Aetna

Earlier this year I had to change all my medical providers because Aetna EPO stopped considering Providence “in network.” I’ve heard a rumor that Aetna may be dropping OHSU as well, which would leave no major hospitals in Portland in-network. Does anyone have knowledge into whether this will happen? And what people with Aetna should do if there are no in-network providers in town?

Under the terms of the transaction, each outstanding share of Aetna common stock is being exchanged for $145.00 in cash and 0.8378 shares of CVS Health common stock.  CVS Health is not issuing any fractional shares in the transaction. Instead, the total number of shares of CVS Health common stock that each Aetna shareholder is entitled to receive is being rounded down to the nearest whole number, and each Aetna shareholder is entitled to receive cash for any fractional share of CVS Health common stock that the Aetna shareholder is otherwise entitled to receive.

The transaction values Aetna at $212 per share or approximately $70 billion. Including the assumption of Aetna’s debt, the total value of the transaction is $78 billion. The combined company's shares are listed on the New York Stock Exchange under the ticker symbol “CVS.” The Aetna brand name will continue to be used in reference to the health insurance products. Going forward, Aetna will operate as a standalone business within the CVS Health enterprise and will be led by members of its current management team.

It says it did not issue any fractional shares, but how was shareholders of Aetna given 0.8378 share of CVS? where did the share come from?

Just got a note from one of my providers at Evergreen stating that Aetna is dropping Evergreen. Sounds like starting October 1st. WTF? Anyone else know more here?

Edit/Update:

Just got the below in MyCharts.

“After working with Aetna since the fall of 2022 to come to a fair agreement that would allow EvergreenHealth to continue to accept Aetna insurance products, EvergreenHealth will no longer be in-network as of October 1, 2023. We sincerely apologize for the inconvenience this may cause. We know that access to healthcare on the Eastside is already limited given high patient demand, and we understand our community wants to receive care locally, close to home, from doctors they trust. We will continue to advocate for you. …”

Just got a correspondence informing us that Aetna will no longer provide coverage for telehealth service. Without any sort of data or research to prove that it is not as efficient as in person is now over as of 12/01/23. A fortune 5 company apparently cannot afford or stand to see our clients prosper.

Denied by Aetna for oxempic . Pre diabetic , currently taking Oz off label and have seen progress. They denied me twice because I do not have diabetes. If anyone has gone through this process and called directly without the doctor please advise on any tips on how to do a phone appeal.

This has been life changing for me and need them to approve my script.

All of your help is greatly appreciated.

Thank you

I’m looking for some insight on my situation, thanks to anyone in advance who takes the time to read this. This might be long too and I’m on mobile so sorry! I’m (27F) in Texas by the way and have RA.

So I recently went part time for work so that I could go back to school full time, which meant I lost insurance through my work (at the moment I work around 24-27 hours a week). With my work insurance, I didn’t have this problem with any medications. The premiums were quite high but everything else was fine. A few months ago I applied through the marketplace and now have Aetna. I made sure that they cover all my medications before I applied but I’ve found out after the fact that this doesn’t actually mean anything for sure, unfortunately.

All the rest of my medications are covered but one of them requires a pre authorization. I’ve been on this particular medication for about 3 years now and I will get very, very sick without it. I was not expecting there to be any issues with the pre auth honestly, but I found out that the insurance rejected it when I called this past Friday for an update. The lady I spoke to over the phone also mentioned that she was kind of surprised it was rejected because my doctor did a verbal pre authorization. I don’t really understand why she said that, because it seems like this happens a lot.

Anyway, I of course called my doctor and left a voicemail explaining the situation but wasn’t feeling very hopeful about it at this point since I was already denied the first time around. My doctor did appeal it and took the time to write a letter and was very thorough about explaining everything. Still got denied. I guess I’m just also ranting right now because I’m feeling upset and frustrated. I’ve never had an issue with this before but my work insurance was the only other insurance I’ve ever had until now, so I’m not familiar with insurance in general and this was a real rude awakening for me that things like this happen to a lot of people. My doctor told me that they just don’t want to pay it. I’m not sure there’s really much else I can do and at this point I’m trying to figure out how to navigate this. Like if I’m better off going back to work full time and trying to manage both work & school or seeing what other alternatives I have to make this work for me… so I could really just use some advice and different perspectives.