging and testing in proximity to those doctors. I didn't expect to have to drive for hours for "urgent care."
But back to the problem. I seriously need to have a referral from my primary care doctor in order to go to an urgent care facility? Yes. Those are the rules.
Me: You must have those rules for a reason. Apparently there are vast numbers of seniors on Medicare turning up at urgent care facilities who don't actually require urgent care.
CS: No. I don't think that's a problem.
Me: Than I assume you made this rule just because you can - with the intention of denying me access to the care I need. And that goes for the referral on the MRI, as well. We went back and forth about that for a month and now, a year later, you're telling me that I need to pay for it and you'll reimburse me?
CS: You might find one of our other plans more to your liking.
Me: I might find another insurance company more to my liking, but probably not. But I'll tell you, I wish I had a recording of this conversation because I'd put it up on the internet so everyone could hear how stupid this is.
She offered to send me information on their other Medicare plans. As far as I'm concerned, the only thing Aetna has going for it is that it's NOT Humana or United Healthcare.
And the other thing that makes me really angry about this is that I'm still up for dealing with their BS. I'm not sure that people in their 80s and 90s can manage it as well, which puts them in a far worse position than I'm in for being taken advantage of by these "rules".
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