Aetna Dependent Eligibility Audit–Digest 2007-2008

Aetna Audit Non-Responders at Amtrak Lose Rail Pass Benefit, Too

June 19, 2008–According to the carrier, all dependent medical, dental and rail pass benefits have been terminated for all those union members who did not respond to the numerous requests from insurance company Aetna for dependent information.  To check benefits status or get further information, call Aetna at 877-277-3368.

*****

ONE LAST CHANCE
Members who have not completed the Aetna audit of dependent eligibility,
call 1-866-682-5619 immediately!

As of February 21, 2008, some 3,000 TCU members still have not responded to the Aetna audit of dependent eligibility.  Those members with dependents who fail to provide the necessary documentation by March 15 will have their dependents’ insurance coverage cancelled.  International President Bob Scardelletti is so concerned about what will happen to these members that he now is personally sending a letter to each and every non-responder that TCU has been informed of by Aetna. (Click here to read the text of the letter.)  He is also asking all Local Chairpersons who have non-responders among the members they represent to make contact with the individuals to give them this straightforward and succinct message: call Aetna at 1-866-682-5619 immediately.  (The union representative cannot intervene in the audit for the member and the audit protocols are not subject to exception or override: the individual must contact Aetna directly.)  The situation is dire.  If you have not responded yet, please do. The time truly is now or never. 

*****

The Good News: Many People Are Finally Contacting Aetna
The Not So Good News: Be Prepared to Be Patient and Persistent
The Solution: Aetna Adds Staff, Extends Hours of Service

February 14, 2008—The audit of dependents being conducted by Aetna on behalf of the National Health and Welfare Plan and Amtrak generated so many calls last week that Aetna was unable to handle all of them. At the urging of TCU and other rail unions, Aetna has added staff to answer the toll free number — 1-866-682-5619 — and extended its hours of service. The Aetna call center is now open Monday through Friday from 8:00 a.m. to 8:00 p.m. and on Saturdays from 8:00 a.m. to 4:00 p.m.  If you call during the week, the best time to call is before 10:00 a.m. or after 4:00 p.m. Members may still experience a wait when calling, so we urge you to be persistent. In general, this week members are getting through to a call center operator in 10 to 15 minutes or less. TCU remains very concerned that members who have not completed the Aetna audit may lose coverage for their dependents for dental, vision and medical services. Coverage will terminate for dependents of non-responders on March 15, 2008. Members who have completed the Aetna audit and have received a confirmation notice do not need to call. The confirmation notice is proof that your dependents have been properrly verified and that their coverage will continue.  If you have completed the audit but did not get a confirmation notice, call 1-866-682-5619 and select the option for obtaining a confirmation.

*****

February 5, 2008TCU is very concerned about what will happen to members who have not completed the Aetna audit of dependents, which will apply not only to dental coverage, but to medical and vision care, too.  Here International President Bob Scardelletti explains the urgency of the situation:

In a last-ditch effort to reduce the astounding number of non-responders to the ongoing dependent eligibility audit being conducted by Aetna, on January 30, 2008, the Joint Plan Committee of the Railroad Employees National Health and Welfare Plan sent the attached notice to those employees who have still not responded. The notice, jointly signed by Robert F. Allen, Chairman of the National Carriers’ Conference Committee, and by me as Chairman of the Cooperating Railway Labor Organizations, advises that coverage for non-responders will terminate on March 15, 2008.

 Let me clarify the consequences of dependent coverage termination.

There is no question that the termination of health insurance coverage for dependents will lead to situations in which physicians or other providers will refuse to provide treatment without payment in advance.  This could occur in a doctor or dentist’s office, a pharmacy, or in the worst-case scenario, in a hospital emergency room or other urgent care setting. Regardless of the medical circumstances, all non-responders must understand that there will be no means to reinstate coverage other than for the employee to provide proof of dependent coverage under the terms of the audit.  I repeat, there will be no “emergency” reinstatement of benefits for dependents, even in a crisis.  An employee’s only recourse, regardless of the medical circumstances, will to be to satisfy the provider’s policy governing the uninsured.

With respect to pharmacy benefits, no prescriptions will be filled through mail order for terminated dependents.  Prescriptions at retail pharmacies must be paid for under the provider’s policies for the uninsured. However, please be warned of the following:

In order to clarify previous advice that benefits will be reinstated retroactively for dependents once the proper documentation has been furnished, you will not be fully reimbursed for prescription purchases at retail pharmacies. Rather, the reimbursement for any purchase at retail will only be reimbursed at 75% when and if dependent coverage is reinstated.

If a member has already submitted documentation of eligibility for his/her dependents, the member should have received a confirmation notice from Aetna. If a confirmation notice was not received, the employee may be in non-responder status, and accordingly, they should contact Aetna immediately at 1-866-682-5619.

Once again, I must state in the strongest terms that the impending termination of medical, dental and vision coverage for thousands of  TCU members’ dependents is a matter of utmost concern.   Non-responders have a last chance to avert termination of dependent benefits, but only if the required documentation is PROVIDED immediately.  Again, if you think you may be on the  non-responder list, contact Aetna immediately at 1-866-682-5619.

 Best Times to Call:

The Aetna call center is open Monday through Friday from 8:00 a.m. to 8:00 p.m and on Saturdays from 8:00 a.m. to 4:00 p.m.  If you call during the week, the best time to call is before 10:00 a.m. or after 4:00 p.m.

 

 

 

*****
URGENT! If You Have Not Responded to the Aetna Audit, Do So Now

January 9, 2008—As of December 31, 2007, Aetna had not received verification of eligibility for 119,398 dependents and spouses. As a result, on or about March 4, 2008, UnitedHealthcare, Aetna, Highmark Blue Cross Blue Shield and Vision Service Plan will begin cancelling coverage for all unverified dependents. Cancellations will apply to the medical, dental, and vision plans.dominos falling close up copy.jpg

If coverage for your spouse or dependents is cancelled due to a failure to provide the required documentation, your only recourse will be to provide the required documents. Although cancelled coverage will be reinstated retroactively upon receipt of the required documents, retroactive reinstatement will not be of any help at the time when a hospital or physician demands cash payment due to lack of coverage.

Once again, we urge in the strongest possible terms that anyone who has not yet responded to the Aetna Dental audit do so immediately. If you do not have the audit package, you should call 866-682-5619 immediately.

Download and post the Special Alert on this subject.

*****

Don’t Lose Out on Benefits for your Spouse and Children—
It Is Imperative to Answer Aetna’s Dependent Eligibility Audit NOW

December 7, 2007Danger lies ahead for far too many members covered under the Railroad Employees National Dental Plan: they have failed to respond to the dependent eligibility audit and soon their spouses and dependents will lose coverage for all railroad insurance plans—medical, dental and vision.  The number who have ignored the audit from Aetna is astonishing.  As of December 4, 2007, there had been no response on behalf of 138,274 dependents.  There is still time, but not much. Read more in this Special Alert, then print it out to pass along to fellow members.  Read President Scardelletti’s letter  to TCU officers.

*****

URGENT: PLEASE DO NOT IGNORE THE AETNA AUDIT
141,166 Dependents Risk Being Dropped from Dental & Medical Coverage

November 2, 2007—That is how many dependents currently covered under the National Dental Plan still have not responded to the Aetna dental audit.  If you have not completed and returned your audit, do not wait— call Aetna’s toll-free help line at 866-682-5619 now.  It is imperative to respond: here’s why.

*****

October 31, 2007—Aetna sent out in September a questionnaire to verify with every covered freight railroad member whether their dependents are eligible for continued coverage.  The deadline is fast approaching.  If you have not returned this, DO SO IMMEDIATELY. If you didn’t return it and you can’t find it, call Aetna’s toll-free help line at 866-682-5619 and get another one.  It is imperative that each employee with dependents responds to this verification mailing: Failure to respond or failure to produce acceptable documentation for dependents will result in termination of dependent coverageand audit results are going to be applied to the Railroad Employees National Medical Plan and the National Vision Plan, too.  If you haven’t responded because you fear some sort of difficulty, know that TCU successfully insisted that the audit commence with a guarantee of amnesty for any employee who has claimed ineligible dependents.  We know not every ineligible dependent on the insurance company rolls is there because of fraud. Many people forget to notify the insurance companies of divorce, court custody decisions, children graduating from college, etc., so there are many reasons why ineligible dependents may still be listed. Whatever the reason that ineligible dependents might be currently listed, members can respond to the audit by removing anyone listed as their dependent with no questions asked, provided they do so within 60 days of receipt of the verification package. Neither the Plan nor the railroad will take any action against an employee or the removed dependent. That means members will not be subject to discipline from the railroad, nor will the insurance company attempt to recover claims previously paid for an ineligible dependent.

Click here for earlier announcement.  (Note this linked to the September 4, 2007 article below.)

*****

September 4, 2007—In order to ensure that each dependent listed under the Railroad Employees National Dental Plan (the “Plan”) meets eligibility requirements, in early September 2007 Aetna will begin mailing freight railroad employees a dependent eligibility verification package. Within 60 days from the date of the mailing, each employee with dependents must verify that existing dependents currently meet eligibility requirements and must also provide documentation of each dependent’s relationship to the employee.

Definitions of eligible dependents are included in the verification package. The primary forms of acceptable documentation are marriage and birth certificates, although alternative documents will also be accepted. The verification package will also explain alternate forms of documentation.  For those who need individual assistance, Aetna has established a toll-free help line at 866-682-5619.

It is of the utmost importance that each employee with dependents respond to the verification mailing. Failure to respond or failure to produce acceptable documentation for dependents will result in termination of dependent coverage.

Audit results will also be applied to the Railroad Employees National Medical Plan and the National Vision Plan. Therefore, members must reply with the necessary documentation in order to continue coverage for their dependents for medical, dental and vision care benefits.

The audit is the first Plan-wide audit of this type, and it is being undertaken in an effort to reduce Plan costs. Insurance consultants and other industry experts place the number of ineligible dependents in a typical plan at between 5 and 15 percent. For the railroad plans, that could mean a savings of millions of dollars. Of course, any reduction in Plan costs will favorably affect employee cost-sharing contributions as well.

TCU has made every effort to ensure that the audit will be conducted in a competent, reasonable manner and that members will have ample time to furnish the required documentation, as well as a toll-free help line at their disposal. Most importantly, TCU also successfully insisted that the audit commence with a guarantee of amnesty for any employee who has claimed ineligible dependents.

We know that not every ineligible dependent on the insurance company rolls is there because of fraud. Many people forget to notify the insurance companies of divorce, court custody decisions, children graduating from college, etc., so there are many reasons why ineligible dependents may still be listed. Whatever the reason that ineligible dependents might be currently listed, members can respond to the audit by removing anyone listed as their dependent with no questions asked, provided they do so within 60 days of receipt of the verification package. Neither the Plan nor the railroad will take any action against an employee or the removed dependent. That means members will not be subject to discipline from the railroad, nor will the insurance company attempt to recover claims previously paid for an ineligible dependent.

TCU members who are covered by the National Dental Plan are urged to complete and return the verification audit as soon as possible. Questions should be directed to Aetna’s toll-free help line at 866-682-5619.

    RELATED ARTICLES

    No posts are directly related to this post.