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Aetna Health InsuranceOutraged

Aetna has prohibited Houston members from receiving Airrosti therapy (rapid recovery therapy) on a self-pay basis for the past two months.

Airrosti was an Aetna participating provider. Airrosti physicians perform their services within primary care physician’s offices here in Houston. The problem began when Aetna and Airrosti entered in contract

negotiations two months ago. Aetna threatened their PCP'S with contract violation and possible contract termination if their Houston members

received Airrosti therapy on site. As such, Houston Aetna patients couldn't receive Airrosti therapy on a cash or out-of-network basis.

Aetna's legal department recently ruled that members could receive Airrosti services on a self-pay or out-of network basis. Such services

would be process under Airrosti separate tax ID. Aetna's recent communication

to their PCP's reiterated the risk of contract violation and termination if PCP's violate their fiduciary responsibilities to Aetna by referring

to out-of-network providers.

It is illegal for a health care provider to limit access to medical services for their members on a self-pay basis. Aetna commands approximately 30% of the Houston patient population.


  • Ti
    ticked123 Feb 20, 2009

    I am so tired of hearing people moan and groan about insurance companies denying them services. What people fail to realize is that the bottom line with services that are not covered or denied for whatever reasons is that 9 times out of ten if a procedure or service is not covered it is the fault of the employer that group insurance policies are obtained through. A perfect case in point is Bariatric surgery I cant even tell you how many times I have talked to someone that is totally outraged over the fact that Aetna or another insurance carrier is denying a medically necessary procedure. I have never heard such a whiney society! First of all, the customer service rep that you call and yell and scream at because you need this surgery because you are morbidly obese cant do a thing to change the fact that this is not covered; Have a conversation with your employer if you are ticked that you cant have this surgery. I am the first to admit that Bariatric surgery is a necessity for some people but for all of you people out there that want to eat whatever you please and gain tons of weight and then have an invasive surgical procedure to fix it don’t expect your insurance to cover this. The deductible and co insurance rates as well as co-pays are no exception to this rule, the employer works with the health insurance carrier to put together a plan that the employer can AFFORD. In reality if they pick the lower co-pay or deductible they are going to pass that expense along to you in your premiums, then everyone will complain about their premiums, which again the health carrier has NOTHING TO DO WITH. We as a society expect that everything be free in life, especially health benefits. NEWSFLASH nothing in life is free and anything pertaining to the health care field is going to be expensive. Don’t expect to get insurance or health care for free because its not going to happen. It is very frustrating to take calls from members who are screaming and yelling at you about things that you cant change and have nothing to do with. So the next time that you get on the phone and are screaming profanities at the customer service rep think twice about where your anger should be directed. Your plan is mostly based on what your employer is willing to pay for and what they want YOUR premiums to be. Think about this, you don’t buy a car without first doing research on the vehicle luxuries and gas mileage you want to get the most for your money. When its time to renew your benefits do some research LIKE YOU WOULD ON ANYTHING ELSE YOU ARE SPENDING MONEY ON!

    0 Votes
  • Jd
    J don gordon Sep 19, 2008
    This comment was posted by
    a verified customer
    Verified customer

    Aetna has provided my wife and me great service over the past nine years.

    Surely there are always complaints about Health Insurance Providers and Physicians and other Health Service Providers. However, these complaints are small in number in comparison to the total amount of service provided.

    I have had my issues with Physicians; however, we are not perfect; and we can not expect them to be perfect. Nor can we expect our Insurance Providers to be perfect.

    They do not resolve all of our complaints and health issues instantaneously or perfectly and should not be expected to do so. They do the best they can as each of us does.

    I suggest we each give thanks daily for our Physicians and other Health Service Providers and our Health Insurance Providers.

    They have many dedicated people who are compassionate and caring and who have to deal with the same people in the Healthcare System each of us has to deal with.

    Let us work for improvement, not perfection, a step at a time, a day at a time. Let us work together. We seem to get further that way.

    By the way in case you are wondering, I am and have been a senior accountant in industry for some thirty years.

    Let us all breathe deeply several times, in and out of course, release slowly and welcome the state of peace, grace and thankfulness, which comes with this process.

    J. Don

    0 Votes
  • Je
    Jeff Sep 09, 2008
    This comment was posted by
    a verified customer
    Verified customer

    Situations involving ones health become such a testy and important event. No one feels like taking chances or playing games when they are not well. And who can blame them. I hope health insurance providers come to their senses or they will only give more ammunition to the people who want to nationalize health care. It's a delicate situation.

    0 Votes

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