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Aetnaclaims

Review updated:

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.

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Comments

  • Ja
      Jun 25, 2010

    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 ;)

    0 Votes
  • Ja
      Jun 25, 2010

    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]

    0 Votes
  • No
      Aug 23, 2010
    Aetna - Never ever use home delivery
    Aetna
    United States

    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.

    0 Votes
  • Mc
      Oct 28, 2010
    Aetna - Refuses to pay my supplemental income
    Aetna
    United States

    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.

    0 Votes
  • Mi
      May 20, 2011
    Aetna - lack of benefits
    Aetna
    Arizona
    United States

    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.

    0 Votes
  • Mo
      May 20, 2011

    Maybe you should just change doctors. If your complaint on here is real, then your doctors office is taking advantage of you. I get my lab etc. results and never have to pay a co pay for it, they tell me over the phone. As for the wellness visit, they get paid more from your ins. co. if its an actual office visit as opposed to a wellness visit, so they basically scammed you. I'd dispute with my ins. company. And I'd change doctors.

    0 Votes

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