Consumer Complaints and Reviews
Prior to signing up with Aetna, I talked to an Aetna "customer service" representative about drug costs and was told that the cost of medications do not apply to my deductible. Not true. I was charged full price for my prescriptions. They paid zero. I called to find out which pharmacies were in network and was told by another uninformed representative that I had no choice, I HAD to use their mail-away company. After paying a high price through the mail away, I found out today that I can use many other pharmacies and the cost would be HALF of what I paid through Aetna. I was lied to again!!! I would not recommend Aetna to anyone. The representatives have no idea what they are talking about and they make up the answers as they go along. Come November, I'm OUT!
I have been dealing with Aetna for a claim I found out was not paid in 2014 and it is 2017. The customer service has been the worst. I have encountered a rude escalation Manager and the supervisors don't know any more than the specialist. They give out contradictory info and lack service training. I have even had managers that say they will call back but don't. I have a long list of service reps name and even requested that the tape from one call be pulled because the rep was so rude. This is the worst and to say that my employer chooses them over other reputable companies saddens me. How do you get anything accomplished with this company. Someone help!
Needed MRI and was denied by their 3rd party. Stated had one 5 years ago. Dr tried peer to peer but no go. I got stuck with Aetna. No choice what retirement benefits changed to. As soon as I can I getting out. The company tells you one thing and it turns out to be wrong. Looks like their third party for precertification only wants to save them money.
Recently changed jobs, new job uses Aetna Insurance. First time I refilled my diabetes medication I received a letter saying the drug ** won't be covered. They recommend a medication that's been around for 50 years my doctor said. Very unhappy with this insurance co.
Aetna Medicare "offers" dental care via Delta. I went to first exam: coming out of commercial dental care (my bro is a dentist...) was still subjected to "complete xrays and panorex." "For my convenience, was given a fluoride treatment... (Cost: uncovered $25.00). Dentist came in, poked around... Said everything was FINE, and off he went. Hygienist went to work. At the end, she hands me a clipboard with a list of "issues," and says that she will not be able to do another cleaning until I have their Deep Cleaning program, which includes injection of ** into the gum areas. Price: $1200.00. WTF! "No, thank you, my bro will do the job. (That doesn't need to be done.)
Flash forward six months: call for hygiene appointment: "Oh, we can't DO that until we do $1200 job. NOT... Call to other dentists on the Aetna/Delta plan: they are ALL part of the one group that has Delta monopoly and NONE of them will do a routine hygiene without dental visit (Aetna only pays for ONE every 24 MONTHS!) and they are able to see that I am "flagged" for $1200.00 treatment. Discussion with Aetna and Delta have been totally USELESS. Back to my usual hygienist, out of pocket. AETNA does NOT provide good dental coverage... BEWARE.
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Stay away! If you must use them have their number on speed dial. Aetna International gave me the run around for 14 months! I now have a permanent hit on my credit report because they failed to pay a claim in a timely fashion (they finally PAID in full). Aetna constantly processed claims incorrectly or only in part (I was 100% covered). I had to call Aetna at least 2-3x per claim to get them resubmitted before they would pay. Aetna delayed payments by requesting records while the hospital had already sent 3x. Aetna once told me all my previous 8 claims so far that year were processed incorrectly. So now I needed to pay.
The only way I was able to get my claims processed was to call over and over until I got an honest Rep (who they probably fired!). I had to play dumb and ask him all about my policy and give him hypothetical questions and scenarios. And He would come back "Yes, you are covered" so then, only then, I said "Ok, well please have a look at these claims numbers and tell me am not covered?" Finally PAID in full. They are dishonest, untrained, or both at processing claims.
This has been the worst experience with an insurance company that I have ever had! My husband has this as a retired member of a company. I have been told I was not a member... even though they were taking the money out. They kept saying my account had to be updated. Finally they found out I was a member. Now they don't want me to send in a check for my medication, and they have my medication on hold. They want to directly take it out of the bank.
I have always been able to pay for my medication by check through other insurances. But now they have a "special" team to say if they will accept a check. Please do yourself a favor and skip this insurance. If I had it to do over, I would have skipped this insurance that was provided by my husband's company and went elsewhere! I'm counting the months till January. Oh and FYI, the survey you take after talking to a representative is only about the rep, not the company. I guess they would get tired of hearing all the complaints.
Unbelievable. My husband quit his job March 30. On March 31, Aetna Specialty Pharmacy called to ask if I wanted my very expensive medication filled. I told the agent "I probably am not covered. My spouse left his job and that is how I get my coverage". The agent said "Ok, well let's see if it approves..." and then "Oh yes, you are still covered, should we send it to you? I replied sure. Well you can guess what happened. I got a bill for $2702.61.
I called Aetna and explained to them what happened. They will look into it. Got a bill in the mail today (July 10). Spoke to a supervisor who told me " You should have known ". I responded that I did in fact inform the rep. She told me that there was no one higher up that I could speak with. I said "Look, I did not reach the shelf, pull out the bottle and send it. I did not make that decision - you did". After threatening to go to the local TV stations, she backed down and suddenly discovered someone she could talk to... this should be interesting! These people are horrible. No request is too small to deny. No amount of common sense will get in the way of poor customer care.
I was so disappointed with Aetna insurance company services provided in Dubai. They are very slow in assessing submitted claims and form and plus I was shocked to see them rejecting an emergency case although doctor confirmed it's an emergency and their doctors who are totally unexperienced with this severe case didn't accept specialized doctor assessment. I am so surprised how an international company globally who is totally a non customer focused service provider.
I was on the phone with Aetna Provider Relations Dept for over an hour trying to resolve an issue regarding "Why our State of Delaware employee patients are being issued medical cards that have random physician names on them and not ours". After an hour of talking to 2 separate provider reps... I asked to be transferred to our PROVIDER REPRESENTATIVE and was told that I could not speak to my rep, but had to fax a letter stating what I needed to speak to the rep about. The rep will receive the fax and decide if my request warrants a return call. They would not even supply me with my rep's name or email. So needless to say our patients (well over 200-300) will receive insurance cards with incorrect primary care names on them, they will need to contact member services to ask to have our name added again and then they will issue ANOTHER card to our patients. WHAT A WASTE OF MONEY AND TIME.
As a practice manager I made many attempts to secure contracts for behavioral health providers and have been refused each time. Network management will not allow phone calls, direct emails to discuss the practitioners' qualifications. They provide only a basic form to complete and then send a denial stating the network is full. The network is not full, open choice is a right in this country (at least today it is) yet Aetna clamps the lid on new providers.
I had to go to Emergency Care to consult a doctor due to a sports related incident. After calling in with Aetna, having them pre-approve my visit and even resorting to an Aetna recommended partner hospital which allowed for Direct Billing, they ended up not covering for the hospital expenses. I only noticed when I was contacted by a Claims Management company acting on behalf of the hospital ca. 6 months after my visit. The ensuing months - long exchange battle was a farce and ended as it started: with Aetna's unwillingness to pay and general incompetence to communicate. The partner hospital cut their ties with Aetna as a result. I changed my insurance provider as a result. I carry deep-rooted despise for this insurance "provider". Never again!
As a pharmacist I spent almost 2 hours being shuffled around trying to get an override for a 10 month old seizure medication. I spoke to 8 different people and none could or would help me!!! This infant was going to have to go 15 days with NO seizure med!!! This is unacceptable!!! How can you sleep at night knowing you have left an infant with no life saving med??? Not only was my time wasted which put me behind but the problem was not solved.
As a physician, Aetna is the worst health insurance company that I have had to deal with. They are extremely difficult to communicate with on behalf of my patients. They are painfully slow in processing requests and appeals and make doctors repeat many steps of the process in advocating for patients. I recommend you seek other insurance if possible.
Aetna Health Ins was great while it was through an employer. Since I switched to Aetna Medicare it's a different story! I have to fight over every claim! Medical claims have to be sent twice. A dental reimbursement claim for $50 was sent 5 times with paid receipt and cancelled check and they are still arguing about it. Their website lacks important information that was included on the Employee member site. Forms have incorrect addresses - Email questions are responded to with canned robotic responses that don't answer the question. Most of their human customer service and claims reps appear not to be able to read and comprehend English. Cheap - but you get less than you paid for. Coverage looks great on paper - but try to get it - good luck! I pity seniors who are less able to deal with this nonsense - they will really get taken advantage of.
I have a masters degree in healthcare administration and previously worked for a health insurance company for several years, and I find Aetna's plans impossible to understand and navigate! I have also found that the company will deny claims even for the most basic care! I will absolutely be changing my insurance carriers during my company's open enrollment!!!
I was hung up on when I ask for the quote to be sent to me via email before I agreed to the terms. I called back and wait time was so long that another party came on and took my information and said I would get a call back. They never called back. Hmmm.
I have this plan through my postal dental plan and it is very affordable and covers more than the other plans out there and you don't have a waiting period to get your benefits. This is a very nice benefit that most other plans also don't offer! And with the low price, you can't beat this plan in my opinion!
My local pharmacy, participating in Aetna, costs $12.88 for generic ** for 30 days. Aetna helpfully informs me that I can order it through their online pharmacy, and get 90 days. Yes, that's convenient. But the cost for 90 days is $408.37. Price confirmed by calling the pharmacy contact line and speaking to an agent because the automated machine doesn't know what ** is. So to save drop-bys at my pharmacy, I have to pay 1056% for the medication? WTH?
I was previously with Anthem Blue Cross and I had a great experience when I had to file out of network claims with this health insurance carrier. My husband's company switched to Aetna recently and it has not been a good experience. Almost every out of network claim that I have submitted has been denied and they do not ever provide explanations of why. And these are claims that were always covered by Anthem Blue Cross in the past. I have submitted some claims to Aetna for re-review over 4x after speaking to claims representatives over 6x to try and figure out why they are being denied. It honestly feels like Aetna is just in the business of denying claims instead of covering them.
I'm in need of an endodontist, and Aetna is not able to provide me with one in 25 miles radius. The list online and the one they sent me is outdated. I called all the dental offices and no one is or has an endodontist. Even the dental offices have been contacting Aetna to change the list for a long time. Some dentists don't even exist anymore. Aetna CS is no help at all. They keep sending me the same list over and over again. NOW I have to go out of network and find me one and pay out of pocket. This insurance is a joke. If you consider to be a member... DON'T DO IT.
Costing almost $700/mo with me paying 139.00/state of IA paying remainder, I cannot utilize this insurance when I work out of state without meeting a $20,000.00 deductible first! Just because I chose a lousy company to work for that promised me health insurance and didn't come through on it before my contract ended, I was forced to get this affordable care act ridiculousness of Aetna insurance or pay a penalty come tax time next year. Was also told by them (Aetna) (and all calls are recorded) the day I went to the Dr that the copay would be $10.00 as opposed to $0 if I were in area. Yes, the provider is in Aetna's network, but out of area for me. I am currently working in CA and live in IA. I do not work in IA, but all over the US...
I'm insured with Aetna through my dad's job. I recently registered for the online app because I was referred to by a representative from a previous conversation. The registering process was simple and easy. However, when I began to look through the website I noticed the website was showing open/unpaid claims that I have previously paid in full through my provider. After seeing this mistake I called Aetna's customer service. I am unpleased with the answers I received. The lady told me there is no way she could inform me if there was a mistake, because the payments go through the medical doctor not Aetna. However, there is an icon that says "make a payment" online. My whole point was if the claims were paid through my provider why is it showing unpaid claims on the app.
Furthermore, if I have to find out if the claims were paid through my provider why is there an icon on YOUR site telling me to make a payment online. This is fraudulent! I know for a fact I paid my bills. If I didn't know any better I could have paid second payments on many claims because their site is not accurate when it comes to paid claims. They basically wanted me to make TWO payments unknowingly if I wasn't smart enough to call. Again the rep did not offer any solutions. I now have to call over TWENTY medical doctors to make sure they received my payments. Smh. Please beware of this. The website/app is very confusing... Also when I asked the representative for assistance on showing me how to use the website over the phone she laughed and replied with "I know the website is very difficult to understand." I am unpleased with the customer service from this situation... I received NO help.
I went to a doctor who is part of John Muir for a routine check. Before going, I inquired with Aetna about the Insurance coverage and got the response that John Muir and the doctor is part of Aetna In-Network. A John Muir Doctor wanted me and wife to do the routine test, and suggested me to go the lab in the first floor. The tests the doctor ordered were mentioned in the document with letterhead saying "LabCorp." Me & my wife went there, and once again inquired LabCorp whether the Aetna Insurance can cover our tests. After seeing my Aetna Plan 80, the LabCorp person said "Yes, all the routine tests are covered by the insurance.”
Out-Of Pocket Payment for Routine Tests (there are couple of test which are not routine I think): I just mentioned one Claim ID (429.99) here on my Wife. There are two more in the received claim status (429.99 & 432.66). For mine, the amount to pay is 244.77. Why should I pay this exorbitant amount "when the doctor who is part of your network referred me to a lab in John Muir facility". I am really shocked and frustrated... All OUT of MY POCKET. Please let me know if you can process all of these in IN-Network, and help me alleviate the burden.
For some background, if you use 30mg ** solutab the Aetna medical bureaucracy will charge $1000 a month copay that must be allowed by the Obamacare monopoly. Aetna offered to mail order my prescription for $1000 for 90 days. If you lower the dose to 1 or two 15 mg pills per day over the counter ** is available for with a doctor prescription. If you take less than 30mg, you can buy it over the counter for $30 a month via insurance for $7 copay. Aetna insurance went berserk and resent me an offer for $1000 copay via mail with 90 days at a time. I refused it and they cut me off at 1 per day which extended me out until June.
The stupidity of this argument is that I can walk in and buy $60 worth over the counter and not use my insurance else pay the medical conspiracy bureaucracy $1000... I assume people simply pay this copay because they don't know that it is sold over the counter. I will being doing this until I am allowed to opt out of this scam. I would prefer not having any insurance than to stay with Athena.
In 2016, I paid this fraudulent outfit $1000/month for health insurance for my wife and me. Our deductible was $6800 each so it was literally no coverage except in the event of something catastrophic. But under Obamacare, we were entitled to one yearly wellness visit each. Aetna has just denied the cost of that visit. On top of that, they decided there wasn't enough cash to lap up in all of Florida so they dumped every Floridian from their roles. Really? If this is what they'll do to screw a customer for a lousy $125, what will they do if you were forced to make a real claim? Wake up voters. Insurance companies are in business to make money off you for their upper management and stock owners. SINGLE PAYER is the only way you will ever know the stress-free safety of having health insurance you can rely on. Ask Canadians - it really works.
When refilling a heart medication at CVS which they make me use, pharmacy does not have a 90 day supply in stock. Aetna will not approve for less days and then pick up rest when it comes in. I had to go 3 days with no heart meds due to this practice. When I called Aetna to complain they told me I should have checked other pharmacies to see if in stock. WTF.
My son needed his vaccinations and a first time doctor's visit for school. We picked a doctor through the Aetna network. When it came time to pay, Aetna didn't have us in their system so I paid out of pocket, anticipating reimbursement. My claim was submitted months ago and I have to keep following up to resolve disputes since they refuse to reimburse me first time stating the doctor is out of coverage, and the second time stating there are multiple network providers.
Supposedly they sent a check for less than 1/3 of the costs paid out of pocket which is a lot of money shortchanged. Weeks later, I'm awaiting receipt of the check simply to return for proper compensation. Never have I EVER dealt with such scandalous behavior as Aetna. Given I've spoken with numerous agents at any given time, it appears this is not the employee practice but the overall provider policies which encourage refusal of payment for promissory coverage. It would be a mistake to choose Aetna coverage over any other provider.
My husband was denied coverage for a spinal fusion. Not a rocket science type of procedure. Since the denial, I have received nothing but poor service and run around from AETNA representatives. I have requested the documentation twice that AETNA says it will provide for "free" regarding the basis for denial. I have received nothing. I have been told conflicting information from each rep I speak with from different clinical policy bulletin numbers to being told my denial letter must have a mistake because the type of procedure is covered and can't be denied. All of this I feel is a stall tactic to discourage members and have them give up on seeking coverage. Meanwhile, they have no problem covering pain meds for same condition. Hmm, married to the pharmaceutical companies perhaps? I pay a high premium and feel AETNA is not holding up their end of the deal when it comes to a significant procedure. This is nothing other than a scam to me.
I have a dental insurance with Aetna through work. In October 2016 my wife had some inlay done and we submit the invoices, they were not processed till now (we are 9th of March 2017), though that time Aetna has requested information that was sent by myself personally as well as my dentist as well. Nevertheless they keep changing the delay reason from asking for X-ray to asking for pre operative and post operative X-rays, to asking for the tooth number. Although all this was provided and they could ask all their question directly to the dentist and get all they want at once!
Now the claim show "We've asked your provider for more information. When we get this, we will consider this charge!!" I am not sure what more information is needed. It seems to me like they just don't want to pay. Any advice on how can I deal with this? Where can I complain? Is there a customer protection agency for these cases or can the insurance companies just drag us like this forever.
Joseph BurnsHealth Insurance Contributing Editor
An independent journalist, Joseph Burns is the health insurance topic leader for the Association of Health Care Journalists and contributes to AHCJ’s Covering Health blog. He has also written about health policy and the business of health care for a wide variety of publications, including Healthcare Finance News, Hospitals & Health Networks, Managed Care magazine, Ophthalmology Management, TaxACT.com, and The Dark Report.
Aetna has been providing health insurance to Connecticut residents since 1853, and today covers people in all 50 states. It is a pioneer in health care legislation and is responsible for making coverage of genetic testing and counseling an industry standard.
- Highly customizable selection of plans: Aetna allows consumers to pick and choose features such as the deductible amount, type of coverage and ability to choose a provider.
- Health insurance bundles: Consumers can easily add dental and vision insurance to their basic health insurance and can bundle insurance with other plans like life insurance.
- Large provider network: Aetna allows consumers to choose from over 587,000 doctors and 5,700 hospitals throughout the United States.
- Offers Medicare Advantage plans: Aetna offers Medicare Advantage plans.
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