SAVOY, Ill. (WCIA) – An Aetna Medicare client went months without updated prescription glasses needed for her daily life after her insurer claimed she had exhausted her vision benefit allowance for the year. Savoy’s patient – who wished not to mention her name – says Aetna “never paid” an eye clinic for glasses on her behalf in 2022. During that time, she “was desperate for reading glasses, like most people my age too.”
She is the latest elderly person to come forward disruptive issues with their Aetna Medicare insurance plans after a months-long Target 3 investigation revealed that pensioners on a state-sponsored scheme had lost their doctors and were struggling to find replacements, while unexpected medical bills arrive on the doorstep.
The woman at the center of this story enrolled in the private market, but the plan she is enrolled in is a Medicare Advantage PPO plan that is the same type – possibly the same plan – as the Department of Central Management Services. (CMS) of Illinois just contracted to Aetna as the only PPO option available to retired public servants for the next ten years.
His story gives us insight into the effectiveness of the plan, which was not previously part of the state’s Total Retiree Advantage Illinois Medicare Advantage Prescription Drug (TRAIL MAPD) health insurance program.
“I never expected to spend my retirement sitting in front of my phone day in and day out trying to fight for my benefits,” she began.
This particular saga began on May 3 when she visited Chittick Eye Care in Savoy for an annual eye exam for updated prescription lenses she “desperately needed”.
She says she left with a quote for a new pair of glasses and ordered it along the way, but they didn’t fit her in the end.
“And I didn’t like the price,” she said.
She says she canceled the order within 48 hours and “that was the start of what happened.”
Chittick staff asked his insurer to reinstate the amount billed for his health insurance benefits in an email shared with reporters.
The plan allocates $300 per year for new glasses or contacts. The eye exam was covered by a copayment that seemed to leave her the full $300 to find glasses at another clinic.
“I tried several,” she said, revealing pages of documents to prove it. Each time he was shown, “there is nothing left in my account until 2023”, an apparent sanction for a pair she never brought home.
“So trying to update my reading glasses was impossible,” she said.
“If the local clinic was not reimbursed, if EyeMed [an intermediary service Aetna contracted by Aetna] hasn’t been refunded, so where’s the money? Who has the money?
“It must be Aetna.”
In a preliminary phone conversation before the interview, the Aetna client used the word “fraud” to describe her experience.
Asked about it in a more formal setting, she replied, “Yes, that’s a term I used. It is a term that I have used in the documents that I send to them.
“They claim they paid for new glasses, new frames and new lenses.”
Three months later, she says, “No one has been paid by Aetna. They withheld the money.
Over the past week, she gave in and bought the cheapest eyeglass option she could afford out of pocket, costing her about $200 from her monthly Social Security.
“It’s getting harder and harder to retire, which was supposed to be a good time in your life,” she says. “You put in years and years of professional or volunteer service, and then when it comes time to retire, you sign up for programs and hope to get some kind of coverage for that.”
She detailed months of phone calls with her insurer where she “came to nowhere”.
“The employee of [Chittick] has been on hold with Aetna for over 47 minutes. And then because it was so long, they got disconnected,” which she said she experienced multiple times.
She was in the process of mounting a formal complaint on Wednesday to send to her insurer.
She said she also filed complaints with the US Centers for Medicare and Medicaid Services, the agency responsible for regulating Medicare Advantage plans like hers. She said she hadn’t heard back and it could still take weeks.
“I don’t think anyone should, especially an older person, an older person, should have to go through all of this,” she concluded. “The paperwork, the phone calls, it’s just unbelievable.”
Journalists asked Aetna representatives why his vision insurance has not yet been restored. This question has remained unanswered as of the date of this report. The company also didn’t say whether this plan is the one state retirees can expect during October’s open enrollment.
Chittick Eye Care issued a statement: “Chittick Eye Care is very dedicated to helping our patients with Aetna Medicare insurance resolve any issues they may have with their benefits. We will work diligently within the resources provided to us by Aetna.
The patient said a representative has been working closely with her since May, including arranging a conference call with Aetna.