Aetna members reviews and complaints 114
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Refusal to fill prescription
In September / October 2009 my husband went to his PCP to obtain a new 90 day prescription refill for his diabetes medications. We received a 90 day script. On the following Tuesday, we learned my husband would be going to Dubai to work on the following Saturday. Because we were unable to work through the mail order process, we went to Wal-Mart and asked if they could assist us with his order. The pharmacist was kind enough to call Aetna on our behalf, after we explained our situation to her.
At that time, our intention was to relocate to the Middle East by December or January, depending on how things went with my husband’s work. We were honest and explained my husband would not be returning to the United States. Aetna partially complied with filling two of the three medications, but refused to fill one of the medications (I believe it was the long-acting diabetes medication).
We had no choice but to send him with what medications we had. Eventually he ran out of the medication Aetna refused to fill. When I asked why they would not refill the medicine, the Aetna representative stated people sell their medications overseas!
I want you to know that as a direct result of Aetna’s incompetence, my husband was unable to pass his physical because his sugar was elevated. He was shipped home without work after several weeks.
I want you to know I called Aetna and really gave it to some poor lady who had to listen to why I was angry. I want you to know, Aetna does not need to worry about my husband and I selling his medications abroad. My husband leaves for work overseas without much more than a week’s notice, and we try to abide by the mail order policies.
We are expecting to leave overseas once more. Today I have requested refills on your website. Please send the medications. We anticipate leaving Houston in Mid-December. A copy of this complaint was filed with the Ombudsman and Consumer protection Division of the Texas Insurance Division, as well as the Texas Better Business Bureau.
Sincerely,
Retroactive Disenrollment
My wife gave birth to my daughter Brigid on September 4th. At that time my healthcare coverage was through Aetna POS, via my employer. Being a responsible guy with a new mouth to feed and looking to cut costs I figured out that this insurance was costing me about 2, 000 a year more than the HMO my employer also offers, so I requested a change under the "life change" bubble that was offered. Now the doctor who delivered my baby has been notified that Aetna wants the 1400+ back that they paid her. Why? Retroactive disenrollment. I have paid Aetna over 260 every two weeks for several years and my employer has matched this amount. They are doing this punitively and I am consulting a lawyer but if they can do this to me they can do it with any major claim, just retractively disenroll you. Call Tim McCarthy at [protected] and ask him how he sleeps at night.
Overcharged
Aetna Specialty Pharmacy is charging me $3, 098.01 for a Synagis shot my son never received (I have proof that they have the medication) and $140 for an in-home nurse visit that never happened.
Last year during insurance selection, Aetna was no longer a choice for medical insurance. I selected Kaiser and then contacted Aetna, Sherwood clinical, and our doctors to inform them of the change.
Aetna claims that on 1/14/2008, the "patient" approved that they send the Synagis medication to Sherwood Clinical (who would send a nurse to the house to administer the shot). Did I forget to mention that my son was 1 year 3 days old at the time?! How could he have approved delivery of the medication? He couldn't even talk! When I mentioned this to them, they said that the person that put in the entry may have been talking about someone else in the household. The truth is that they never received approval and made an entry that was an out right lie.
Aetna's next claim was that they sent the medication to Sherwood Clinical. When I contacted Sherwood Clinical, they informed me that they did receive the medication, but after reviewing their records (which showed that I told them about the change in insurance) they called Aetna to find out how to return the Synagis, and returned it via UPS (I have the UPS Shipping Receipt and the name of the person at Aetna Specialty Pharmacy who accepted and signed for the meds). Aetna claimed that they don't accept returned medicine. But when presented with proof that they did accept it, they backpedaled and said that they destroyed it. Lies on top of lies, and once again--why am I being billed for medication I never receieved, which they have and probably re-distributed to another patient.
I received the first bill in April, and spoke with a representative on 4/24/08. An investigation was supposed to take place and I was supposed to be told of the results. The only thing that happened was I received another bill.
So, I called the Reimbursement Department (6/12/08)--again provided them with all of the information--again, and was told that the case would be resubmitted to Quality Assurance for investigation, and someone would contact me with the results--again.
All that happened was that I received another bill in the mail, which not only has the $3098.01 charge for the Synagis, a $140.00 charge was added on 4/25/08 (the day after my initial call to Aetna Specialty Pharmacy), for a nurse visit that NEVER happened (Sherwood Clinical will attest to this).
I've done my due diligence:
I informed the insurance company, the doctor, Aetna Specialty Pharmacy, & Sherwood Clinical of the change in insurance.
I did NOT give Aetna Specialty Pharmacy approval to deliver the Synagis to Sherwood Clinical.
My son did NOT receive a shot from Aetna (Kaiser provided him with his January Synagis shot at the Kaiser Facility (a little late--1st weekend in February)).
I have the UPS Shipment Receipt which shows that the Synagis was shipped to Aetna Specialty Pharmacy and signed for by one of their employees.
So, why am I being billed for medication they STILL have, and for a nurse visit that never happened? I'm sending a copy of this letter to Clark Howard and the Chairman & Cheif Executive Officer of Aetna, Inc.
At this point, the payment is 90 days past due. So not only do I need them to stop trying to bill me for medication they still have, I'll need them to remove whatever entry(ies) they've placed on my credit report.
I'm sending this letter hoping that getting the word out will generate enough conversation that someone will take interest and tell me can be done to help me out of this mess.
The complaint has been investigated and resolved to the customer’s satisfaction.
they don't care if you get your meds or not on time. been dealing with them since last week of December...still waiting for shipment. For the past year I received a med from them using the regular ordering "line"..when I went to check on delivery was told it was never called in by doc office..checked with them and yes it was called in. Only to find out that it is considered a "specialty med" (after a year of ordering from regular pharmacy?). Well was told finally it would go out next day. I called just to make sure it shipped, and was told it was "computer reversed" and did not ship due to a price increase (in 1 day REALLY). When I asked why I wasn't informed of the non shipment I was told that since it was "computer reversed" I would not have received notification. This med is needed to be taken on a daily basis..life sustaining. When I told the rep this, she said "oh well". Hopefully it will be shipped today and arrive tomorrow. CUSTOMER SERVICE IS ALMOST AS BAD AS VERIZON.
FSA Claims
Aetna makes it incredibly hard to submit any claim, and seems to have an automatic rejection policy for FSA claims. We have filled out every form there is and make sure that we double dot and cross every letter. But still the claim comes back with some nit pick. Luckily we were able to find a group of people who have had the same experience, and are initiating a class action.
They have also pushed us into online ordering for meds, in which they charge us more than our local grocery store.
Hopefully we will be successful and get Aetna to pay for its blatant dishonesty.
The complaint has been investigated and resolved to the customer’s satisfaction.
Faxed my claim for my FSA reimbursement four times. Followed up with calls to confirm receipt each time. Each time they said they didn't receive it. I have my fax delivery confirmation from my machine showing it was successfully delivered. They won't accept email and have no way to submit claims online. Their only suggestion is to pay for registered mail and submit the claim that way. TO GET MY OWN MONEY BACK!?
Feels like a tactic to keep the money beyond the filing deadline.
We would like to be included as we deal with this every single year. Today we received a denial letter stating the claim was submitted after the Apr 30 deadline. I know for an absolute fact it was not late because it was in the same envelope as other claims that were paid!
Kristen L
How do I get in on this? They have asked me to substantiate almost all of my purchases when they are sent through Aetna Medical Insurance! Why can they not talk to each other?! Now I am having to do their work for them and send them all this information. I'm sure my whole company would be willing to join in on this lawsuit.
I agree with your comments about Aetna's FSA program. They make it close to impossible to get money back from our account, with $ I set aside from every paycheck. They want double and triple proof for almost every visit to the doctor or procedure.
paid for meds and now they refuse
My fiance has had Aetna for over 10 years. He has a brain tumor that is controlled with Brand name meds only (there are no generics yet, these meds are new) These injectable meds cost $170, 000 a year. Aetna has paid for them for over 2 years but now as of Oct 1st they gave him a maximun limit of $2, 500 per year for brand name prescriptions. So they are basically dropping him after 10 years of being a member because of this cost. They will not budge. Without the meds his tumor will grow so large that it will invade his brain and he will die. We are scared to death now thanks to Aetna.
The complaint has been investigated and resolved to the customer’s satisfaction.
Contact the drug maker and see if they won't pick up the cost. Sometimes they will and also check to see if your state has a program that might pick up the cost.
Good luck.
Rude service
I waited 3 months to qualify for insurance at my employer. I went to a physician on the Aetna approved list. The doctor ordered blood tests which Aetna did pay but they won't pay for the office visit.
I have to send proof of prior insurance (which I did not have since I was out of work for a year) and fill out a questionnaire. I mean they deduct money each month from my paycheck and won't pay the doctor. I do not like Aetna and have found their customer service people to be rude. I had no choice in provider care but if I did, I would never choose Aetna.
The complaint has been investigated and resolved to the customer’s satisfaction.
Denial of claim for office visit
They are the worst insurance company. I had a problem many years ago and they still are a problem. Refuse to pay my doctor's office visit. Want proof I don't have a pre-existing condition even though they paid for blood work but won't pay the doctor's office visit and want me to pay it. Why do I even have insurance coverage that is deducted out of my paycheck each month and they won't pay for an office visit? Spent all morning on the phone with customer service and felt I wasted my time.
The complaint has been investigated and resolved to the customer’s satisfaction.
Whenever there is ANY issue you should 1st call your PLAN SPONSOR'S REPRESENTATIVE.
You can call your human resources department of the employer the AETNA insurance is through.
Ask for the insurance benefits specialist & ask them why your employer chose AETNA - explain how
they may not want to go with AETNA as an option for the next open benefits registration.
The liason may be able to get some action.
This really freaks out everyone at AETNA because they risk losing the contract ;)
Denial of coverage
I have so-called health insurance with Aetna. Several weeks ago I had to see my ophthalmologist for certain symptoms which she diagnosed as punctate keratitis, conjuncitivitis, and severe dry eye syndrome in both eyes. As part of the treatment she inserted plugs in the lower tear ducts of both eyes to help with the dryness and help retain the prescribed steroid drops in the eyes. Aetna refused to pay for the procedures, saying that they violated the ban on multiple surgical procedures in one visit. Instead, Aetna paid a much lower amount towards the cost of the plug for one eye. Now I'm stuck with $250 to pay for the plug on one eye.
Oh, was I supposed to choose WHICH eye to treat that day and forego treatment on the other until another day? Was I supposed to incur charges for an additional office visit? Aetna must be one of the worst insurance companies in the U.S.
The complaint has been investigated and resolved to the customer’s satisfaction.
It's 2015 and I'm a 52 year old woman. I was a dancer, a snowboarder and a very active person until I started having back issues in 2011. In 2013 my Husbands new employer gave us Health insurance through Aetna. This employer hired a Benefits Managing company to handle all benefits for employee's and their families. I was seeing a Physical Therapist pretty much every week once a week from Dec 2013 until April 2015 and it was helping. I had to stop because Aetna cut me off. They decided I should not get PT any longer. They decided I'd had enough and that I don't need it any more, or I'm abusing it (like I LOVE having to go to the PT every week to feel good...) that I "Should" be better...I could SCREAM with frustration at this situation! I just want to say, WHAT. THE. FRACK!? We pay a pretty penny for health insurance every month. Am I suppose to feel bad for saying this makes me mad because Aetna IS covering my other issues? AM I suppose to say, "Oh well, It's MY fault I have a ailments and I'm LUCKY...lucky me...they're covering the other ailments, so just buck it up?"
I feel completely dehumanized. I ALMOSt feel like a factory farmed animal. I don't count, I'm just a policy number "bucking up" alright.. as far as THEY're CONcerned, I'm "bucking up" THEIR money! Clearly it's costing Aetna TOO Much to money to keep me healthy and not in pain.
what is there to do? I literally feel like this world is a lost cause and it's Big Pharma and Big Insurance Companies (among others) who are indeed conducting "death panels". it's not a "political thing" at ALL, it's a $$$$$$ MOney Thing.
This is a great venue to vent to, but, honestly, is anyone at Aetna going to see this? DO they even give a crap? ahhh what's worse Aetan or Reality?
AETNA does not pay LTD. They are in the business of denying claims. Please take a look at complain board.
my daugter's health is jepordized because her aetna policy won't cover anymoremental health benefits
Aetna won't even pay for basic coverage of primary care physicians in my plan coverage. That's not anything special, I am talking about just going to the primary care physican, they won't even pay my claim for regular doctor visits.
Aetna SUCKS.
I have been trying to get three claims from 2013 resolved for the past almost two year. The provider is in network but used an out of network TIN. I've been told that all hte information has been corrected and the claims will be reprocessed several times. Now I'm told that the claims are too old to reprocess. I get thet mistakes occur. However, I trust people to fix their mistakes and this one is strictly now an AETNA issue. The reprocessing of the corrected claims is in a loop of rejection - for over 18 months.
I am a 42 year old female who has had insurance since I was 18 years old. I've been covered by varipus plans ranging from Cigna to BCBS and I can say with confidence I have never had a more shoddy, patient/claim unfriendly, unproductive plan as Aetna. Nearly every visit to anywhere resulted in a denial of payment, which resulted in a letter to me from the provider of balance due, which resulted in my having to take time to call the insurance, wait on hold, jot down numbers, make return calls in some instances and basically coordinate payment. In truth, Aetna should have been paying ME for working. This is clearly a tactic to save money, banking on the patients who lack the knowhow, patience and/or determination to go the distance and hold these scheisters accountable for a service that has been paid for, but not received. Seeing the large amounts of complaints on here, I see this review will come as no surprise
http://www.diattorney.com/
I am currently fighting with AETNA ! Ebony Doctor is the 4th person to handle my case. According to her my Dr. has not sent the correct paperwork, but my Dr. said he has never received a request for any xrays, MRI's or cat scans. I think this is their game. They say" we don't have the correct paperwork" but they simply don't asked for it! My Dr. told me they have played this "game" with him and several of his patients for years now. My Dr. spoke to one of "their Doctors" on the phone and he totally discredited him more or less told him in so many words he was wrong about his diagnosis and treatment. I have had two surgery's and a third forthcoming. I have spoke to three managers, but I just found out that two of the "managers" were not they lied, they were just reps. I even had a "manager "named Wanda that gave me some bull story about how a whole panel of people( like a review board) would be making the final decision on whether or not they will continue my pay after May 9th 2011. I again just found out that is a bold face lie as well, a rep just told me it is Ebony Doctors decision alone! Ebony is not a doctor. not a nurse. has no medical degree of any type. I guess it's just up to her weather I loose my home, car everything. I am a single mother of two that has been with Bank of America for 18 years, yes 18years I have paid for LTD just in case something happened to me my children and I could survive. I suffer with great depression and pray many times daily. I pray for all of you as well. Unfortunately it's all about the all mighty dollar, and no they don't give a ###. why would they? It's not them or their wives or mother or child right? I wonder what happens when AETNA employees get hurt? Would they deny their own? I hope they never have to miss a bar b que or a graduation or a wedding because they are laying in bed in pain. I am optimistic though I have sent medical proof of my disability and with another surgry on the calander I'm sure they will continue my 60%. I will update as soon as I hear back . Good luck to all of you .
Whenever there is ANY issue you should 1st call your PLAN SPONSOR'S REPRESENTATIVE.
You can call your human resources department of the employer the AETNA insurance is through.
Ask for the insurance benefits specialist & ask them why your employer chose AETNA - explain how
they may not want to go with AETNA as an option for the next open benefits registration.
The liason may be able to get some action.
This really freaks out everyone at AETNA because they risk losing the contract ;)
You can also keep going to the ER ;)
My Aetna summary plan description clearly states that 60 visits per year are covered for physical therapy. Nowhere does it state that after 25 visits the PT would be subject to medical review. I underwent radial head surgery on New Year's eve and have undergone painful and progressively active-assisted physical therapy since mid Jan. I have not reached my maximum medical improvement nor my max of 60 days. Aetna's online claim tracker shows checks issued to my physical therapy office. However, last Friday I receive a letter that RETROACTIVELY denies payment for my physical therapy after March 8 based on a Clinical Bulletin that is not referenced in my summary plan description nor was ever mentioned when the member services told my PT office that I was covered for 60 visits prior to my even starting physical therapy. Aetna's plan misrepresents its coverage and to my detriment I relied on their written words and issuance of checks. It isn't a new tactic, on Oct 24, 2003, Aetna settled a federal lawsuit with doctors over the same issues. I am appealing as high as I can go, but I can't even reach a case manager cuz they hide behind their automated phnoe system.
According to a report on the lawsuit: The settlement requires changes and commitments in Aetna's business practices to eliminate "the worst of the improper practices involved in managed care." Among the changes, which will affect all doctors treating Aetna patients:
Eliminating downloading and improper bundling and computerized denial practices.
Establishing the standard of a "physician, exercising prudential clinical judgment" for "medically necessary services, and allowing cost to be considered only when an alternative service is at least as likely to produce equivalent results."
Creating a dispute-resolution procedure, using an independent external review of decisions regarding medical necessity.
Providing a facilitator to assist physicians in enforcing the agreement.
Creating a $100 million fund for physicians to recover some of their damages.
Establishing a foundation "dedicated to promoting high-quality health care."
The agreement also requires Aetna to pay lawyers representing the doctors $50 million in attorney's fees, including $6.5 million in expenses.
Denial of Long Term Disability Benifits
I applied for long term disability benefits through my employer (Federal Government) under a policy that I had purchased 13 years ago. I suffer from a progressive neurodegenerative disease (contracted well after the purchase of my policy) and had reached a point where I could no longer work. It took Aetna approximately 6 months to reply with an initial denial of LTD benefits. I followed Aetna's appeal process and was denied once more and was informed (by Aetna) that there were no more avenue's to seek the disability benefits coverage that I had purchased. I am now in the process of suing Aetna for my disability benefits under "Bad Faith" reasoning. My complaint regards the fact that while I have been battling with Aetna for my disability benefits, I have been awarded full disability benefits and back-pay from Social Security which is the MOST STRINGENT of disability agency's to deal with. I have no idea what to expect from the upcoming legal battle.
The complaint has been investigated and resolved to the customer’s satisfaction.
Fighting with Aetna is a nightmare, but i found out though AETNA is hard to touch, their employees Doctors and Nurses and Behavioral clinicians are easy to touch they are based out of Florida, if you believe they participated in deceptive practices file a personal complaint with the Florida Department of Health, they will review your allegations of neglect, malpractice or deception and these individuals can lose their license to practice in this state! That would make them think twice before screwing someone over, and screw them if they do, keep in mind they don't have jurisdiction over Aetna or any insurance company it's self just the employees, which is good enough for me. Spread the word! They can't operate if they dont have a licensed staff!
I want to file a complaint against Aetna for deducting from my ltd a auto loss of income policy ihave had for years prior.
Aetna is the absolute worst or all insurance companies. I think a class action suit against them is just what is needed. Anyone interested in joining me please contact me by email me at Cody6723@yahoo.com. I have a really good attorney who has taken my case and would welcome a class action suit against them. Power comes in numbers and we should get what we have paid for. We are disabled and they know this, but have been getting away with not paying claims for years and years. Let's do this together. I too have been turned down for LTD though my doctors have sent reports stating that I am disabled. They set me up with one of their doctors who knew nothing about my disease. He recommended they follow the advice of my doctor and of course they didn't. What is this all about? How they get away with what they do is wrong! Write to your congressman about them.
From what I understand about Aetna and long term disability, once you have been approved to disability social security they stop payments. You actually cannot get both. I'm sure it is written in small print somewhere in your policy.
Surprised, Aetna has been sued? But, still has not paid out...
http://www.longtermdisabilityblog.com/2011/05/aetna-south-carolina-claim-denial.html
Aetna LTD is not worth paying for. The company wants to sells the insurance but, when it comes time to pay out they do not want to stand behind the insurance they sold you. They steal your money and run. Once you need to collect on the policy and you receive your payments they bring in THIER own specialist, they pay good money for to say, you no longer need to be drawing the payment and stop payments. Does not matter what YOUR doctor reports says, they do not want to hear anything from your specialist. They are the ones paying out on your policy and they want the payments to stop. Believe me I have been there and I know how they work. Don't call them and expect them to return ANY of your calls! They say they called and no one was home..And all the doctors they tried to contact never returned any of their calls or they never filled out the required paper work...Anyone needing a lawyer to fight Aetna needs to go through a disability lawyer and good luck with that. Most lawyer will not fight a LTD case because there is no big pay out for them. Unless there is a class action law suit filed against Aetna that may be the only way you could get a lawyer to help you. Either way it is all about the big money! I will never recommend LTD to anyone.
i too am having problems getting Aetna to pay my LTD benifits, I was just declared diabled by social security in a hearing and I called about my "open" LTD policy they act like they have no idea what I am talking about, they claim it was closed in July 2007 even after acknowledging to my wife that I did reopen it in September 2007 but it was supposedly closed because I failed to provide some records and I was never told. This is a lie their rep called me in December 2007 saying everything was in order and to just call them when my claim with social security was approved. Aetna is aweful, to treat a disabled person like me who is in constant severe pain like this? They just don't care! Aeta is fake and should be avoided at all costs. I will not drop this but obviously I am going to have to sue them now and that will take years, what if I die in the mean time? I HATE AETNA! If you have a LTD policy with Aetna it is worthless!
I agree totally with everbody here. Please update us all.
I too am having the same problem only mine is with prudential. My degenerative disk disease is well documented; I also have bone spurs in both my shoulders. I tried for a year to continue working but the pain is too much. I was on short term disability 2 different times dealing with this so you would think that I should just be able to roll my last std over into ltd but no! It is coming upon a year and I am still not getting anything but denial after denial from them. Social security is still going through their investigation. In the meantime I am broke. I know these insurance companies hope that people like us will either be discouraged by their denials and go away or go broke and not be able to pursue them further and/or lastly commit suicide. Those are harsh words but it's true. They would rather we kill ourselves just so they would not have to pay. I realize things are this way because so many people in the past have committed fraud and it's a shame that people with real medical conditions are now being treated like this but when you have a mountain of medical evidence it should not take an act of God to get them to pay. Does anyone have an answer to what we can do? Can anyone help? I'm at my wits end and don't know what to do. I'm about to lose my house, my car and everything I've worked hard to get. This isn't fair! Please can someone help?
I do not know if attorney Herbert Hill [protected], in Orlando, Florida would file a class action law suit against Aetna, on our behalf, but maybe if enough of us were to call him he would decide to represent us with such a suit. We have to stand up and fight Aetna. We cannot allow Aetna to get away with money that is owed to us.
Health Insurance
I have paid into Aetna Insurance for 3 years...first time I try to use my insurance...nothing but problems...took 4 hours of phone calls from my job and still could not get my prescription..talked to 3 different departments, 3 different people and they can't even get the spelling of my medication straight...was given 3 different prices of the meds..and then they couldn't find my meds in their system...being on a 3 tier level for meds...Generic is suppose to be $15.00 co-pay..., then I went to the pharmacy to get and Aetna wants to charge me $60.00...left without my prescription...called, was told no that the regular prescription should be $32.18...and the generic should be $60.00...this is absolutely nuts...2 days now and I still don't have my prescription and I'm in Severe PAIN...AETNA ABSOLUTELY SUCKS AND THEY HAVE NO CLUE ON THE OTHER END OF THE PHONE...MY FIRST EXPERIENCE AFTER PAYING FOR 3 YEARS IS A NIGHTMARE
The complaint has been investigated and resolved to the customer’s satisfaction.
If your employer had the type of AETNA insurance that just has AETNA reviewing & paying claims... is it your employer's money used to pay the bills instead of AETNA's money? If it is, then it's very possible your employer is aware of all your health information including labs, diagnoses, vital signs, medications & every chart ever made on you. The employer is the "payor" and possibly has access to all of your information. It's seems wrong to alert employers of high risk / "high dollar" employees. I expressed my concerns about this and didn't get far. They claim the employer doesn't have the name of the actual employee costing them so much $$$.
I wonder though if an employer could figure out which of it's employees has been in the ICU for 20+ days? It doesn't seem too difficult for them to figure it out.
Whenever there is ANY issue you should 1st call your PLAN SPONSOR'S REPRESENTATIVE.
You can call your human resources department of the employer the AETNA insurance is through.
Ask for the insurance benefits specialist & ask them why your employer chose AETNA - explain how
they may not want to go with AETNA as an option for the next open benefits registration.
The liason may be able to get some action.
This really freaks out everyone at AETNA because they risk losing the contract ;)
Aetna Health Insurance
I worked for an Insurance broker for just over a year and dealt with claims and complaints on a regular basis. Now I know that certain things are not covered, however with Aetna there are a few things I would like to share. Out of all the companies I worked with they were hard to deal with and when I say that I mean: Rude customer service people and no accountability.
This insurance was provided through Group Insurance at work so I figured I was getting a great deal. The providers on the list in my area would not see new patients for a waiting period of 4-6 months. And given the state of the economy I wasn't sure how long I would be able to afford it. Anyway after I got through the entire list of providers with just one doctor willing to see me that month. I called Aetna and asked to change my provider, they said, "No problem." After 10 minutes of waiting I was informed that there was an issue with that provider and they couldn't make it my primary at the time. The Representative went on to say as long as they are an Aetna provider I can see that Doctor. I went to a simple standard check up with urine analysis, blood work, reflects, and check for hernia. Now About 7 months after my visit I get a letter from a billing company stating I owe them 150.00. Aetna refused to pay even though I called to verify and had given them up to 1600.00 without going to the Doctor once. They made the process drag out for the next 3 months with promises it would be resolved, but it never happened. The Claim was denied on three different occasions. Two times due to an invalid tax id that the doctor uses and Aetna requires. I am now in the midst of filing an appeal and it's almost been a year since the visit and I am still slugging it out with this insurance company that enjoys collecting money. But, refuses to pay for one Doctor visit in a year. I had not been to the Doctor in 2 years because of tough times and this is what I had to deal with.
I understand their are regulations on policy on what’s cover and what’s not. But, to mis-inform customers and then say well their are no notes on the call so must pay the full amount. This is a prime example of Insurance company abusing the fact this country has one of the worst providers of Medical assistance. I make too much for Medicare and not enough for regular insurance. Their are millions of Americans like me that get the shaft from companies like this on a monthly basis. This company I would recommend you stay away from if possible. However, until they fix the system in this country they will profit from us when we are sick and when we are healthy. They refuse to provide basic checkups and increase our rates because we fail to go to the Doctor due to fact it's such a Dam hassle. I am sure some will say stop complaining or just pay the bill. For 1600.00 a year I think I deserve a doctor visit with simple co-pay that was explained to me when I joined. I highly advise you go with Humana if you can qualify or is worth it in your individual situation. Will write back with the outcome; however I have a feeling it will take a year from the date I went to the doctor. wtf
The complaint has been investigated and resolved to the customer’s satisfaction.
If your employer had the type of AETNA insurance that just has AETNA reviewing & paying claims... is it your employer's money used to pay the bills instead of AETNA's money? If it is, then it's very possible your employer is aware of all your health information including labs, diagnoses, vital signs, medications & every chart ever made on you. The employer is the "payor" and possibly has access to all of your information. It's seems wrong to alert employers of high risk / "high dollar" employees. I expressed my concerns about this and didn't get far. They claim the employer doesn't have the name of the actual employee costing them so much $$$.
I wonder though if an employer could figure out which of it's employees has been in the ICU for 20+ days? It doesn't seem too difficult for them to figure it out.
As far as speaking to a supervisor / manager... try calling:
[protected] or [protected]
Aetna - Bad Faith Disability Claims Handling
My disability income was unlawfully cut off in February--Aetna claimed they performed a peer review, but they did not according to my doctors! Consequently, I have not been able to get the medical care and pain medications that I need and I do not have the money for my rent or other costs of living. I thought that my employer would reward all the extra...
Read full review of Aetna and 9 commentsHigh cost, Low benefits
My employer ( One of the big banks taking gobs of taxpayer money to clean up their bad business practices) switched my health insurance coverage to Aetna and I have had nothing but problems since. Aetna seems to cover very little compared to my former provider and they demonstrate a "Couldn't care less" attitude when I call to get their reasons for dening claims that the old provider covered with no questions. Since I pay just as much for my current Aetna policy as I did for the old one, ( a bit more in fact) the difference in coverage is nothing short of a complete rip-off. I have no choice in the matter as my employer offers no other option ( I wonder how much Aetna is paying for that) I strongly advise anyone with an opportunity to choose their healt care insurance provider to avoid Aetna like the Plauge! (they don't cover that either, I'm sure)
The complaint has been investigated and resolved to the customer’s satisfaction.
If your employer had the type of AETNA insurance that just has AETNA reviewing & paying claims... is it your employer's money used to pay the bills instead of AETNA's money? If it is, then it's very possible your employer is aware of all your health information including labs, diagnoses, vital signs, medications & every chart ever made on you. The employer is the "payor" and possibly has access to all of your information. It's seems wrong to alert employers of high risk / "high dollar" employees. I expressed my concerns about this and didn't get far. They claim the employer doesn't have the name of the actual employee costing them so much $$$.
I wonder though if an employer could figure out which of it's employees has been in the ICU for 20+ days? It doesn't seem too difficult for them to figure it out.
I think AETNA was blaming underestimating the costs of "cobra" patients for a decline in their profits at one point recently.
Maybe they want you to cancel your cobra coverage?
As far as speaking to a supervisor / manager... try calling:
[protected] or [protected]
I have never had such terrible customer service in my life! I'm currently on Cobra and had to change my benefit plan due to a HUGE increase in price (over $200), with higher co-pays for doctor visits and prescriptions. I was given 3 other options to choose from but no information on co-pays or rx prices. Simple information right? Wrong! I talked to 3 people at Aetna and they could give me NO information on any of these plans! I kept asking to speak to someone else and same story. I must add that EVERY single rep I spoke with was rude, snarky, and kept me on hold forever! Finally, I asked to speak to a supervisor, and the rep rudely said, "Okay!" I was on hold for 20 minutes and finally hung up. Once my Cobra ends, I will try to locate another insurance company. I will NEVER pay for an Aetna insurance plan.
Aetna sucks. I had surgery on my neck almost 3years ago. Now I am having numbness and tingling in my right arm and fingers. This was a symptom before the surgery. They had to put 2 metal rods in my neck. I am clearly having a problem again. Aetna denied an MRI that my neurosurgeon ordered to see what is going on. Then my rheumatologist ordered one, and they denied it also. This is just 1 thing in a long line of insurance fraud and abuse by them.
We own a sm. business and have AETNA ins. until this year we have had no claims. Of the 7 claims only one was processed correctly. All of these claims fall under the co-pay part of the policy. Every time I call they tell me it should have been paid but due NOTHING about it. To make matters worse it's time to renew our policy and they have inceased the preium ove $200.00 a month
It wouldn't be so bad if you could bypass the inconsiderate reps by asking for a supervisor. WARNING! If "Mike" from Middletown picks up when you call... call back. He's rude and refused to allow a supervisor to speak with me. He told me to "get a pen, I'm waiting, now write Mike, M-I-K-E, #A243977..." and hung up the phone. I'm a teacher and our family purchased our medical benefits through my husband, chosing AETNA. Next time we will pass. I'd rather even pay more money and be treated with respect than ever be in that position again. The way he spoke to me- he had to be alone because he was loud.
Health Claims
Aetna did not pay claims submitted in 2008. Presription and recommendations were issued by Medical Physician Specialist and Aetna still refused to pay, stating procedures unnecessary.
The complaint has been investigated and resolved to the customer’s satisfaction.
they are cheaters they have you paying in but they cut off benefits
Non-English Speaking &Helpdesk&
In this day and age when American jobs are taken away, I called Aetna for info twice. Both times, I was transfered to an "agent" who was obviously outsourced. Oxford was in the U.S.
Time for us to start making our decisions based on what companies outsource.
The complaint has been investigated and resolved to the customer’s satisfaction.
When I was a young soldier in Thailand (U.S. Air Force 1972), I was expected to speak their language when "in their country". I did find someone to teach me some reading skill, but writing was a definite challenge. Point is; I did learn to speak most of the proper dialect in a few short months. If I could have stayed another year, I would have been able to almost master it. The more I visited downtown like the markets, theatre, taxi drivers, etc., really helped me learn the local language and customs.
If you want to live in my country, please learn the language. If your country is so bad, then why don't you change it ? You are not entitled to anything here in the USA.
English is what is spoken and written here. My company does not, and will not cater to anyone who does not speak english.
Denial of well care benefit
I am a professional w family insured by an Aetna PPO. I have a particularly agregious example of what has become the norm in the insurance industry and that is claim denial by default.
Recently Aetna denied coverage of my 6 year old daughter's annual well-care visit. The reason? Apparently we had only allowed 359 days between appointments and they look for "12 consecutive months" to have elapsed.
Given a company that will automatically deny well-care coverage for a healthy 6 year old, one can only imagine the heartache they give to someone truly sick.
B. Craft
The complaint has been investigated and resolved to the customer’s satisfaction.
I feel your pain . . .also Grace family with Aetna PPO insurnace which brings sighs of frustration from providers whenever they hear we're covered (or often not!) by Aetna . . .We also ran into the 359 day rule and were denied well visit coverage. Also had to fight for a well visit to be covered because the children rec'd flu shots several months prior! They fight every claimthey possibly can . . .becareful if your chuildren ever need surgery! The coverage is awful even when medically necessary! Aetna is considered the bottom of the barrell in the industry . . .way out in front when it comes to screwing members at any costs . . . I don't know why Grace continues with this coverage ? . . oh I know . .. it such bad ocverage and the cheapest available they can keep paying the execs big bonues while their emplpoyees children do without health coverage and necessary medications . . . Grace refuses to cover my sons asthma medication or even the antibiotics he needed for ear infections as a baby because they were not on the formulary! He is alleregic to the oneon formulary and even with a doctor's note, they refused . . .nice . . .real interested in the well being of their employees and familes . . . the almighty dollar . . Hang in there . . .I'd let HR know how crappy the coverage is . .until we all complain loud enough they will nver listen . .
Flex fund
I registered for a flex fund through my employer at the time of the birth of my third child. I was assured by both Aetna and my employer that the matter was common place, and that whatever eligible expenses occurred as a result of the birth could be recompensed from my flex fund. Now I am being told by Aetna that I was not covered by my flex fund due to a delay in payroll deduction. I am being told by my former employer that this is 1) untrue and 2) a common, though inexplicable response for Aetna. Starbucks (former employer) has been nothing but supportive (yay Starbucks) but as usual Aetna is stonewalling, misdirecting and delaying resolving the issue. Their administration of flex fund claims is reprehensible. Were they in a position to actually profit from this practice, they would have been sued already. Sadly though, they are not: the funds in question are forfeited if nothing is done with them by the end of the year. They are playing games with other people's money simply because they are arrogant, mean spirited and lazy. How sad...
The complaint has been investigated and resolved to the customer’s satisfaction.
They suck
I HATE AETNA! THEY ARE MAKING MY FIRST PREGANCY A LIVING HELL. FIRST THEY TELL ME THAT THE ULTRA SCREEN, WHICH TESTS FOR DOWN SYNDROME IS NOT COVERED IN MY PLAN-OR ANYONE'S PLAN FOR THAT MATTER. MY DOCTOR TOLD ME THEY ARE ***THE ONLY*** INSURANCE THAT DOESN'T COVER THIS, EVEN THOUGH IT IS RECOMMENDED BY THE NATIONAL BOARD OF OBGYN'S. SECOND, I GET A LETTER IN THE MAIL FROM THEM TODAY STATING THAT ANY TESTS THAT ARE DONE AND SENT TO THE COMPANY "LABCORP" ARE NOT COVERED UNDER AETNA, ONLY TESTS SENT TO "QUEST" WILL BE PAID BY THEM. MY DOCTOR ONLY USES LABCORP-SO NOW I AM JUST WAITING TO GET A BILL FROM LABCORP TO PAY FOR A FREAKIN PAP TEST. I AM SO MAD! AND THERE IS NOTHING I CAN DO ABOUT IT EXCEPT STAY MAD.
The complaint has been investigated and resolved to the customer’s satisfaction.
If your employer had the type of AETNA insurance that just has AETNA reviewing & paying claims... is it your employer's money used to pay the bills instead of AETNA's money? If it is, then it's very possible your employer is aware of all your health information including labs, diagnoses, vital signs, medications & every chart ever made on you. The employer is the "payor" and possibly has access to all of your information. It's seems wrong to alert employers of high risk / "high dollar" employees. I expressed my concerns about this and didn't get far. They claim the employer doesn't have the name of the actual employee costing them so much $$$.
I wonder though if an employer could figure out which of it's employees has been in the ICU for 20+ days? It doesn't seem too difficult for them to figure it out.
Whenever there is ANY issue you should 1st call your PLAN SPONSOR'S REPRESENTATIVE.
You can call your human resources department of the employer the AETNA insurance is through.
Ask for the insurance benefits specialist & ask them why your employer chose AETNA - explain how
they may not want to go with AETNA as an option for the next open benefits registration.
The liason may be able to get some action.
This really freaks out everyone at AETNA because they risk losing the contract ;)
claims
I was told over the telephone when i called customer svc about a claim that although i work, my husband's medical ins (which was aetna) would be primary due to him being older than I. Although I was always told in the past that your employer is always primary and anything else is secondary, i thought she knew the law better than i did and besides she worked for an ins company so she should know(at least that's what i thought). I told her that true what she wa telling me to put it in our computer file about what she told me. She also adv me to let all of my Dr.'s offices know to change it as aetna being primary. So I did. 6 mths later i get a letter from my human resources dept saying they were primary and we had a long conversation about it and i explained what aetna had told me. I then called aetna about it and spoke w/another operator whom advised me that what i was previously told was incorrect information. i asked her to look in my file at the notation of my initial call and the remarks were there about the conversation i had w/the operator telling me that aetna was primary because of my husband being older. well to make a long story short, they asked for all of the money back from the DR's offices that ws paid and i had to file w/my own insurance. Of course my own ins didn't pay because of a "timely filing limit" and aetna refused to take responsibility of their error and pay the bills. They are not professional and their staff isn't knowledgeable. They gave my the wrong info which in turn caused me to have medic al bills out of this world that my ins company and theirs especially don't want to pay.
Aetne has denied payment for the difference of what EDD is not paying for my medical leave, due to Work related injury, back, wrest, and stress on the job injury. Bank Of America. I appealed with full report from Chiro and Phscy and still they deny pymnt stating report does not give details of this being work related and Medical test and analysis indicated in the report stat stress due to back injury and stress at Bank of America. and she will have to fwrd this over to the physical medical department and mental health with not approve it, I received and denial letter. not that sum other dept will review.
They go from not following your written instructions on the reorder form. to charging your credit card for refills you did not request and without your authorization. I think in most states they consider that illegal. When you try to get it corrected -they tell you all kinds of different stories. They did this twice within the past three week period. Do not I repeat to not use these people. The attorny general in Florida should look into their business practices. They have serious problem within their company. Again do not ever use these people
Where is a good lawyer when you need them.
Aetna schedule of benefits shows that there is a no co-pay and deductible is waived for routine physical exams. Did you know that routine doesn't include talking to your doctor about your health concerns? I asked about my weight and she diagnosed me as overweight. So since I have a diagnosis, it is now considered an office visit and I am responsible for the co-pay and the deductible. Since she is concerned that I might have a thyroid problem, she orders lab work. There is a higher co-pay for getting blood drawn. I was curious about my results and was told to schedule another appointment and pay another co-pay to find out that I don't have a thyroid problem. I asked the doctors office and Aetna about paying much more than I expected to pay. I was told I am responsible for knowing how my insurance company works. I was told that a wellness exam is only covered if I am well. If I am sick, or I ask the doctor if I could be sick, then it is not covered. So in the future, when my doctor asks me if I have any concerns or questions, I will answer "I am well." Actually, I am going to stop going to my doctor. Since I can't afford to be un-well, I can't afford to find out if there is anything wrong with me.
If your employer had the type of AETNA insurance that just has AETNA reviewing & paying claims... is it your employer's money used to pay the bills instead of AETNA's money? If it is, then it's very possible your employer is aware of all your health information including labs, diagnoses, vital signs, medications & every chart ever made on you. The employer is the "payor" and possibly has access to all of your information. It's seems wrong to alert employers of high risk / "high dollar" employees. I expressed my concerns about this and didn't get far. They claim the employer doesn't have the name of the actual employee costing them so much $$$.
I wonder though if an employer could figure out which of it's employees has been in the ICU for 20+ days? It doesn't seem too difficult for them to figure it out.
The "COB- coordination of benefits" will happen at least once per year to see if there is possibly another insurance company that should be primary.
It's definitely a pain.
As far as speaking to a supervisor / manager... try calling:
[protected] or [protected]
Whenever there is ANY issue you should 1st call your PLAN SPONSOR'S REPRESENTATIVE.
You can call your human resources department of the employer the AETNA insurance is through.
Ask for the insurance benefits specialist & ask them why your employer chose AETNA - explain how
they may not want to go with AETNA as an option for the next open benefits registration.
The liason may be able to get some action.
This really freaks out everyone at AETNA because they risk losing the contract ;)
Don't pay, Docs don't take it
Went to the doc in April of '07, they still haven't paid. Looking for a new doc, but no one wants to take SRC Aetna insurance because they have a bad reputation. Tried to get an appointment recently and not one of the doctors on their list online will take me before the middle of January. What am I paying them for? If I didn't have health insurance I would be better off! Isn't that sad?
My husband and I are paying a lot of money for a policy that is USELESS. I was recently in the ER and they said that they can't bill me because I"m not in their nextwork..even though the people at Aetna say my hospital is in their network.
My doctors are all coming back to me and saying that I'm going to have to pay out of pocket because nothing is covered under them. Only $350 is covered...and I have to make $350 stretch out for a CT scan, blood work, chiropractor, and therapist?
Yeah, right. What am I paying for this insurance for? Do you realize that there is better health care for the uninsured in clinics than people who are insured by Aetna SRC? This insurance is a scam at best!
I have experienced it first hand with SRC. It is truely unbelieveble they can get away with what they do. I have 6 bills for 3 days of service (1 day for blood work, one day for xrays, and one day for a one hour procedure). The 6 billers for the misc services have all been unsuccessful at getting SRC to receive the bills. Even though the billers have fax confirmations, electronic filing confirmations, and sent bills by U.S. mail, they all "disappear" on the SRC end. Amazing. Its been six months and I spend about 4 hours a month on the phone trying to get them to find the bills as we re-fax them. Capitalism an at its finest.
Aetna In-depth Review
In summary, Aetna is a well-known insurance provider with a broad range of products. While some users find value in their offerings, others may encounter challenges with customer service and claims processing. It is important to consider both the positive and negative aspects before making a decision.
Company Overview
Aetna has a long history and background in insurance industry. They offer many types of insurance products, including health, dental, and vision coverage. Service area and availability can vary, so checking if Aetna operates in your region is important.
Insurance Plans and Coverage Options
- Individual and Family Plans are available for personal coverage needs.
- Employer Health Plans are offered for businesses looking to cover their employees.
- Medicare Plans are provided for seniors and others eligible for Medicare.
- Dental and Vision Coverage can be added to health plans for comprehensive care.
- Additional Benefits and Wellness Programs are offered to promote health and wellbeing.
Pricing and Value
Cost comparison with competitors is difficult without specific details, but Aetna is known to be competitive. Deductibles and out-of-pocket maximums will depend on the chosen plan. Premiums and discounts may apply in certain situations, and overall, Aetna is considered to offer good value for money.
Customer Service Experience
Some users find ease of contacting customer support to be satisfactory, while others may experience difficulties. Responsiveness and support quality can vary. Claims processing efficiency is a critical aspect, with mixed reviews. Aetna provides online tools and resources for customer assistance.
Member Resources and Tools
The mobile app functionality is designed for on-the-go management of insurance. Member portal features allow for easy access to plan details. Educational resources are available to help understand insurance options. Health management tools are provided to assist in maintaining a healthy lifestyle.
Network of Providers
Aetna has a sizeable and diverse provider network. Finding in-network providers is generally straightforward. Access to specialists and facilities is an important factor in choosing Aetna.
Claims and Billing Process
Transparency of billing process is crucial, and Aetna aims to provide clear information. Ease of filing claims is a highlighted feature. Speed of reimbursement and accuracy of billing statements are areas where experiences may vary.
Policy Management
Policy updates and changes are manageable with Aetna's online policy management capabilities. The renewal process and options are designed to be user-friendly.
Customer Feedback and Reviews
Customer satisfaction ratings for Aetna are mixed. Analysis of positive and negative reviews can provide insight into the company's performance. Testimonials and case studies may be available for a more personal perspective.
Financial Strength and Stability
The company's financial ratings are strong, indicating stability. Aetna's market share and industry standing are significant. Long-term reliability is a factor many users consider when choosing an insurance provider.
Legal and Regulatory Compliance
Aetna is known to comply with health insurance regulations. Handling of privacy and data security is taken seriously. The record of legal disputes or violations, if any, should be researched for informed decision-making.
Corporate Social Responsibility
Aetna is involved in community philanthropy and strives for environmental sustainability. Employee welfare initiatives are part of their corporate responsibility efforts.
Pros and Cons Summary
- Key Advantages: Comprehensive coverage options, wellness programs, and a strong provider network.
- Potential Drawbacks: Customer service and claims processing may not meet everyone's expectations.
Final Verdict and Recommendations
Overall, Aetna is suitable for many users with different needs. Recommendations will depend on specific circumstances, such as location and desired coverage. It is advisable to compare plans and read customer reviews to ensure Aetna meets your requirements.
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If your employer had the type of AETNA insurance that just has AETNA reviewing & paying claims... is it your employer's money used to pay the bills instead of AETNA's money? If it is, then it's very possible your employer is aware of all your health information including labs, diagnoses, vital signs, medications & every chart ever made on you. The employer is the "payor" and possibly has access to all of your information. It's seems wrong to alert employers of high risk / "high dollar" employees. I expressed my concerns about this and didn't get far. They claim the employer doesn't have the name of the actual employee costing them so much $$$.
I wonder though if an employer could figure out which of it's employees has been in the ICU for 20+ days? It doesn't seem too difficult for them to figure it out.
As far as speaking to a supervisor / manager... try calling:
[protected] or [protected]
Well, if you are like us you can't just get it filled anywhere as the company insists you use mail order for long-term prescriptions.
My experience the last three years has been hell when it's been time to get my new refills after my checkup with my doctor. In each case the doctor's office FAXed the prescriptions in my presence. Days go by, then weeks. When contacted they claim they never got the FAXes. So we do it over again. Same thing. Days and then weeks go by. Third time is finally the charm to at least get put into their system. It takes them four days to pull them off a FAX queue and then two more days to fill and ship, which they apparently do on a slow boat. Right now it has been since February 18 (five weeks) since the scripts were first ordered and I don't have them yet. They won't put a trace on the shipment until 14 days after shipping. If this was once it would be one thing, but it happens every year. I told them my doctor has done everything but hand-carry the scripts from Houston to Florida and begged for help to how to do it differently to expedite the process but they don't have any answers. I asked to talk to someone about the processes and they told me there was no one I could talk to. The doctor's office says they have constant problems with Aetna pharmacy. I know the online list of my medications is always wrong. We may just have to totally forego insurance and get them filled at Walmart, which is probably what Aetna wants in the first place.
These are meds for hypertension and it is imperative I take them daily. They don't give a crap about the patients who are suffering and stressed out over their medications.