SAVOY, Ill. (WCIA) — An Aetna Medicare customer went months without updated prescription glasses needed for her everyday life after her insurer claimed she used up her vision benefit allotment for the year. The Savoy patient — who wished to leave her name out of the story — says Aetna “never paid” an eye clinic for glasses on her behalf in 2022. Meanwhile, she “needed reading glasses desperately, like most people my age too.”
She is the latest senior to come forward about disruptive issues with their Aetna Medicare insurance plans after a months-long Target 3 investigation revealed retirees on a state-sponsored plan lost their doctors and have been struggling to find replacements, all while unexpected medical bills are landing on the doorstep.
The woman at the center of this story enrolled through the private marketplace, but the plan she’s enrolled in is a Medicare Advantage PPO plan which is the same type — possibly the same plan — that the Illinois Department of Central Management Services (CMS) just contracted to Aetna as the only PPO option offered to retired state workers for the next ten years.
Her story gives us a glimpse into the efficacy of the plan, that has not previously been a part of the state retiree health insurance (Total Retiree Advantage Illinois Medicare Advantage Prescription Drug (TRAIL MAPD)) program.
“I did not expect to spend my retirement, sitting by my phone day after day trying to fight for my benefits,” she began.
This particular saga began May 3 when she headed to Chittick Eye Care in Savoy for an annual eye exam for updated prescription lenses she “needed desperately.”
She says she left with a quote for new pair of glasses and the order on the way, but they ultimately weren’t the right match for her.
“And I did not like the price,” she said.
She says she canceled the order within 48 hours, and “that was the beginning of what has happened.”
Chittick staff requested that her insurer reinstate the amount charged to her Medicare benefits in an email shared with reporters.
The plan allots $300 dollars a year toward new glasses or contacts. The eye exam was covered with a co-pay which appeared to leave her the full $300 to find glasses at another clinic.
“I tried several,” she said, revealing pages of paperwork to back it up. Each time she was shown, “there is nothing left in my account until 2023,” an apparent penalty for a pair she never took home.
“So trying to ultimately get my reading glasses updated has been impossible,” she said.
“If the local clinic was not reimbursed, if EyeMed [an intermediary service Aetna contracted by Aetna] was not reimbursed, then where’s the money? Who’s got the money?”
“It has to be Aetna.”
In a preliminary phone conversation ahead of the interview, the Aetna customer used the word “fraud” to describe her experience.
When asked about it in the more formal setting, she said, “Yes, it’s a term I’ve used. It’s a term I’ve used in the paperwork that I’m sending to them.”
“They’re claiming that they paid for new glasses, new frames and lenses.”
Three months later, she says, “Nobody’s gotten paid from Aetna. They have withheld the money.”
Within the last week, she gave in and bought the cheapest glasses option she could come up with out-of-pocket which cost her about $200 dollars from her monthly social security.
“It’s getting harder to retire, which was supposed to be a good time in one’s life,” she said. “You put in years and years of service professionally, or as a volunteer, and then when it comes time to retire, you sign up for programs and hope that you get some kind of coverage for that.”
She detailed months of phone calls with her insurance provider where she “got nowhere.”
“The staff person from [Chittick] was put on hold with Aetna for over 47 minutes. And then because it was so long, they were disconnected,” something she said she’s experienced multiple times.
She was in the process of putting together a formal complaint Wednesday to send to her insurer.
She said she also filed complaints with the U.S. Centers for Medicare and Medicaid Services, the agency in charge of regulating Medicare Advantage plans like hers. She said she hasn’t heard back and that could be weeks away still.
“I don’t think anybody should, particularly an elderly person, senior citizen, should have to go through all this,” she concluded. “The paperwork, the phone calls, it’s just been incredible.”
Reporters asked Aetna representatives why her vision insurance has yet to be reinstated. That question was left unanswered as of this report. The company also did not clarify whether this plan is the one state retirees can expect at October open enrollment.
Chittick Eye Care did provide a statement: “Chittick Eye Care is very dedicated to helping our patients with Aetna Medicare insurance to resolve any issues they may have with their benefits. We will work diligently within what resources we are provided through Aetna.”
The patient said a representative there has worked closely with her since May, including setting up a conference call with Aetna.