About Aetna Health Insurance
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My insurance provider is listed as Aetna through my employer. Cool. So, when I needed to see a therapist for PTSD I searched the website, read my plan benefits and looks like it is covered. I go to a therapist, give them my insurance information (which they accept, and are in Network), and have several sessions. Yesterday I get a notification that my claims for therapy have been denied and I owe 1300.00. It is super great for my mental health to receive such news. I panic, and call Aetna. They tell me oh no! Those services are covered by Optum. What is Optum? Who knows! I googled, I tried to find info on Aetna's website, I did everything I could. There is no helpful information about this online.
Unless you have mind reading capabilities, as far as I can see, there is no way for a new user to know that Optum is a separate entity from Aetna and who you go through for mental health care. I'm not trying to get in touch with Optum to see if my care is covered. Whomever came up with this system is insane. I shouldn't have to dig and dig just to figure out who to contact, what company covers what, etc etc. Absolute **. Run! Elsewhere.
I have to use Aetna since my company partner's with them. I pay into the top one available Aetna Choice POS. I needed a surgery because I have chronic sinus infection which cause me to have headaches, facial pressure and throwing up due to mucus. I also have one of the worst deviated septum so I cannot breathe at all out of the right side of my nose. This makes it hard for me to sleep etc.
I was going to have surgery to have this corrected and Aetna said it was not a necessity! It is not a necessity to breathe? It isn't a necessity to work? Because the sinus issues keep me from being able to work a full work day sometimes and most weekends I am stuck in bed in a dark room in a fetal position in pain or nauseous. My doctor appealed, I gave my side of things and they still said they would not approve! All this 5 days before my scheduled surgery! Why do I pay the most for "premium" insurance if it does nothing for me? I am glad me not breathing isn't a priority.
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My daughter paid out of pocket over $2,000 for medical work and the company kept promising to send her a check. They lied. The worst customer service with reps who like to argue with you. As a retiree I wish that my former employer never switched from Blue Cross/Blue Shield. Stay far away from this company. They need to be investigated.
STAY AWAY FROM THIS COMPANY. The plan coverage details listed are confusing. Their representatives and my doctor's assistants weren't able to decipher the information provided which resulted in the denial of an MRI that I desperately need. I'm experiencing severe spine pain with neurological symptoms and they expect me to wait up to 30 days for an appeal process. Wish I would have read these reviews before I became a member.
Husband had to have surgery. Did our best to get referrals for specialists leading up to it. Claims folks kept nitpicking but eventually paid. He was cleared by Aetna for surgery. He has the surgery and then the hospital submits the bill. Suddenly they start to second guess and we had to send his medical records. Now their nincompoops are claiming the surgery, which had been pre-approved, is now not medically necessary and we have to pay $45k ourselves. So now we have to go through a lengthy appeal process and contact doctors and meet with their appeals department. And all this to happen during the work day when I am supposed to be, you know, working.
Aetna deserted me in my hour of need. I am 75 years old and was very active till I started having back pain shooting down my right leg. I could not drive, bike, etc. About all I could do to relieve the pain was to lay on the floor. I could not even attend church on Sundays. My orthopedic Doctor requested an MRI to determine treatment and it was denied by Aetna. Aetna suggested physical therapy and I went. The first thing I heard at PT was "do you have an MRI." So it has been about 8 months of pain. Over the last 10 years I have paid into Medicare over $40,000.00 in monthly payments and Aetna denies a Doctor requested MRI.
Every bad thing you hear about insurance companies is represented by Aetna. I received an approval letter for a treatment. The medicine they approved was not carried by their required pharmacy. After many hours of contact trying to get an explanation of why they would approve a medicine and require me to use the pharmacy that doesn’t carry it I was told that there was a specialty pharmacy that did carry it but that they couldn’t find the approval. I offered to email them the approval I was sent. I was told that they would override whatever was out there and approve the medication.
When the pharmacy called to schedule the appointment with the doctor all had been approved. When setting the actual appointment a denial was received by the pharmacy for the same thing I already had an approval for. The next day in the mail I got a denial. I have been sent to more extensions people departments everything you can imagine that I don’t need. The only thing I can’t do is actually get someone to speak to me about the issue. I’m sure what they’re hoping is that I will throw my hands up and give up. I won’t, I will just have to continue to deal with his poor poor company. Great at taking people's money but not great at providing a service.
I had 3 different doctors recommend an MRI, it was declined by AETNA EVERY SINGLE TIME. I had it done anyway, because I care about a Dr.'s recommendation. They clearly don't. BASED ON MRI FINDINGS, a CT Scan was recommended, which obviously was declined. I had to file an appeal in order to get it approved by AETNA. Total waste of time over and over again. I have been requested approval for the MRI since April 2022, we are in July, 3 months later, Stella L. is not working today... Or any other unacceptable excuse.
I have a record of all my calls and the time I wasted miserably with AETNA and Evicor (the company they use to determine if an specialist's recommendation is worthy or not). Today, for instance, I called Evicore two times and AETNA 3 times, started at 14:33 and finished with a call to AETNA at 17:03 that lasted 45'. That's what they do: you are a ping-pong ball, they don't give you names or emails to document anything; they make you spit your liver repeating apologies they don't feel. During my short experience with AETNA I am convinced that the company's only concern is saving as much money as possible to the expense of their customers health.
This is the worst plan for providers to become credentialed. I have credentialed 6 providers over the last year and only 2 have just been approved. Credentialing is easy but waiting on Aetna is the worst. They credential fast. You see the patients then they won't pay the provider stating they are waiting on the contracting specialist to add them to the roster. So if you plan on being a provider expect a waiting period to get paid way over 1 year then they stale date your claims.
I have called everyday for 1 year and always get the same response, "Oh I will escalate this to the contracting department." Don't expect an answer because they never get to the escalation. You call back the next week and they say, "Oh I will escalate this." They have no representatives for you to speak with, only people who answer the calls in the Philippines. They can only tell you they will escalate. It's not their fault because this is what they are told to do and then they hold the brunt of the upset providers because the contracting department does not get back with you. I will never recommend Aetna to any of my patients or people I know. It's a nightmare.
Tried and failed 3 times to get a simple cardiac stress test authorized. I had to cancel THREE appointments. They will blame their vendor Evercore, but I contracted with Aetna, not Evercore! The worst! Would not recommend to my worst enemy!
Aetna author 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.
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