Aetna Health Insurance

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Consumer Complaints and Reviews

cheryl of Chino, CA on
Satisfaction Rating

My doctor took me off of work. I provided Aetna with my doctor's information, location, fax, e-mail and phone number along with a medical authorization. After 30 days they denied my claim because they said they were not getting the medical records and told me to get them. I talked to my medical provider who said they sent everything Aetna asked for. When setting up an appointment to see my doctor it is done through the internet only allowing for a few letters so I was brief and stated my arm was sore and decided to talk in person about what was really bothering me. Aetna just saw, arm sore and denied my claim based on that, they never looked through the entire record and notes from my doctor. I have asked for copies of my file including all e-mails and still after 4 requests they do not even acknowledge receiving my request.

Gary of Sioux City, IA on
Satisfaction Rating

Coventry which is owned by Aetna is no longer offering healthcare coverage in Iowa so Aetna took over those plans and rates increased dramatically because of this so called company within a company swap. My experience with Coventry was good in 2016. It has been nothing short of a major disappointment since Aetna took over my health coverage. The customer service is awful and the login to access to your plan has been a nightmare to say the least. Tried using Walgreens for a generic 1mg prescription that cost $10 a in 2016 and my bill was $177.00 because Walgreens did not make Aetna's preferred provider list? This is very disturbing how much control Aetna has over filling a simple generic prescription. My advice to you is simple. Find another carrier if you live in Iowa. I am.

Marie of Wayne, NJ on
Satisfaction Rating

The worst experience I have ever had with an insurance company. For three days all I have gotten is the runaround from one department to the other in an effort to have anti-rejection medication filled. Depending on who you talk with at Aetna you are covered and then rejected. Do not use them for your insurance needs.

Cee Cee of Malott, WA on
Satisfaction Rating

I had open heart surgery in August 2016. Since then it has been one fight after another to get paid from these people. Currently they are 3 weeks behind on my case again. My last pay was in December 2016. Still waiting. Do these people think that our bills don't exist. My paperwork gets lost, I have resorted to making my doctor send me all the confirmation letters that the documents were sent and received on certain dates. Oh and don't expect a callback from your case worker. I have left numerous messages and never received callbacks. Now my case worker not receiving messages at this time. That's what I got today when I tried to call her. I even went so far as to write a letter to the CEO of the company that just got some public relations person to call me but guess what? Nothing changed. Still waiting.

Balaji of Old Bridge, NJ on
Satisfaction Rating

Aetna will make every effort to deny your claim by sending a letter saying that procedures are experimental. My wife got stuck with a 2400$ bill for genetic testing when she is pregnant because Aetna considers genetic testing as experimental. NEVER GO WITH AETNA.

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Mohammad of Englewood, CO on
Satisfaction Rating

Aetna is the worst for everything. I went to urgent care for my wife and they billed me for $612.80 for emergency charges and $12 for doctor which I was able to see in my claim list. Then I got a bill of $482 which I paid assuming that it is the adjusted amount of $612.80 (I may wrong in my assumption). After sometime I got a call from the hospital that you have the amount due to paid. I said I already paid, then they said "no that is from different department."

I said ok but whatever bill should come to me will come from Aetna and I should be able to see that in my claim list, which I was not able to see of the amount 482. Then I called Aetna and started having mail conversation then they said "no, you have to pay $612 + $12 + $ 482." I asked them why I am not able to see the claim of $482, the billed charged to me and they didn't answered me. They cheated me. So I will not recommend anyone for Aetna. Please be careful with them.

Vikas of Randolph, NJ on
Satisfaction Rating

I have been selecting Aetna as insurance provider since 2009 and never used their services much until 2016 as I am young (31 years old now) professional. In 2016 we had a baby in October and my wife has been diagnosed with multiple diseases (not a good year from family health perspective). Since my wife has reached the plan coinsurance limit, Aetna started rejecting most of the claims for her. Recently she had to go in emergency for Pancreatitis attack and Aetna rejected the claim stating it wasn't necessary??? They are just increasing my pain. I will never suggest them to anyone. Next year onward I am planning to change to UHG - other insurance provider by my employer. Please suggest what should I do and who should I contact?

Rosemary of Richmond, VA on
Satisfaction Rating

On 10/27/16 I sent a check in the amount of $1,405 covering annual premium and $20 processing fee for Aetna Supplemental Health Insurance. The following week I received a letter dated 11/1/16 declining my application and stating I would receive my refund with seven to ten days. It is now 12/2/16 and I have not received my refund. I called and was told the check was cut 12/1/16. I don't know whether or not it was mailed but I consider their business policy disgraceful.

Janeth of Newnan, GA on
Satisfaction Rating

I went to the dentist for a surgical procedure for my daughter. The dentist office called right there and were told the dental procedure was covered and they even gave them a $ amount of coverage. They were never instructed to call medical or oral surgery department. Then, they turned around and denied the whole claim. Sent it to medical including the x-rays and doctor's visit. Aetna has created an "oral surgery department" as I was told by the rep when I called, to get away with not paying dental benefits and tricking the dentists and patients to keep their money. If you're a large business, don't get Aetna for you company, it's a terrible service for your workers.

Allen of Cary, NC on
Satisfaction Rating

I had an Aetna Medicare Advantage plan for 2016 (premier PPO). That plan rejected routine vaccinations by my approved doctor and made me appeal them to get them approved. In 2017 they took a generic medication, **, and arbitrarily switched it from tier 2 to tier 4, causing the copay to go from $15 to $100. Many people don't check their plans before renewing. Next year this will be a rude awakening for those on that medication who don't. This caused me to switched to another company, Gateway, for a drug savings of $600.

Linda of Scottsdale, AZ on
Satisfaction Rating

I called the 800# listed in the 2017 Medicare booklet for supplemental insurance on 10/10/16. The agent, Greg, signed me up after asking a lengthy series of questions to ensure I qualified, which I did. I waited and waited with no further contact until I called to expedite in early November. Was told application wasn't received until 10/26 and it was incomplete. No one called to tell me it was incomplete and here it was 2 weeks later. I was told I would be emailed the 'health' questions to get this thing going. No email. Called again. New Person.

Sent 3 pages which I had to print and then go out to a fax machine to return. Oops, I was sent the wrong page. I only found this out after calling again. I was resent page 6, printed it, filled it out and went out AGAIN to have it faxed. No call back. I called in 4 days only to be told they hadn't received page 6 but didn't matter because now they needed page 7 as well. Unbelievable. Then, after much prodding, they located page 6 but were going to email page 7. After escalating to a case manager, I received page 7 and went through my standard process. Now three times to a fax machine.

Called again to let the person know it was faxed. I was told to call yet another number and go through the questions with the Underwriting Dept. Of course, they had no paperwork for me but the nurse asked the questions anyway. I called, again, to let them know I spoke with Underwriting. In the meantime, I was sent yet another email telling me they failed to send me another required page. Then, for the very first time since 10/10, Lauren called me back to tell me I could ignore that email because I HAD BEEN DECLINED because of an AFIB diagnosis that occurred in 2007. Said the drugs taken for AFIB are on the automatic decline list and yet that was not mentioned when I answered the questions on 10/10 stating I had a AFIB diagnosis.

I am in shock. Never in all my years have I experienced such a complete lack of competency displayed from the very first phone call to the very last. This involved over 11 different people. I guess I should be grateful I was declined as I don't believe Aetna is a company I wish to have as an insurer. What a complete disgrace. I don't believe anyone at Aetna will read this but I hope it serves as a warning to other consumers to not waste your time as I did.

Carol of Lubbock, TX on
Satisfaction Rating

It used to be that health insurance was simple. You met your deductible and then the company paid 80% of the rest. Now we have all this details about certain labs, certain procedures. It's ridiculous. I must go to a cardiologist once a year for congestive heart failure. My insurance has always paid for my echo, my blood tests, etc... This year, they will approve none of it because they want you to go to a central lab - which doesn't even offer the tests I must have. When I called about this, the customer service rep (whose name was Wendell) came out of the blue and said, "Well, we don't care about you. Not at all." I thought I was hearing things, but he repeated it. I guess I shouldn't be surprised, their CEO makes a quarter of a million dollars a day. Insurance companies are parasites on our population. We need to put them out of business with single payer medicare for all.

Kelly of Lakewood, OH on
Satisfaction Rating

My experience with having Aetna as a health care provider has been nothing but problematic. With my salary being on the lower end (as I am in my early twenties and a full-time student), I qualified for Obamacare. However, even with that discount, the premium is $190.00, with the specialty co-pay at $45. The main care I receive is in regards to mental health, so I have always understood that, with any provider, specialty care is more expensive. However, paying $200 per month for insurance, $45 per week for therapy sessions, $45 per psychiatrist visits, plus the co-pay on my medications meant that I was a 21 year old full-time student spending $500 or more a month on health care.

When I began seeing my initial therapist, Aetna repeatedly sent her documents requiring personal information regarding my condition be sent to them. While I am not fully opposed to this, it becomes a major point of aggravation considering they opt to pay for things required due to my conditions. Regarding my medication, I am prescribed a stimulant for attention difficulties. More than once I was unable to pick up my prescription at the pharmacy because the insurance put a hold on it until my doctor gave a specific reason as to why I was prescribed it. I'm sorry, but if I have a legitimate doctor's prescription written, I deserve access to the medication. If Aetna is so curious as to know why I am on a medication, sure, let them inquire away and know all of my health information, but do not prevent me from accessing my medication in the meantime.

Due to the fact that I am on a stimulant/narcotic, my doctor initially drug tested me (to make sure she wasn't prescribing ** to someone prone to drug abuse). This typically should not be a problem because if it is required by my doctor, then it should typically be covered under my copay. However, 5-6 months later, I received an invoice from the drug testing company stating that my insurance only covered so much and it was then my responsibility to owe the remaining $200. (Mind you that money will not be coming out of my pocket.)

At one point I was having login problems and really needed to check whether my bill was accidentally overdue because I was being denied a necessary blood draw from an outpatient clinic due to insurance related reasons. Because of both the login problems and the coverage issue, I needed to call Aetna and speak with someone to help resolve the issue. I spent about 45 minutes speaking to computer operators and pressing numerous numbers on my dial pad trying to find someone to speak to, only to receive more computers. I then tried the Ask Ann icon on the website, only to realize this would not link me to Instant Messaging with an Aetna worker, but was simply a computer generated search engine (with a smiling woman's picture on it for some reason).

At some point I was finally able to speak with a real-life person (thank God) and explained I needed to pay my bill over the phone so I could finally go back and receive health care at the outpatient. While I thought she entered for the entirety of my bill to be paid, only one month was paid. Later in the month I finally resolved my login issues and found that my Auto-Pay had not been set up correctly, so my bills were not being paid. I was then told my balance was about $550.

Recently, I went to the pharmacy to have my prescriptions filled and found that the cost was $100 instead of the usual $30. I checked my balance and it is at $0 and my coverage should be covering the whole of this month. I called, but the computer (of course) on the other end told me it is always best to call the number on the back of my insurance card first. So I did this and talked with a kind woman about why my insurance is no longer covering anything. She checked things out, then asked if I had called my insurance first. Apparently my insurance card directed me to call the insurance MARKETPLACE, instead of Aetna itself (because why would Aetna be willing to speak with its own customers?). The woman on the end was still able to put in a notice and she did everything she could to help me.

However, those claims can take up to 30 days. This means that I will not be taking my medication and will have to cancel my doctor's appointments (because without insurance coverage those about $500 a session) for the rest of the month. I will clearly be buying new insurance during open enrollment and will discourage anyone I know from ever going through health care with this company.

Wanda of Shepherd, MT on
Satisfaction Rating

After purchasing a medicare supplement plan for myself and husband from Aetna, we decided to go with another company. I called to make the cancellations and did what they requested. First they gave me the wrong fax number, then wouldn't accept the fax for my husband. I didn't find this out till I called for an update on my cancellation. So we called again, talked to the customer service, did what they asked and waited. NO emails on the progress so I called again, my check was sent out on the 3rd which is 3 weeks from the first call. They are fast to get your money and VERY slow to return it.

Jenna of Ramona, CA on
Satisfaction Rating

My dentist called to verify I had insurance and yes I did and all was fine. Then suddenly after all the work is done there was a refusal to make payment. This place supposedly never got the appeal that I have proof made it to them. Every person I ever spoke with had major attitude and made up lame excuses always different. I have not experienced anything so dirty from a company this size ever in my life!!!

H of Elmhurst, NY on
Satisfaction Rating

Lack of transparency and clarity in their plans. When you purchase Aetna plan you think you will be covered. When you actually file a claim you realize you were duped by them. In my case they refused to cover annual physical performed at walk-in clinic. Paying their premiums is a total waste of money.

Ashley of Leeds, AL on
Satisfaction Rating

My company switched insurance providers to Aetna and did not notify us... neither did Aetna. I get a bill a year later stating I owe my doctor money. I call United, they call my company HR. They call Aetna. I get this Indian guy I'm having trouble understanding, but I can hear his attitude. It took me 5 times to explain that of course my doctor's office didn't file it correctly because I wasn't notified of any change. I asked why he didn't get some basic info from my HR rep when she WAS JUST ON THE PHONE WITH HIM! I don't know the service date, I don't know anything because I switched companies 8 months ago. This company can't do any investigating on their own. I've been given the runaround. They can't notify their subscribers. Don't get involved with them. I remember my oral surgeon having to call for over 1.5 hours to get help and get me covered.

Barbara of Flowery Branch, GA on
Satisfaction Rating

Horrible experience with these people! They do not honor their claims even though it is written in their benefits plan. Every time you call to get more info about why they REFUSE to pay... you get a different person with a different EXCUSE as to why they won't pay. My office manager at my doctor's office who has 30 years experience with dealing with insurance companies said she has never seen any insurance company give so many ridiculous reasons and EXCUSES for non-payment on something that is in their own benefit package.

They wanted more paperwork, then more documentation, then more this, than more that... So then we filed an appeal and guess what??? Then all of a sudden that was denied because they said it was more than 180 days and it's too late to do anything! So in other words they deliberately delayed the claim by giving us all these EXCUSES to tag us along so our 180 day time limit (and never told us this was time sensitive as well) would run out. What a poor excuse for an insurance company... I am cancelling and not recommending to anyone. Heard they were losing money anyway and very obvious they are trying to make it up by not honoring their claims! And just look at their reviews!!!

Kim of Thomson, GA on
Satisfaction Rating

Over the past 3 weeks, our family called Aetna and our physician's office to get a pre-certification done on my knee injections. Each time we called Aetna, it was another excuse: no medical record sent, etc... because they gave the wrong fax #. Then after 2 weeks of calling for hours, they inform us the knee injection needing approval is not in approved injections and other 3 injections (lesser performing ones) has to be done first before the best is done. I consider this very wasteful after I have had the other three - they want us to try them AGAIN. Aetna = tons of wasted phone hours, incompetence on receiving and applying records sent not once but 3 times from the doctor's office and ALL EXCUSES. We are saving to pay out of pocket.

Michael of Phoenix, AZ on
Satisfaction Rating

I took LOA from work due to extreme fatigue, dizziness, fainting, nausea, and extreme high blood pressure. Leave was suggested by my manager and my doctor. It took a couple months to run tests. I called to report to Aetna of was taking leave and that was all I heard from them for 2 weeks. After two weeks I called back and they never started my claim and never sent my Dr info they needed a reply to. They called me a week later and told me they would deny my case due to not hearing from my Dr. They were extremely rude. They finally reached out to my Dr but didn't get all info needed. But refused to tell me what other info they needed. They denied my claim. I took it through the appeal process and again denied. They sent a letter as to why but in this letter they claimed I was taking meds I have never been on nor prescribed. They gave false stories as to my condition.

At one point they said I was blacking out but that was no reason not to go to work. Well I couldn't drive like that. The appeals lady was again extremely rude and would raise her voice to me. I now have to pay my work back a paycheck and didn't receive a paycheck. I fell behind on bills and may have to claim bankruptcy now. Aetna made lies in the statement and I have all my Dr's notes to proof the discrepancies. I am looking for a lawyer now. If anyone else had this issue please contact me.

Nicholas of Barnesville, OH on
Satisfaction Rating

My wife is diabetic and Aetna refuses to pay for her medications she needs, the pharmacy said I could pay $200 cash to get her meds and I don't have that kind of money lying around. Also my wife got extremely sick one night at work and left work and went to a hospital over by where she works and Aetna refuses to pay for her to see a doctor that night. Then lately I had to save my CDL license and I ended up paying out of pocket $800 cause Aetna said they wouldn't help pay for the CDL physical, and the doctor I was seeing who was a quack anyways ordered a test.

She wanted ran and she told me that she had talked to Aetna and they would cover the entire price of the test, so I did the test and 2 weeks later I get a bill in the mail for $2500, and so now I have collections calling me which is some dumbass **. My hours and wife's hours at work just got cut also so we are making $1000 less per month, IDK what we are going to do. Has anyone talked with a lawyer to get a class action lawsuit against these crooks?

margaret of Roseville, CA on
Satisfaction Rating

Aetna has the best mental health benefits in the industry, according to our providers (hospitals, clinics, doctors and counselors). One hospitalization can be over $100,00 easily, and max out-of -pocket is less than $3000, at least for our plan. They have been very easy to work with, mostly not requiring any contact at all from us. When we did call their answers were prompt and accurate. They have been truly amazing.

joe of Phoenix, AZ on
Satisfaction Rating

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.

Kim of Plantation, FL on
Satisfaction Rating

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.

chris of Denver, CO on
Satisfaction Rating

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.

Brett of Colorado Springs, CO on
Satisfaction Rating

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.

K. of Phoenix, AZ on
Satisfaction Rating

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!

Donna of Jackson, WY on
Satisfaction Rating

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.

Gina of Santa Fe, NM on
Satisfaction Rating

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!

Sandra of Hemet, CA on
Satisfaction Rating

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.

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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.    More about Joseph→

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.

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Company Name:
Aetna
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