Consumer Complaints and Reviews
I recently was informed by Aetna that a claim needed specific information from me to be resolved. So after several emails and phone calls to both Aetna and my doctor. I found out what they really needed was a diagnostic code - something I would never have. I asked that a Vice President explain this to me. I wanted to see if management would also be dumbfounded by these events. What I was told was even more dumbfounding - a Vice President cannot reply to my email. Whoever heard of a Vice President that cannot use email? I guess Aetna has.
I am insured by Coventry. I was told by my Coventry representative and doctor's office to use Aetna Specialty for prescriptions I needed. I was told it is the only pharmacy I could purchase from to use my Coventry benefits on these medications. I called to get prices so I could comparison shop. (Walgreens and Freedom gave me base prices over the phone without a prescription having been processed, so I assumed Aetna would.) I called the number on my doctor's Aetna medical request form. I pressed "8" as instructed by the automated message because I am a Coventry member. When a human finally answered, she asked for my member ID.
Long short - they had no knowledge of why I was calling them if I have Coventry and not Aetna. The Aetna rep expected me to say "Oh! Silly me for calling the wrong insurance company", hang up, and never bother her again. Instead I persisted. They passed my call through to another department. Each time I explained that I was calling for prices and that I'm a Coventry member. On the 5th transfer, the representative finally acknowledged that I called the correct pharmacy. Unfortunately, she informed me that I could not get prices without a prescription. I was angry, but thought, "Ok, they have a policy. I'll call back after the prescription is run through."
I waited a few days and called back after confirming that the prescription had been sent to them. Again I went through the business of them wondering why I called Aetna as a Coventry patient. I was passed along to 4 different reps and then told to call Express Scripts (the pharmacy Coventry uses for non-specialty drugs). Needless to say, that was fruitless. I continued trying each afternoon when I got off work to get prices from them. It took 13 days and a call from my Coventry rep for them to give a cost. The cost was quoted to me by my Coventry rep - not Aetna. She had acted as my advocate.
Next struggle - getting them to apply my 50% benefit: When I finally was able to get them to acknowledge my order, they would not give me my cost once benefits were applied. (I knew what my benefit was and could calculate it myself, but was afraid something wouldn't be right on their end after all the craziness I had experienced. Side note - this order cost about $5,000 out-of-pocket.) The first evening their reason was: "This was run through pharmacy benefits instead of medical, so we cannot give you a price." She said she would send an e-mail to the insurance department since they are only available by phone until 3:00, and I'd receive a phone call the next day.
There was no call. I tried again. This time the answer was "We do not give out costs until it is run through insurance and yours has not been run. I will expedite this and you will receive a call by noon tomorrow." There was no call. I tried again. This time the response was "We do not run claims through insurance until the day the drugs are processed for shipping." Me: " So how will I know the price of my order? What if I cannot accept the order because I cannot afford it?" Crickets... The next day was more of the same. I called my Coventry representative again and she took care of it.
As far as pricing, I only bought half of my prescribed medications through them. The other half cost less paying full price at another US pharmacy. The other pharmacy was easy to use, and they send a UPS tracking number via e-mail so you have an estimated time of delivery. Aetna sends you nothing. I was toId that I could call them to get a tracking number, but I just couldn't muster up the patience to call them again.
Aetna in Denver, Colorado is not adding new eye doctors in Colorado. In order to reduce costs, they feel that it is better to not add doctors, so waits to see doctors are longer so they pay out less money. Terrible patient care.
I am an Aetna subscriber suffering from a severe case of cervical stenosis resulting in pain, discomfort, and numbness of my extremities (arms, hands mostly). There are two methods of treating this condition. One is Cervical Disc Arthroplasty (CDA) which has been a mainstream surgical procedure for the past 6 years. It is far superior to the alternate approach Anterior Cervical Discectomy and Fusion (ACDF) which has been around for approximately 50 years. CDA has a higher success rate (96% compared to 92%). CDA has a faster recovery time (6 weeks vs 6 MONTHS). CDA has no impact on neck mobility following the surgery, whereas ACDF limits neck mobility due to the fusion of one or more discs. CDA has lower risk of other complications whereas ACDF has a high tendency for bone spurs to form at the graph sites resulting in further complications and possible additional surgeries.
Yet with all of this information, Aetna refuses to approve the CDA surgery for its subscribers because they consider it to be an experimental surgery. Interesting. Do the executives at Aetna still drive cars from the 60s and 70s because they consider current models to be experimental models? Come out of the dark ages Aetna and embrace the advancements being made in the medical field. The good news... Aetna still approves the use of leeches for various medical conditions.
Aetna employs "customer advocates" as a facade for service when in fact they sit at a desk and reiterate everything I can see in front of me on my computer and they don't know or do anything else. As customers all we're doing is lining the already bulging pockets of the CEO and his lemmings. Aetna Inc. Chief Executive Mark T. Bertolini's compensation was valued at $17.3 million last year, up from $15.1 million in 2014, reflecting higher stock and option awards. Mr. Bertolini received a base salary of about $1 million and a bonus of $1.84 million. While we pay extortion prices on our monthly premiums for BS care and helpless "customer advocates."
I can get preventive care for my colon, but not for my skin in sunny Arizona. A Dermatology checkup must not pay as much as a colonoscopy or I can be poisoned by a vaccine, but I can't be checked for melanoma because it's not covered in the crap Aetna Plus Plan with a Premium of over $450 / month. Aetna has cornered the license to steal from its customers and does so with no qualms. Karma Baby!
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I logged onto Aetna.com to "join the network" and filled out an application request. It apparently "submitted" with a note that I will be notified in 7-10 days that they received it. After that, I went back on the website to register an account so I can log on and check status. Here is where the problem begins. There is no clear way to do this. So I contacted the number that came up for help but all that happened after that was the typical Aetna experience (transfer-transfer-transfer-transfer). Every person asks me for my tax id number and I tell them it will not come up because I'm not in your system yet and all I want to do is register an account with an ID and password.
A couple months ago I tried to get on with Aetna and same thing (transfer-transfer-transfer-transfer). It seems nobody can answer the simplest question: Who can help me register an account? Basically the problem is, they ask me my ID number then tell me "it's not coming up." Then I tell them the story "I'm not in your system yet because I just filled out the application. How can I register an account online so I can check information and status?" and they send me on the same wild goose chase I went through 2 months ago.
Occasionally, I get someone asking me "who transferred you to me" and honestly I usually cannot tell them because I've been transferred too many times and I am utterly confused and fed up at that point. Once in a while I get empathy "Oh I'm sorry you are going through this" and then they quickly revert back to what they said before and transfer me again. I have never experienced anything like this before with any other insurance company or any business/company/organization for that matter. I am extremely hesitant to become a provider for Aetna at this point even if they get back to me saying they accepted my application. I can only imagine what it is like to file a claim if it's that hard just to join the network.
I had 2 eye surgeries in June and July of 2015 to treat a malignant tumor on my retina. I had Aetna through my employer. There was only one facility in New Mexico that could perform both procedures which included a retinal surgeon, oncologist and the handling of radioactive materials implanted in and then removed from the eye. Aetna does not contract in the state of New Mexico, and I was hard pressed to find 2 surgical teams in a neighboring state, because of the size of the tumor and the danger that delay would risk of the cancer metastasizing elsewhere in my body.
After weeks of trying to get Aetna to approve the facility as in network, they finally told me I would be approved. (The surgical scheduler and the retinologist's nurse had to intervene on my behalf several time to explain why I had to have the procedures done at the particular facility). I was never sent an explanation of benefits, and paid deductibles and co pays as I was billed. In February of 2016, 7 months later, I received a bill from the hospital for $6,000. I called the facility and was told by Lovelace that Aetna had made and then retracted the adjustment. For the next 8 months, I called Aetna and was assured my out of network costs had been approved and that they would pay the balance, and that it was in error that the facility was balance billing me.
The threats to send me to collections continued each month. I had to connect patient account reps with Aetna reps each time, and had to ask Aetna to send copy of contractual agreement to facility and was told each time that contracts were being reviewed. I just received a notice saying the bill would go to collections immediately.
I called Aetna and spoke to a senior rep and she told me that the chance to appeal had expired after 180 days. I told her I only learned there was a balance due 210 days after the surgeries. She told me I had never been approved in network, that Aetna had only agreed to pay 100% of contracted amount. They also billed me for $1000.00 out of network deductible as well as my standard in network deductible. She said there would be no further appeals but I could file a complaint. I asked for written transcripts of all of my recorded phone conversations and she said Aetna does not have to provide those. I contacted the hospital and they put me through to a senior billing specialist and she told me that the senior rep with Aetna had resubmitted the contract after the grace period had expired, and it did not include proof that I had been approved as in network, that benefits would be paid to the highest level.
The Lovelace rep I spoke to said that Feb. of 2016 was when they learned that the contractual agreement had been altered by Aetna and resubmitted only after my chance to appeal had been exhausted. She said it was common practice within the industry to proceed in good faith on the part of the insurance companies that they will pay the amount as in network, or on the agreed upon price. She told me she had heard many stories exactly like mine, all involving Aetna as the insurance company. Lovelace had multiple conversations with Aetna reps and were told repeatedly the contracts were being reviewed and that they would pay the balance. Lovelace did confirm that the bill would be going to collections in the next week or so, and at this point my only hope would be to try and negotiate a lower balance or payment schedule.
It is just deplorable that an agency is allowed to deliberately deceive the patient, refuse to pay the facilities, and alter contractual agreements after the insured and the medical facilities have been approved for payment. I am currently unemployed and my credit is going to suffer because I cannot afford to pay the minimum that Lovelace requires. Please, there must be some way to prevent these practices! I pray that there will be a class action lawsuit against these crooks!
My doctor of many years entered a small medical group about a year ago. Tossed from doctor to doctor who don't know my history and don't take the time to know me. My refills before were next day, then it jumped 72 hours without notice. My fiance saw the doctor on regular appt. Calls 2 weeks later and was told he must go in again to see the doctor?? WTH he was just there 2 weeks ago. Now Aetna makes it mandatory to see the doctor every month. Again WTH?? Who can miss this much work? And who's going to pay the copay? Then after all my history with Kaiser specialist these IDIOTS are saying I have to see pain management who won't refill until after a 2-3 hour sedated procedure to have deep shots. How will this help my arthritis? It can't. Aeta shove your insurance and rules where the Sun doesn't shine... going back to KAISER.
PS: saw an older man at Walmart 90 plus years, I see him get out of car grab his walker with seat. 15 minutes later he's in the pharmacy line. AETNA won't allow his pain meds sent through drive-through. WTH is wrong with you dumb asses??? Answer EVERYTHING!!! My company is not renewing with AETNA Oct 1st. BYE BYE IDIOTS. Sorry in so much pain, can't sleep, eat, sit, lay down because our refills are held hostage.
Aetna is a joke! Almost one year and they still have not paid on a hospice claim of $3,600.00 for my mother. Her insurance policy pays for hospice nursing home room and board at 100%. We have spoken to supervisor after supervisor who have given us the same old line of "oh yes. We understand your frustration and we certainly will get to the bottom of this", only to have no one get back to us and no bill paid.
Upon calling Aetna time after time we have heard every excuse in the book as to why they have not paid. From "we need the Medicare explanation of benefits" which we personally faxed to them 8 months ago, to "the nursing home has not billed this correctly ", yes, they have, to "we have never received a bill from the hospice provider", which we personally faxed to them also. We have turned this over to the PA Insurance Commissioner. We are also seeking legal counsel on our own to sue. This has been a nightmare and the emotional damage we've had to endure from reliving our mother's final days over and over again is just unreal. Do not ever willing choose Aetna as your insurance provider. We have nothing good to say about their customer service or their coverage.
I called today 8 times... They disconnected my conversation 6 times... Spoke to james ,gerald and roslyn etc. I think due to them getting out of obama care, they are doing disservice and poor service to force consumer away from obamacare... which is ridiculous... and outrageous. Poor business practices. I request department of consumer affairs to investigate these practices.
Their doctors also doing poor services systematically. Doctors will make you wait for longtime in the offices... They will see other patience first purposely. So you can question them... and their office staff will tell you that I have different insurance. It happened to me more than two times. It's an organized crime they are committing and nobody to question these practices. When all these will stop. When government gives them the contract, they should sign to be penalized for these kinds and other frauds they commit to the consumers/Public. Poor people don't have time to complaints?????
In brief: I have never had insurance like AETNA. In my life I've had Kaiser, Blue Cross, Blue Shield, and now AETNA, so I do have some basis for comparison. But AETNA denies just about every claim. It's always the wrong provider, wrong lab, wrong pharmacy, wrong EMERGENCY SURGEON (yeah, you can guess that emergency appendectomy story is a fun one!) It's really, really bad folks. I even call AETNA member services to confirm whether or not something's covered before I do it. But it seems, even I am not clever enough to outsmart them. Because AETNA member services LIES. They will tell you what you are doing or who you are seeing is in network, when it isn't. Only months later will you find that your claim has been denied.
Honestly, now, what that teaches me is either: 1. Don't seek any health care- emergency, preventative, or otherwise. or 2. Be ready to come up with $1000's if you dare to ask. Gee - I guess I'm going to wait until I'm really sick then! I wonder how many people are going to make the same choices, possibly endangering their health, or worse, die waiting for "in network approval"...Class action suit. I am in. AETNA needs to buck up and be a provider of services, rather than a denier of services.
I have had to Neurosurgeons agree that a spinal fusion is necessary to alleviate the excruciating pain that I live in. Four times Aetna has denied the surgery. The first surgeon having had experience with Aetna refused to do the peer-to-peer knowing that they would deny the surgery anyway and all it would do is take time from his other patients. The second surgeon submitted a letter explaining why he felt the surgery was necessary and again they denied it. The doctor even took the time and did the peer-to-peer and they denied it.
My doctor told me that there was nothing more he can do for me until I changed insurance companies because there was no way Aetna would approve the surgery I need. I'm sure these people that make these decisions have no medical degree. They figure at the end of the year you will change insurance companies & become someone else's problem. I live on pain killers that don't really help anymore and surgery is my only hope. Stay away from this company!
Aetna denied my prescription twice for the doctor at 2 different pharmacies. The doctor's office got involved and Aetna agreed to fill the prescription using "their" pharmacy. This prescription is now 6 weeks old and has never been sent to me. When I spoke with Aetna's "special pharmacy" they have been sitting on the prescription for 11 days and haven't shipped it. They are doing this because of the extremely high cost of the drug. Denying someone these things should be criminal when they are just trying to curb their costs for 6 weeks. This is saving Aetna a lot of money by delaying the shipments. There is no way that I am the only person that is experiencing these issues with this insurance company.
Has anyone contacted any lawyers for a class action lawsuit against Aetna? Aetna also had me under 2 different policies charging me the deductibles for both because they messed up the accounts. I took months of dealing and paying 2 deductibles before they changed the accounts and put me under the one that I actually signed up for.
December 18th, 2015 my wife was sent to the emergency room with what turned out to be a stroke scare. Thankfully it was a much lesser condition but we still incurred an emergency room visit, ambulance transport, and 2 days of observation in the hospital. At the time, we both were covered under the L-3 Aetna Gold plan. My experience has been misery inducing to say the least.
The biggest issue is with the two day observation. This occurred at Lovelace Downtown and initially Aetna indicated that they would pay on the claim. This lasted three months. We were then informed that Lovelace Downtown is not in Aetna's network nor was pre-certification obtained and we were responsible the entirety of the $20,606.63 bill. In terms of pre-certification this is false. The Lovelace emergency room did obtain pre-certification and I provided it to Aetna multiple times over the past five months, to no effect. Last month Lovelace threatened to send me to collections over this.
On top of that, there was an additional bill for the emergency room visit to the tune of $7,116.50. Initially Aetna paid its portion and we paid our responsibility and I thought the matter closed. I was informed two days ago that Aetna has retroactively denied this claim as also being from a non-covered provider and took its payment back, leaving me additionally burdened with the unpaid balance ($6,500 or so). This is in spite that clear statement on page 22 of the benefits guide that states, clearly, that emergency services are covered. To say that Aetna has provided both myself and my wife with months of stress and heartburn is an understatement. The fact that we are getting this kind of runaround when we were under the most comprehensive plan offered borders on the ludicrous.
Aetna is ruining my life!! Hello, I'm KL, I'm 34 and 11/12's years young. ;) I suffer from several disorders that keep me on several medications around the clock, which also come with having several specialists. All of my many "- ologist" 's are treating me for one thing or another. I had Blue Cross Blue Shield for 2 years. During that time, I had all the MRI'S, CT scans, EEG's, ultrasounds, etc. I rode the roller coaster of adding new meds, increasing the dosages, decreasing the dosages, getting another medication to try, stopping another, more medications for the side effects of other medications... You get the picture.
I've finally gotten to the point where I am on the right medications and am seeing the right doctors. My conditions are improving and I'm starting to get my life back on track. All of this, until BCBS canceled all PPO plans in Texas as of 12/31/15. I reviewed 75 medical plans. I read all the brochures, I read all the coverage offers, I thought about premium and out of pocket costs, I learned everything about the plans that I could have through and through.
I ended up choosing this Aetna plan because even though my out-of-pocket max is 4 times my old plan, it was the only plan that covered all of my doctors with whom I've built a rapport and where each is aware and knowledgeable of my medical history through and through. Here comes January, 2016 and the transition from BCBS to Aetna begins. One by one, about half of my daily regular medications get rejected. One by one, none of my doctors are receiving payment from Aetna. One by one, my doctors have been forced to dismiss me as a patient due to Aetna's criminal negligence of my health.
I'm at my wit's end and don't know what to do. You can't screen shot their site (Unless you own 2 phones and can use one to record the other because it's privacy blocked). I miss my doctors!! It's terrifying to have to look for new ones who don't know what's going on. It's terrifying to get thousands of dollars of medical bills in the mailbox every day. I never would have given this plan a second glance if I knew that they wouldn't cover my "dream team," which consists of carefully chosen physicians who are on the same page with my health. They take great care of me and should be compensated as soon as possible. That is no easy feat either, it took me 2 years to get to this point.
When you call Aetna, it's a crap shoot of whom you'll be speaking to and what system they are on. I've had several reps CONFIRM my doctors are approved in network, while I've had other reps say no, about the SAME PERSON! I'm 3 days out from becoming very ill when my medications run out because I still don't know where to go, or who to see.
To add insult to injury, Aetna sent a warning letter out to all of my doctors informing them that I see several docs at once, as well as informing them of what medications I'm on. The letter I received spoke about getting me help during the "transition" now that all my docs know of all my meds and would probably stop prescribing them.
How idiotic can 1 company be?? First off, all my doctors know what I take. I'm not looking to die because of a contraindication, not on my watch. Also, the reason I have all those doctors are because they're my specialists!! I have a primary doc, neurologist, endocrinologist, rheumatologist, pain management doc, cardiologist, gynecologist, pulmonary sleep doc, and they are lucky that I no longer need my chiropractor, orthopedic doctor, or physical therapist.
I'm at wit's end. I'm trying not to sob as I write this, but they are making my already very difficult life a living hell. When I do call, looking for help and support, I end up being traded along as they each pass the buck, 4 different people transferring me back and forth, till it hits 3 hours 40 minutes and the line "accidentally" goes dead...? Well, looks like I am pretty close to adding psychiatrist to the mix because it's a living nightmare what they've done to me the last 7 months.
I wish there were a class action lawsuit that we could file against these crooks. I turn 35 in 3 weeks and I'm forced to be stuck living in an 85 year old body. How can they be allowed to do this?? How?? It's like the mail room intern at Aetna is shredding every bill that is delivered to make good on their reputation as slime. The other intern gets to hold the big red rubber stamp as he plays, DENIED DENIED DENIED on all of the claims. How fun!Aetna, you may have won the battle, but you won't win the war. This is the end for now. I'll leave you with a Johnny Cash song that is dedicated to you, Aetna.
Good evening, everybody. "You can run on for a long time. Run on for a long time. Run on for a long time. Sooner or later God'll cut you down. Sooner or later God'll cut you down. Go tell that long tongue liar. Go and tell that midnight rider. Tell the rambler, the gambler, the back biter, tell 'em that God's gonna cut 'em down. Tell 'em that God's gonna cut 'em down."
We were forced into this insurance plan because my husband's company switched. Part of it includes dental insurance that matches what we had before with UHC, so on paper it looked excellent... until you file a claim. Claims were filed on our behalf by the oral surgeon we used. No denial or acknowledgement was ever received by us. Our surgeon's staff made numerous follow up phone calls where they were told the bill would be paid, but no payment and nothing in writing from AETNA. We ended up having to pay it ourselves.
Then AETNA sent us a check for $900 marked page 1 of 4 without any additional pages. We called to see what the payment was for and they told us it was for my services and promised to send the rest of the pages. Weeks later no pages received so we called again. This time they said the payment was an accident and we should return the money. We did not, and have not heard another word about it. They still stiffed us on the other claim and since we never received any denials we cannot dispute it. Everyone at my husband's job is having problems with them, so I am hoping we get switched back to UHC. AETNA are thieves, the worst health insurance ever!!!
While most of the complaints on this site are from people who have Aetna plans, my complaint comes as a PAST employee who saw first hand the corruption and disregard the company had for those who strove to perform their duties and for those insured. I worked for Aetna for ten years. During that time I received consistent pay bonus because of my performance. In the three month period prior to Aetna laying off a large group of employees, I had received a bonus. Aetna then laid off employees who were approaching retirement age, or those who had health issues. (Aetna was a self-insured company which means they were responsible financially for fees to healthcare providers of their employees.) Stands to reason that if you have heart issues or are a brittle diabetic, you cost your employer more money since you are going to the doctor more often.
One of the people they laid off was unable to find a job. She was a diabetic and the stress was overwhelming for her. She had recently bought a home and as a single individual, the weight of her situation was fully on her shoulders. This type of stress for a brittle diabetic leads to dramatic health issues. She was found dead in her home at the age of 47. Another employee with Muscular Dystrophy, who was an outstanding employee with multiple bonus for wonderful performance, was laid off also. Of course, Aetna has a plethora of lawyers who are called into action to defend their reasons for the layoffs.
And then people wonder why mistakes are made at Aetna. I can tell you why. The remaining staff are required to do the work of two and three individuals. Over their shoulder they have mid-management haranguing them to work harder and faster. Good grief, they even complain if you use the restroom too close to the end of your shift. (You might miss an incoming call.) We were all Master's level clinicians that were laid off and yet we were treated as if we were high school drop outs.
I now run screaming from any contact with Aetna and I would advise you to do the same. If, behind closed doors, they treat their employees shabbily, you know they don't give a rat's arse about you. It is all about the money. As a clinician, I was always trying to get as many days of treatment for the family member who was in the hospital. Since when does the insurance company know what is enough care compared to the doctors and therapists?
Oh, and while I am at it, the CEO makes $4.76 MILLION a year in salary, stock options, perks, etc. His parachute, should he lose his job is $131. MILLION. When Mark Bertolini came to our site, I specifically asked him, in a roomful of witnesses, if there were going to be any more layoffs. He looked me straight in the eye and said, "No." Four months later half the team was laid off. This is the caliber of people that are running this company. If you have ANY OTHER CHOICE for an insurance company, do yourself a favor and use them.
And before you think this information is from a malcontent, I found another job... better paying, more respect and better benefits. I'm just hoping that by expressing my experience and those of hundreds of other past employees, you will be forewarned and protect yourself from this money-grubbing, uncaring, greedy company.
The appeal process was a total farce in which Aetna's representatives blew off my surgeon during the "peer to peer review," lied about the date on their final appeal decision to make it look like they complied with their 30 day deadline, and forwarded "an independent physician's opinion" to the Independent Medical Review which was never disclosed to me. Bottom line: review EVERYTHING involved in your appeal, because they will try to pull a fast one every step of the way. I'm switching to BCBS first chance I get!
I have a dental emergency. I called a dentist to get seen, and they need Aetna to fax them a pre-authorization before they can see me. No problem... Until I try to call Aetna and talk to a live person. Any time their horrible phone system tries to transfer me to an agent, it hangs up on me. It doesn't matter whether I say "agent", "representative", or press 0. Apparently those are set in the system to just hang up the call to avoid dealing with paying customers. HORRIBLE, horrible customer service.
I've been insured twice with Aetna International while working abroad. While the website has evolved somewhat over time, the claims process remains absolutely abysmal. On the positive side, the coverage was pretty solid, the deductible was low, and not much was disputed from Aetna's side. However, virtually every claim I filed was mishandled in some way and required follow-up, sometimes five or more times for a single claim.
Sometimes all records of a claim mysteriously disappeared, and Aetna said they had no idea what had happened. In these cases, I forwarded them my confirmations of the submissions and they asked me to re-submit everything from scratch since they didn't know what had gone wrong. In other cases, I've had claims which were processed, approved, and supposedly paid out, but can't find any payment corresponding to the date on which they claimed to have paid. When I've asked for confirmation of where the money was sent, they didn't know and said they'd have to investigate.
In other cases, payments did come through, but without a clear reference to identify which claims they corresponded to, and Aetna's own people couldn't identify which payments corresponded to which claims. This isn't a trivial problem when you're working with foreign currencies whose values fluctuate. If I submit a claim in yen or euros, it's not clear what the corresponding value will be when the reimbursement reaches my US account. And since they sometimes pay out multiple claims in a single lump, this makes it even harder to identify as the customer.
I've also encountered numerous cases where they have messed up the dates of a claim, leading to further confusion. Aetna International is based in the US, but forms submitted abroad typically have the date format reversed (mm/dd). One would think an insurer that caters specifically to expats would have this figured out, but no.
Every time I have called Aetna customer service for help in resolving any of these issues, the staff (always in a Philippine call center) have been patient and courteous. But in most cases, whoever I'm speaking to will eventually say they need more time and will call me back and send a confirmation email after reviewing everything. Unfortunately, I never hear anything, by email or phone. There's zero accountability. In every case, I've ultimately had to call back and repeat the process until I can get someone who is willing to do everything while I'm on the phone. (So if you're reading this and new to Aetna, don't let them hang up!) I've lost count of how many hours I've wasted trying to re-confirm things.
Ever since my husband's company has switched to Aetna, we've had nightmares with insurance coverage. I just got a bill from 2014 that I paid my share of and now they are retroactively charging me for a screening procedure, which my Dr. told me was medically necessary. The Dr.'s apparently don't decide what is necessary, Aetna does. I have no trust in this company. Nor do I have any trust left in this country's medical system. I honestly will not go back to a Dr. unless I have a medical emergency because each time I go I end up owing hundreds of dollars, and this is with top insurance. I let them draw my blood for an "employee wellness" screen. I don't believe they care about people's wellness at all, just increasing their profits. This is a nefarious company operating in a nefarious system.
This is the absolute worst health insurance company and customer service. They have ripped me off of $187.00 hard earned dollars. You would think a company of this size would have enough brains to realize that they spent more than $187.00 of their time arguing with me about something that they were 100% wrong about.
I enrolled with their outrageous rates and they were unable to provide me with ANY form of information 15 days into the month as far as member number or member card. I was forced to go to Urgent Care and pay out of pocket because they couldn't get their ** together 15 days after enrollment. I was lied to numerous times by customer service (telling me my check had mailed) and 6 months later, I'm still waiting for it. The real kicker is that they had the audacity to try to tell me that I could have gotten my member id number before going to the doctor... which is 100000% FALSE. Why would I want to lay out MY money if I didn't have to??? This is the intelligence level you will be dealing with when you put your life in the hands of Aetna. They should be out of business before they really hurt someone.
I had to go to Urgent Care for a broken foot. I paid everything myself with a credit card, submitted the claim to AETNA to get reimbursed. I have called them maybe 25 times and each time they have a different excuse why they can't pay me: "your doctor gave a invoice that is not right", "wrong code was put into your account", "the bill was not itemized correctly" etc. Numerous stupid excuses and I jumped through hoops overtime getting them what they wanted. It has now been a year and I still don't have my money. Now they say that they paid to the urgent care! So I need to call the urgent care to get my money back from them... How stupid can people be! I pay $2500 per year for this insurance and have not gotten a cent back from $148 that they owe me. Don't use this insurance!
Received a bill from Eastern Maine Medical Center for $215. According to Aetna, their contracted charges with the facility allows for a charge of $344.08. They sent me a note "Your responsibility on this claim is $344.08." This makes no sense. If the bill is $215, I'm not about to pay more than the bill because I have insurance with Aetna. I have the high deductible plan, so I'm paying all the bills until the deductible has been met.
If I could give less than 1 star I would, but unfortunately one star is the lowest rating possible. On June 22, 2016 my daughter was admitted into a residential treatment facility for help with self-harm issues, marijuana addiction and an eating disorder. In the last 4 months my daughter has had 4 hospitalizations for cutting and threats of suicide. Her last stay in a short term facility was for 6 days where she was diagnosed for PTSD and it was strongly suggested by her doctor that she should enter residential treatment. Her regular therapist and psychiatrist also were in agreement she should enter residential treatment.
To get my daughter pre-approved, I provided Aetna with documentation from 2 different hospitals, her psychiatrist and her therapist to get her approved for the facility. She was approved on June 22, 2016 and entered the facility. So on June 30, 2016 I find out Aetna has been denying the hospital's claims and has denied to appeals so I have to pick my daughter up from the facility this weekend. Aetna deems she does not need residential treatment. I am not sure how on Earth they can deem she doesn't need to be in the facility, when she had to have her nails cut due to her scratching deep cuts in her arms, blacking out at the facility along with other issues. When she is at home we have to put away knives, forks and razors as she will cut herself. She has broken dishes and use the glass shards to cut herself.
I am just beside myself as I pay A LOT of money to cover my family on the top tier PPO plan that my company offers and when we need the insurance the most they don't come through. I contacted a case manager and the complete lack of compassion and understanding was evident. Why do they offer case managers if they can provide NO value to subscribers except to echo what the insurance company has already stated. Aetna is worthless insurance and I am completely disappointed in company. I know after this this year I will be looking in to what my options are.
My family has a history of Factor V blood disorder. Mom, two brothers, nieces and nephews all have this blood disorder. I started to get the same symptoms. My brothers got before they each had blood clots in their lungs. Both came pretty close to dying because of these lung clots. I immediately sought help from my primary doctor who sent me to a blood specialist doctor. Both doctors recommended that I get tested for Factor V blood disorder to make sure that I would not suffer the same consequences that my brothers did. Blood was drawn and shipped off to Quest labs as directed by Aetna. I get a bill from Quest labs stating that Aetna refused to pay for the lab services due to the fact that the testing of the blood was experimental/investigatory and that they would not pay for these kind of services.
If I am suffering the same symptoms my brothers had right before they got blood clots in their lungs it makes sense to get tested before I suffer a lung clot. Even though two doctors recommended that I get the blood test done, Aetna still calls it investigatory and refuses to pay. I pay $800 monthly to have an insurance just in case I need to use it and when I need it Aetna refuses to step in and pay. They will take your money but will not cover you when needed. Stay away from these crooks. Tell everyone you know that this insurance runs a scam and will not cover your bills when needed. STAY AWAY from AETNA!!! They suck!!!
STAY AWAY FROM any Aetna Dental Plans. I bought this plan (DMO plan) for my family and guest what? The plan just only covers a few dollars out of $1500 cost!!! What a joke. The dentist explained to me that the plan that I bought is the worst dental plan she ever knew of. Don't fall into this scam when it says "NO DEDUCTIBLE and NO maximum allowance" because it will make you will pay 99.99% of the cost.
I have asthma and use inhalers on a daily basis to control my breathing. I have a valid prescription on file with sufficient refills and not an expired prescription. I called in my refill on Friday morning and went on Saturday morning to pick it up. When I got to CVS, they told me that Caremark has rejected the prescription. I inquired on why and the pharmacist did not know and advised to call the insurance to find out. I called the insurance and they advised that because I filled the prescription twice already their contract requires them to fill a 90-day prescription to save me money. That's a laughing matter. They should be honest and instead say this is to save our corporation money.
With asthma, my medication can change at any time usually every month to 2 months so making me get a 90 day supply and paying for a 90 day supply wastes my money and the medication which just piles up in my medicine cabinet. There are major prescription drug problems in this country but the insurance adds to it and promotes the issue. However, I explain to the representation that I need my medication and am willing to pick up the 90 day supply. They advised that they need a script for a 90 day supply in order to refill and has faxed my doctor's office the request for the 90 day supply. Please keep in mind I still have a valid 30 day refill on file. I advised them that it is Saturday so my doctor's office is current closed and will not be open again until Tuesday as it is a holiday weekend (July 4th). They apologized and said they can't do anything until they get a 90 day script. I spoke with a manager as well who refused to allow the refill on a valid prescription.
Speaking with these people clearly shows that health insurance IS IN NO WAY SHAPE OR FORM about the health of the people who pay them every month for coverage, but instead about their profits. Clearly I am wasting my money by paying for health insurance. It's just amazing that they would refuse to refill a prescription that they have on file because of a contract they have to save them money. I asked them what would happen if something were to happen to me because I didn't have my medication and they simply said, "I can't refill your prescription." Please fix this health insurance issue not just for me but for everyone wasting their money on it. This is criminal of a company to hold medication hostage to save money. It is a matter of life and death for some people but they are willing to risk the lives of people.
On June 6, 2016, I filed a STD claim with Aetna because I was scheduled to have extensive right shoulder surgery on June 24, 2016. I signed and returned the information release to Aetna within their required time. Along with the signed authorization, I advised Aetna, in writing, that I wanted a copy of any documents obtained with the release. I specified that I wanted the documentation within 10 days of Aetna's receipt. Furthermore, Aetna's own release states that I can view or copy any records obtained with the release.
On June 22, I viewed my claim activity online and it noted that documentation was received that same day. I had traded voicemail messages with my Aetna claims manager over the course of a few days. On June 30, the last phone message that I received from Aetna was that they will not provide me any documentation until my claim is closed. I noticed another entry that additional documentation was received on June 30. Aetna's refusal to provide me a copy of the documents is in direct conflict with their own information release. I can find no legal basis for Aetna to refuse my request. I am not requesting anything covered under the work-product doctrine. I simply want a copy of my records that I am required to pay for (according to Aetna).
Aetna also has my return to work date as July 22 and states my claim will be closed on that date. However, my doctor advised Aetna in writing that I will very likely need physical therapy and I will miss additional work for PT sessions. It appears to me that Aetna is completely ignoring the fact that I will need PT in the near future. Obviously, my physician will have to complete yet another form regarding PT again.
In addition, I will not be out of my arm sling until early August. I am also right-hand dominant. My job as a claims adjusters (what irony) requires a lot of keyboarding/typing and use of a mouse. It is taking for forever just to write this review. There is no way I can safely drive an auto or perform my job duties with only my left arm/hand. My husband still must help me shower, dress and perform other personal tasks. If I were to return to work, who will help me when I need to use the restroom??? I have given Aetna a few days to reconsider their position on providing me a copy of MY own records. After that... Follows a written complaint to Ohio's Department of Insurance.
A biopsy recently confirmed recurrence of breast cancer that I originally had in both breasts and total lymph nodes seven years ago so my oncologist ordered a PET scan to determine the locations of the returned cancer before I see the surgeon next week. Aetna has denied authorization for this scan. These greedy insurance companies should be cited for denying exactly what well-meaning patients are paying them for. I don't know how their employees can lay their heads down at night and sleep knowing they are denying required procedures for cancer patients. This miserly-immoral group is creating pitiful situations for sick people, but they sure make sure they get our premiums every month.
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