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I rarely go to the doctor, but anytime I have if my doctor prescribes me medication that I NEED, tests to be ran, procedures, whatever the case may be... I am denied EVERY. SINGLE. TIME. By Aetna insurance. I have shingles currently, I was denied antivirals today. I had bursitis on my right knee that grew to unusually large grapefruit sized lump, I mean it was huge. I had to carry this around, sometimes waking in excruciating pain because they kept denying for just the MRI to be done, which per their guidelines is required before the surgery.
A year later. After many peer to peer calls between my ortho doc & the medical director with Aetna, many appeal letters including pictures of my knee sent to the appeal board (for the medical director to review), prior authorizations, written requests, & phone calls begging... finally was approved. Then was denied for surgery twice before being approved almost 2 months following the long waited MRI approval.
I battle & struggle daily with endometriosis, but they will not approve for a scope to be done, which is required before surgery! The list goes on, medications, doctor visits. It is beyond ridiculous, unsafe, unethical, & morally wrong! If my doctor states the diagnosis, the medication or following procedure should go hand in hand to treat the diagnosis. I have been diagnosed, meaning by a doctor I have this or that, and the insurance company doesn't believe I need treatment or the medicine to become healthy again?!? If you are sick or in pain, the last thing you want to do is fight for treatment!!!
I should not have to wait weeks, months, years sometimes before receiving treatment! I do understand some situations in which a medical director sitting at a desk all day would or could trump what a trained doctor or nurse practitioner has stated, but this would be rare! Never go with this company! They are under investigation in California for a similar situation to mine. Research them! They are horrible. In essence, killing people. These medical directors are concerned with their financial gain or loss, not anyone's health!
I love the denial, "it is not medically necessary", get this one a lot. So, it isn't medically necessary to go to the ER when I have a 6 inch piece of glass through my hand... they stated, the above about not medically necessary, & could had waited til the next day & see a family physician. So I call my family physician after receiving this denial of payment letter, who tells me, "I would had sent you to the ER, and if you waited as long as they stated you should had, you would risk infection, unable to close up after so many hours, & that no facility in our local area in a 50 mile distance would even do it considering they do not do stitches, only at the ER (in my particular area!), & not to mention the glass sticking out of your hand both sides, all the way through would have been a little painful & in the way!"
I am in awe how much I have to dread going to the doctor for my HEALTH in FEAR that what I needed wont "suite" the Aetna medical director, how much I have to fight for what I need, & how many times they can deny a claim (small-big) that directly affects my health & life, sometimes it has been life or death! Shingles equals antivirals. Infection equals antibiotics. I have been denied every time. No joke. No exaggeration. The picture below of my knee is half of what it became before I finally was able to have surgery!
I had some tests done that my Primary Care Doctor has wanted done to determine the cause of my wheezing while exercising. Aetna paid the claim the first time, but then about 7 months later they charged it back to the provider, who then charged me for the services. For SIX MONTHS I went back and forth between the 2 companies trying to get the COVERED SERVICES PAID, after 6 months the provider threatened to send me to collections, so I had to pay it. What other choice did I have? I can't afford it, I can't have it on my credit, and this is I think how AETNA is making SO MUCH MONEY! THEY CHEAT PEOPLE by charging back covered services and then screw the people caught in the middle between the providers and the customer service reps who are all POWERLESS TO DO ANYTHING. DO NOT USE THIS COMPANY!
I deal with many insurance companies for a living. Aetna is absolutely the worst of the worst. Their modus operandi is deny & then give you the runaround. I would rate them a minus 10. Believe all the negative reviews, stay far away!!
My daughter was in a car accident in Feb, 2018. After going back and forth between the car insurance and Aetna (our health insurance), we were able to settle the 'policy covered' amount with the car insurance. We gave the 'exhaustion letter' to Aetna in the beginning of May. It's been almost 3 months and Aetna has yet to send all the EOB's (explanation of benefit) to the medical providers. The bills are piling up with the additional threat of being sent to collections. Spoke with Aetna multiple times, but keep on giving the runaround.
The agents are rude and not helpful; their answers are inconsistent with one exception. They always have 2 weeks to send the EOBs to the service providers. And this is the case when we received the EOBs around July 1. The trauma of child in a car accident and the surgery after that is something I would not wish on anyone. Even more than that, I would not wish anyone experience this super efficient, well-oiled machine. Not sure if it is just Aetna or is this a common response amongst the payer community in health care. But I get a sense that they think the way for them to avoid paying is to stall and outlast the average patient.
I have called 10 times today and the system recognizes me and I ask to speak with representative. I hold for about 5 minutes and it goes directly to my comments about the representative who just helped me. I never was connected to a rep. What's up???
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I chose this supplement when I turned 65 as a supplement to Medicare. Beware of their PRESCRIPTION stipulations! At 65, they are tinkering with what medications are okay for me to take. Seriously? If I have a written prescription from my physician of 8 years, the insurance company should not require ME or MY PHYSICIAN to jump through hoops to follow their guidelines. I have a prescription that they will only fill for people age 18 and younger. Oh my GOD! If my physician is intelligent enough to know of a use for this medication at my age of 65, why in the world am I paying them $40 for something that was free on my insurance. BEFORE I thought I was so lucky to be on Medicare? I am paying more out of pocket per month than I pay for the Medicare deduction out of my social security check. This is absolutely outrageous and UNHEALTHY for the patient! I'm leaving them ASAP!!!
Don't even bother thinking you are covered by the short-term disability insurance. My doctor took me out of work for a month and Aetna is the worse. They requested the same documents 3 times! My doctor faxed documentation 3 times with fax confirmation proof. I've uploaded the same documents 3 times. When I called in, the customer service reps were so nice...as they did NOTHING to assist me. The last time I spoke to someone for 10 minutes, I finally asked if they were going to actually do anything and they told me I'd have to talk to my case manager.
I've left Audrian ** messages and have never once gotten a call back. I've submitted complaints via their website 3 times with no reply. After a month of getting the run around and lots of duplicate requests for documents, they flat out denied my claim and closed my case. They are such a huge company that does not care about any of their paying customers at all because we obviously don't have many choices. I will NEVER take this insurance in the future. I pay around $550/month for absolutely nothing. I was better off when I didn't pay for any insurance. America is screwed with healthcare and this is another reason why. I hated Kaiser, but would rather go with them next time.
I have had an extremely negative experience with Aetna. They do not care about the health of their customers at all. I filed claims with them 17 months ago that I still have not received reimbursement for, despite repeated phone calls. Because of this, I have to keep looking up my claims on two different websites, since they recently switched to a new system, which is extremely inconvenient. I have spent dozens of hours on the phone with them with few results. Every time I submit a claim, they tell me they need more and more information from me to process the claim, and then when I do provide that information, they tell me that they didn't receive it. They process my claims out of order and tell me that I haven't submitted claims that I definitely have.
Many claims I have submitted three or four times, at their request. Sometimes when they give me cheques, they don't tell me what the reimbursement is for, so I have to try to look it up on their website for my records, which is often difficult. They have trouble processing many of the prescriptions my doctor gives me. My pharmacy will call them to ask about the delay in processing the prescription, and Aetna tells them they will call me the next day, but they do not. Several times, I have had to give up on said prescriptions and simply ask my doctor to prescribe me a different medicine.
Their coverage is extremely limited, deductibles are ridiculously high, and their call wait times are very long. I have had to stay late at work multiple times because I had to wait so long on the phone trying to talk to them during my lunch break, and they inconveniently do not offer customer support before 9:00 a.m., after 5 p.m., or on the weekends. I cannot recommend steering clear of this company strongly enough.
Released my social security number to third party. Aetna contracts with Mirixia a company who profits from Medicare Part D patients. That company then contacts my pharmacy to have this 3rd party monitor my medications. Our social security numbers were stolen in 2014. Now CVS Pharmacy is buying Aetna & both have had massive data breaches. Customer service is a joke.
I would give Zero stars if it was an option. Our family pays full premium for our primary dental through my military retirement with Delta Dental. We opted to take Aetna Dental as a secondary through my husband's job to pick up what Delta doesn’t cover. After paying them hundreds in premiums, I used Aetna for the first time on a dental crown, they only paid $37 for my crown leaving us with a $450+ dental bill. They told me if they were our primary, or if we didn’t have any other insurance, they would have covered the whole amount of the crown less a $50 deductible. What’s the point of paying full premium for a secondary insurance if they only pay out a small portion of the cost that didn’t even come close to meeting their maximum payment for the procedure? Absolute waste of money to have them as secondary! Canceling our policy with Aetna immediately.
My aged mother has healthcare insurance with Aetna Senior Products. Her premium is paid automatically with a VISA card provided as a retiree benefit to her from her former employer. The third party administrator (Conexis / Wage Works) was delinquent in distributing new VISA cards to its clients. The card arrived on the 18th of May and the former card expired that month. Since my mother's premium was automatically charged to that card, and the new card did not arrive in time, Aetna placed my mother's insurance policy in a lapsed state. Aetna required me to provide (by surface mail) a new credit card authorization form. This form was mailed from the post office on May 21.
As of today, June 18, Aetna has not been able to locate this form. The address to which it was sent was correct; it is a P.O. Box, and evidently there is no person to answer a telephone at that location. After sending this form a second time, it has still not been located, and in ten days time, mother's health insurance will again lapse. I have been told by 4 different Aetna customer service representatives that no other form of transmission is acceptable for this form - neither fax nor as an email attachment.
Today, after threatening to involve either my attorney or my congressman, I was finally transferred to a kind supervisor at Aetna. He readily suggested that I fax the form. This has been done. I had asked to be allowed to fax that form multiple times. Why did it take threatening action to agree to a fax transmission? Aetna is irresponsible in the way it trains and manages its customer service staff. Its callous disregard for its good customers, allowing their healthcare policies to lapse through their own inept document handling must change.
I have their short term disability insurance through work. I’m on a disability leave. They call and send letters constantly that they’ve not received required information. There are confirmed faxes that they have. Also they look at the wrong dates. The earliest possible improvement date was interpreted as a return to work date. The problem is with my ankles and there is no sitting whatsoever and no breaks for the 5-6 hours I work daily. I’d like to see them standing, walking and carrying things with a bad sprain on one ankle and a tendon tear on the other. Aetna is a nightmare to deal with. I feel harrassed by them.
I changed to Aetna because my doctor retired and the new doctor would not accept the insurance I had. The insurance I never had any problems within over 6 years. I should have had a clue that Aetna was not the right choice when the Teacher's Retirement System of which my mother is a part of moved their account from Aetna. Since being insured with Aetna, I have had to change 3 of my medications because of their Tier system. The medications that I had been taking for at least 3 years were all a Tier 4 medicines with a cost of over $100. Then today 6/12/18, my doctor gave a new medication and refilled my inhaler prescription.
They were sent directly to the pharmacy during my office visit. Before I could get out of the parking lot, the pharmacy called to let me know Aetna would not approve my inhaler or my new medicine. I called Aetna and was told that my inhaler was a Tier 4 and would cost me $100 or I could change to a lower Tier medicine. I got the names of those and went back into the doctor's office to ask to change to one of those. For my new medication, Aetna did not have an alternate. Aetna does pay for any medicine for this condition I have. I am changing as soon as I can. This insurance does not appear to care about their clients.
My son needed oral surgery, prior to the surgery I contacted Aetna to find out if the sugery would be covered. I spoke with a claims representative, who told me that "yes, the removal of impacted teeth" would be covered. She gave me instructions on how to file the claim, since the oral surgeon would not file the claim with Aetna (this should have been a clue). I submitted the claim after the surgery and several weeks later it was denied.
When I called to find out why the claim was denied, I was told that the original claims representative that I spoke to was not trained in Oral/Maxillofacial Surgery coverage and that she should not have told me that the procedure would be covered. This new Oral/Maxillofacial claim specialist said that in fact, my Aetna plan does not cover the extraction of impacted teeth. However if I had taken my son to an approved facility, such as the local hospital, that they then would have covered the facility and anesthesia. So none of the $1000 we paid will go towards our deductible and it is too late to investigate a different treatment option or location, due to untrained personnel.
Doctor sent my Rx here for a 90 day supply. They never sent it because of some sort of error, but also never called me to notify me. Was blocked from filling the Rx because they had already run insurance, even though they never sent the medication. DANGEROUS AND INCOMPETENT.
Ironically, I gave Aetna reps a 5 star rating when I was signing up. They were pleasant, informative and gracious. Unfortunately, the rest of the company doesn't facilitate the same efficiency. I take only a few drugs and was very pleased the first year. The second year, you better hold on to your pants. The 90 day price I paid last year for one drug was $232, the same drug now cost $864. ** they won't even cover any longer. Man, what a difference a year makes. I'm currently searching for a new company.
I have been trying to submit a claim to Aetna for over 6 weeks now. I have spoken to 4 different Aetna claims representatives who have all given me different instructions and different places to fax the claims request and invoices to. Every time I fax the information I receive a confirmation that the fax went through. Then I have to wait at least a week for Aetna to supposedly scan in the claim documents and start the process before I can check on it. Every time I call to check on the progress they say they can't find any information on the claim and I have to re-fax it to a different number. I've asked to speak with managers and they won't transfer me. The whole process is absolutely absurd and it makes it impossible for anyone to be reimbursed.
Denials - Since we have been with Aetna, we have had trouble getting MRIs, prescription, and medical procedures, that I need for my neck and shoulders. Test have been done like EMG with physical therapy, and narcotic medications that are not helping with pain. My wife plans to drop Aetna federal open house.
I retired from ArcelorMittal Steel in Georgetown, SC in 2006, disability. Since that time my medical insurance has gone through several companies. I have Medicare, several companies and now a Medicare/Aetna advantage policy. I have had a Medicare advantage policy for several years now. I have never had so many problems getting claims paid. I am also covered under my wife's medical policy and that company does not receive the proper paperwork from my insurance to pay claims so they are getting denied and I am being held responsible for payment. Now I am being told it is MY responsibility to get the claims information to the insurance company.
I was not given a choice to opt out of the Medicare Advantage program. I would rather have Medicare and an insurance company, not an advantage program. I have even had to pay doctors visits out of pocket because they do NOT accept Medicare advantage insurance. Also ArcelorMittal in Georgetown, SC has closed down and been sold to another company. I am extremely upset with this situation and honestly cannot afford to pay all of these premiums AND doctor/hospital bills that are not getting paid. I guess my fifth back surgery will not happen because I cannot afford to pay what the insurances do not/will not pay.
I don't really know where to start with our nightmare experience with Aetna Thailand! Your local staff are super unprofessional. Worse sales experience ever, the sales manager **, only wanting to get her commission form sale! Didn't inform us as customer any details in advance! We signed and purchased the insurance package, before we actually receiving the insurance detail package! How ridiculous is this? Never ever buy Aetna in Thailand, find an international company. Don't deal with Thai! Disgusting!
Aetna is denying our insurance claims in order to obtain information that we are not required to provide under our policy. Aetna is unethical and puts their business needs before people. They only will tell us what they cover and what is not covered under the policy so it is difficult to understand what a procedure will cost or be covered. It's difficult to get information such as what our primary care physician is assigned to our family. The Aetna website is down much of the time and when it is up it is so poorly designed that it is not useful...
Had Aetna Medicare POO Plan last year. Cost an additional $180.00 per month and I am still getting bills from providers for what Aetna wouldn't pay. I had to pay not only the deductible and the monthly payment plus what they get from Medicare and I still received bills months later, even for standard blood tests. When I would complain to Aetna customer service they would tell you it will be taken care of and a lot of times they would say, “You don't owe the provider any more money” and they would contact the provider and resolve the issue.
Then a few weeks later you get a letter from Aetna saying the time for opening an investigation has expired, of course you already left a review after the customer service person told you it would all be taken care of. So I call them again and they do the same thing over. Imagine doing this on everything from blood tests to regular doctors’ visits and it's overwhelming. I'm still paying medical bills from last year. Never had such a horrible experience from any other insurance company, not even close.
I am pleased to announce that upon contacting the Aetna, Inc. Corporate Office, they were very cordial in solving my problem. They did so promptly, restoring my coverage seamless. No gaps in coverage. Apparently I had no idea my premiums went up, which is true of all insurances. They tend to go up instead of down. Thank you for this site.
Aetna cancel my insurance w/o a warning. Then after cashing in my payments, 2 months after they sent me a letter along w/ a check for more than $200 saying I "have elected to let my policy lapse" giving a date of March 1st, 2 2018. During those 2 months I have gone to Drs. and hospitals, but they say there is a gap of months they will not cover me b/c the policy already lapse. So, now without a supplemental I will have to pay for the thousands of dollars charged during a fall I sustained in March, & my cancer treatments. Being on Social Security it pose not a hardship but something worst. Maybe this is the way is going to be in the era of Trump when death panels are set up by Insurance Companies instead of the government.
Between what my employer pays & what I pay, we're giving Aetna $2,200 a month for health insurance for myself & my wife. We have their "platinum" plan. It's almost impossible to find a doctor or facility in their network. Many providers say they take Aetna but Aetna always comes back with they're out of network. Also, Aetna's Navigator sucks!!! Absolutely the Worst! I have never hated a plan more in my life!!! Buyer beware!
I pay for insurance thru my employment. I'm in good health however recently caught a flu. I get to pay 100% of the Dr. appointment because of a $2000 deductible. It's cheaper not to pay for insurance that does not cover any part of Dr. visit. Shame on you and the government requiring me to spend money for nothing. I assume this was due to Dr., lawyers and politicians needed more of my money. I am waiting for the IRS now.
If I could give Aetna zero stars, I would. Aetna is an absolute disgrace and total waste of me and my employer's money. They have third party boards deliberate whether or not a treatment plan prescribed by your doctor (like a specialist, that you pay more money for) is appropriate or not. They deny simple prescriptions such as high dose ** and require unnecessary x-rays that the doctor knows won't show what they need, exposing you to more radiation, in order for them to approve the tests such as MRIs that the doctor knows will provide proof of a diagnosis.
The "customer service" number is a joke. They clearly do not keep notes on cases and refuse to provide information to the policyholder regarding case status. I have been on the phone for a total of 5 hours today, being bounced around from Aetna to their third-party evaluators and have NO more information than I started with. I was even hung up on when I requested to be transferred to someone who had a better connection (the person I was talking to was incredibly hard to hear either because of the connection or because they were just mumbling). I, nor my doctors staff, have time to deal with this circus. Which I guess is Aetna's tactic, to exhaust and frustrate you to the point you give up and cancel all tests and appointments. Why is an insurance company allowed to prevent care? If they know whats best for me, why am I going to a specialist in the first place?!
I took my daughter to a follow-up appointment yesterday with an in-network orthopedic surgeon to review MRI results. It appears she has a small broken screw fragment or metallic debris from a prior intervention that causes her knee to lock and makes it difficult for her to walk. The doctor recommended arthroscopic surgery and scheduled her surgery for tomorrow. Today, I received a call from the surgery center letting me know they were canceling her surgery because they are not in-network. After spending an hour and forty five minutes on the phone with Aetna, I was told the surgery center was in-network. Of course, that made sense - if the provider is in-network, clearly the facility where he performs surgery is in-network. Well, that was not the case. The surgery center informed Aetna that they had canceled their in-network contract in 2010.
Our choices now are to wait over two weeks for the same surgeon to perform the procedure at a hospital (and risk having my daughter miss her high school graduation), or search for another in-network provider to perform the surgery within the next week. Of course, I now know that I have to ask what surgery center the provider uses before I waste our time at another appointment - and make sure it is in-network (no guarantees, obviously). We had to enroll for coverage through Aetna this year due to my husband’s employer. In prior years, we have been covered by Blue Cross Blue Shield and UnitedHealthcare and never had any such issues. As soon as open enrollment comes around, we will choose a different option. And, as a senior HR professional with significant experience administering health plans, I will never consider Aetna as an option for our employees.
My husband was discharged from a skilled nursing facility for rehab on a partial hip replacement. The surgeon did not recommend that he be discharged on the date set by Aetna due to some concerns. The facility filed for an appeal to keep my husband longer based on the surgeon's findings but it was denied by Aetna. My husband was discharged without medical equipment and home health care in place. It took one week to get wound care through home health care. Physical therapy took one week also. In the meantime, muscles atrophy if no PT/OT is administered. It took 3 weeks for occupational therapy to get started. I bought a walker and shower chair on my own. My husband broke the shower chair from a fall. I had the PT and surgeon order one and am still waiting - it has been 3 weeks. I have contacted Medicare but they do not know how to resolve the home health care issues. I guess it is time to seek an attorney.
Health insurance is a scam - Just not worth it for the money. These companies and this one in particular. I meet my deductible right before the end of the year. And then start everything over again so I have to pay more. You should keep the covering the 80%. Especially because I've been giving money to this company for years, without a single claim, that they had to put any money too! The worthless company, worthless healthcare system!
This entire process has been nothing but a nightmare. Countless claims have been opened then closed, opened and closed. They constantly tell me that they are missing documents that they adamantly state have been sent to me. I receive nothing from them except letters telling me that the claim has been denied. Each time I call, I have to start from scratch, providing information that I've given to them over and over again. I can be looking right at my account on my computer screen, showing the documents I've submitted and they will tell me that nothing is showing up. In the meantime, my last medical bill has now been sent to collections in the all the while Aetna reassuring me that they had reopened it. This entire experience has been exhausting and frustrating, all things one does not need while battling a medical condition and trying to recover from surgery. Their policies and practices need to be investigated.
Aetna expert review by Joseph Burns
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.
Best for: Heads of families, senior citizens
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