About 'aetna insurance'|Antique Advertising Mirror - Aetna Insurance
Insurance. It's a part of modern-day working life for most of us, and I know we should all feel fortunate if we have it. But that doesn't mean it isn't frustrating sometimes. The details of your prescription benefits might be buried somewhere in the insurance packet your employer has given you. However, how it works when you are at the pharmacy can be mysterious. Even as a pharmacist who bills prescription claims all day long, I still don't always understand all the details, but I'll try to cover the basics for you. Online Billing using BINs Almost all insurance plans, including state Medicaid plans, are billed online. At the pharmacy we enter the numbers on your card into the computer, and the computer does the rest. The information on your card is absolutely necessary. Sometimes I look back on the good old days when we only dealt with a handful of plans, and they all used Social Security Numbers as ID numbers. Now we deal with so many different plans every day, I don't think I could list them all, and few use SSNs anymore. The magic number on your card is the BIN. BIN stands for Bank Identification Number; a confusing term because there are no banks involved at this point in the billing. Apparently the term is a holdover from early electronic banking lingo. This 5 digit number tells our computer where to send the claim, and if we have trouble we can usually find a help-desk phone number for that BIN. Pharmacy Benefit Managers The claim is not transmitted directly to your insurance company. It is sent off to what is known as a Pharmacy Benefit Manager (PBM), a for-profit company that only handles prescription billing. It may be a separate branch of your insurance company, like Aetna, or it can be a completely different entity like Medco or Express Scripts. Each PBM has a different BIN. It can get even more confusing if your employer decides to switch PBMs. They may have signed a new contract with the new PBM that has promised to give the same benefits, but that doesn't mean everything is the same for online billing of the claim. Without the new card (or at least the new BIN and ID numbers), you may have a hard time at the pharmacy. Here in Washington State, state employees have had PBM changes twice in the last several years. If you are in a large group like state employees or a major employer in your area, the pharmacy can probably figure it out for you, but to be safe you should always have a copy of your newest card on you. Formularies, Prior Authorizations, and other Restrictions There are many people who think PBMs are evil companies, denying your prescription claims just for the fun of it. The truth, in my humble opinion, is they are only one part of our messed-up for-profit insurance system in this country. The PBMs offer employers different coverage plans at different prices. The lower priced plans that many employers choose to try to keep overhead down will have higher co-pays and more restrictions. The major restriction you should know about is the formulary. This is a list of preferred medications that the PBMs don't make readily available to pharmacies or doctors, or if they do, it is incredibly complicated because different plans offered by that PBM have different formularies. My advice to you is to get a copy of your plan's formulary for yourself. It may be available on PBMs website for patients to download, or you should be able to call customer service and have a copy mailed to you. This will hopefully save you from the dreaded Prior Authorization (PA) situation. Many expensive medications will not be on the formulary, and the PBM will only cover them after getting more information from the prescriber. If the prescriber gives them the answers they want about your diagnosis and other, cheaper medications you may have tried, then a PA will be given. I might agree that this is a reasonable cost-saving measure, except that it usually takes anywhere from a few days to a few weeks to get a reply to a PA request. When one plan wanted to get PAs on an expensive antibiotic (as if the patient could wait several days to start it!), I was thoroughly disgusted with them. All plans will have a maximum quantity per fill. This is usually 30 to 34 days at a retail pharmacy. More and more PBMs are offering the option of a larger supply if go with their mail-order pharmacy. Or you may only be able to fill only a few times at your neighborhood pharmacy and then be forced into mail-order. There can also be limits on the quantities of certain medications that are lower than your usual maximum quantity. This usually applies to "as needed" medications like those for sleep, migraines, and erectile dysfunction. With state-run programs there is usually a middle man who handles billing, but doesn't call the shots as much as the PBMs. There are still restrictions and medications that require PAs, but these are determined by the state, not the company processing the claim. What to do if you are unhappy with your coverage The whole medical insurance system needs a major overhaul if you ask me. Contact your congressperson if you want to see healthcare reform. In the meantime, you will have to work within the system. Let your employer know if you don't like your coverage. You and your co-workers might be able to negotiate with your employer for a better pharmacy benefit package the next time around. Also, remember your employer may have signed the contract, but you are paying the premium (benefits are part of your compensation for working hard). The insurance company works for you; not the other way around, so don't hesitate to call the customer service phone number on your card if you have any questions. If you do run into a situation where the plan is giving you a hard time over a PA, don't give up. Have the pharmacy call, have your doctor call, and call yourself until you get a satisfactory response from the PBM.Always have your current prescription insurance card on you.Have your doctor check your plan's formulary.Don't forget the insurance company works for you; not the other way around. |
Image of aetna insurance
aetna insurance Image 1
aetna insurance Image 2
aetna insurance Image 3
aetna insurance Image 4
aetna insurance Image 5
Related blog with aetna insurance
- blessedbyachild.blogspot.com/...issue or should I say Aetna- the big insurance giant has ... more about health insurance and the ins and... with many Aetna receptionists...
- insurance-company-profiles.blogspot.com/...long-term care, and disability plans, and medical management capabilities. Aetna Insurance Company Profile: Health Insurance Industry Service Area(s): United States of...
- arthuryinfan.wordpress.com/...schedule if he/she join the ASH network when treating a patient who has Aetna insurance. But, sometime, if the patient has Aetna Acupuncture benefit, Aetna may pay the acupuncture...
- ephemera.typepad.com/... mirror was produced as a promotional item for an Aetna insurance agent named John G. Myers. Normally, it's difficult to determine the age of ...
- no-dictator-needed.blogspot.com/...news about the mega-profit Aetna health insurance company may just push you...Technorati Tags: Aetna , Health Care , 1% , Barack...Occupy Wall Street , Health Insurance , Medicare , Current ...
- marsavrilmai.blogspot.com/...should thus choose a family to insure and a history of dental care, considering the aetna dental insurance plan of insurance. An alternative dental care procedures because they're the...
- cheaphealthinsuranceplan1987.wordpress.com/aetna medical health insurance Aetna medical insurance providers tend to...care bills, imagine what you would do. Aetna medical insurance providers consider good health care...
- ducknetweb.blogspot.com/..., they said they are pulling out of the health insurance exchange there as well! Aetna is located in Hartford, Connecticut. I swear if the government doesn...
- shine.yahoo.com/blogs/author/ycn-1204497/Aetna Health Insurance :One of the most famous ... from this dental insurance plan. The Dental Fund is the most popular Aetna dental plan which is very...
- insuranceclaimsissues.typepad.com/insurance_claims_and_issu/... by the Affordable Care Act. Like the officials of other Health Insurance Companies, Aetna's President publicly supports the ACA. At the same time, however, Aetna is...
Aetna Insurance - Blog Homepage Results
Aetna Insurance | Business health insurance plans and services from Aetna serve ...
If you enroll in an affordable group health insurance plan, you will have access to many benefits. Many people believe this statement...
... your healthiness and much more with Aetna Medicine Various claim that they are the...in the market place. That they offer a deal any insurance policy-just after citizens could not resist...
Related Video with aetna insurance
aetna insurance Video 1
aetna insurance Video 2
aetna insurance Video 3