Thursday, December 18, 2008


Okay, so I've had experience dealing with insurance companies before.  But never, ever have I had to deal with a company that is as conniving, lying, and scandalous as Aetna.

I am on the phone with them a couple of times a month to question a claim decision or to follow up on something I've appealed before.  I don't think I submit a large amount of claims, but it seems that every single thing I submit is denied or short paid for one reason or another.  Usually it takes awhile to get it figured out but eventually it's just super annoying and a HUGE waste of my time.

An example.

Last year I saw Dr X.  His office submited the charges.  Aetna refused to pay because they said that Dr. X was not covered under their plan and that if I would just look under the docFind link on their website I could find a huge list of everyone who is covered.  I told them I had looked there.  The woman told me to look again.  

I hung up and looked again.  

There he was.  

Listed as covered.  

So I called back and talked to some man who told me to look under the docFind link.  I told him I did.  I even walked him through the steps I took to find Dr. X.  He put me on hold forever and came back and said he would resubmit it because it did indeed look like Dr. X was covered.  A couple of weeks later I got a letter from Aetna saying the claim had been reviewed again and was denied.  


So I called.  


The woman told me to use docFind because Dr. X wasn't covered.  I asked to talk to a manager who told me Dr. X wasn't covered.  I walked the manager through the steps and he said it was a mistake.  I told him that his company's mistake shouldn't cost me.  He told me to appeal the decision but that there was nothing else he could do.  

So I appealed.  

Aetna denied the claim.  


So I went online to the docFind and printed off the pages showing Dr. X's name.  That's right.  Dr. X was still listed as in-network even though supposedly his contract with them had expired well over a year prior and I had been talking to them about this claim for over 6 months (which one would think would be plenty of time for them to update/correct their website - in fact, just for fun I went in tonight to look one more time.  Sure enough 15 months after this all started Dr. X is STILL listed as in-network).  

Then I appealed.  


I sent in 20 pages of documentation.  This time the appeal went to my employer.  A few weeks later I received a letter from my employer saying that my appeal was approved and Aetna was responsible to pay.  They paid 10 months after the charges were incurred.  It had taken me hours of time spent listening to hold music and hours of time gathing information, but I swear when that letter arrived I thought I was going to run through the snow naked I was so happy.

So several weeks ago I started going to a new chiropractor (Dr. Y).  He was recommended by someone I know, and before I made my first appointment I went to docFind to make sure he was covered.  Sure enough, there he was.  

So I went to my first appointment and second and third.  Each time I happily paid the copay.  And today I received the first notice of the claim.  They told me I would need to pay 30% of the total bill - not just the copay.  WTF?  So I emailed Aetna and asked for clarification of why I had to pay 30%.  Their email back to me:  

Dear Ms. Cmuser:

Thank you for using the Aetna Navigator website to contact Aetna Member Services.

This is in response to your claim question on yourself for 12/03/08 from Dr. Y for $XXX.

We have processed this claim according to your
non-preferred level of benefits because this provider does not have a contract with Aetna.

Search for Aetna providers by logging in to Aetna Navigator and selecting Find Health Care in DocFind.
Blah, blah, blah.  
You have got to be kidding me.  This cannot seriously be happening to me again.  But it is.  I went online tonight and there is Dr. Y listed as in-network.  
This isn't the only type of problem I've had with Aetna.  Everything from them saying I couldn't have two physicals in one year (I only had one - they paid for it after I faxed them proof) to them saying blood tests couldn't be covered because they weren't medically necessary (they were ordered by their in-network PCP, but I guess that doesn't qualify - or at least it didn't right away.  They paid for them after I sent them paperwork and a letter from my doctor).  
So, tomorrow I will call Aetna.  I will start all over again.  Then I will report them for being the lying scoundrals they are.  What's the point of having insurance if you have to fight them all the time?

Sunday, December 14, 2008

Birthday Dinner

Last night we went out to dinner at Benihana's with friends to celebrate my 30th birthday. It was a great night - and was so good to see everyone again. Thanks to everyone who came - you made it an unforgettable night.

Kristin and me at Benihana's

Our chef, Moises, doing his stuff

Moises and me

Jehn, Michele, and Heather

Beth and Lisa

Michele and Heather


Birthday cake fun with Lucy (the guinea pig)

Me with Bear, an awesome birthday gift from Kristin

Popcorn Trains

So when I was little we would make these things called popcorn trains. I don't remember making them every year, but I know whenever we did it was good times all around - popping the popcorn, forming the trains, getting the frosting ready, and, the best part, getting the candy opened and poured into bowls.  Within minutes all of us would be hunched over our box car or train, trying to get it to look just right.  There was never a shortage of candy chomping, laughter, or "oh crap!" going around.  

Making popcorn trains is one of my favorite holiday memories, so every Christmas I think about it and consider making one.  I've never done it because I never knew what we'd do with it, but this year I told Kristin she should make them with her 3rd graders. She agreed, but only if I would come in and run a "station" (no pun intended) at her holiday party on Friday. They have 4 stations where 6 kids come for 20 minutes and do an activity. So my station will be making the engine car of a popcorn train. 

I pulled out the recipe a few weeks ago and have been mulling over how this is going to work. This weekend I went out and bought a bunch of stuff to try - the key is going to be ease since there will only be 1 of me and 24 of them (in groups of 6, but still!).

So this morning I made a 3-car train. I had limited candy resources (because I only wanted to use what I was going to have there for the kids to use) and tested out a new frosting (in a can instead of the homemade stuff). I'm still not sure if the canned frosting is going to work. I really need a frosting that is going to set up and get hard in a short amount of time (like before the kids have to take them and run out to their buses)...and I'm not thinking the canned frosting is going to work for that. If it doesn't I'll be going to a candy store to buy a ton of decorating bags and tips and spending all Friday morning making frosting (we're going to be making a ton of train cars Thursday night if anyone is interested in helping :)).

Anyway, the final product is below. It's not done very well (I totally blame the canned frosting), but what can I say - I did the best I could with what I had this morning :)

Wednesday, December 10, 2008

Jon Stewart with Mike Huckabee

Thanks to Justin for this -

Sunday, December 7, 2008

Haul Out the Holly

I like to try to get the Christmas decorations up shortly after Thanksgiving. I've been a little slow this year, but today I finally got to it and started setting things up. Kristin cleaned out the tree corner (there were stacks of books she needs to take to school) and even helped unpack a few nativities.

A short explanation of the nativities - once when I was like 12 I saw a news story about a woman who had like 300 nativity sets. I decided I wanted to have more than her and so the collection started. Seems like every year I get another one. I'm not such a huge collector anymore (realized they take a lot of time to set up, a lot of time to take down, and a ton of room to store), but I still get a set from people occasionally when they see a great one or travel to some far off land and score me a really cool one.

I'm not sure how many I have anymore - most of them are still stored at my parents' house in Utah, but I had a few (5) here that I brought when I moved and my mom knew someone who was coming out this fall and sent an additional 12 in their U-haul. So now we have 17 nativities set up in our living room. Kristin says it's her own personal hell, but I think it's festive.

The tree (Bianca) is patiently waiting to be unpacked and decorated and then I need to get the mess of boxes and bins and other stuff packed away so that in 3 weeks I can get it all out again to pack up everything for another 11 months. I love the holidays.

And now some pictures for your enjoyment (or so you can sympathize with Kristin):

When I first unpacked this one Mary was missing. It came with two guys who looked similar and I wasn't sure which was Joseph and which was the we decided this could be our gay-friendly nativity. I did find Mary later...but I kind of like this one just the way it is.

The one on the left is from Mexico, the one in the middle is a candle holder, and the one on the right is one I received from my sister, Cassi (and also one of my favorites!).

I don't remember where this one came from, but it's snowmen.

The one on the left is from a friend, Lisa. She got it for me in Israel (thanks, Lisa!). The one on the right plays Silent Night and is indeed the one that can be heard in the infamous "Danette Dancing" video which is probably still floating around out there somewhere.

I received this one from my parents - it's from The Music Box Company.

The top set is a bunch of bears. Under that is a tea set - the sheep are the cups, Mary is the tea pot, Joseph is the cream, and the camel is the sugar. Weird, I know.

The top set was also given to me by my sister. It's another favorite of mine and Kristin's very favorite. It's called "S'mores Nativity." You can't see it very well, but the people are made of "marshmallows" sitting on "chocolate" and a "graham cracker." Super cute although everyone seems to think it's sacrilege. Under that is another tea set. I think was obsessed with those when I was 15.

On the top left is a Willow Tree set. Another favorite, and a gift from my parents. On the right is a white ceramic set I got as a hand-me-down from my grandma. On the bottom left is a small Precious Moments globe. In the middle is a cute set I got from my friend, Michelle, and on the left is a patchwork set I think I got from my parents (?).
PS - Going to take better pictures of these later...something to look forward to, right? :)

Monday, December 1, 2008

Untouchable Face

I saw this on a friend's blog and thought I'd steal it.

1.  Put your iTunes on shuffle.
2.  For each question, press the next button to get your answer.
3.  You must write that song name down no matter how silly it makes you look.
4.  Title this email what the answer to your last question is.

Here we go!

1.  If someone says "Is this okay?"  You say:
Things Can Only Get Better (The Best of Howard Jones)

2.  How would you describe yourself?
Get it on Tonight (Montell Jordan)

3.  What do you like in a guy/girl?
Borderline (Madonna)

4.  How do you feel today?
Twist and Shout (The Beatles)

5.  What is your life's purpose?
Are You Lonesome Tonight (Elvis)

6.  What do your parents think of you?
Funky Cold Medina (Tone Loc)

7.  What do you often think about?
Only Women (Alice Cooper)

8.  What do you think of the person you like?
What About Now (Lonestar)

9.  What is your life story?
How Do You Like Me Now (Toby Keith)

10.  What do you think when you see the person you like?
Is There Life Out There (Reba McEntire)

11.  What will you dance to at your wedding?
Holes in the Floor of Heaven (Steve Wariner) 
(even though we really danced to Bless the Broken Road by Rascal Flatts)

12.  What will they play at your funeral?
Vogue (Madonna)

13.  What is your biggest fear?
Love the One You're With (Steven Stills)

14.  What is your biggest secret?
My Bionic Eyes (Liz Phair)

15.  What do you think of your friends?
Little Miss Can't Be Wrong (Spin Doctors)

16.  What are you going to name this post?
Untouchable Face (Ani Difranco)