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Aetna / Aetna Health Insurance

United States Review updated:
100% 5
Contact information:
Health Benefits Direct
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


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A  25th of Jun, 2010 by 
Agree Disagree +1 Votes
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:
860-748-8186 or 210-771-0214

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