My son, qualified for ALTCS in 2011. He was being tube fed through a G-tube and was receiving formula and supplies through the company Apria (also known as Coram).
Before he qualified for ALTCTS and AHCCCS, he was on Aetna. Aetna covered his supplies 100%, since he was dependent on his tube for nutrition. For some reason, Aetna adopted Meritain to handle their claims in July 2013. They decided to stop covering his supplies yet I did not receive a letter or phone call.
You can see why I was shocked when 6 months later I received a bill from CORAM. I still thought it was a mistake. There was no way that Meritain would just stop coverage that was being paid continuously before. I called Aetna.
No excuses or apologies from them. Just told me how to appeal it. I went through all the appeal paperwork in January 2014. I never heard a word.
Aetna didn’t let me know if it was accepted. CORAM stopped sending bills. Until November 2014. I just received a bill from CORAM for $7,432.67.
I do believe AETNA MERITAIN is completely responsible for this. They did not inform me when they weren’t covering, they did not inform me of my appeal status, and they are just plain terrible for thinking a tube fed infant does not deserve the formula nutrition his life was dependent on.
Since I cannot get anyone to listen to me over the phone. I am submitting this letter with a copy of the CORAM bill.
Product or Service Mentioned: Meritain Health Medical Claim.
Reason of review: non payment, no communication.
Monetary Loss: $7432.
Preferred solution: Full refund.