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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.
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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.
I have a severe intestinal disorder that requires infusions every 8 weeks. My first red flag with this company is when they denied my treatment at the infusion center that I typically get treated at. They said I would need to have it done at my doctor's office. My doctor's office tried to explain that they were not setup to do infusions in the office. Aetna still denied and now my doc office has to set me up in their office. I essentially have to sit in a chair for 4 hours in a windowless room which is uncomfortable and isolating. My infusion center provides a comfortable chair to lay, not sit in, WiFi, TV, pillow and blankets, snacks if need be because I need to eat small amounts of food throughout the day on top of my regular meals, and windows to look out of.
My second red flag came when Aetna called to procure $5700 from me to cover my deductible upfront before they would send my medicine. Never have I dealt with an insurance company who owns their own pharmacy and then makes patients pay for the meds before giving them their treatments. Typically the insurance company would purchase the meds from the infusion center, I would get my treatment and then I could apply for financial assistance and a low interest loan to cover the deductible. This is ludicrous for a company to be able to operate this way. I am a week past due on my infusion and my health and pockets are now paying the price. This is an absolutely heartless company.
Aetna has saved me a lot of money. I am interested to see what happens with CVS buying Aetna. Sometimes I have to call them because the health vendor is asking payment before I know what I am expected to pay. I learned to always check with them for paying a bill or waiting for the monthly statement.
My Arthroscopic knee surgery was approved and now after I have had the surgery I received a letter saying it has been denied. I wouldn't have had it done if it was not approved beforehand. This company is messed up.
I have had several issues with Aetna which I found most frustrating. They do absolutely nothing to encourage their insured to get an annual physical or any other annual exams. I found their customer service to be of poor quality, and I was relieved when Hewlett Packard, again, offered a United Healthcare PPO to its retirees.
I have been with Aetna ever since I selected them as my Health Insurance from my employer, which was at least 10+ years before I retired in 2014. I kept them as my Health Insurer thru Medicare when I had to select one, because I never had any problems dealing with them at any time while they were my insurer. I had to deal with them on a few occasions so can honestly say that all the staff I dealt with were a pleasure to work with. Aetna is a great organization, and I am hoping that they will remain the same if/when CVS purchases them.
Paying out of the pocket is high. And Aetna do not cover most of the health needs. The co-pay is high for special doctors. The insurance company want you to visit the doctors, under this insurance. Why...if one is comfortable with the old doctor. And also they do not cover brand name prescription.
Managing my family's healthcare has been much more financially challenging with current Aetna plan. The coverage isn't what it used to and between premiums, deductibles and the 20% copay I have for everything, my out-of-pocket is a large percentage of my income. More than mortgage payment.
Aetna is good insurance in some respects, and not so good in others. My policy is a teacher employee contract with a large Catholic Diocese. There is apparently a part of our policy that states that any procedure done in the doctor's office has a co-pay of $35, however once when I was having a back procedure multiple times in the doctor's office, I was told the procedure would count toward my deductible. I paid almost $1000 upfront. The doctor's office staff called, as did I to verify the cost to me, but no one appeared to know anything about this caveat in the policy. When the claim was processed, my responsibility was $35 for each procedure. The doctor had to reimburse me around $900.
I have serious health issues and I can never get any of my medication because this company covers nothing. I call customer service. After waiting an hour they hang up on me. I am leaving this company and anyone who ask me about this company I will tell them not to get it.
I have been an Aetna member for years and years and really don't have too many complaints about them but I am seriously stewing about this issue. For years as a diabetic I have received monthly allotments of test strips I need for testing and for years they have always wanted diabetic patients to use One Touch Test Strips. We actually get covered 100% for the strips but only as long as they are One Touch, not another brand, not any brand. Now late in 2017 Aetna paid for many of us to get ahold of the brand new amazing Medtronic Mini-Med 670g insulin pump. This thing is amazing because it's new and has been referred to as an artificial pancreas and takes a lot of the work out of being a type 1 diabetic and really helps with keeping blood sugar levels stable so one might ask, what the problem?
The brand new 670g pump is accompanied by another name brand glucose meter called the Bayer Contour Next Meter and this thing in an of itself is amazing. It is Bluetooth synced to the pump and transfers all data from itself to the pump which makes things a lot easier to manage. However Aetna says that the only blood glucose test strips they are willing to cover at 100% are any test strips that are from you guessed it... One Touch! You know there is a back room agreement there because even the idea of using a different company's test strips draws a negative view from Aetna. They plainly state that test strips are covered at the Medicare rate of 80% leaving a 20% patient co-pay. But if you get test strips from One Touch we will cover them for you at 100% (aren't they nice!).
My question is this... Why would they go to the trouble of approving Type 1 Juvenile diabetics (who are on Medicare) to use the now totally talked about, totally awesome Medtronic Mini-Med Insulin Pump knowing full well that there is Bayer Contour Meter that is synced to it that would make life easier for us... But yet they won't cover those test strips fully and say that unless we use One Touch Test Strips we will ultimately be responsible for 20%? Today I called and spoke to someone in the appropriate department and was told the following. The guy I talked to said that One Touch reached out to them and asked them if they would consider becoming a preferred provider and Aetna agreed. They are under contract apparently to use One Touch as their preferred provider so One Touch is hooking them up with a deal obviously and as a result they're telling their customers, "Yah use One Touch and we will cover the entire cost!"
Monopoly? CVS... Monopoly? Aetna... Monopoly? One Touch??? One Touch gets the backroom deal that they want from a big league insurance company like Aetna and Aetna now owned by CVS will continue to force their customers (many of whom work with limited monthly budgets who can't swing the 20% of other test strips) to lock into using One Touch Test Strips indefinitely!
I won't say Aetna at this point but will say that both One Touch and CVS are making out like bandits and will continue to at the expense of many patients being able to access the appropriate test strips that their doctors and endocrinologists prefer they use! Thanks Aetna for selling us down the road to One Touch. Speaking of which wasn't Aetna one of the big insurance companies that tried to get out of covering Obamacare patients under Awesome President Obama's Affordable Care Act because the selfish and greedy company said they weren't making enough money?
Wife went in to her doctors for routine blood work. Found out after it was done that Aetna does not cover Pregnancy test! They tell me it is experimental. Even though I was told that all of the other insurance companies cover it, they refuse to. I have been on the phone with them over 5 times now fighting this. They also have an agreement with Quest to reduce the cost by $20 because they refuse to cover it. The Dr office said Aetna started denying this test all of a sudden. Absolutely ridiculous. Stay as far away as you can from Aetna. They are a joke.
Claims for 4300$ which insurance can’t explain is usual thingThey even doesn’t know who is provider and what’s going on. (I’ve finally received the bill from this provider for 90$ but claim for 4300$ is still there.) And one more claim for 900$ for annual examination (what supposed to be free). It’s super stressful to receive all these claims. The same thing happens for all my workers. Worst experience ever. I can’t understand why this company still exist.
We have had to "step-down" on our coverage this year due to increasing premiums. To date, I have spent the better part of this month on the phone with either the Pharmacy Management or Medical Coverage Depts. I am exhausted and extremely frustrated with their level of customer service, I've read a few of the reviews and have experienced much of what has been covered. To the gentleman in Woodland Park, CO. I know about the CVS fiasco, you are allowed 3 courtesy fills at the pharmacy of your choice, then... you must use mail order or go inside a Target store as we don't have CVS freestanding in Colorado Springs. This I know as I was a Pharmacy Tech for Walgreens.
Fortunately, they (CVS) will take your discount card, it's just so inconvenient. I have issues with my back and legs and it is literally a pain to go and get prescriptions. Tonight I was to have a sleep test until I found out my copay is $1,100.00 Have mercy... appointment cancelled, thanks Aetna for all you do which is virtually nothing. I've been conveniently hung up on, suddenly no one could hear me. I've done Pre Authorizations for meds in the Pharmacy and when I speak with their "Senior Resolution Specialist" it's as if these people have no clue what I'm talking about. It will take 3-5 business days to approve a drug I've been taking for 10 years and cannot stop taking abruptly. I am just appalled at Aetna as a whole. Not recommended!!! Sorry for the tirade.
I had Aetna for 2 years but decided to go to Blue Cross this year. November 1 was my date of cancellation. They took $235.16 from auto draft on November 11th as did Blue Cross, my new provider. I had major surgery 11/10 so when I was able to address this, I did so. Sending all documentation showing my new health cards from Blue Cross. They said they paid claims for November, therefore only sending me refund of $100.51. I have asked for proof of such claims paid but the quarterly statement only showed 10/4 claims paid by Aetna. They won't deal with emails, snail mail or fax only, which I don't have a fax machine. I advise seniors to look elsewhere. I'm still fighting for proof of claims paid in November.
I had 2 part D med plan choices for my disabled brother. I picked Aetna as Nadia (enrollment) quoted me specific individual, month by month, prices for each of his 16 prescription meds. She LIED. Told me 2 of the meds were $60 per month each. 1st month I get the refill... Aetna (and 5 reps constantly being transferred over 2.5 hours) are charging $141 EACH per month. $162 extra per month. I am now in the grievance process. If you have had this same problem or are a lawyer representing others in similar situation, please contact me.
My group insurance switched me from Cigna to Aetna. A drug that cost $0.50 with my Cigna plan went to $5.00 with Aetna. Since this was the first time I used Aetna drug coverage, called up the customer helpline at the back of the card to inquire about such discrepancy and if this was going to be typical henceforth. First of all the line was terrible, very difficult to hear the other party, obviously an overseas “help” desk. The first lady to take my call, could not answer any question so she transferred me over to someone else. Same thing, all she said was that this drug would cost me $5.00, couldn't help understand why and if this would be typical going into the future. I stayed online which is what I was supposed to do to give a feedback on the call, but was unceremoniously disconnected after a few minutes of waiting.
I have been with Aetna Dental for 2 years. While Aetna tries hard not to pay any portion of my periodontal cleanings, they have been paying their little piddly $30 for my cleanings (every 4 months) while I pay the $95 balance. Keep in mind, periodontal scaling is fairly pricey and is needed at least 3X per year depending on the patient. The amount is not the issue though. After paying their piddly amount for almost 2 years, Aetna decides to decline payment on all future visits stating they have no history of periodontal problems. Not only do they have my dental records showing my history, including previous surgeries, they would never have paid anything for almost 2 years if they didn't have it, right? And I just now (January) got their declination for my August cleaning and December cleaning.
They tried this before but when I called them, they said "sorry we must have made a mistake." Now they do this again? That's not a mistake. It's about as intentional as you get. My employer is one of the country's largest insurance companies, and Aetna makes a lot of money having such a large company as a policyholder. Although we don't deal with health insurance products, we would never treat claimants the way they do, and they should still be ashamed of themselves for even attempting their sleazy tactics with us. I can't wait until I can pull out of Aetna and join another carrier.
I just spent the better part of 2 hours on the phone with Aetna Medicare RX service. It was the most frustrating and horrible customer service experience of my entire life. I made a mail order on December 11th and it has still not shipped. Today is Jan. 10th. They are charging me $27.00 to overnight a shipment of 2 generic drugs that cost $4. And every mistake in the course of this order has been theirs! I have submitted a grievance. Their new motto should be "Aetna - We make every process much more difficult than it needs to be."
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.
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