Al Schwartz sent a message to Mark Bertolini - Chairman and Chief Executive Officer of Aetna - Email Address that said:
Ive been covered by Aetnas Medicare Elite Plan since January 1, 2017. I chose this plan because of Aetnas reputation and because the plans summary of benefits fit my needs. Among the plans benefits was that there was no copay for the annual preventive physical. This was consistent with the health plans that Ive used for the last 25 years. Health insurance companies dont charge copays for these annual preventive visits because it is in their financial interests to catch member health problems early when they are much less expensive to deal with.
However, when I had an annual preventive physical this past January, I was billed a $10 co-pay for the electrocardiogram and another $10 for the fecal blood test—two tests that I had never been charged a co-pay for before by the health-insurance plans I had used for over 25 years—all of which said they did not charge a co-pay for an annual preventive physical And Actually Did Not Charge Any Co-Pay.
The description of Medicare plan benefits that Aetna puts out comparing the benefits of the Aetna Medicare Elite Plan (PPO) H5521-120 (which I chose) with two other Medicare plans said that my Elite Plan has a $0 co-pay for an annual physical with an in-network physician (which I used).
The summary of benefits for my Aetna Medicare Elite Plan also says that an annual preventive visit has $0 dollars co-pay when done by an in patient physician.
In addition the Evidence of Coverage for my Aetna Medicare Elite Plan says $0 co-pay for an annual routine physical when done by an in-network physician.
None of these Aetna documents say that there is an exception to the $0 co-pay rule for an electrocardiogram or a an assay test for blood in a fecal sample when part of an annual physical and my medical groups billing office said that both of these tests are correctly coded to link to my annual physical.
Between Mar. 2 and May 25 of this year I had several conversations with Aetna customer service representatives without being able to bring this issue to closure. As far back as my Mar 2. call, the Aetna customer service representative I spoke to said he reviewed my policy and spoke to my medical groups billing department, which would issue a new bill with zero co-pay. However, when I spoke to my groups billing department in May, they said they never got an EOB from Aetna that would authorize them to do that.
I urge Aetna to do the right thing and honor its agreement.
Alfred Schwartz
ID: MEBMLQ4C
Alcs1947@gmail.com
