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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.
As a provider, it has been a nightmare trying to get reimbursed for services from Aetna. Each follow up phone call is routed to a different department and each inquiry has gotten different answers. Aetna is delinquent with payments, stalling, then denying previously paid services for no reason. We are a small solo medical massage business now forced into taking legal action to collect over $5000 for unpaid services rendered as an in network provider. No explanation has been provided as to why mid-year coverage for these patients was suddenly was stopped. They are processing my claims as "provider reimbursement" "$0.00" WHY? We now are no longer willing to accept Aetna covered patients into our health care practice.
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For anyone considering using Aetna for health insurance, please read this message and avoid Aetna at all costs!! My hope is that this message might help another family avoid all of the suffering we have endured because of Aetna! At the end of November, we received a letter from Aetna, our health insurance provider, that they would no longer cover occupational therapy sessions for our 7 year old son, who has an autism diagnosis. They stated that occupational therapy services for a person with autism should be short-term. (What?? I would hope that a company that provides medical coverage would understand that there is nothing about Autism that is short-term!) My husband, Jay, and I were shocked because our plan allowed for 90 occupational therapy sessions a year, so we couldn’t understand why Aetna would deny this type of service, especially when we were well within our number of allowable visits.
And what was even more shocking, was the fact that they were deeming autism and sensory needs related to autism to be a short-term necessity. We filed an appeal with Aetna to try and overturn their denial of future coverage. At one point, Jay called about our appeal and an Aetna representative told him that a doctor had never actually looked at our file! How can they deem a medical service an unnecessary of a doctor hasn’t reviewed the case???
4 months later, Jay and I have spent hours and hours on the phone with Aetna representatives and managers. Recently, a manager promised Jay that our son’s file would be sent to us so that we could review it while we awaited their decision. Of course the file was never sent to us. We were told we would have to wait 45 days for Aetna to make their determination about our appeal. So when I called today to find out the verdict, I was told that they only looked at one specific Occupational Therapy (OT) service date for our appeal, instead of considering the fact that we were appealing their denial of all OT services, not just ONE!!
It is absolutely disgusting to think that families have to go through all of this... It is challenging enough to help and support a child with a disability, but to have to fight the insurance companies about coverage of services that they claim to cover in your plan is downright appalling. Jay works in this industry, so he knows the way that these cases work and the appropriate measures that should be taken when customers are calling in and requesting information about claims. But not Aetna, they have made so many errors along the way, they are completely unreliable and responsive, and the bottom line is that they simply do not care about the welfare of their customers.
This entire experience has been so distributing and taxing on our family and 4 months later we are no closer to a resolution. We were just told that we need to resubmit a new appeal because of way their appeals work and this is due to their “process.” I encourage every person that is considering switching to Aetna for insurance, to never ever consider using them!!
I wish there were 0 star rating. Aetna is my company's choice, and the monthly premium is $1,600 for my family of 2. I only have one daily medicine for HepB. And that is the ONLY drug we need. We are both, thank God, otherwise healthy. It used to cost $30 co-pay per month. Then in 2017, Aetna adjusted the price to 30% co-insurance or $321 per month. The reason, they claimed, is that a generic version is becoming available. Now 15 months later, there is no generic version of that medicine. I look forward to Amazon/JPM/Berkshire and joint-effort for better medical insurance product. Before that, I am lobbying my company to ditch Aetna. A terrible company!
Customer service worst. Customer service people doesn't know what is covered and not. Every time you call for the same concern needs to explain from the beginning and they don't track or maintain and will get different answers. This insurance and customer service is horrible.
My mom is now on Aetna managed Medicare through Boeing and I can certainly say that Aetna is ruthless and worse than Medicare. At 80 years old my mom fell in her assisted living home and was hospitalized and got the flu all in a couple of days. After the hospital she was then transferred to a skilled nursing home and in less than two weeks Aetna managed Medicare is kicking her off the usual 100 days of covered skilled nursing and now my mom will need to pay over $600 per day out of pocket for skilled nursing care. They say she was refusing to get better. When you are recovering from the flu, dehydrated and in pain anyone would refuse to do physical therapy!
For anyone who is on Boeing’s Aetna plan I would warn you and your parents not to get put on the Aetna managed Medicare. They are cold-hearted, profit-only oriented thieves who would rather cut off an old widow than help her recover. Great job Aetna and the morons at Boeing who shoved all the Rockwell retirees onto Aetna.
MRI denied prior to a Parotid Deep Lobe Tumor Surgery. Why would someone be denied an MRI when there is a tumor present, especially around the head and neck area? My surgeon didn't really know for sure until he went in to remove the tumor that it was a deep lobe tumor. Had I had an MRI he would have been better prepared. Thankfully I had an excellent surgeon!
Aetna did not charge me for Xolair treatment all last year, then, as of January, they levied a $630 fee per shot but only notified me of this after I received 3 of them. When I asked for the reason for the charge, they never got back to me in 10 days as promised. I spent an hour on the phone to finally discover their only explanation was that it was billed correctly at the Medicare Advantage plan rate of 20% of the gross amount in 2017.
Furthermore, the Aetna senior analyst informed me I had been incorrectly billed last year and Aetna may very well hold me financially responsible for all last year's amount! The doctor showed me their statement from last year showing I was responsible for a 0 charge, but the Aetna analyst said they have the right to audit their bills for two years after the fact and hold me liable for past billing amounting to $4,000+! How can they do this? I went ahead and took the prescription on the quote the doctor originally received for $0. Can they get away with this? This is corrupt!!!
Aetna is refusing to pay a claim for a surgery I had in October 2017. I had a hernia with complications and needed surgery to repair it. It is now March and the doctor and I have appealed their decision (that there was no reason to repair a hernia) and they are still stalling on paying the claim. Research has shown me that this is a common abusive tactic on Aetna’s behalf meant to cheat and defraud their customers.
I am having a great deal of difficulty obtaining the medications I need from Aetna, and they do not initiate communication about their decisions. I had already had one ** shot in June, 2017, 6 and was due for another in December. It is a drug for osteoporosis and must be taken every 6 months. My doctors contacted Aetna several times but received no response. In late February, she contacted Aetna again and was told it was refused. I called about it and was told the doctor had never called. A few days later, Blue Cross, my husband's insurer, called and told me they had approved **, but I needed to make a $140 copay. Aetna Specialty Pharmacy would have been free to me, because it is mail order. I called Aetna again, and they said that they had decided to approve my ** after all. Meanwhile, I have received NO ** from either, no communication from either, and it is March, 2018. Aetna is supposed to contact me today. We'll see.
When Costco managed my medication, I always had it on time. They contacted me by phone when it was time to reorder **, a biological drug for rheumatoid arthritis, which must be taken weekly. Aetna never communicates with me when it is time to reorder, and the online account information states when I can reorder, which does not allow enough time for it to get here. I called about that, and they said I could order now, but no one has contacted me about arranging delivery, and I will be surprised if they do. The drug has gone from $1000 to $4000 a month.
Aetna does not want you to take expensive drugs and throws obstacles in your way, such as yearly approval requirements, ordering difficulties, incorrect information on when you can order, initial non-approvals followed by approvals, and you are not informed of anything that is going on and wonder why you are not receiving your medication or receiving it on time. In order to work, these drugs MUST be taken on time. Unfortunately, the Anchorage School District, which is self-insured, has chosen Aetna to manage their health insurance, and they care little about your health, just saving money.
Blew my back out and had to go crawl into the ER on Saturday two weeks ago. ER took xrays, gave me a shot, gave me a prescription, told me to take **, and see my regular doc on Monday. Saw my regular doc on the Monday. She gave me two shots, several more prescriptions, and made a referral to a neurosurgeon. I see the PA at the neurosurgeon on Thursday. He evaluates my condition and schedules me for an MRI at the earliest appointment which is a week and half later on Sunday at 1:30 PM. Just before close of business on the Friday before the MRI appt, I get a telephone call from the MRI scheduler informing me that AETNA has denied coverage for my MRI. I'm sucking it up and am still at work.
So, my wife gets on the phone calling everybody that she can reach at that time of day. She speaks to somebody at AETNA that tells her that the doc's note are "not very good" and that I need to meet at least one of six conditions to get approved for the MRI. I met at least four of the six items provided. The person then tells my wife that I could pay for the MRI out of pocket, request a peer to peer review, and then they might approve the test. I show up at the facility for the MRI fully expecting to have to pay the $2500 for the test to be told by the receptionist that they took me off the schedule because AETNA refused to pay for the test. Now here I am almost two weeks later, still in severe back pain, no reflexes in left left leg, weakness in my left left leg, and walking crooked as hell. Man does that ever make you feel good to pay insurance premiums!
Aetna changes categories/tiers for drugs so that even if your initial year with them had reasonable prices, the next year, charges can be double for no good reason. One of my meds - which is a generic - went from being categorized as a generic to being categorized as a tier 2 drug. Nothing changed with the prescription or the drug, Aetna just decided to jack up the price. When I was prescribed another medication that needed to be used ALONG WITH the original medication, they refused coverage since I was already using the "alternative". Over a two day period, it was like being in the twilight zone. My doctor faxed numerous explanations and documentation indicating the necessity of a two-pronged approach, but Aetna's automatons just kept repeating back the same reasons for denial. Leaving Aetna as soon as possible (unfortunately that will be next year) but making sure no one else falls into their trap. Find another insurer!
I have had Aetna since January 2018. I can't believe the medication I have been on for years had small co-pays. With Aetna, they don't cover any of my prescriptions. Further, I receive letters from them saying they only cover generic ones. I have not taken insulin since January. Every time my doctor recommends a product, Aetna says not covered. I contacted Aetna and the customer service was really bad. Aetna would not even discuss options. Aetna kept saying you need to meet the deductible first... That would be 5k.
I have had Aetna for 1 month and a half now. I can't believe the medication I have been on for years had small co-pays. With Aetna, they don't cover any of my prescriptions. Further, I receive letters from them saying they only cover generic ones. I am afraid to go to the doctors' offices with this insurance. The fear they won't cover it. My new answer to the question: Do you have health insurance? I say No; I have Aetna.
I have a severe medical condition and they have denied several of my claims. I pay my monthly premium on time, but they still are refusing to cover me. When I call them, they are extremely rude and won't give me time of day. Stay clear of Aetna. The insurance is for healthy people not those with serious conditions.
I recently had Aetna health insurance through my employer. I was having back pain with pain radiating down the backs of my legs. I was referred to a specialist, he did MRI and xrays, it was determined I needed spinal stabilization surgery. This was in April. Aetna denied approval for this surgery. I was put off work while my doctor and I tried to get Aetna to approve this surgery. Several attempts led to the same answer from Aetna…it's not medically necessary. Me on the other hand can only stand for about 1,1/2- 2 minutes without having to sit to get a little relief from the pain. This went on for 3 1/2 months, all the while Aetna said I had to do physical therapy and pain injections. Which I did do over the course of the summer and Aetna gave my medical provider a hard time about approving my second pain shot and THEY ARE THE ONES THAT WANTED ME TO GET THEM!!!
When I was in jeopardy of losing my medical insurance as well as my job. I unwillingly went back to work. I lasted about 6 weeks when I got up 1 morning and couldn't walk. I had my wife take me to ER which led to me a stay in the hospital for a week. At that time I had my leave about all exhausted and therefore I was given the ultimatum I could either retire or be terminated. So I ended up having to retire with a penalty because I'm not of retirement age yet. After retirement I obtained a different medical insurance which approved my surgery. Yes Aetna health insurance did me no favors and in my opinion is the scum of the earth of health insurance providers. The lawmakers in this country need to lessen the power the health insurance companies have. When they can flush a man's livelihood and future down the toilet and not bat an eye there's something seriously wrong!!
I have had this insurance for over a number of years with no problems. They are fast, and no problems with paying out claims. My insurance is better than anyone in my family.
Aetna has been helpful with all my calls. They have a comprehensive list of providers in-network, the personnel is very friendly and follow through with any health issues is pretty thorough. They seem better than most other providers in this area. They are what works for me, but my husband has a different insurance provider that better addresses his needs. Also, sometimes the online member site is not so easy to navigate and sometimes they make you jump through hoops to get your medication. You have to reiterate that you have been through a step process, then have your Dr. notify them repeatedly in order to get the same meds you have gotten from them for years. This happens every time you need to renew a prescription.
Pre-authorized for cervical disc replacement in March 2017. I also had my scheduled outpatient lumbar spinal surgery 2 months later. When I was a few days home from the lumbar spine surgery I started getting retroactive denials for the cervical disc replacement surgery that Aetna pre-approved. When I had outpatient knee surgery in September, it was immediately denied. All of these procedures were covered procedures in my plan. My employer provided healthcare is self-insured, Aetna only administers the plan. I lived on the phone from May to December, when both the cervical disc replacement and the knee surgery were finally paid. I filed appeal after appeal with Aetna, complaints with the BBB and the Board of Labor. I am convinced it was the stress from dealing with Aetna's denials caused me to have a relapse of my MS and develop multiple new brain lesions.
My coverage is through Coventry (which is a division of Aetna). I've been a member for 4 years and their service has been awesome. They have covered any claim submitted.
Aetna insurance was a bad experience for my needs. I could not afford to pay the deductible amount of $1,500.00 necessary, so I refused all medical care while under Aetna coverage.
Their drug formulary keeps dropping meds that we have been taking forcing us to change meds. The deductible on the Aetna direct is rather high $3000 and includes the cost of drugs so that at the cost of certain brand drugs or specialty drugs can be very expensive until you meet the deductible. Lastly what they might consider routine on certain exams such as eye exams and mammograms is very limited in scope forcing you to pay out of pocket for something you thought might be covered in full.
They deny necessary claims and jeopardize people health. Just be mindful of the insurance you pick if you want higher prescriptions and less claims paid then go with Aetna.
I have managed software QA teams larger than 40 people, and these people are friendly folks sitting infront of an IT system that would be an upgrade for Home Depot. They call you via robocall, telling you it's urgent to refill your Rx, you press 1, then they ask what you want. No clue they called you. EVERY single cycle of refill, they mess something up. If your auth expires one day after your refill, they wait and say they only can tell when they ask for authorization. BS. They then claim it takes 2 days to process a fax...then either way, you have to call THEM. They say 'it would be too hard to call you'. Aetna the insurance co does themselves disservice to allow this pharmacy to use their name...and then hold US their customers, hostage to use them. Shame on you, Aetna.
$2500 deductible although the prescription formulary provides my maintenance drugs at no cost. Med express is not covered and you must pay full price for a visit. It does count towards the deductible but it is an expense that should be covered like an office visit copay.
Run as far away from this company as you can! I spoke with an insurance agent Aetna Medicare PPO. I only wanted information. I had double knee replacement surgery scheduled for two weeks from now and found out today that they railroaded me and enrolled me without my permission out of Medicare into their program. I’ve had to cancel my surgery. They enrolled me without my permission! It’s only five days after the beginning of the month when They said I became enrolled by them. I never gave them permission.
They refuse to unenrolled me although allegedly I was enrolled by them February 1 and I contacted them February 5. It has really ruined my life because I have bone on bone knees. I can’t walk and I won’t be able to reschedule the surgery for months from now. I spoke with Medicare and there is nothing they could do. This company they are scam artists and I also blame the agent. This has been a nightmare! They are criminals.
I cannot say enough good things about Aetna's customer service team members. Anytime I called, they went out of their way to help me. I even had a customer service representative call my Dr's office to try and help lower a copay for a preventative service that should have been zero. That said, Aetna insurance does not have some of the extra programs like an over the counter free benefit through mail order, and their in-house mail order pharmacy had the same prices as going to a local pharmacy. For me having some medications that could only be filled at a local pharmacy, the mail order pharmacy was of no use.
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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