Aetna Health Insurance
ConsumerAffairs Unaccredited Brand
I'll start by mentioning that it is 11 days past my group health insurance effective date. It was supposed to be active on December 1st, 2017. It is now December 11th and we still haven't been "entered" into their system. Therefore, my family and I "do not exist" in Aetna's world, nor does any medical professional recognize that we have health insurance. I have never heard of any insurer ever doing this to their customers.
While waiting, I had to pay for two doctors' visits (full price since no insurance was "in effect" and we couldn't get the negotiated rate). Okay, I can deal with that and will file it when/if we are activated at Aetna. The straw that broke the camel's back was when I had to pay full price on my son's medication -- around $700. My patience was gone at that point. I called customer service (again) who wouldn't help me because "I wasn't in their system." After about 6 different phone calls and 4 hours of my time, they finally routed me to someone in the Rx insurer department.
I had a simple question -- When my plan and member information FINALLY gets entered into their system, is it possible that the medications my son took were going to require a pre-authorization. I just wanted to be prepared since these pre-authorizations can take up to 10 - 15 business days from the time you have to send it to the doctor for initiation. I didn't want to fork out another $700 for the following month.
The customer service (National Accounts) lady was very rude -- she wouldn't let me get a word in and interrupted constantly. I have never been treated like that by any customer service rep I have ever spoken with. She was very stern with her voice. I got her name and department, but somehow lost it over the following weekend. I wanted to file a complaint. I was angry at myself for losing it. The lady told me that no one would answer my question because the member information was not in the system. She refused to route me to anyone that might help.
I understand that. I just wanted to know if it was typical for them to require pre-authorization for the medicines. I asked to be routed to someone in Rx to talk with anyway. She kept saying with a firm voice "No." Her reasoning... It could have been one of two Rx insurers -- Aetna or Optima Rx. I had a simple solution - Give me the number to both centers and will ask both of them. It would still give me some idea. She still said "No." After demanding that I have her full name and department, she finally gave it to me.
Again, I know that when/if we get entered into their system, I can file the claim individually and perhaps get my money back. But, I was told by the pharmacist that since I didn't get a pre-authorization, Aetna/Optima is not required to pay the claim. A pre-authorization is required before obtaining the drugs -- and Aetna was known for doing this.
I don't know how I will react if it happens. I will appeal, but who knows how long the appeal process will take and even if it would be overturned. I have some say-so whether or not my company will decide to change carriers for the next plan year. I assure you, I will do everything in my power to ensure this happens -- regardless of costs. NEVER, NEVER, NEVER will I use Aetna again and I would encourage the same for others if they have a choice. Also, if CVS acquires Aetna, then CVS will never receive a dime from me either. I hope this helps someone.
Been with Aetna for 4 months through employer. To start, they had my name misspelled, zip code wrong, and birthday wrong in their system. I had to update this through my employer and even after updating it twice while sitting in HR, they got my birthday wrong a second time and then got my social wrong. Basically anything they could have screwed up, they did. This prevented me from going to a doctor for 2 months as my information didn’t match. Since then, my wife and I (we work for the same company and have the same insurance) have tried to make several doctor's appointments. Half the information on their websites regarding in network doctors is incorrect and/or out of date. Most phone numbers we’ve called are no longer in service and the few we got through to aren’t accepting new patients even though the Aetna website says otherwise.
When we finally did get an appointment, we called them to double check that it was in network. The woman we talked to said that the doctor we were seeing was not in network. We got the number for two alternatives and called both numbers. They were both invalid numbers. We then checked the Aetna app and found that several doctors at that office were covered, so we went back inside to talk to the front desk staff who said that all their doctors should be in network, so we called them again. We had to get someone from the dr office’s billing dept to speak with the Aetna rep and even she had trouble getting a straight answer out of them. They finally confirmed through the tax ID that the whole office is covered. This was after we cancelled the appointment due to the initial incorrect info. Thankfully they were able to work us back in in less than 30 minutes, but we’re still concerned there will be billing issues. Everything with Aetna is a headache.
Went for a routine cologuard colorectal cancer screening. Aetna denies coverage because "exact sciences is out of network". There are NO alternatives for a cologuard screening. Also, it has been approved by the FDA since 2014. Finally, there are 150,000 new cases of colorectal cancer every year in the USA. This is a medically necessary and approved screening. There is ZERO reason not to cover this screening for what is the 2nd most common cancer in the country (lung cancer is the first most common). Really a terrible firm, STAY AWAY!!
Not sure where to begin. I first went to a hospital linked to Aetna for a routine physical and stated up front that my primary care physician (PCP) had retired so that I needed a new PCP. Filled out the paperwork, came back the following week for my physical, and all cool... until two months later when I am abroad and Aetna says that they will not cover because I did not go to my non-existent PCP.
Later in a major vehicle accident, which hospital bills >100K, and Aetna sends me a letter that I need to find someone else to bill because it was not a medical issue. I somewhat agree here as should be covered by the other driver (at fault) insurance, but just the letter with the immediate exclusion ridiculous. I have paid Aetna well over 100K over 15 year. Stuck with them because my employer, and have pretty much got nothing in return when even the basics arise. All that plus just basic customer service really bad. Now stuck with trying to force my employer to jettison Aetna. Maybe will be not so hard, because seeing all the other complaints here, others might feel the same.
Aetna service is beyond poor. 10 days after my son was admitted to ICU with a TBI and days after the trauma ER Dr. Stated we should be transferred to acute rehab. Aetna approved our facility. We checked out of our hotel, gas up and waited to follow transport of our son to PHX. At the last minute we are informed that they will not cover the Dr. Ordered transfer unless we cover 13k for transport and the hospital will not release him under Dr. Order to us to transport. Now we are sleeping in the hospital and our son is not receiving the directed care. We have been in touch and very active in this process without any quality of service. With Aetna buyer be careful. I pray this delayed treatment does not hinder my son's recovery.
- 960,338 reviews on ConsumerAffairs are verified.
- We require contact information to ensure our reviewers are real.
- We use intelligent software that helps us maintain the integrity of reviews.
- Our moderators read all reviews to verify quality and helpfulness.
For more information about reviews on ConsumerAffairs.com please visit our FAQ.
Aetna is the best insurance I have been enrolled for over fifteen years. If I had a problem, I called them. Got the information need to go a professional for the care needed, then follow up on claims and contact for you to resolve a billing problem. Atena is more expensive than the other companies but their coverage is awesome so far.
I am covered under an employer plan which recently changed from Highmark to Aetna PPO. Went to open-enrollment meetings and were lied to about our coverage staying the same except now we have deductibles for “in” and “out” of network. As employees we have to go through this so-called “Get Healthy” program to give us a percentage off of our premium. What a joke!! Yet in my earnest effort to maintain my health through annual hormone testing because I had breast cancer and carry BRCA 2 gene requiring a mastectomy and hysterectomy, Aetna refuses to contract with this lab and it is the only one that can provide this that the doctor prefers to use. I have to test to maintain optimum hormone levels which is CRUCIAL to good health.
I was on the phone for an hour asking representative to find an in-network lab exactly like Genova who can provide this to no avail. They are incompetent! Then again questioning why they refuse to pay the claims or refuse to contract with Genova. This test normally costs $1900. Genova billed me $656 cash discount price. I can see more and more families going bankrupt over healthcare because of greedy CEOs whose only concern is the buck in his pocket and no concern over quality customer service. SHAME ON AETNA!! Never had this problem with Highmark.
A representative for Aetna called because I applied for health insurance through a website online. He wanted a credit card or my bank account number so I told him I would think about it and call him back. He says very rudely "what's to think about". I also wanted to get information sent to me but they "don't do that" he says. Makes me wonder if it's a scam and he didn't sound very professional, not like when I talk to HSBC or Geico representatives. Has anyone experienced this type of call from Aetna?
I called the billing department when I noticed they did not withdraw my auto deduct payment from my bank in August. They told me I had a 352.20 credit to my account from public assistance. It took them 2 months to straighten that out, they assured me it was all settled. This month I check my bank statement and they took out 501.20 when they should have taken 179.20, bounced my account and the ** tell they will call me back. When I ask no answer. I know from the last time it took 15 days for them to get back to me. They are beyond incompetent!!!
I received a bill from Aetna Pharmacy Management, and the only way it could be paid was via a check or credit card number using their return envelope. Not online, not over the phone. This is 2017; who doesn’t have a website to accept payments? Setting aside this pointless restriction that smacks off payment obstruction... The envelope provided was plain paper with no security features whatsoever - anyone could plainly read my credit card information through it. Trust me when I say I will hold Aetna liable for any loss incurred.
Aetna took a payment out of my checking account after I told them not to because I wanted to change insurance companies. I called them and they were very nasty with me and demanded I write them a letter stating the name of my new insurance company, my policy number, and reason for changing insurance companies. I did as they demanded and when I called my new insurance company to let them know what Aetna demanded from me, they said it is a federal law that Aetna reimburse me for the insurance payment and I have a right to change insurance companies.
I feel my civil rights were violated and my privacy was invaded when Aetna demanded to know my new insurance policy number. Aetna also made a fraudulent withdraw from my checking account. I have contacted the BBB, my bank, and I wrote a letter to the Insurance Commissioner. So far nobody has helped me get my money back. I am on Social Security and Aetna took away my money for medication and food for the month of September. Can anyone help me? Please? People beware of Aetna Insurance Co.
Aetna denied my child's coverage for using a doctor that was not her primary. Problem is I was going through a divorce and moved out of state and could not use her primary. I called and talked to every person I could or was allowed to and all were dead ends. I would not recommend this company to any person or business.
Aetna Insurance promotes itself as Healthcare joined with State of AZ Medicaid Program. Not informed, consulted; nor did I consent to becoming a part of that program; already had full coverage mandated by law through UHC. Found out at an appointment, denied to be seen based on false and derogatory information place in the State of AZ Healthcare System by the State of AZ. Six months AZ Administrative Court process restored by right to choose my own healthcare insurance provider back to UHC.
Stressful ordeal to argue my case against Jill **, attorney, for Aetna against the State of AZ for violation of my rights. UHC filed suit against Aetna on their own matters; had to obtain AZ Court permission to be able to do so outside of the Administrative hearing process I was restricted to. Aetna delayed, denied, did not pay my medical expenses liable for during six month period of time. Aetna did not reimburse me for medical expenses I paid during that time; required. AZ in collusion, complicit in violation of my rights, ongoing failure to provide healthcare coverage detailed, outline in my UHC dual complete healthcare benefits coverage publications.
My 13 year old son's Foot and Ankle Surgeon ordered an MRI to determine if his foot had a stress fracture. Aetna denied this MRI based upon published "international and national" standards. When I asked why this was denied, the standards were cited. I have spent over 3 hours trying to push this MRI through. In the meantime, it has been 10 days and we still don't have an MRI. I pay 1614.00 a month for my coverage. My son's bones are breaking and an MRI will help us determine why but no one will accept ownership inside the company.
Last year they approved the MRI in one day. Not sure what is going on this year with Aetna. Customer service people are less knowledgeable also. I was told I could have my doctor do a peer to peer review or a reconsideration, but a reconsideration would take 5 more days. Policy should change that automatically denies MRIs until after 2 weeks according to industry standards and need to then submit an additional request for an MRI.
I have had multiple claims now with Aetna and selected the plan I did because it 100% covered childbirth. After having a child born I have had to call the company 5 times to get claims adjusted appropriately and have been given a litany of excuses as to why it was filed wrong ranging from they accidentally used last year's rates or the person doing the previous claim was missing information etc. Perhaps reasonable the first time. The 5th time it simply astounding. They assured me they were fixing the claim and I owed nothing each time. I didn't realize they had utterly failed to properly pay the hospital when I got a call from a debt collector. Fortunately the hospital was agreeable and placed my account on hold until insurance actually pays properly.
Aetna had my wife registered as a male. They had ages wrong. They have reliably filed claims wrong. They are utterly incapable of doing their job and should not be trusted -- it's not my job to hound the insurance company. I already pay them exorbitant fees. I expect professionalism and accountability. I am switching back to Blue Cross Blue Shield after this horror show of a company.
I have been getting my Flu shots at Rite Aid for 3 yrs. This year I went to Rite Aid only to be told that Aetna won't cover the high dose Flu vaccine they have. Aetna only will do generic vaccines and my pharmacy handles only ** that offers increased protection for at risk seniors. I contacted Aetna for a review that they ignored. I have been bounced around through 6 different service reps for hours only to be told that medical and not prescriptions with pay for the shot. Went back to Rite Aid and again rejected by Aetna. This company has no respect or compassion for its members. Absolutely horrible to deal with. I will be going back to the pharmacy and paying cash for this vaccine. So Sad that they treat seniors this way.
I am a counselor in Illinois. Recently, I left full-time employment to pursue part-time private practice. This involves becoming credentialed with the various insurance companies so that one can receive payment. Becoming credentialed with Blue Cross/Blue Shield and Cigna was straightforward. It took some time, but there were no real snags. Aetna, however, has been a nightmare. The practice I joined used to work out of another city than it does now. It's been where it's currently located for several years now. I never put down the old address on any of the forms I completed. My guess is that Aetna got it from the tax ID they wanted and I submitted -- I submitted the one for the practice, since I don't have one individually. They sent me an email to say that I was credentialed, but when I got a potential client who had Aetna and I double-checked, they said I was 'in-network' at the old location, but 'out-of-network' at the current location.
I would have to fax a letter requesting that my contract be connected to the current location. It would take about two weeks for this to go through. I did so back in early May. During subsequent calls -- many of them -- it had never gone through, although they had gotten the fax. They don't appear to have a system that keeps them up-do-date on what's happening with an account, so that I'd have to tell the whole story over and over and over again. Forget being able to work consistently with one person -- they don't even have individual extensions. Various people told me that they had expedited -- or in their lingo 'escalated' the process. They'd tell me that it would go through in 5-7 days. But when I'd call back to check, I'd be told that I was still out-of-network where I'm actually practicing.
One person actually told me that I was 'good to go' and I subsequently called another potential client with the news who countered with: "Oh, that's interesting. I checked and they don't show you as in-network." It is now late August and after having been told during my last call that the process had been 'escalated' and would take 5-7 days to go through, I was told this morning, that it will take 30 days. I told them to forget it.
If they're this poor at credentialing, I can't imagine the hassle that billers and customers have getting them to pay legitimate bills. Indeed, the man who owns the practice in which I work told me that he'd advise me to forget them and that he had pulled himself out of their network. I genuinely feel for people who rely on Aetna to pay their medical bills. That's got to be horrible to be sick and absolutely need and deserve coverage (that you've purchased) and be given such a horrific runaround. If you can deal with another insurance company, do.
I had a procedure done in mid January 2017 and they still haven't been able to get the claim adjusted correctly. It is now mid-August and after over 20 phone calls and having my company involved, my initial claim and subsequent claims are so messed up. I am in total disbelief that living human beings could be so ignorant. I even sent in a letter adjusting the claims for them according to how much they pay the doctors for the various services and they still can't get it right. They admitted numerous times to me that there was something wrong with the way the claims were handled too. I just don't know what to do anymore. I have never experienced such incompetence before!
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.
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!
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
Health 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 Health Insurance Company Information
- Company Name: