Aetna
reviews and complaints

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.

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they need, but find it incredulous that they can pay me for two years and then decide that my chronic condition is no longer valid.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!

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!

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!

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.

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.

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.

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!

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.

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.

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.

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.

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

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

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!

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.

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.

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?

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,