I can for Aetna HMO. Both parents liked what Aetna was covering, especially prescriptions and very low co pays. However, Aetna is noted for being very rigged in their decisions and it's darn near impossible to get them to see reason and logic. This cost my father his life this year and it's the reason why my mother is leaving Aetna. Aetna's appeals are covered by a company called Livante and their decisions are rendered by letter by both Quality Improvement Organizations (QIO) and Livante. The personnel on the phones are very courteous and seemingly understanding but Livanta's process on first appeal comes down to their independent doctors looking over the same records again. Denial comes within 24 hours. It takes longer for them to render a verdict on second appeals as different independent doctors are called in to also read the appealer's argument and facts as well as look over the previous records. In my second appeal letters I strongly laid out facts to back my appeal and pointed out falsehoods on the rehab center's discharge papers. I also pointed out the treatment my father was getting was literally killing him, which it did a month or so later.
I'll go into detail on my father's case so you can see the insanity of Aetna's rehabilitation prescriptions and the lessening lengths of rehab as he got worse because the prescriptions were wrong. It's not an exaggeration to write that Aetna must have spent tens or hundreds of thousands on procedures, visiting nurses and medicine when all they had to do was give my father the correct rehabilitation prescription. If you feel healthy enough to not go into a hospital in the next year, then Aetna is a good option to keep costs down on your medicine and doctors' visits. If you feel you might be going into the hospital in the next year's time, then I would advise you to steer clear of Aetna.
The following is a condensed account that led to my father's death-- a man who could walk with the aid of two canes at the start of February 2019: In the middle of that month, my father elected to be taken to the hospital after slipping off his mattress onto the floor without injury; he wanted his diabetic legs to be looked at. He contracted diarrhea the very next day that made him incontinent in the bowels for months. He went to the Aetna-approved rehab center to undo six days of hospital atrophy and to strengthen himself enough to get up from a prone position. Instead, he was released in weaker condition because Aetna prescribed sub-acute therapy five hours a week over the course of twenty days. Because of Dad's weakened condition he slipped out of bed again and this time hurt his knee. Six more days in the hospital was followed by now 16 days of sub-acute rehabilitation. This time Dad could only stand and not walk and they put a catheter in him that four days after he was ambulanced back to his bed had him go into septic shock with him being sent to the hospital ICU. During his four days home I discovered he had a large bedsore on one cheek near the tailbone. He almost died the following night in the ICU. He was sent to another rehab facility where the administrator promised to bring in male therapists to help Dad stand and walk but instead only used the two small female occupational and physical therapists, who were actually getting Dad his core strength back to the point where he could raise an inch or two from his wheelchair. Even with this progress, Aetna stopped his therapy at 14 days. Dad was ambulanced back to bed totally bedridden and now sporting a second large bedsore on his other cheek below the tailbone. After almost a month of at home recovery time with visiting nurses and therapists, Dad had to go back to the hospital again because of the infection caused by the bed sores. Dad was given a double operation of a colostomy and extraction of all the necrotic flesh of the bedsores which left him in extreme pain and a breakfast bowl-size crater in his backside that required a wound pump. Even in this state, Aetna STILL prescribed SUB-ACUTE rehabilitation at a third rehabilitation facility when an ACUTE facility was in the very same hospital. After stool was still getting through, my father was sent back to the hospital where the backside wound had turned black and necrotic. By then my father was on morphine and he didn't have it in him to go through any more pain. Dad was then sent to a hospice where, two days before he died, he was begging the hospice nurses to put him in a coma because he had more to contribute to the world.
There is a lot more to the story but the bottom line is this: A man who only needed at the very least to undo six days of hospital bed atrophy, who could walk and take care of his own bodily functions and enjoyed the holidays with his family and their families, is no longer around because of his treatment and the deafness of Aetna and Aetna's appeal company. I'm not lying when I tell you that seeing my father wronged like that and having all my pleas for his welfare rejected has haunted me as much as the sound of my father's "Oh my God"s and "Help me"s those final two months of his life.
I don't know if Aetna's other plans will get you more success regarding appeals but if you see the company name Livante regarding an appeal you may wish to make in the future, you should take note.
My family celebrated Thanksgiving Friday. If Dad was given the correct rehabilitation prescription by Aetna, my father would have been at that table with his family.
