Aetna’s earns a 2.7-star rating from 115 reviews, showing that the majority of policyholders are somewhat satisfied with health insurance plans.
- All
- Reviews only
- Complaints only
- Resolved
- Unresolved
- Replied by the business
- Unreplied
- With attachments
Aetna claim denial/ payment reduction
I would like to alert readers regarding Aetna PPO denial of claims and reimbursement decrease practices. In 2010, Aetna PPO Health Insurance tried the following to eliminate/ reduce claims from my husband's providers:-
1) Arbitrarily decided that he had other primary insurance and denied all claims after a date chosen by them.
2) Arbitrarily applied a 75% discount to bills previously paid in full. It seems that a discount program was erroneously applied to the provider. The reduction came to light when the provider billed us for the difference.
Both of these were eventually resolved but only after hours and weeks of phone calls.
The complaint has been investigated and resolved to the customer’s satisfaction.
Customer Service Issues and Non-Payment of Benefits
I am quite happy to provide copies of all the correspondence exchanged with Aetna, but your electronic form does not allow me to attach the Word documents. Please advise of an email address so I can forward those to you.
Quite simply, Aetna's policy seems to be to demoralize and intimidate the client. They have made empty promises to return phone calls, make insinuations about psychological issues versus the true medical condition of narcolepsy, and stalled beyond belief. They continue to say I can appeal, but quite frankly I think this is a stalling tactic to break down the spirit of the policy holder.
My claim for $60, 000 may seem relatively insignificant to them, but it is my only source of income and I resent them treating me like a criminal. I am happy to provide whatever they need, but find it incredulous that they can pay me for two years and then decide that my chronic condition is no longer valid. All of my medical documentation says differently. Multiple sleep studies and two sleep specialist have confirmed my condition, but Aetna continues to rope me along...all the while making it impossible to pay for my medications, etc. when I have no income.
Please help!
The complaint has been investigated and resolved to the customer’s satisfaction.
Medicare Prescription Processing/Denials/Appeals
My mother started her Medicare Part D plan in 2008. I retained Aetna for her in 2009 and I still kept them in 2010. Despite knowing the changes in their Drug Formulary, there was no need to change plans given I was ASSURED that my mothers' prior authorizations would still cover 4 medications - in writing. For those who do not know, a Preferred Drug Formulary is their "list" of drugs they will cover and at what price "Tier", Brand vs. Generic, etc. These 4 medications were covered in 2008 and 2009 via the "prior authorizations", hence the need for these prior authorizations which allowed her to get the medications for 3 years. All I did was confirm and ensure that these were, in fact, still valid to which I have correspondence that it was.
So January RX refill time comes around and I fill everything for her (14 scripts total) without a problem. 3 weeks and 2 days later, I receive a letter stating one of her RX's was filled as a "One-Time Courtesy" and she needs to find a "preferred" drug that is similar OR obtain a Prior Authorization! Mind you, as stated above, I CONFIRMED with them that her prior authorizations would STILL be in effect until August 31st 2011.
The next day, another letter, same reason, different drug. Next day, 2 letters this time (separate envelopes - could have saved a stamp given these were all filled the same day and all the letters had the same date - go figure). Now, I have letters stating ALL FOUR of the medications, already approved via Prior Authorizations, were no longer covered! Confused yet? Good - you should be; that was AETNA'S purpose. Nevertheless, ALL four letters are contrary to the APPROVAL correspondence stating (all 4 medications) are COVERED FROM AUGUST 01, 2010 - AUGUST 31, 2011.
AETNA did this as a tactic, to lock-in my mother for ANOTHER year, knowing full well that on January 1st of EACH YEAR, ANY PRIOR "PRIOR AUTHORIZATIONS" BECOME NULL & VOID! I was NEVER told this, ALL letters say otherwise, this did not happen when we went from [protected], and let us not forget the APPROVED UNTIL AUGUST 31, 2011!
Then the phone calls to AETNA started - of course not ONE person was helpful until the very end, approximately 35 reps, 3 supervisors, and 2 1/2 weeks later. Let's not forget too that these "We changed our minds" letters came only DAYS before her medications were due to be refilled come February.
Her doctor and I had to BOTH file an expedited appeal for a formulary exception, which basically asks AETNA to cover it even though it's not on the Formulary. This was denied stating "PATIENT MUST UTILIZE 2 OTHER LONG-ACTING MEDICATIONS OVER A 90 DAY PERIOD BEFORE WE CAN CONSIDER A FORMULARY EXCEPTION". Before they would cover the drug again? Ummm - this is why we had these approved already - so now AETNA wants my mother to go backwards, suffer tremendously for 3 months, in order to "prove" that they do not work? Upon speaking with them about this "denial", I advised that my mother already went through this, that's why we have the Prior Authorizations, and yet I am told that is NOT SUFFICIENT since this did not occur in the last 6 months! WHY WOULD IT? SHE HAD AUTHORIZATIONS FOR THE MEDICATIONS THAT DO WORK! Now what must I do? Appeal time - and not just a regular one, an "expedited" one since we're down to LESS THAN A WEEK before she is out completely.
Nevertheless, in my 10-page appeal as well as through her physician giving me time in his office to back up the statements with medical data, ALL of this was outlined. ALL was faxed, I printed the confirmation, and even contacted them to ensure it was received. I was told yes and the doctor, who had also called the day after, was also told ALL info needed was received. 2 days later, I get a phone call stating NEITHER THE DOCTOR NOR I, ON BEHALF OF MY MOTHER, SUBMITTED RECORDS/RATIONALE WITHIN 48 HOURS! This is when the phone-wars began. I miraculously found a manager, who just happened to get suckered into the phone call in my opinion, gave me a DIRECT fax number, I faxed all my stuff and the doctor's stuff to her while on the phone, she cofirmed receipt and faxed a signature page back to me indicating 52 pages were received, and she forwarded this to the person handling the appeal.
THE DAY AFTER her medications ran out, I got a phone call indicating the appeal(s) had been approved. While this is good news of course, the fact is that I had the chance to AVOID ALL OF THIS ENTIRELY HAD WRITTEN CORRESPONDENCE BEEN HONORED FROM THE START! Obviously AETNA had no leg to stand on when the only dates I have refer to an expiration of August 2011; NO WHERE does it state that the "New Year" would "void" the "prior" prior authorizations. To add insult to injury, however, it then came to my attention that I neglected to handle the "quantity limitations" on the other 2 medications. SO, I guess AETNA already knew once they heard my name that it's best to just fix it NOW, i did not have to go through all that hell AGAIN for the remaining two medications.
The point of all this?
#1: Especially when you are dealing with elderly people or worse, those who are experiencing dementia or Alzheimer's, the HUGE book you get when open-enrollment starts every November is enough for the SMARTEST OF THE SMART to be confused!
#2: DECEPTIVE TRADE PRACTICES - Sending out not one, not two, not three, but FOUR different letters for FOUR different medications with FOUR different approvals and then turning around and DENYING they are valid due to the standard "Start of a New Year" line of BS.
#3: Waiting until the patient is ALMOST OUT OF MEDICATION to advise them there will be an issue of non-coverage.
#4: Trying to make an old woman suffer, without just cause or god-forbid HUMANITY, by attempting to demand her to take medications that are known to NOT work and cause major side-effects, for THREE MONTHS before 'considering' approval of the Exception.
#5: Having to turn myself into a Lawyer, basically, in order to put together EVERY SHRED of documentation possible, while sitting with and LITERALLY spending time at her Doctor's office with her physician to write out all these explanations and "chronologies" and "How AETNA is blatantly WRONG". I mentioned the lawyer part as I quoted EVERY piece of legal mumbo-jumbo THEY USED ON MY MOTHER to use for my Mother's advantage. Given the coverage under the policy is, afterall, a Contract, that means I will just throw the legal mumbo-jumbo right back at AETNA.
#6: Make this ALL HAPPEN within 4 or 5 days that never would have happened if I was just told, back in November, that in order for my mother's Prior Authorizations to be valid starting on January 1st 2011, I would need to start the process THEN instead of having to scramble for 4 days, non-stop, before she ran out of medications.
HOW can ANYONE sleep at night knowing they are putting others' lives in jeopardy EVERY SINGLE DAY OVER THE ALMIGHTY DOLLAR? What is wrong with this country that companies are ALLOWED to hurt people? This is not just about my mother - this is about ALL our elderly, disabled, or retired people who have Medicare, specifically Aetna's Medicare Prescription plan. I can't emphasize these points enough over how deceptive AETNA has been. Here I think I'm being proactive in regards to my mother's health and what happens? CATASTROPHE.
People beware - and I DO NOT - I repeat DO NOT say this as an insult in the least but have others help you even if you think/believe/advised your plan is FINE. Whether you're 65 or 85, they WILL TRY to throw you under the bus and you'll be left with NOTHING! If myself, my mother's Doctor, and her Doctor's attorney had issues resolving what should have been a VERY simple matter, I can only imagine, as well as FULLY understand, what has been done to others. Luckily and with ALOT of prayer, the wool did not get pulled over MY eyes from these idiots looking for suckers to just "give in" and allow them to have their salaries and other perks. I wonder if they get bonuses for MORE denials? Surely that's the case otherwise what is the incentive to cause THIS much grief for people?
Imagine this being your elderly mother, father, aunt, uncle, neighbor, and/or friends having THEIR medical needs just ripped from underneath them. SAD THAT PEOPLE DILIGENTLY WORK HARD AT FINDING WAYS TO MAKE THESE PEOPLE SUFFER ALL FOR THE SAKE OF THE ALMIGHTY DOLLAR! Then imagine having to put together a HUGE presentation for them in 72 hours or you're screwed. Like I said so many times - WHY was I not told THEN instead of NOW? Retention via Deception!
SHAME ON YOU AETNA! SHAME ON YOU!
Aetna also throws the pharmacy under the table, as they send back via internet the amount they will pay, and when our pharmacy gets the check ( if we do...they are 4 months behind now!) they reduce our payment, too! This company, under CVS, has to be stopped!
They are definitely not health care, they are the definition of health apathy! It's all about the almighty dollar, not about the patient! Went into the pharmacy profession to help people, not to send a CEO on an expensive trip to a exotic location! I feel for you!
Medicare Prescription Processing/Denials/Appeals
My mother started her Medicare Part D plan in 2008. I retained Aetna for her in 2009 and I still kept them in 2010. Despite knowing the changes in their Drug Formulary, there was no need to change plans given I was ASSURED that my mothers' prior authorizations would still cover 4 medications - in writing. For those who do not know, a Preferred Drug Formulary is their "list" of drugs they will cover and at what price "Tier", Brand vs. Generic, etc. These 4 medications were covered in 2008 and 2009 via the "prior authorizations", hence the need for these prior authorizations which allowed her to get the medications for 3 years. All I did was confirm and ensure that these were, in fact, still valid to which I have correspondence that it was.
So January RX refill time comes around and I fill everything for her (14 scripts total) without a problem. 3 weeks and 2 days later, I receive a letter stating one of her RX's was filled as a "One-Time Courtesy" and she needs to find a "preferred" drug that is similar OR obtain a Prior Authorization! Mind you, as stated above, I CONFIRMED with them that her prior authorizations would STILL be in effect until August 31st 2011.
The next day, another letter, same reason, different drug. Next day, 2 letters this time (separate envelopes - could have saved a stamp given these were all filled the same day and all the letters had the same date - go figure). Now, I have letters stating ALL FOUR of the medications, already approved via Prior Authorizations, were no longer covered! Confused yet? Good - you should be; that was AETNA'S purpose. Nevertheless, ALL four letters are contrary to the APPROVAL correspondence stating (all 4 medications) are COVERED FROM AUGUST 01, 2010 - AUGUST 31, 2011.
AETNA did this as a tactic, to lock-in my mother for ANOTHER year, knowing full well that on January 1st of EACH YEAR, ANY PRIOR "PRIOR AUTHORIZATIONS" BECOME NULL & VOID! I was NEVER told this, ALL letters say otherwise, this did not happen when we went from [protected], and let us not forget the APPROVED UNTIL AUGUST 31, 2011!
Then the phone calls to AETNA started - of course not ONE person was helpful until the very end, approximately 35 reps, 3 supervisors, and 2 1/2 weeks later. Let's not forget too that these "We changed our minds" letters came only DAYS before her medications were due to be refilled come February.
Her doctor and I had to BOTH file an expedited appeal for a formulary exception, which basically asks AETNA to cover it even though it's not on the Formulary. This was denied stating "PATIENT MUST UTILIZE 2 OTHER LONG-ACTING MEDICATIONS OVER A 90 DAY PERIOD BEFORE WE CAN CONSIDER A FORMULARY EXCEPTION". Before they would cover the drug again? Ummm - this is why we had these approved already - so now AETNA wants my mother to go backwards, suffer tremendously for 3 months, in order to "prove" that they do not work? Upon speaking with them about this "denial", I advised that my mother already went through this, that's why we have the Prior Authorizations, and yet I am told that is NOT SUFFICIENT since this did not occur in the last 6 months! WHY WOULD IT? SHE HAD AUTHORIZATIONS FOR THE MEDICATIONS THAT DO WORK! Now what must I do? Appeal time - and not just a regular one, an "expedited" one since we're down to LESS THAN A WEEK before she is out completely.
Nevertheless, in my 10-page appeal as well as through her physician giving me time in his office to back up the statements with medical data, ALL of this was outlined. ALL was faxed, I printed the confirmation, and even contacted them to ensure it was received. I was told yes and the doctor, who had also called the day after, was also told ALL info needed was received. 2 days later, I get a phone call stating NEITHER THE DOCTOR NOR I, ON BEHALF OF MY MOTHER, SUBMITTED RECORDS/RATIONALE WITHIN 48 HOURS! This is when the phone-wars began. I miraculously found a manager, who just happened to get suckered into the phone call in my opinion, gave me a DIRECT fax number, I faxed all my stuff and the doctor's stuff to her while on the phone, she cofirmed receipt and faxed a signature page back to me indicating 52 pages were received, and she forwarded this to the person handling the appeal.
THE DAY AFTER her medications ran out, I got a phone call indicating the appeal(s) had been approved. While this is good news of course, the fact is that I had the chance to AVOID ALL OF THIS ENTIRELY HAD WRITTEN CORRESPONDENCE BEEN HONORED FROM THE START! Obviously AETNA had no leg to stand on when the only dates I have refer to an expiration of August 2011; NO WHERE does it state that the "New Year" would "void" the "prior" prior authorizations. To add insult to injury, however, it then came to my attention that I neglected to handle the "quantity limitations" on the other 2 medications. SO, I guess AETNA already knew once they heard my name that it's best to just fix it NOW, i did not have to go through all that hell AGAIN for the remaining two medications.
The point of all this?
#1: Especially when you are dealing with elderly people or worse, those who are experiencing dementia or Alzheimer's, the HUGE book you get when open-enrollment starts every November is enough for the SMARTEST OF THE SMART to be confused!
#2: DECEPTIVE TRADE PRACTICES - Sending out not one, not two, not three, but FOUR different letters for FOUR different medications with FOUR different approvals and then turning around and DENYING they are valid due to the standard "Start of a New Year" line of BS.
#3: Waiting until the patient is ALMOST OUT OF MEDICATION to advise them there will be an issue of non-coverage.
#4: Trying to make an old woman suffer, without just cause or god-forbid HUMANITY, by attempting to demand her to take medications that are known to NOT work and cause major side-effects, for THREE MONTHS before 'considering' approval of the Exception.
#5: Having to turn myself into a Lawyer, basically, in order to put together EVERY SHRED of documentation possible, while sitting with and LITERALLY spending time at her Doctor's office with her physician to write out all these explanations and "chronologies" and "How AETNA is blatantly WRONG". I mentioned the lawyer part as I quoted EVERY piece of legal mumbo-jumbo THEY USED ON MY MOTHER to use for my Mother's advantage. Given the coverage under the policy is, afterall, a Contract, that means I will just throw the legal mumbo-jumbo right back at AETNA.
#6: Make this ALL HAPPEN within 4 or 5 days that never would have happened if I was just told, back in November, that in order for my mother's Prior Authorizations to be valid starting on January 1st 2011, I would need to start the process THEN instead of having to scramble for 4 days, non-stop, before she ran out of medications.
HOW can ANYONE sleep at night knowing they are putting others' lives in jeopardy EVERY SINGLE DAY OVER THE ALMIGHTY DOLLAR? What is wrong with this country that companies are ALLOWED to hurt people? This is not just about my mother - this is about ALL our elderly, disabled, or retired people who have Medicare, specifically Aetna's Medicare Prescription plan. I can't emphasize these points enough over how deceptive AETNA has been. Here I think I'm being proactive in regards to my mother's health and what happens? CATASTROPHE.
People beware - and I DO NOT - I repeat DO NOT say this as an insult in the least but have others help you even if you think/believe/advised your plan is FINE. Whether you're 65 or 85, they WILL TRY to throw you under the bus and you'll be left with NOTHING! If myself, my mother's Doctor, and her Doctor's attorney had issues resolving what should have been a VERY simple matter, I can only imagine, as well as FULLY understand, what has been done to others. Luckily and with ALOT of prayer, the wool did not get pulled over MY eyes from these idiots looking for suckers to just "give in" and allow them to have their salaries and other perks. I wonder if they get bonuses for MORE denials? Surely that's the case otherwise what is the incentive to cause THIS much grief for people?
Imagine this being your elderly mother, father, aunt, uncle, neighbor, and/or friends having THEIR medical needs just ripped from underneath them. SAD THAT PEOPLE DILIGENTLY WORK HARD AT FINDING WAYS TO MAKE THESE PEOPLE SUFFER ALL FOR THE SAKE OF THE ALMIGHTY DOLLAR! Then imagine having to put together a HUGE presentation for them in 72 hours or you're screwed. Like I said so many times - WHY was I not told THEN instead of NOW? Retention via Deception!
SHAME ON YOU AETNA! SHAME ON YOU!
Call 1-800-MEDICARE to report them. They do not want you to do this! Just to check, call Aetna Medicare and ask them for the number to actual MEDICARE. They will say that they do not have the number. They do, they just don't want you to call. How do I know? I was a representative with them for 4 years. Aetna was sanctioned by MEDICARE for over a year, and they deserve it even longer.
Won't pay for Celebrex
If Aetna thinks for one minute they're not going to cover my Celebrex, the ONLY drug I take, they had better think again. I'm contacting the Attorney General tomorrow, and after that, I'm going to Congress, because, you see, I live in Washington DC. And here in Washington DC, not only do people have an UNLIMITED capacity to ***, we know how to do it. This issue is NOT going away, it's not going to go away, not now, not ever. I have tried other drugs and nothing works but Celebrex. Nothing. On Celebrex, I can live like a normal person. Without it, I will be in a wheel chair.
denied short term disability
I had gone out of work on medical leave on August 3rd 2010 and was told to apply for short term disability thru the company sponsered plan thru Aetna. I did so and was denied in September and I thus filed and appeal with them and in the mean while had no money coming in and had to borrow from family and friends and that ran out. So I am being evicted from my apt and lost my car insurance and the cell phone was shut off. Now here it is Feb 5 months since i filed the appeal and was denied again and said i cant appeal again my case is now closed but i can pursue a civil case...And because I was deied my claim all together I have been fired from my job.Thanks to Aetna I have lost everything. But hey what do they care they still get paid every week.
The complaint has been investigated and resolved to the customer’s satisfaction.
I certainly do not intend to undermine the situation however having been round & round with disability payments, I sort of became an "advocate" per se. The bad part here - it's an INTERNAL appeal. Why the hell would they decide against themselves? Of course they won't. What people don't know, myself included, is that IF/WHEN you have to appeal, never go into it without representation. Yes, I know this possibly means $$ that we do not have, however there are MANY places out there that help the disabled. If it wasn't for their help, I doubt I would have obtained the disability payments while going through the social security process. I learned my lessons so I was more than prepared for SSA which resulted in that being approved.
However Aetna, just as you've indicated, have their own doctors/nurses that read whatever is sent in and nothing more. They sent me to MANY doctors as well, of which I finally said I will NOT go again given the cost of all these exams you've sent me on equal a month's pay! It would have been the 6th doctor - trying to get one - just one - to say "Nope he's fine" but they couldn't. Subsequently they had to pay out - plus my point of all the money they're spending on exams/tests is likely ten times MORE than what I am owed. Last time I saw, an MRI ran $8, 000. One month's pay would only be $1, 900 - and that is at the 60% level that is all we're entitled to anyway!
All I know is it is a shame that we pay into something and end up having to fight like mad, while we're in the worst shape imaginable, just to try and survive. Most of us do not, and those of us who do only BARELY keep on. I ended up in foreclosure and god knows how much else over them not paying. 4 months later, after plowing through savings and racking up debt, I finally prevailed. Then again, did I really prevail whenever the damage that was done, due to the delay in payment, is going to haunt me for YEARS? Those late-pays are on our credit reports for up to 7 years! THANKS!
At least you're doing the right thing and going to the State Insurance Commissions. I may be wrong, but you *might* be able to get compensatory damages. If not, there are hundreds of attorneys just waiting for that phone to ring & take your case on a contingency. Of course, document, document, & document EVERYTHING and get every shred of medical data available. It may cost to get the copies ($40 for all of mine & I had an entire BOX - no joke), but when the attorney knows you are fully prepared, that's showing YOU mean business, and also less work for the attorney to get the ball rolling.
Very similar situation with me. I was denied and now it's in the "final stages" as they call it in the appeal process, but I hear it's not in my favor, and I asked what is my next resourse and they too mentioned civil court. I think Aetna disabity insurance is a fraud and should be reported. Who are they do decide from their nurses and doctors without meeting you and after getting information from not one but three physicians I have seen and filled out extensive paper work. I lived and worked in PA and like the person's complaint against Aetna that I just read, I too have no money and I had to move out of the place we were living because I cannot afford to live there. Now I live in another state. I just don't get why we pay into disability if they don't even consider the doctors facts and notes. I just think they will do whatever it takes NOT to pay you. I will go to the top if I have to. I am far from done!
Denial of claims due to incorrect Tax ID
I have been dealing with an insurance claim since March of 2008 with countless denials by Aetna. Aetna claims that the wrong tax id number has been filed with the claim, in turn a new claim has been filed with the correct tax id number only to be denied. Each time I call they tell me to have the doctor’s office just resubmit the claim with the correct number and it will be taken care of. The claim has been submitted well over 15 times and they still deny the number is correct. I have spoken to at least 6 different reps some reps numerous times and there still has been no resolution. I am at my wits end with them at this point, it has been almost three years and still no resolution. The Dr office has threatened to send the claim to a collections agent. For some reason now that Aetna won't pay their contracted bills the Dr office feels it is alright to take me to collections and not return any of my calls. Thanks Aetna and Dr Fraterrigo for ruining my credit.
The complaint has been investigated and resolved to the customer’s satisfaction.
I used to work in medical billing for a large Hospital organization and we used to see this issue all the time. Really the responsibility lies with the Dr Office. You should not have to deal with this issue as it is a mistake easily corrected by the Dr Office billing department calling Aetna and resolving it. Another thing to note is that if multiple claims come in to the insurance company with the same information they will be denied as duplicate filing. The claims system for large insurance companies are automated and they receive the majority of their claims electronically. If your Dr. Office has already submitted the claim with the incorrect TID (Tax ID number) but the claim was not purged from Aetna's system then all incoming claims that match the original claim will be denied as duplicate. Typically incoming claims are identified by the subscribers ID number (your policy number), Date of Birth, Date of Service and Claim amount. The TID is only used to locate the contract information in regards to reimbursement rate and mailing address.
Most likely the claim will have to be processed manually by Aetna and that will only happen when the Dr. Office's billing department contacts Aetna directly. There is a clause in many contracts between providers (Dr. Offices) and Insurance companies know as "Timely Filing". This clause varies but in general it is a set time period of when bills have to be submitted. If the bill was not submitted and reviewed with in that period the claim will never be paid and the provider will have to absorb the cost. Some smaller companies like Dr. Offices will try to bill the consumer knowing that they have no understanding of the billing process. Believe me in the 6 years I worked in billing it was an always changing and convoluted environment.
Recently insurance companies have been requiring offices to use their NPI number or National Provider Identifier in place of the TID.
Good luck to you and hope this information helps...
Denying &life sustaining medication&
THIS IS INHUMANE! My doctor, my pharmacist, and I have been in contact with AETNA for 3 days. I have not had my synthroid since 9/15/10. Aetna would only reimburse for generics, so I use them for the past 3 months. I did not respond to Levoxyl(GENERIC CRAP), and my T3 & T4 are so low that my doctor told me if I feel ill to go directly to the ER. He had no samples to give me. My doctor wrote "patient blood levels improved on Synthroid", been on medication since 1980. AETNA SAID, it is not saying the medicine didn't work, just that you "improved" on the brand? WHAT? going to ER and this could have been avoided!
Refuses to pay for radiation treatments to remove prostrate cancer
I was diagnosed with prostrate cancer after a biopsy from an in network urologist. He scheduled an appointment with a radiologist to start treatment. Aetna refused to pay for the biopsy. Aetna also refused to pay all imaging procedures to penpoint the areas of my prostate that has the cancer. I am at the moment trying to pay of the imaging company and the urologist to the tune of quite few thousand dollars. I still have to come up with the money to pay for any procedures to remove the cancer.
Aetna never gave a reason for not authorizing payment other than the procedures are not authorize even though all of the doctors were in network doctors. Aetna has turned out to be a horrible company. I get my insurance through a group plan at work. The plan is provided by Oasis Outsourcing. The years that I have paid into the insurance plan has turned out to be a complete waste of money and time.
The complaint has been investigated and resolved to the customer’s satisfaction.
I can completely understand what you are going through with Aetna. I was diagnosed with Thyroid Cancer and I have surgery scheduled for a Thyroidectomy in a week, I just got a letter from Aetna refusing to pay for the byopsy, ultrasound, uptake scan and CT Scan. Basically everything that has led me to this point. Unfortunatley this is the only means of insurance we have through my husbands work . We had Aetna about 10 years ago and had the SAME problems with them. Unpaid claims... they refuse to pay for anything! Call your Insurance Commissioner! These clowns need to be put out of business. I hope eveything goes well with your treatment ..god bless and good luck!
I'm so sorry for what you're going through. I can't even imagine denying a patient diagnosed with cancer & needing treatments.
I know the last thing you want to do is chase AETNA around with everything going on. Perhaps you can give a Release of Information to
a trusted relative or friend to get to the bottom of it.
Don't give up! Seriously this HAS to be a miscommunication.
Try calling the "PHA" (personal health advocate) # on the back of your insurance card...
Try calling the AETNA Case Management department for your particular contract & insist on being assigned a Case Manager to work & help you with all of this.
Also, your doctor's office should have an insurance specialist that can help you clean up this mess.
You can also go online @ aetna.com to get information on AETNA's specific policies relating to your care.
******If you really want to get AETNA's attention to this matter... call your Human Resources department & request to speak with your "Insurance Liason.
******Tell them everything ask that they contact AETNA for you to see what is going on during this critical time in your life when you need them
to really come through for you. Express that they really should take this into consideration when picking what insurance to offer their employees.
Call the head of your organization also & let THEM know also.
Good Luck. Hope everything works out for you soon.
Scam
At the end of 2009, GE insisted that everyone convert to a more self-managed medical insurance plan.
ccThey held onsite information / question/answer seminars for employees and retires.
The information they spewed concerning assurances that pre-existing medical conditions would still be covered and answers to specific questions turned out to be totally false, and outright LIES.
What they accomplished was to turn over autonomous coverage decision authority to Aetna and a couple of other insurance companies, who's only incentive is to make sure most medical claims end up getting paid by patients. GE made sure of this autonomy by removing all GE contact information about medical issues from all of their web sites and documentation.
In addition Aetna makes the claim appeal process so difficult and their denial of claims absolute.
There is a back door to file a formal complaint, contrary to MA law, which states such a process is supposed o be readily available, which Aetna will give you the link to the form if they are pressured hard enough.
The joke to the whole formal complaint process is that a board made up of Aetna people decide the disposition of the claim and in order to appeal to GE, one must submit a formal appeal on a claim 3 times before GE Benefits will even discuss the issue. In other words, there is NO appeal process, GE made sure of that. So where are we, we can get $30 physicals covered but any thing requiring lab tests or pre-existing conditions, the patient is on his own.
This s how GE looks to the future to reduce Health care costs, make it so retirees can't afford the care and they will all eventually die prematurely, Soylent Green does not sound so absurd now.
Now I have the choice of paying medical bills or going without necessary tests and exams and pay my many other expenses on my limted retirement income.
I either die or go broke and die.
Try contacting your GE Insurance Liason in your H.R. department. They may be able to shake AETNA's tree to see what nuts fall out.
If all else fails... just keep going to the ER. They can't turn you away & they can't demand payment from you in the ER. They have to just
treat you & AETNA has to pay it. If you go to the ER frequently enough... like 3 times per month... AETNA nurses will definitely be calling YOU and then you'll
get some help to keep you from going to the ER again.
You can keep appealing their decisions & eventually they have to have an outside physician review your appeal for fairness ;)
Good Luck.
Aetna representatives lied to me over the phone
My complaints with Aetna health insurance range from August 2009 to present. The claims are regarding therapy services for my daughter who has cerebral palsy. I have two major ongoing problems: Aetna representatives lied to me over the phone, telling me that more therapy than the 60 days written in plan would be available once her doctor wrote in a letter, and then Aetna denied the coverage for these claims stating it was not in my policy and would not stand behind the misinformation given by their employees that led me to continue therapy and then had to pay for it on my own. My second complaint is regarding the copay amounts for the therapy sessions that we did have, Aetna has retroactively changed the amounts of the copays, and credits have been issued to me, however the amounts are not consistent and Aetna now is refusing to give me a detailing of what the copays were, or show me where in my policy it states what the copays are. They are now saying that they made a "mistake" in covering the therapy in the first place, so they are not giving me the information or further credits to make the copays consistent.
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 ;)
Health Insurance Not Covering Claims
My complaints with Aetna health insurance range from August 2009 to present. The claims are regarding therapy services for my daughter who has cerebral palsy. I have two major ongoing problems: Aetna representatives lied to me over the phone, telling me that more therapy than the 60 days written in plan would be available once her doctor wrote in a letter, and then Aetna denied the coverage for these claims stating it was not in my policy and would not stand behind the misinformation given by their employees that led me to continue therapy and then had to pay for it on my own. My second complaint is regarding the copay amounts for the therapy sessions that we did have, Aetna has retroactively changed the amounts of the copays, and credits have been issued to me, however the amounts are not consistent and Aetna now is refusing to give me a detailing of what the copays were, or show me where in my policy it states what the copays are. They are now saying that they made a "mistake" in covering the therapy in the first place, so they are not giving me the information or further credits to make the copays consistent.
Aetna not covering claims & giving false information over the phone.
My complaints with Aetna health insurance range from August 2009 to present. The claims are regarding therapy services for my daughter who has cerebral palsy. I have two major ongoing problems: Aetna representatives lied to me over the phone, telling me that more therapy than the 60 days written in plan would be available once her doctor wrote in a letter, and then Aetna denied the coverage for these claims stating it was not in my policy and would not stand behind the misinformation given by their employees that led me to continue therapy and then had to pay for it on my own. My second complaint is regarding the copay amounts for the therapy sessions that we did have, Aetna has retroactively changed the amounts of the copays, and credits have been issued to me, however the amounts are not consistent and Aetna now is refusing to give me a detailing of what the copays were, or show me where in my policy it states what the copays are. They are now saying that they made a "mistake" in covering the therapy in the first place, so they are not giving me the information or further credits to make the copays consistent.
A full accounting of all the problems I have had can be found on my blog: http://bit.ly/Chianna
Health Ins & disability pay - short-term
Complaints Board:
Aetna Health Insurance doing cost containment review through 3rd party consultant called ACCENT. Have worked at UPS part-time since 02/08. Accident at home on 10/30/09 and placed on STD on 11/04/09 which ends on 05/02/10 as far as pay. Aetna doing a cost containment review through consultant ACCENT. Didn't start using insurance significantly until 11/04/09 when rushed to the hospital. I have neuromuscular, musculoskeletal, cardiovascular and mental health impairments. They are looking for some way to drop me. Can you say Erin Brokovich. Very slimey people. UPS is better than this. I have never been paid on time resulting in my inability to pay for medications, copays, deductibles and transportation to appointments. This lack of timely payments has caused mental health relapses and rehospitalizations. Not a very good cost containment approach. Aetna Disability is doing a peer review. Their RNCM system is totally broker - slow and very impersonal. Recerifications all the time which cause delays. I've been a social worker for over 25 years and i have never seen such a horrible system. Think long and hard before you buy health insurance from Aetna. They like moving the ball and goal posts.
Glen Swift
UPS Part-Time Employee
Aetna Health Insurance
Aetna Disability
Veteran
The complaint has been investigated and resolved to the customer’s satisfaction.
Im sorry about you're health situation and for you're loss of inability to work. So you have worked for UPS for what 1 1/2 yrs, from what i read above...? I'm sorry that you think UPS or Aetna is lacking in "politeness" but as far as a "part-time, hourly" employee, how in the heck can you complain about being paid 26 week of 60% of what you were making before you're injury... I myself have been working "!@PART-TIME!@!" for 14 YEARS! How can you even sit there and bash the company or insurance for being "semiprofessional, rude, or following-up" on what is there job and what they deal with day-in day-0ut. I have been told that UPS IS if not the, but 1 of the best part-time jobs in the WORLD! So maybe you are under the influence of just not to happy right now, but I have not been the perfect employee at UPS but I darn sure cannot complain about anything EXCEPT that it take 10+ years pretty much anywhere in the country to get a full-time job. SO ENOUGH SAID and by the way, im on disability right now and was going to have a 2-level back fusion which was not worker's comp, and was going to cost around 50, 000+ dollars and 100% paid for..."FROM A PART-TIME JOB THAT PAY'S YOU'RE INSURANCE". So since the job market is so well off and Obama is getting us all those jobs for us wonderful American's, then quit UPS and go find another job that will support you're "disability's". I wish the best for you and you're recovery, and when you do find better job then PLEASE let me know, and you can post it on this website so the rest of America can go apply... GOOD LUCK and BEST WISHES
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 & 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.
Take Our Money, Won't Pay Bills
My fiance was on an Aetna plan through Cal COBRA (getting the coverage started was a three-month long nightmare in and of itself, but that's another story). For one reason or another (again, the subject of an entirely different complaint), it appears as though her coverage was cancelled as of 3/1/10 (not that we were notified this, of course). The premium check for the month of March had already been sent in and cashed, however, and now the office that cashed the check for close to $200 says that she's still "active, " yet the office that should be paying the bill for a standard doctor's visit says she's been terminated. They won't return the funds from the premium check, nor will they cover standard medical expenses for the period the premium covered--they are trying to get a free month's premium out of us for nothing!
I'm not about to roll over and take this, yet fighting them is an insanely time consuming process--no one we can get on the phone can answer a question, and we've been waiting for a call back from a "supervisor" for the past two weeks (with repeated calls from us to them in the meantime). This is only the last and most blatant piece of extremely incompetent or purposefully fraudulent activity we have been exposed to through Aetna; she is leaving COBRA early just to get away from them. Bring on the single payer system--it can;t be any worse than this!
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 ;)
Poor coverage
I had a chance to use my AETNA dental benefits which our employer so graciously provided us with. I had two dental offices tell me my coverage (for a root canal and crown) was below average. I ended up paying 60-70% of the cost of those two pretty basic procedures. People at both dental offices were even surprised and remarked (with laughter) how poor the coverage was.
Our company switched to AETNA at the beginning of 2009 and our coverage is far inferior to what we had before. We pay more than 600 dollars a month for health and dental.
The complaint has been investigated and resolved to the customer’s satisfaction.
Short and Long term disability
My wife received a head injury a while ago in a car accident. She was originally mis-diagnosed as being bi-polar, but over a period of time she had multiple problems at work (all related to her injury). She was terminated from work because she was not "safe" to work with patients. Two months after that she was tested and it was found she has moderate to severe brain damage. She is not allowed to drive now and cannot work due to her multiple symptoms. her employer who terminated her told Aetna that they support extending disability benefits to her and Aetna first told me she was eligible for benefits, but as soon as the first check was supposed to be mailed to her they went back on their original determination and are now saying she is not eligible for benefits since she was terminated from her job before the brain damage was diagnosed. The medical reports clearly state that her injury is from the accident, but they will not even look at that since they say she was terminated before we applied for benefits. Now that's insurance for you.
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 & 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 to 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
I got the bait and switch routine from Aetna. They got me to sign on with them by offering me a high deductable insurance plan for $190 a month. The deductable is $3000. Then they had an automated response that I was accepted but that my premium would be $251+some change because I have had hypertension in the past that is now controlled by a $4.00 a month prescription (as well as diet and exercise). I called and asked what the deal was and was old that they raised it by 25% because they could, and that it did not matter that the hypertension was under control. Then they also let me know that any effects that they deem to be cause by the hypertension were considered a pre-existing condition and would not be covered.
So why am I paying extra?
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 ;)
Short Term Disability
AETNA has the worst disability claims analysts i've ever seen and dealt with... they are rude, liers, and just deny claims so they don't have to pay out, and side w/ whoever the company you work for... they take their time and extend the appeals because they are too lazy to get it done right away.. I don't think the disability analyts there are qualified at...
Read full review of Aetna and 39 commentsRefusal 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,
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.
Aetna Reviews 0
If you represent Aetna, take charge of your business profile by claiming it and stay informed about any new reviews or complaints submitted.
About Aetna
Here is a guide on how to file a complaint with Aetna on ComplaintsBoard.com:
1. Log in or Create an Account:
- If you have an account, log in to your ComplaintsBoard.com account. If not, create a new account to proceed.
2. Navigating to the Complaint Form:
- Locate and click on the 'File a Complaint' button on the ComplaintsBoard.com website. You can find this button at the top right corner of the website.
3. Writing the Title:
- Summarize the main issue you have with Aetna in the 'Complaint Title' section.
4. Detailing the Experience:
- Provide detailed information about your experience with Aetna. Include key areas such as transactions, steps taken to resolve the issue, personal impact, and the nature of the problem.
5. Attaching Supporting Documents:
- Attach any relevant supporting documents to strengthen your complaint. Avoid including sensitive personal data.
6. Filling Optional Fields:
- Use the 'Claimed Loss' field to state any financial losses and the 'Desired Outcome' field to specify the resolution you are seeking.
7. Review Before Submission:
- Review your complaint for clarity, accuracy, and completeness before submitting it.
8. Submission Process:
- Submit your complaint by clicking the 'Submit' button.
9. Post-Submission Actions:
- Regularly check for responses or updates related to your complaint on ComplaintsBoard.com.
Ensure you follow these steps carefully to effectively file a complaint with Aetna on ComplaintsBoard.com.
Overview of Aetna complaint handling
-
Aetna Contacts
-
Aetna phone numbers+1 (800) 872-3862+1 (800) 872-3862Click up if you have successfully reached Aetna by calling +1 (800) 872-3862 phone number 0 0 users reported that they have successfully reached Aetna by calling +1 (800) 872-3862 phone number Click down if you have unsuccessfully reached Aetna by calling +1 (800) 872-3862 phone number 0 0 users reported that they have UNsuccessfully reached Aetna by calling +1 (800) 872-3862 phone numberCustomer Service+1 (855) 335-1407+1 (855) 335-1407Click up if you have successfully reached Aetna by calling +1 (855) 335-1407 phone number 0 0 users reported that they have successfully reached Aetna by calling +1 (855) 335-1407 phone number Click down if you have unsuccessfully reached Aetna by calling +1 (855) 335-1407 phone number 0 0 users reported that they have UNsuccessfully reached Aetna by calling +1 (855) 335-1407 phone numberMedicare Advantage+1 (800) 345-6022+1 (800) 345-6022Click up if you have successfully reached Aetna by calling +1 (800) 345-6022 phone number 0 0 users reported that they have successfully reached Aetna by calling +1 (800) 345-6022 phone number Click down if you have unsuccessfully reached Aetna by calling +1 (800) 345-6022 phone number 0 0 users reported that they have UNsuccessfully reached Aetna by calling +1 (800) 345-6022 phone numberMedicare Supplement Plans+1 (800) 307-4830+1 (800) 307-4830Click up if you have successfully reached Aetna by calling +1 (800) 307-4830 phone number 0 0 users reported that they have successfully reached Aetna by calling +1 (800) 307-4830 phone number Click down if you have unsuccessfully reached Aetna by calling +1 (800) 307-4830 phone number 0 0 users reported that they have UNsuccessfully reached Aetna by calling +1 (800) 307-4830 phone numberCoverage+1 (800) 633-4227+1 (800) 633-4227Click up if you have successfully reached Aetna by calling +1 (800) 633-4227 phone number 0 0 users reported that they have successfully reached Aetna by calling +1 (800) 633-4227 phone number Click down if you have unsuccessfully reached Aetna by calling +1 (800) 633-4227 phone number 0 0 users reported that they have UNsuccessfully reached Aetna by calling +1 (800) 633-4227 phone numberMedicare Helpline & Website
-
Aetna emailssocialmediacustomerservice@aetna.com100%Confidence score: 100%Support
-
Aetna address151 Farmington Ave., Hartford, Connecticut, 06156, United States
-
Aetna social media
-
Checked and verified by Janet This contact information is personally checked and verified by the ComplaintsBoard representative. Learn moreDec 06, 2024
- View all Aetna contacts
Most discussed Aetna complaints
I am having trouble canceling my policy and they continue to charge meRecent comments about Aetna company
I am having trouble canceling my policy and they continue to charge meOur Commitment
We make sure all complaints and reviews are from real people sharing genuine experiences.
We offer easy tools for businesses and reviewers to solve issues together. Learn how it works.
We support and promote the right for reviewers to express their opinions and ideas freely without censorship or restrictions, as long as it's respectful and within our Terms and Conditions, of course ;)
Our rating system is open and honest, ensuring unbiased evaluations for all businesses on the platform. Learn more.
Personal details of reviewers are strictly confidential and hidden from everyone.
Our website is designed to be user-friendly, accessible, and absolutely free for everyone to use.