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2.8 110 Reviews

Aetna Complaints Summary

49 Resolved
61 Unresolved
Our verdict: Dealing with Aetna, which has an average resolution rate, requires some diligence. Research their service in depth and read a variety of customer reviews for a balanced view. Approach any customer service interactions with detailed and well-prepared queries to facilitate a better resolution process.
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3:06 pm EDT
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Aetna Denied Maternity coverage 12 weeks into the pregnancy

My daughter has dependent coverage on my health insurance through my employer. In March of 2013, she became pregnant.
I downloaded my policy coverage and saw in the policy that pregnancy was covered.
I called AETNA to confirm that her pregnancy was covered. One of their representatives assured me it was.
My daughter's doctor called Aetna to confirm that her pregnancy was covered. The representative assured the doctor her maternity costs were covered and gave the doctors office an authorization number
Aetna paid the first 6 claims of my daughter's pre-natal doctor's visits.
The 7th claim they denied, the reason being her pregnancy wasnt covered.
I called aetna, they told me dependent's didnt have maternity coverage.
Basically they decided after 12 weeks she really didnt have coverage, after representatives on 2 separate occasions assured both myself AND her doctor (with an auth code) it was covered.
Now we have a huge financial problem. We can no longer go out and purchase a maternity plan with another insurance company as she is already 12 weeks into the pregnancy.
I have sent an appeal to Aetna. According to their website, it will take 30 days for them to even acknowledge anything one way or the other. In the meantime, my daughter needs pre-natal care.
What should be a happy, joyous time in our lives has turned into an insurance nightmare!

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Aetna Aetna Refuses To Pay Medical Claims

My medical follow-ups were refused, because Aetna failed to pay my existing claims. I contacted Aetna on numerous occasions and their representatives said the claims were satisfied. However, Aetna’s online resources reflect that the claims are not paid. Also, I’m refused medical follow-ups and being contacted by collection agencies for non-payments. The collection agencies forwarded this information to the credit bureau. Presently, I need medical attention & medication, but worried about accumulating additional unpaid claims. Aetna is causing me more medical problems and anxiety by refusing to satisfy the claims in question.

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Aetna claim denial

Being at age of 69.5 Aetna approved primary care physician directed me to get a shingles vaccination. His office doesn't keep the vaccine due to storage requirements. He said to go to a pharmacy to get the vaccination. I went to Kroger where I have had prescriptions filled for one time use (maintenance med.s require Aetna mail order). I got the $200 vaccination and Aetna denied claim stating Kroger wasn't approved as a provider. Perhaps it's due to me being a working senior on an employee plan they are handling my claim in this manner.

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Aetna Slow to pay

They are the rudest when you finally reach someone. They lied to me, and told me that my claim was approved, ONLY AFTER I told them that my reason being out was a nationwide LAW, so what was the hold up? I have been out of work, and without pay for 6 weeks now, and still no paycheck. So, 3 days later, I called to check on the status of my check, and there was NONE. So, I once again spoke to someone, and she said that they just approved it today. So, that where the lie comes in.
I bet that they would cut off my insurance if I didnt pay them, so where the heck is my money? Its Dec, and Christmas and I have depleted my savings account to live off of, hey, I didnt ask for breast cancer, you know, and the law states that if you get a masectomy that reconstruction is part of your treatment. I applied for this on Oct. 19, and now its Dec 13, and I have no money still.
HOW PATHETIC>AND SLOW>AND RUDE.

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Aetna Retroactive denial of benefits

My Aetna summary plan description clearly states that 60 visits per year are covered for physical therapy. Nowhere does it state that after 25 visits the PT would be subject to medical review. I underwent radial head surgery on New Year's eve and have undergone painful and progressively active-assisted physical therapy since mid Jan. I have not reached my maximum medical improvement nor my max of 60 days. Aetna's online claim tracker shows checks issued to my physical therapy office. However, last Friday I receive a letter that RETROACTIVELY denies payment for my physical therapy after March 8 based on a Clinical Bulletin that is not referenced in my summary plan description nor was ever mentioned when the member services told my PT office that I was covered for 60 visits prior to my even starting physical therapy. Aetna's plan misrepresents its coverage and to my detriment I relied on their written words and issuance of checks. It isn't a new tactic, on Oct 24, 2003, Aetna settled a federal lawsuit with doctors over the same issues. I am appealing as high as I can go, but I can't even reach a case manager cuz they hide behind their automated phnoe system.

According to a report on the lawsuit: The settlement requires changes and commitments in Aetna's business practices to eliminate "the worst of the improper practices involved in managed care." Among the changes, which will affect all doctors treating Aetna patients:

Eliminating downloading and improper bundling and computerized denial practices.
Establishing the standard of a "physician, exercising prudential clinical judgment" for "medically necessary services, and allowing cost to be considered only when an alternative service is at least as likely to produce equivalent results."
Creating a dispute-resolution procedure, using an independent external review of decisions regarding medical necessity.
Providing a facilitator to assist physicians in enforcing the agreement.
Creating a $100 million fund for physicians to recover some of their damages.
Establishing a foundation "dedicated to promoting high-quality health care."
The agreement also requires Aetna to pay lawyers representing the doctors $50 million in attorney's fees, including $6.5 million in expenses.

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SpeakUp2010
, US
May 05, 2010 7:44 pm EDT
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My Aetna summary plan description clearly states that 60 visits per year are covered for physical therapy. Nowhere does it state that after 25 visits the PT would be subject to medical review. I underwent radial head surgery on New Year's eve and have undergone painful and progressively active-assisted physical therapy since mid Jan. I have not reached my maximum medical improvement nor my max of 60 days. Aetna's online claim tracker shows checks issued to my physical therapy office. However, last Friday I receive a letter that RETROACTIVELY denies payment for my physical therapy after March 8 based on a Clinical Bulletin that is not referenced in my summary plan description nor was ever mentioned when the member services told my PT office that I was covered for 60 visits prior to my even starting physical therapy. Aetna's plan misrepresents its coverage and to my detriment I relied on their written words and issuance of checks. It isn't a new tactic, on Oct 24, 2003, Aetna settled a federal lawsuit with doctors over the same issues. I am appealing as high as I can go, but I can't even reach a case manager cuz they hide behind their automated phnoe system.

According to a report on the lawsuit: The settlement requires changes and commitments in Aetna's business practices to eliminate "the worst of the improper practices involved in managed care." Among the changes, which will affect all doctors treating Aetna patients:

Eliminating downloading and improper bundling and computerized denial practices.
Establishing the standard of a "physician, exercising prudential clinical judgment" for "medically necessary services, and allowing cost to be considered only when an alternative service is at least as likely to produce equivalent results."
Creating a dispute-resolution procedure, using an independent external review of decisions regarding medical necessity.
Providing a facilitator to assist physicians in enforcing the agreement.
Creating a $100 million fund for physicians to recover some of their damages.
Establishing a foundation "dedicated to promoting high-quality health care."
The agreement also requires Aetna to pay lawyers representing the doctors $50 million in attorney's fees, including $6.5 million in expenses.

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Aetna Deductions without permission

SRC Aetna began collecting payments from my paychecks 5 months after coverage had been terminated. Now I am fighting them to get my money back and to stop the insurance deductions. They refuse to dis-enroll/un-enroll me, even though technically I was dis-enrolled last August because I have other coverage. Its been a nightmare and now I can't go to work because they are taking my entire paycheck. It has been a month since they filed an "escalation" and nothing has happened despite numerous phone calls. CVS my employer won't do anything. So I've filed a complaint with the BBB, soon I will file with the state insurance department.

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Cat Hexis
, US
Jul 12, 2021 1:59 pm EDT

Almost the same thing, except it was from my bank account.

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Aetna Family policy

Where do I begin? Without going through every instance of denial, over charging, incorrect billing etc. that AETNA put me through - I will just tell you to never do business with AETNA health insurance. I paid over $6, 000 in premiums and they would not even pay for a $275.00 lab bill for my husband who has never been sick before in his life - and was not even sick after that. I filled out form after form, along with his doctor, that there were no pre-existing conditions. This was just bloodwork. And after talking to representatives from the Philipines (with all the money they make, they can't hire Americans?) that are robotic and will not even listen to reasoning, I decided that it was best for my family to not even be covered by health insurance. Why pay all of this money when you get nothing in return? SHAME ON AETNA - SHAME ON THIS COUNTRY - for allowing American citizens to be ripped off and robbed of their dignity.

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sdmember
, BG
Jun 07, 2012 3:47 pm EDT

what Diane implied I can't believe that anyone able to get paid $8690 in 4 weeks on the internet. did you read this website lazycash26.com

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Aetna Lying about Med Supp rates

I was told that my medicare supplement F was only $128 and that it was guaranteed not to increase. It did and I feel I was lied to. It increased to almost $200. This was not supposed to happen. I bought this over the internet and phone from Medigap 360 with an agent that I never saw that went by the name of Brad Jenkins in Austin, TX. I am going with another company locally that actually comes out to talk to me in person and will not lie to me. Thank God I am still in my six month enrollment. The other company is a bit more expensive but I am not being lied to (actually I would be paying more than $128 but less than $200. Don't trust this guy. He sits in an office in Texas and waits for the inevitable phone call guaranteed to make him money. Go with an insurance guy who comes out to see you and works hard to keep your business since he in on commission and not salary.

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Paulette Robertson Clardy
, US
Oct 18, 2017 3:44 pm EDT

I have used Medigap 360 for six years, and Brad Jenkins is my agent. He does not tell people that your insurance will not go up. He will find the cheapest one for you at the time. He can tell you what companies have a history of keeping their rates steady, and which one tend to have large increases... by their record. But, he definitely doesn't say rates won't go up.

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Aetna Claim denial of everything

I began having terrible pain in my right leg in March 2011. I worked as a server at UNO Chicago Grill in Orlando.I started in October 2010. I believe in insurance and thought it was an attractive perk. I signed up for the max and best quality immediately. I complained several times to my boss when I never received my card. Several visits and increasing pain was masked with pharmaceuticals. The meds were 10 and 15 dollar co pays according to my paperwork. Several denials and endless calls led to fasceous remarks that only $500 was covered per year, when plainly stated $500 per month. I was ridiculed at work because of the pain. Totally humiliated in fear of loosing my job I took medical leave. I'm 30 years old and in need of a total hip replacement. I'mmediatly they began denying claims and inundated with confusing denials and threats to drop. My employer said I no longer worked their. I offered to even roll silverware to help pay premiums. I lost everything depleted all my savings, unable to work, denied government help and unemployment, suffering in constant pain unable to walk and refused surgery by three orthopedic surgeons, only to be dropped almost a year later drowning in debt and medical bills unable to finish my last year of college. I'm growing weaker by the day and scared and disgusted, alone. Worthless. How is this right? My doctor wont even see me.

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Aetna 25% up-charge Because of $7.51 Rx

AARP Essential Premier Health Insurance Plan. Aetna charged me a 25% up-charge because of a $7.51 Rx that had a total annual cost of $30.04 to $37.55. I even paid 100% of the total cost. Now I don't need the Rx and Aetna refuses to lower my rate with a letter from my doctor. They require me to complete another 5-yr look-back application so they can look for a "new" pre-existing condition (just as if I were a new applicant) and they requires 6 months of additional up-charge premium before they will even consider a lower rate.

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Paulbflo
, US
Feb 04, 2012 8:51 pm EST

Call your state attorney general

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Aetna denial of coverage

After four years of chronic, disabling gastric pain, last year my wife was finally diagnosed at the Cleveland Clinic and a method of pain treatment was strongly recommended by two of the best doctors in the world in this field. After months of appeals, Aetna's final decision was to deny her the care. Her only recourse has been and apparently will continue to be morphine, which is an incredibly poor substitute for long term care.

Now my young daughter has been diagnosed with fibromyalgia and another team of the finest doctors in this area of medicine has stated that an inpatient treatment program would give her the greatest opportunity to successfully deal with it. Again, Aetna has said the treatment was not "medically necessary."

Aetna practices health care denial, not coverage. They second-guess world-renowned specialists, and abandon patients to suffer in pain.

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drummer51
hackensack, US
Aug 20, 2010 2:47 pm EDT
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Aetna recently denied my request for neurosurgery on my lower back to correct severe pain, by sending me a letter stating that " an Aetna panel of experts, led by a board certified obstrician and gynecologist has reviewed your request for neurosurgery on your back, and have denied it." I am a 62 year old male, and I am not pregnant! Why on earth would an ob-gyn ruleon my request for neurosurgery?!?

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drummer51
hackensack, US
Aug 21, 2010 11:00 pm EDT
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Thank you Erin, that is very helpful info and I will follow up with Aetna.

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UncleBob
Texas, US
Aug 20, 2010 4:42 pm EDT
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It sounds like you are ready to change your PPO as soon as you can. Have you tried AARP Secure Horizons?

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Aetna Denial Letter will not Pay

My mother passed away on June 18th, 2009. My father had AD&D insurance with Aetna through his employer. The Medical Examiner ruled my mother’s death an accident. My father recieved a letter from Aetna in September stating that all claims will be processed. Six months later, still nothing from Aetna! I told my dad to call Aetna to see what the hold up was. That’s when the nightmare started! Aetna was saying that they never recieved the correct paperwork. The Human Resource Dept. told my father that they sent over everything to Aetna.

It was back and forth, back and forth. Finally, my dad recieves a denial letter from Aetna. At the time, I worked for an attorney. He requested a copy of the policy. After going through the policy with a fine tooth comb, he contacted Aetna with evidence that Aetna should pay! Then Aetna sent out defferent print outs of reasons why they wouldnt pay. none of it makes any sense! Needless to say, I’m not going to let this go! We have hired an attorney to sue Aetna Insurance! Its not the money, because no amount of money will ever bring my mother back, its the principal of the whole thing.

The insurance company trying to get over on the little man! NOT THIS TIME BUDDY!

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Aetna Fraud

State Corporation Commission
Virginia Bureau of Insurance
PO Box 1157
Richmond, VA. 23218
Charles Sisk Jr. Fax [protected]

County of Delaware County
Consumer Affairs
201 West Front Street
Media, PA 19063
Roslyn Jackson

Aetna Disability Insurance Company
PO Box 14554
Lexington, KY. [protected] Fax [protected]

Commonwealt of Pennsylvania Insurance Department
Bureau of Consumer Services
1209 Strawberry Square
Harrisburg, PA. 17120
Attn: Brian Cristini

Pennsylvania Insurance Board
(Philadelphia Division)
801 Market Street, Room 6062
Philadelphia, PA 19107
Fax: [protected]

Bureau of Consumer Service
Insurance Department
1209 Strawberry Square
Harrisburg, PA 17120
Fax: [protected]
E-mail: [protected]@state.pa.us
www.insurance.state.pa.us

NAIC Corporate Office
444 North Capitol Street NW,
Suite 701
Washington, DC 20001
[protected]@naic.org
[protected]@naic.org

August 3, 2011

I would like to know how you can allow an organization such as Aetna Insurance to keep their license, and fraudulently take peoples money without any consequences.

I am once again writing to tell you that Aetna Life Insurance Company has again threatened to stop my LTD Benefits, stating that THEY found I am capable of doing some sort of work, even though my treating doctor has stated that I am totally incapable of work. (Letter from my physician enclosed).

Today, August 3, 2011 I received a call from Peggy from Aetna Life Insurance stating that AETNA has determined that I can in fact return to some sort of work and they will stop my checks of $244 a month.

This is AGAINST my treating doctors orders.

For two years Aetna has attempted to stop the benefits, WHICH I AM ENTITLED TO, for my LTD, which I paid for through payroll deduction. Today, they have determined (without ever even seeing me) that I can go back to work, and they are stopping these benefits.

In March 2011, my doctor was sent a Capabilities and Limitations worksheet which he filled out, (I am sending a copy), stating in writing “TOTALLY DISBALED.”

In April 2011, Aetna tried to say they were stopping my benefits because my doctor never responded to their letter. When I told them that he did in fact return it because I have the certified letter to prove it, they suddenly found it.

In May, 2011, another Aetna Rep called me and said they were going to stop my benefits because they never received an answer from my doctor. Again, I had a SECOND certified letter receipt stating that I had RESENT the doctors answers to them.

Again, they found that they had indeed received it.

In July 2011, I received another Capabilities and Limitations worksheet from them. (This is the same exact letter my doctor filled out twice and sent back to them since March), and again they stated they did not receive it.

Once again, I have a 3rd certified letter stating that I did in fact send it to them. My doctor got to the point that he said he cannot continue to fill these out every 3 weeks for me.

I am sending you a copy of my doctors signed sheet stating in plain English, “Totally disabled from employment”, yet Aetna is now playing God and saying I can in fact work.

I am seeking legal assistance in filing a suit against Aetna.

Sincerely,

Robert Hearn
Control # 622733

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Aetna Preventive care not paid

AETNA has sent me a brochure and email advising myself and family to take annual preventive check up with my Doctor last year end. I paid my premium for the entire year and went for the physical for first time. ( Annual physical is 100 % covered without deductible per AETNA !) Doctor prescribed a routine blood work and I went to Quest for lab. I did not take any prescription from the doctor nor was any problem reported except I took flu shot. When the lab results came out and reported that I have a little cholesterol ( Any adult above 40 has little cholesterol in these days !). AETNA denied my claim saying that it is a sick visit and I have to pay from my deductible for both doctor visit and lab . Thus I see the email and brochure that Aetna sent out is a scam between doctors and lab people to get more business and get your money . AETNA has no ethics in their business. Don’t ever join their plan.

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Aetna Worst Health Insurance

Aetna has major problems with it's customer service and website which is not user friendly. I am working 3 part time jobs so I have very little time to contact Aetna. I wanted to upgrade my insurance but I'm told I need to reapply.. i've gone to website and have no clue where to go, I've called 3 times and the last they were supposed to mail me the form, . This was 3 weeks ago;. In fact, I have called Aetna on 4 different occasions and asked for things to be mailed and never received anything". Question: Are there any real people that work for Aetna!. Someone cashes my check every month with no problem;. The joke is that they send me emails requesting feed back and they never ever call me or respond'. Aetna-you deserve an "F" and I am looking elsewhere since you were too *** lazy to even mail me a lousy form I requested.

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Aetna failure to fill requested prescription repeatedly

I have had my doctor's office fax in a prescription for celebrex twice last week, June 1st and 2nd. It has been a week and still my prescription for celebrex has not been received, according to the Aetna RX Home Delivery. Originally I was turned down for the prescribed dose that my docter recommends and now that I finally have the okay for a half dose, I cannot get them to fill it. I am over 60 and suffer from severe joint pain in the knees and hips. I have gone without this medicine for over a month. I am very frustrated with this HMO.

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Aetna NO Coverage At All

Aetna is without a doubt the WORST health insurance you could purchase. It's a rip off and a total waste of money. I got this garbage insurance through my workplace last August. I work part time and they took $89 a paycheck out for their worthless insurance. I have made 2 Emergency Room trips since August and Aetna has paid a grand total of $400 towards the bills. I am now $8500 in debt. They pay for NOTHING. I dropped them this morning and was told I have to keep paying on the policy until July 1. What a joke! AVOID AETNA LIKE THE PLAGUE!

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SSOAB
Jacksonville, US
May 06, 2011 10:35 pm EDT

You are so right. You may as well not have insurance. Keep your money because you are going to need it, to pay the medical expenses, that they are not going to pay.

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Aetna 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.

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Aetna 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!

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Aetna 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!

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lmm cpht
Harford, US
Aug 25, 2014 6:39 pm EDT
Verified customer This comment was posted by a verified customer. Learn more

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!

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