Aetna Health Insurance Reviews
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About Aetna Health Insurance
- Helpful customer service
- Wide range of coverage options
- Quick claims processing
- Affordable premiums
- Frequent claim denials
- High out-of-pocket costs
- Limited provider network
Aetna Health Insurance Reviews
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Reviewed March 21, 2016
Aetna constantly denies claims for prescribed medication. Then their appeal process is so absurd that you will quite possibly die before you get thru it. It is 100% made so the customer will give up because of time and lack of progress. I am sure because of Aetna low level of health care coverage people have died unnecessarily. There automated service is the worst, their callback reliability is ridicules and non-existent.
Employee # ** is incompetent at (his/her) job. They simply don't know who the customer is. They try to talk over you. Their procedure is to argue the customer into submission, not help as the "Support Number" would imply. Elvin employee # ** is another on the incompetent call center personnel ("Manager"). I was guaranteed a phone call back in 30 min by the so called Next in Command in their ridiculous chain. Though I made it quite clear that the callback needed to be returned within 30 min (a time frame they choose), that time has came and went. There is a medication that I have been on for ten or so years. Aetna plays some pre-auth game every January, like they haven't been paying it for the last 12 (and ten years). THEY ARE THE WORST IN THEIR FIELD!! AETNA I AM NOT GLAD I MET YA. Corporate Greed is all this boils down to.
Reviewed March 15, 2016
When I enrolled in a Coventry policy via the Marketplace, there was a glitch in the Marketplace's system that cancelled out our enrollment and enrolled us in a plan that would void out our $572/mo premium tax credit. The Marketplace accepted responsibility for this mistake and has attempted to straighten it out with Coventry. While they were able to convince them that from February onward, I will receive the tax credit, they have repeatedly refused to backdate it to January. I have been dealing with this for two and a half months now and Coventry has repeatedly been rude and refused to understand that I legitimately should have those tax credits. Their most recent refusal letter cited some Marketplace guidelines, in spite of the fact that the Marketplace is the one telling them to backdate it in the first place.
In addition, they have added a $20 fee to my account. When I asked about this, three different employees have given me three different reasons for it, none of which are valid. While the highest-ranking of the three was eventually able to see it from my viewpoint and claimed he requested the fee be removed, that has been two weeks ago and it doesn't seem like it's been removed yet. Now there appears to be another mystery $20 fee added and I am suddenly unable to call in and ask about it. On top of this, they attempted to deny claims of mine in the process of this because it has taken so long to sort out. Please avoid this insurance carrier. Not worth the extra time and headaches they have caused.
Reviewed March 15, 2016
Wow, what a joke! They call their "customer service reps" concierges. The rep that answered my call was so snobbish and rude that it certainly fit. There was no customer service at all, so concieeerge fits well! I tried to get some form that they are requiring to be filled out before paying for my 6-year-old's emergency service payment is paid by them. This has been going on for over 2 months. I was told first by the rep that he could not find the form and then that I did not have access to it. This just adds insult to injury! This is the worst insurance ever!!!
Reviewed March 14, 2016
I have had Aetna for years, because it's really the only thing offered through my work that has providers in my area. They have gotten worse over the years. Here are some of the experiences I've had - I regularly see a provider who does not bill insurance. Lame, I know, but I have gone ahead and submitted the forms myself using the claim form provided by Aetna. They have lost the paperwork more than once, forcing me to resubmit. They have also reimbursed for some dates of a submittal and not other dates even though they were submitted at the same time.
I was having surgery. We submitted the pre-authorization form. The approval came back for an office visit. We resubmitted the pre-approval, and it came back as an office visit. This time I had a copy of what the doctor sent in and could see all the correct coding and that it was for SURGERY not a consult. I called aetna. I was told that the doctor had submitted pre-approval for a consult. When I said "no", and I had the paperwork right in front of me that had all the coding and description of surgery, the story changed. She said they had entered it incorrectly and the doctor would have to resubmit. I said "no", there should be no more delays due to their error, we shouldn't have to resubmit. She still refused. I asked to speak to her manager and she refused.
This happened two more times and then I told her she'd left me no choice but to go to the insurance commissioner. At that point, they changed it in their system so it correctly reflected that it was a pre-authorization for surgery. Approval came, I had surgery and the bill came and Aetna had reimbursed nothing for anesthesia. When I called, I was told that anesthesia was not part of the procedure?? Umm. I had surgery!
Fast forward to now. I need surgery again (meh!). I have been told by 3 different doctors that the longer I go without surgery, the more likely it is I will have permanent nerve damage. My doctor submitted the pre-authorization form. Based on past experience I didn't trust aetna. I waited a couple days and then called to check on the status. The first person I spoke to at Aetna said "no pre-authorization has been submitted". I called back my doctor office and they assured me it had been submitted two days ago and gave me the confirmation number.
I call Aetna back. This time they say they have the pre-authorization. They say the status is "pending". I ask them what that means and how long it will take. I'm transferred and told that it's being reviewed by a team of nurses. Hmm. She said "it can take up to 15 business days". I ask if there is anything that can be done to speed up the process and she says that if my doctor marks it urgent, it can be sped up. It really should have ended there, but then she gets snide and says she doesn't see what the hurry is, my procedure isn't until April 12 (about a month from now). I have no idea where she came up with that. My procedure hasn't been scheduled because they haven't flipping approved it. When I try to explain that to her, she cuts me off and says "that's what the schedule is". I am actually wondering if I should pay out of pocket for insurance just so I can get away from Aetna. That's how bad it is.
Reviewed March 13, 2016
I need to have surgery on my neck and Aetna has denied it. I meet all requirements. I'm out of work at this time because of my neck. This surgery would give me back my life and I could return back to work. So angry and disheartening that you put all this money out on insurance and you don't get the treatment you need. It's ridiculous.
Reviewed March 11, 2016
My employer recently went through a merger and changed our health insurance from Blue Cross to Aetna. It's almost impossible to find an in-network provider. The website supposedly lists participating providers and I relied on that. To my surprise when I show up for an appointment, they say they don't accept Aetna and never have. So I call them. They gave me the name of a provider that they say participates within 30 miles of my home. But when I call, I find out the practice has moved and is actually 70 miles away. So back to Aetna I go, and they give me another name but say I need to confirm with the provider and then call them back to see if they'd accept it. When you call back, all of a sudden, no, that provider isn't in-network.
Over the last three days I have reached out to a dozen providers and no one within 50 miles will accept Aetna. They all tell me the same thing: Aetna Insurance is terrible. It's not insurance at all because you end up paying for everything out of pocket and they just collect the premiums. Can't wait to retire and get on Medicare!
Reviewed March 7, 2016
I called 46 offices before I burst into tears. No one is accepting my insurance and I have an ear infection. I signed up for the free healthcare because I don't make enough at my work. I guess I'll be paying out of pocket regardless now from some other office.
Reviewed March 1, 2016
My husband's employer just changed our health insurance to Aetna. We went from a $500 deductible to a "family" deductible of $3500. And after trying to use the insurance, we just realized it's going to take us forever to meet the deductible, not because we don't have medical, but because Aetna denies just about every claim. Acupuncture is "experimental" and not covered. My hospital is "in network" but the iodine, epidural, and drugs they gave me in my last surgery was "out of network." Iodine to sanitize an injection site out of network? Are you kidding me? How can you even sue these liars? This is a lying disreputable company--stay as far away from Aetna as you can!
Reviewed Feb. 28, 2016
DON'T GET SICK IN AMERICA., and if you do, make sure you're not covered by AETNA. I am a 52 year old disabled nurse. After years of lifting and moving patients, my back problems hijacked my career and life. A car accident in 2009 further complicated my problems. I have had 5 back surgeries and more procedures than I can count, yet I've been able to salvage a life. My husband and I, recently purchased health insurance through the marketplace. We decided on Aetna because his medication is on their formulary. This was a tragic mistake.
I've been taking medication to manage pain for many years. I have been stable and doing well on these medications for 6 years or more. When roughly my prescription to the pharmacy, I had no idea that life as I knew it was about to come to an end. The pharmacist was unable to fill the prescription because it required a pre- authorization. They said this could be done by phone, or in writing. Since my Dr refuses to do anything involving the insurance company by phone because of the time it requires. I opted for in writing and request a form. I was told that they would not call the Insurance company. In desperation, I called and requested the form be sent leading them to believe I was an employee of the Dr's office. I'm not proud of this, but I didn't know what else to do.
Two days later, I received a denial letter. It said that I had in fact tried and failed these meds with my previous Dr and those records were no longer available. Aetna, gave me a fax number to send them a letter from my Dr and a composed recollection of the medications I tried and failed. I did this, and my Dr also did this. In addition to the number they gave me, I also had information sent to every related fax number I could find. I then called Aetna to ask the status and ask if they now have all of the information. The next three days I spent calling Aetna, I was told that they could not find me in their system. I gave them my name, date of birth, social security number and my husband's social security number and they still could not find me.
On day four after being denied coverage, I've been hung up on and given the runaround. I spoke with a manager, or so I thought. She said that Aetna had not received any of the 6 faxes my Dr and I both sent. I explained the situation and that this was a medicine I could not just stop taking. She assured me that she would help. She asked me to re-send the information to her, and she would call me one way or another that day. In the meantime, I was now rationing my medication. As a result of the pain and numbness, I could no longer feel if my bladder was empty after voiding. I developed a severe urinary tract infection. The "manager" that promised to return my phone call, never did. My Dr sent another request for additional information from Aetna. They wanted to know if I was a "member" and if I had tried Tylenol and Motrin.
I called Aetna again asking to speak with Stephanie. The manager I spoke with I was told she was a supervisor, she was not. This person told me that all they could do is call Stephanie on the other line. They did so and said that she was working on it and would call me the following day one way or another. She did not call the next day or the day after that. I phoned Aetna again and was told everything had been transferred to the Appeals unit and a decision would be made February 26th.
I called on this date and was told a decision had been made and they would be notifying the Dr by mail. They could not access the information to tell me the result. I have since been to the pharmacy twice and on both occasions, they were unable to put it through. So here I am, lying in bed, feeling nothing put pain and frustration. I will never recommend them to anyone and I would cancel it if I could. Aetna is not in the Insurance business, they're in the making money business. Thanks for reading my story.
Reviewed Feb. 27, 2016
I had obtained Medicare Part D coverage from Coventry First Health, an Aetna company. After a while, I realized that I paid $400 one year and paid the insurance company over $400 yet they paid only $100 for my meds; a tidy 300% return on their investment! I discussed this with a pharmacist who agreed with my conclusion. She said that insurance companies love people like me who are not on a lot of expensive drugs; furthermore, I could pay even less for my medications if I went onto one of their (the drug store's) plans.
I had paid Coventry for a year (there is no discount over paying monthly) and tried to cancel my plan. The first thing they said was that Medicare Part D is mandatory. This is an outright lie. I was then told that if I canceled my plan, I would have to pay 1% of $24 to the government. I told her that I would be happy to pay them 24 cents in order to get rid of me. She finally told me that Coventry would send me the paperwork to cancel my policy. After many weeks and another phone call, I have still not received the material. I could already be off of it if I had not paid for an entire year. I suggest that if a customer has any question at all as to whether they need the coverage, pay monthly rather than annually until they are sure they need the coverage. Insurance companies know that it would cost more for an attorney to sue them than what they cheated someone out of.
Reviewed Feb. 26, 2016
Now, Aetna wants to control all prescription refills and control the delivery dates at the prices they decide to set for co-insurance. Yesterday, I received a letter from Aetna stating that I've reached my limit on prescription refills, and "it's time to sign-up for prescriptions by mail delivery". So, I called Aetna and asked how much my co-insurance would be on a brand medication. Their price was higher than the co-insurance I currently pay at my local pharmacy. So, the Aetna agent said, "do you want to opt of the program?" I said, "what program?" She said, "the prescription by mail program." I told her that there was no mention of an opt-out program in their letter. She said that if I don't opt-out of the "prescription by mail program", then I'd be responsible for 100% of all my prescription costs - and Aetna would pay nothing!
So, this is Aetna's new policy to control refills, control prices, and mail them out when they think it's time. If Aetna was honest and straight-forward - in their letter they would have stated, "This an Opt-Out Letter" in the headline. Instead, they hide this option to stay with your pharmacy with one short sentence at the end of the letter without even using the term - "opt-out". Just outrageous!
Reviewed Feb. 22, 2016
A slick new trick by Aetna in a recent letter states: "Action Required: Time to sign up for prescription delivery." The first sentence says, "You have reached your fill limit at a retail pharmacy for your prescriptions" and "From now on use our mail delivery program, etc." So, I called to find out what the co-pay would be on a brand prescription without a generic. Guess what? Their (3) month supply price was higher than the co-pay through my pharmacy. So, I was asked if I wanted to "opt-out." I said "Opt-out of what?" They told me that unless I opted-out of mail delivery, I would be responsible for the entire amount of the prescription, and Aetna would pay nothing! This is a new, bizarre policy by Aetna to control your prescriptions and ship them to you on their schedule. I suggested that they explain the member's choice to "opt-out" in the same big black letters that they use to explain the mail delivery program.
So, beware: there is only one short sentence at the very end of the letter which states, "Or, you can tell us that you would like to continue getting your refills at a retail pharmacy." The words "opt-out" are never used. This letter is deceptively written to suck you right into Aetna's mail delivery program. It's obvious, that they want full control over dispensing all of our medications. For those who think that ObamaCare should be terminated - learn a lesson from this - and understand that the health insurance industry needs much more regulation and NOT LESS!
Reviewed Feb. 19, 2016
This company is worthless for an Expat living abroad. The website varies, and as of late, when you try and navigate the site to submit a claim, you can't find it. Their "Ask Ann" is a joke, you are asked to fax or mail the claim in. International company LOL. They also pick and choose as to what message they will reply to. The brief period their website allowed you go upload a claim is apparently gone, and the few I did, I cannot get a reply from their customer service. I implore to you. Look elsewhere if you have a choice of providers before embarking overseas.
Reviewed Feb. 19, 2016
I am a healthy male in my 50's, self-employed. I have had Aetna coverage purchased through Costco since 2010, and in that time have paid in excess of $45,000 in premiums without making a single claim other than a routine GP checkup. My physician has recently prescribed me an anti-depressant which required pre-certification, and Aetna has denied it. This medication is important for my health. Before this I have never claimed a prescription medication from Aetna. I feel I have been scammed and that this is very shabby treatment for a customer who has paid top dollar for this "coverage" and by the way has a perfect on-time payment history. I intend to find another plan ASAP.
Reviewed Feb. 19, 2016
I have been trying to book an appointment with a surgeon for 2 weeks now based on my log in account with Aetna provider directory. I book the doctor appointment and the doctor office calls the provider number on the card to verify benefits and they tell them they are not in network on the plan. I call member benefits and they verify, yes the doctor is in network on the plan and attempt calling the doctor office who explains that the provider number tells them they won't get paid and are not in network.
Apparently no one can fix this issue either. So round and round I go and even received emails saying, "Yes all claims will be processed by Thai doctor." But the doctor refuses to take me. I call another doctor on the plan and the same thing occurs. Yes they are in network but when they call the provider number they tell them no they are not on the plan. What good is a provider directory if no one will take me??? No one wants to take these health care exchange plans Mr. Obama!!! The insurance company lies and says these doctors will accept it and no one will. The insurance company has not received this issue! It is crazy that none of these doctors are really on the plan that are listed and they won't see you cause they are scared they won't get paid. Shame on Aetna and shame on this crappy Obamacare!!
Reviewed Feb. 16, 2016
Finding a good doctor that accepted Aetna was relatively difficult. The receptionists all told me that they had so many issues with Aetna in the past that they will no longer accept it. After the birth of my son I absolutely understand why. It's been nearly 2 YEARS, and now I have another baby on the way. They are trying to stick me with thousands of dollars in bills. The most recent one I am fighting they are saying that I owe just under 30,000.00 that they are trying to say they will not cover. For reference, my deductible was 2,000 dollars so where they are saying I'm responsible for 30,000 dollars is beyond me. The customer service rep also couldn't tell me and tried to blame it on the hospital but unfortunately Aetna has been the common, miserable denominator in all of this.
It's been a 2-year long battle with them between the hospital and Aetna and me. An absolute nightmare. I understand that insurance companies can be frustrating to deal with, but this one has no good reviews, and has been the most frustrating and deceitful company I have had to work with. I'm really, really looking forward to switching over to my husband's select med. Good riddance. How companies like this are still in business, I have no idea. This is one of those times the government needs to step in and shut these scam artists down once and for all.
Reviewed Feb. 16, 2016
For over a month I have been dealing with Aetna Specialty Pharmacy to get a prescription refilled which has been nothing but stressful. I was left a message by the pharmacy to call and get my refill which I did, but was told it needed a preauthorization which I didn't understand since they already filled it for (this was the beginning of January 2016). I was told they called the doctor's office for the preauthorization to be filled out and that they also faced the paperwork. Second week of January until today February 16 I called every week to check on my refill, I was told the doctor's office never faxed back the preauthorization, I was told they had the incorrect information for the doctor's office and so on.
Finally today I was told that my claim was denied but they couldn't give me a reason because the letter was mailed to my doctor's office, I asked why if they already filled the script before why all of a sudden it was denied. I believe Aetna doesn't want to fill prescriptions that aren't on their preferred list. I honestly wish there was something else to be done than to write a review. Thank God my prescription isn't for a life threatening illness.
Reviewed Feb. 11, 2016
I initially called Aetna to make sure that my wellness exam doctor was in network and my appointment would be fully covered. The customer representative checked the Tax ID number that I got from my doctor and assured me that the appointment would be fully covered. After going to my appointment I was billed for the appointment because the doctor was not actually in network for me and the customer representative gave me incorrect information. I have appealed my claim to Aetna twice because I do not feel that I should have to pay for their representative's mistake. Both times the appeals were denied. Aetna has now told me that there is nothing further that they can do, and if I do not like their decision I can pursue an external appeals process.
I should not be forced to pay for a mistake that the customer representative made. I understand that everyone makes mistakes, but as a company Aetna should back up its employees and pay for the mistakes that they make. It should not fall on the person who originally called to make sure that the doctor was in network to pay for being given wrong information. If I cannot count on my customer insurance representative to give me correct information then how am I ever supposed to know which doctors I can and cannot see?
Reviewed Feb. 11, 2016
Pulmonary recommended to take dymista as failed nasonex and Flonase for allergic rhinitis /nasal problems - The Pulm clinic tried preauthorization but denied by AETNA. Dymista was helping with the symptoms and I dont want any change of meds if dymista is helping! I called Preauthorization and was told to send appeal letter which I did, but no answer back if they have got it and reviewed or not. I am now feeling the heartache how my patients must be feeling. I have to change this insurance and have spoken to my husband. We have secondary insurance Blue Cross so I need to check if they would cover meds. Why are insurance companies giving us such a hard time - I now understand why my private colleagues are so frustrated!
Reviewed Feb. 1, 2016
Seriously. Isn't Vitamin D one of the major vitamins out there? These greedy ** will cover ** but will not cover a vitamin D test for a 5 year old. How sick is that? And people wonder why Trump will be the next president. What a disgrace. This company should be ashamed of itself.
Reviewed Jan. 29, 2016
Aetna should be embarrassed as they are forcing me to go back to my doctor a third time to get this addressed. Wonder why medical costs are so high? It's because of all the effort it takes to get the products and services ALREADY paid for!
Reviewed Jan. 27, 2016
I was recently put on Donnatal and then when the new year changed I found out that I needed to get a preauthorization for my medication. The only problem is if I go off Donnatal for too long I can have a seizure, so I spent the next week waiting on Aetna to approve me. While that was happening I was spending 117 a day for four pills. My wife called after five days and Aetna said that my DR had never faxed in the preauthorization. We talked to the doctor and yes, in fact they did send it in.
We called them back and then they said "Your case is still in clinical review." Then days later we get a letter in the mail from Aetna saying that my medicine is now no longer being paid for by Aetna. This means if I want to continue to live without pain then I will have to pay about $1500.00 a month. Donnatal was the ONLY thing that made my life better after decades of pain and anguish.
Reviewed Jan. 23, 2016
My son lives in San Diego. I live in Michigan. My son has Aetna Health Insurance through his employer Scripps. He fell on 1/17/16 and injured his right elbow. Went to ER, got x-rays and splint and was told to get a referral to an orthopedic, sooner rather than later. Saw his primary on 1/18/16, got the referral, called and was told they are closed until next Monday! That would be 1/25/16, more than one week after the injury! This is unbelievable to me. I have HAP in Michigan and consider it to be less than adequate but they have it 100% over Aetna. On another note, a couple of years ago my mother-in-law's health coverage was arbitrarily cancelled by Aetna at age 90! This company should be closed down!!!
Reviewed Jan. 19, 2016
The hold time and costs of plans are ridiculous. One time it was three hours in total and all I needed was a print out of what I paid for the year. My plan was 2016, covers nothing as it's subject to the deductible. Stay away from this company.
Reviewed Jan. 16, 2016
Neurosurgeon try to get approval for ACDF but Aetna will not approve surgery in manner surgeon wants (anterior, artificial disc, cage vs posterior, bone graft, no cage). Aetna reps not knowledgeable about appeals process, telling me different time frames--take 20 days, 30 days, no right to external appeal, told me there is. And getting an address change? Next to friggin' impossible. Requested 5 times--still not changed. Can't wait to opt out. HATE AETNA SO MUCH!
Reviewed Jan. 14, 2016
What is on my mind is that Aetna Insurance has not yet paid a claim for a doctor that provided a service for me in May of 2014. This came to my attention as the doctor is now billing me for the amount that Aetna has not yet paid. I totally agree that it is way past due. I called Aetna and spoke to nice people who lied to me very nicely and to a person said, "Your claim will be processed in seven to ten business days." I was told this on December 30, 2014. And on December 15, 2015, and Dec. 23, 2015. And on Jan 4, 2016 and believe it or not, again on Jan. 11, 2016. But this time she said, "Really, I mean it." Not one person said there was a problem I should address. Not one specialist that I was connected too told me that Aetna would not pay, they all agree Aetna will pay it, in... you guessed it. 7 to 10 Business days.
How many out there think that Aetna will indeed pay this in the 7 to 10 business days from 1-11-16, the last date I was told, "really, your claim is in process"? Does anyone know how to complain about insurance companies? Why can we be legally required to have insurance and pay those premiums on time or no insurance no matter how much has been paid in over the years, but insurance aren't required to pay claims in a somewhat timely manner. Thanks for your kind attention.
Reviewed Jan. 13, 2016
Trying to get divorced but my spouse must carry my health insurance until it's over. AETNA would not change my address to ensure my spouse would not receive my EOB until I talked to about ten people and spent five hours on the phone and they STILL have yet to actually make the change. They keep telling me it has to go through my estranged husband, which is absolutely impossible. So, they are sharing my protected health information. Also, I have a court order to change my last name but they say my husband must authorize that as well. I had absolutely no issue when his employer was with United Health. I would definitely stay away from AETNA if possible! They are horrible and will break the law and share protected health information!!!
Reviewed Jan. 12, 2016
My rates and what they actually cover for the exorbitant cost should be outlawed - $1122.00 a month for my husband and me. We still have to pay for any blood work, tests and all prescription costs and a trip to the ER left us with a $2000.00 bill. As soon as I find other insurance, I am dropping Aetna without looking back.
Reviewed Jan. 10, 2016
Joined Aetna about 3 weeks ago. It is now jan. 9. For 10 days I've been trying to get an ID card. Tried to activate account to get ID card. Answered questions and got a message that it couldn't activate account and I needed to call them. Called number and chose the call me back option because wait time was too long. Did this twice, been 4 days, no one has called yet. Two phone numbers and only useless virtual operators answer. They'll take your money but won't provide any service. Will start looking for a new insurance company tomorrow.
Reviewed Jan. 8, 2016
So I call Aetna at the 800-892-8043 member number for a SIMPLE question of wanting to find out who to call for a specialty being they no longer use who they put on the back of their ins card provided to me. The guy turns this simple inquiry to me needing to just go log in to my site (my little child is curled up asleep on my lap, NO) so he can assist me but thinks now I turned into a physicians office vs a member. Huh?! No, I am a MEMBER looking for a number to call to locate a specific type of provider for a child. Now he wants details... Are you ** kidding me?! I told you what number I need, it's NONE of your damn business why I need to find this doctor nor am I asking him to find one for me. I ended up pissed and telling him I'd figure it out later and hung up.
Reviewed Jan. 8, 2016
I was left on hold for over 2.5 hrs. Then told their tech support was working on website. No ID cards after paying premium 4 weeks ago. Nightmare.
Reviewed Jan. 6, 2016
Hold time is hours- pay well below cost and since they are part of Caremark think other Caremark insurances offset the loss from Aetna!!! If you support your pharmacy and the care they give you stay away from this company! Hold time and customer service has to be one of the worst in the industry.
Reviewed Jan. 5, 2016
This is a horrible company. Canceled coverage in the entire state of NY without notifying customer. Only found out I wasn't covered anymore when I couldn't fill a prescription. They should not be in business, and US healthcare is a joke.
Reviewed Jan. 5, 2016
Aetna Insurance as the administrator of our health scope account is useless, not due totally to them but the fact that under ObamaCare nothing is covered - your deductibles are so high that all the money we pay in goes to pay for all the lazy people that don't work. We'd be better off to just have catastrophic insurance because in essence this is what we have. This company constantly denies my claims and even denies that I am covered under my husband's plan. I hope the idiots that voted for Obama are satisfied. He and the losers in Congress that passed this bill don't have to be under ObamaCare so they will never feel our pain.
Reviewed Jan. 4, 2016
I have tried to deal with Aetna since December 9, 2015, it is now 1/4/2016. They have given me the runaround, will not respond, been dishonest. I used to work for physicians and am used to dealing with Insurance, I have never been lied to as much as I have with this company. I will go to the state board of Insurance and the Insurance Commissioner. I pay for the insurance and they will not respond to our questions. They now say we are not entitled to hearing aids because we have had them in the last 4 years. Our plan allows for hearing aids every four years. It has been 8 years, they are stalling to avoid paying for the hearing aids. It is a benefit and they have no right to not pay. They are a joke.
Reviewed Dec. 29, 2015
My story is too long to tell -- months of trying to change from one Aetna Plan to another. I have NEVER experience such a poorly coordinated company. One customer service rep has no clue, another entered so many typos that next agent couldn't even find me. And don't bother emailing them. Each agent is nice once you get them so you think all is well but, NO. You have to be on hold for over an hour again and again.
I am now very concerned that the policy they have sold me is also a sham and I can't do anything about it because of all the new rules. I happen to be healthy but how can those who really have urgent healthcare questions get any help when phone wait times are over an hour and website navigator only works sometimes --and then all Aetna's follow-up is non-existent. Please AETNA, for the sake of your members, please try to address your customer service issues. Give those nice agents a system that works. Stress isn't good for health by the way.
Reviewed Dec. 23, 2015
I was informed through my OPERS account that I had retirement medical reimbursement funds of 1034 dollars in my account. I thought, "Great, this is really gonna help me out." Aetna hung up twice. I spoke to at least 4 different people. They lost my paperwork twice. I finally just decided after 1 month of arguing to just let it go. What a shame that a company can do this to people that have earned a benefit. What a bunch of lowlifes.
Reviewed Dec. 19, 2015
First off, the only reason we got this health care was that it was the only insurance offered through Spherion where my husband works currently. It must be said that Aetna is a professional scam artist as in their contract they have it worded so that you are paying whatever outrageous amount they give you EVERY time you get paid. Therefore, there is no monthly amount.
Our personal situation has them taking $308.00 out of my husband's check before taxes every time he gets paid which is weekly. $1,232 for health insurance on my husband and my son is ridiculous. What's more outrageous is that in order to cancel this policy due to OBAMACARE (Thank you... NOT!), we need to get on a different insurance using the very little $200.00 our family makes a week. Absolutely, positively WILL NEVER refer anyone to this company and their scam artistry because once they have you, they have you. And thanks to OBAMACARE, this type of treatment is "legal".
Reviewed Dec. 19, 2015
I have had problems with Aetna for 15 years. I call them because of problems at least 3 times a year which then takes about 3 weeks to 1.5 months (or longer) to rectify for the time being, then the problem rears its ugly head again or we have another issue. This includes not being able to get medication or having medication sent to a wrong address (in another state) and receiving wrong information many times. Aetna's customer service either in person, or via their "contact us" email is continually apologizing but they don't help take care of the problem. We stay because it's the best the company offers.
Reviewed Dec. 18, 2015
I have not had even one positive experience with Aetna administering my claims. Each and every claim has been an issue and has taken hours to resolve. The current issue has now been going for three months and I am back to square one due to Aetna inefficiencies.
Reviewed Dec. 18, 2015
I recently got on Aetna better health due to finding out if was pregnant. I also knew my OBGYN who I've gone through before when I was working, accepts it, but I could not qualify for the other two insurances that she takes as well. I recently had a cold with severe congestion. I felt I could take care of it myself, which I was able to clear the congestion but not the cough. Now it is going on a total of 3 weeks, and the coughing has got so bad that it almost forces me to throw up at times. I was told a cold going on 3 weeks is not a good thing, so I tried to go to a near quick clinic but they refused my insurance. I did not try the PCP listed on the card since I knew it might take a while to get seen but at this point, I decided to call.
Call the number of my Aetna card, and the Dr name given did not exist at this location and the Staff there hung up on me. So I call Aetna, and they give me 3 listings. One did not work, the other I have been there before and they are terrible, and the third did not take it. So I decided I would go online and try through the Aetna site. I put in my specifics for the Aetna insurance and looking for PCP in 10 miles radius, and called as many as I could. Still no one accepting Aetna, or my specific type of Aetna. I called Aetna back up and they gave me 3 more. Still no or numbers not working.
I get to see my OBGYN next week but I know it's not her job to refer me and my biggest fear is no ENT probably takes Aetna. I called my son's ENT which I could of sworn at one time took it, and they told me no. I knew maybe 6 years back a lot of places took Aetna cause I had it, now no one does. If by chance you get one they have no spots of new patients.
I feel if I have pneumonia, laryngitis or something that obviously needs treating. I'm not going to be able to get it treated, and due to having to leave my job a while back to take care of my mother dying of cancer, I can't pay any side clinics or the ER since no one else is accepting it either. Guess we kill ourselves working to afford insurance or risk dying because no one is accepting it. I know I can call and change the insurance but that is going to take 15 more business days. Then I have to go through the headache of calling around again, in order to find someone willing to accept it. I have a feeling that any of the other insurance I can pick from have been dropped by many Dr's in my city. Glad I'm not having a heart attack or I'd be screwed.
Customer service: Whenever I have called I have always got nice representatives on the phone, though it is not their fault if the listings are not updated and they have no idea who is accepting the insurance or new patients. Value: In my city, it looks as if it's not worth anything. Coverage: Can't really rate that since I have not be able to be seen other than my OBGYN. It covers everything I need for her, but getting seen for other health issues for a PCP no luck.
Reviewed Dec. 13, 2015
Aetna assured me multiple times that my grandchildren would be covered for 31 days following their births to my daughters who are dependents on my insurance. They paid the claims for my grandson but continually denied them for my granddaughter. They were born in May and June. A representative even wrote a letter to a pediatrician's office telling them gd was covered. Now in December they claim they paid grandson in error and have retroactively denied his claims! I have been placed on hold for up to 30 minutes, been talked to rudely, and denied the ability to speak to a supervisor! This insurance company is the worst!
Reviewed Dec. 4, 2015
A claim was processed incorrectly, and the payment I was waiting for went to the doctor! This is a claim I file on a regular basis using the superbill the doctor gives me, since he is out of network he doesn't participate with Aetna (can't say I blame him). So I called to correct it, was told it would be reprocessed in a few days, and the money pulled from the provider. A week later I called to check, and was told it was reprocessed again incorrectly, and were giving me reasons why which were not given by the first person who stated it was "human error." This time suddenly I needed more documentation than the usual superbill which is exactly the same as always, and I get the check always. After various incompetent people (I must say I agree with Sam of Plano TX but it's more like ghetto talk) one representative took it upon themselves to call my doctor and ask him to just give me the money instead of them doing their job, how unprofessional is that?!
After contacting them again to share the inappropriateness of that move, I was told I will be banned from calling. What? Is that legal? So if I would phone to follow up, since they never call back when they say within 24 to 48 hour window, a supervisor would each time take the phone away from the representative. Further, I was told by the supervisor that it is open season and they are too busy to spend all this time on my issue. I explained if they didn't make a mistake I wouldn't be calling at all, I have better things to do. Many of these calls exacerbated my health condition and raised my stress level and blood pressure! Needless to say, I am ending my membership the end of the year. I would advise anyone else to do the same, and those looking into joining, don't do it!!!
Reviewed Dec. 3, 2015
Signed up for Aetna's health care policy that was supposed to start Jan 1. They started billing me immediately instead of waiting for January. They would not issue me a refund or set up billing to start correctly. I had to cancel the policy entirely.
Reviewed Dec. 3, 2015
Our young daughter was on a trip abroad and had a medical emergency while there. Thank God she was taken care of by professionals at a hospital. The trip was spent in a hospital room though, which ruined a dream vacation for her and her mother. When they returned to the U.S. after having to spend an additional week there to recover, my wife made a claim to Aetna for the charges she had to pay for personally. Lots of out of pocket charges.
The claim was made five months ago and we have yet to receive payments from Aetna, even though we have international medical coverage. My poor wife is going through Hell with this and they seem to ignore her requests. What they are doing is criminal. We are unemployed and the cost of the surgery and medical support has caused us immeasurable grief. If this is something you want to go through, use Aetna. The pain they are causing us is hard to understand. Their unAmerican approach to people should be reviewed by the government.
Reviewed Nov. 29, 2015
My parents just received their information on the new Tier 1, Tier 2 set up with Aetna. It is horrible. They are elderly and now have to drive 15 miles to a location to get their medicine instead of where they used to go to CVS just a couple of miles away. I just don't understand how these insurance companies can structure things so that they force people, who do not have the means to go far, to go farther, drive farther. Now the hospital they have been going to is now tier 2. With the illnesses and visits to their hospital now will be changed? Doctors that know my mother, in particular, case. Just absolutely disheartening what these insurance companies, especially the big ones like Aetna, are doing to our people.
Reviewed Nov. 25, 2015
Before ObamaCare Aetna wouldn't cover my disabled son. They repeatedly lost all the forms I sent them for close to a year. Last year I tried to have a procedure after my deductible was paid but they drug their feet on authorizing it till the year was over and I had to pay for it myself. Now I need a CPAP machine. They wont cover it. They say I have to rent it over a 10 month period which should be just enough time to use up my money to pay for the deductible by the end of the year. And then If I want to use my insurance after the deductible is paid they will drag their feet again until the next year. Well after I finish paying for my CPAP machine I still won't own it. If I change insurance they take it back! I pay thousand of dollars... At least 5,000 for premiums and deductibles and then this is what I get. Can't stand Aetna... Worst Ever.
Reviewed Nov. 22, 2015
After receiving an offer letter for a new company I was excited to move into my new position. During the hiring process I was informed my health provider would be Aetna. I have always been with Blue Cross Blue Shield, a fortunate member of an amazing health provider who really takes care of their customers! After enrollment of my benefits I was explained that I would have in-network doctors to utilize, but being new to this provider I made sure to do my research on their process. Keep in mind I am never sick and very rarely have to go to the doctor's outside of annual checkups, which was to be covered by Aetna with my plan outside of the co-pay which is to be expected. I was at work and started feeling sick, dizziness specifically which will eventually be determined to be vertigo, so naturally I called Aetna to see which doctors were covered in my plan in my area.
I was informed by the Aetna representative that there were a few options so she had me on the phone for approximately 20-30 minutes calling around to local doctors in my network to see if they had availability to see me the same day, as my symptoms were making it hard to function normally. I clarified with her that the doctor I was being sent to would be covered in my plan and that they accepted Aetna plans. I was ASSURED they accepted Aetna (after all, why wouldn't they if the AETNA REPRESENTATIVE was referring me to them) and even spoke to the doctor's receptionist who ran my card information and reassured me again that I was covered under that doctor. Since this is my first time working with Aetna, I trusted the customer representative. I went to see the doctor and they diagnosed me with Vertigo, and also prescribed a full lab workup which I was again told would be covered by my provider, AETNA.
Needless to say, I followed doctor's orders and here I am writing a complaint. A month after my visit I started receiving bills from Aetna that totaled to $1,500 dollars in charges that were not covered because I did not have an approved referral AND my referred doctor by Aetna and whom stated I was approved and my insurance was accepted there is now claiming they were full with Aetna patients and therefore were rejecting my coverage!! Now, if you've been following the story I think it's pretty clear that my assumption as a NEW member of AETNA, a single young 26 year old women who has just gotten off of her parent's insurance and is following the process as dictated by Aetna's OWN REPRESENTATIVE, it is pretty evident that I had received a legitimate referral! I appealed the claims immediately and have since been denied 4 months later.
I am extremely disappointed in the lack of integrity of this company, their process and unwillingness to take ownership for a lack of communication and loyalty to their own members throughout this entire ordeal and appeal process. I feel as though my voice is not being heard and I am being penalized for their poor process alignment. I will be appealing these claims again, but multiple customer service representatives have made it very clear I will not win. They said it was my responsibility to get a referral from my provided physician (what is this?) and that I should've gotten a letter stating who that was. Well, no letter was received and throughout the entire conversation with the initial Aetna representative who placed me at the physician she mentioned nothing about having an assigned physician.
Being that I had only had the coverage for a week, I would've assumed she would've provided accurate information since the company trains here. No such thing exists with Blue Cross Blue Shield to my knowledge and if a new customer called into their customer service line asking for assistance on finding a doctor and a "assigned doctor" was on the account already, I KNOW they would've explained this process of getting a proper referral from the assigned doctor to make sure their customer would certainly avoid any such confusion, missteps or penalties.
If you have an opportunity to select or vote on a provider through your employer, steer clear of AETNA. They don't look at you as a person but a number that will line their pockets as you try to navigate the intricacies of their policies and procedures, assisted by customer service reps who will neglect to provide you information that will help you avoid penalties! I stated earlier that I will be appealing my claims again. If they finally decide to take this situation seriously, I will keep everyone posted on the hope to be "positive" outcome!
Reviewed Nov. 17, 2015
The worst customer service on earth. Called and was hung up on 4 times. I can tell you it's a bunch of ** that talk their language and just there for a pay check. Not politically correct, just the facts. Run!
Reviewed Nov. 12, 2015
My husband was admitted to the hospital with a COPD flare up. After a week in hospital, the hospital requested he be moved to Gaylord for rehab. Claim request denied. Aetna felt that husband could receive care in hospital. Hospital does not do rehab. He can't walk 30 feet without his blood oxygen dropping to 73. What the hell kind of medical directors do you have that would deny inhouse pulmonary rehab in a facility that specializes in it and is on your plan? At this point, Aetna by their denial of claim, is causing a serious problem in my husband's recovery by not allowing him to go to a facility designed specifically for his issues. Their phone representatives are rude and have no interest in resolving this. Companies like Aetna should not be allowed to operate if they can't provide coverage according to their policies.
Reviewed Nov. 7, 2015
I had Aetna Med Advantage 2 years ago. I take 7 meds. Aetna made my meds Tier 4 and 5 which makes drugs cost 2600 for all HMO's and PPO's. I checked all 36 other plans. My meds were Tier 1-2 cost 1400-1600. Go with other companies - compare Aetna. Ripoff.
Reviewed Nov. 3, 2015
I am doing my internship in Chicago and during the year, I had some health problems and I needed to go visit the Physicians Immediate Care. I paid my 20$ copay for visiting and today I was informed that the charges about one of the days I walked-in is against my responsibility and I need to pay an amount of $374.00 because it was billed by the "routine code". Well, now my question is: Why they can charged me this amount if I was never asked about what I was treated for?
On September 10th, CIEE Insurance Support sent me an email desalinated to other person, asking informations about: complete name and address of all physicians and clinics that have treated me before my period in the USA and also, the list of all medications which I have taken until my period in the USA. And failure to respond that email will result in the claims remaining unpaid and become my responsibility to pay to the provider. I replied in the same day saying that I thought they contacted the wrong person and they should contact the right one.
On October 15th - more than one month later - another person from CIEE Insurance Support answered me if I have visited a doctor during the summer. If so, to respond the questions that were previously sent to me. I replied in the same day saying "yes I did" and that I didn't answered in that time because I thought the email was destined to another person. Also I said that previously in this year, I visited a doctor and I sent the information in April, if they could use them: the physicians and medications. On October 26th, the same person from CIEE Insurance Support answered me asking me again the information. I replied in the same day all information regarding the physicians and medications.
Today, November 3rd, I received the answer that I need to pay for my visit and the other visit is open to Aetna to process the claim. I told them that I refuse to pay the amount because I was never questioned about what was my problem. How can they assume that my visit was ROUTINE visit if they never asked me? I have all the emails proving what I am writing here and if necessary, I will go further with my allegations, because is not fair for any of the patients to pay for something that it was never questioned. In the first two times that I went to an ER, I received all papers to answer what I was treated for, when the symptoms started and relevant information regarding my treatment. And, this time, it does not happened. What is the purpose of the insurance then? This is the most horrible service that I could have had in the USA and the worst part is that I didn't have the option to choose my insurance.
Reviewed Nov. 3, 2015
Writing for my son-in-law as he remains too sick to do this. He has seen two specialists (gastroentology) which have ignored him even after multiple calls to find out results of thousands of dollars of testing. He has been sick for almost 6 weeks and cannot eat anything without severe pain. One specialist, after a cat scan even told him that he should just go to emergency. Worse service I have ever heard of from an insurance and the doctors they represent.
Reviewed Nov. 2, 2015
Aetna informed me, without explanation, that it is not going to renew my grandfathered health insurance policy. This means I must find another which is likely to be twice expensive, or else go to a health sharing program (currently looking at Liberty Health Share). "Aetna: Not There When you Need Them" would be a good summary. I can't give it only one star, though, because it did work well for me when I had it.
Reviewed Oct. 31, 2015
I have had a horrible time with Aetna and am grateful my company is changing insurance companies. They have inaccurately put holds on my account, stopping me from going to planned appointments when I first scheduled them. They have denied claims because it was not the main service. We were on a cruise and needed to go to the emergency doctor. They covered only part of the service because "the IV and medicine was not an essential part of the treatment." It has been a nightmare. They are not open any Saturdays and often are closed on lunch for team meetings (as stated on the automated caller).
Reviewed Oct. 31, 2015
I have two insurances, Cigna as my primary and Aetna as my secondary. I have see very few errors with Cigna but the amount of errors with Aetna is very upsetting. Aetna's EOBs are misleading and they do not give the correct information, then the reps don't know what they are doing most of the time. I have been told that a claim was paid over and over again by Aetna so I did not pay the bill thinking that Aetna would clear it up with the provider; only to find out that I have been sent to a collection agency because of Aetna misleading me into thinking they had paid the bill.
Reviewed Oct. 30, 2015
The game is this: The staff go over these bills with me (one by one) and then argue that they should have to pay it because of my deductible. To each operator, I clarify my policy. They put me on hold to investigate my policy (7 to 15 minutes each time) and then admit that they are responsible for 80 percent and the invoice will be re-submitted. This monthly phone call is never less than one hour and is rarely fruitful. Sometimes they will pay half (like a few of these), and every so often don't pay at all. Again, prescriptions are promised to be paid at 80 percent no deductible. We should not have to fight this fight every month.
I do not have a constant contact at AETNA and always get a different operator, just like AT&T. Continually have to re-explain and then am each time advised that the problem will be fixed. When I have asked for a printout, they send an inaccessible file. This has been going on for 2 years. Plus I have sent them receipts and never received a refund.
Reviewed Oct. 27, 2015
I was told I had shingles. I called Aetna and was told I didn't need a primary care doctor. I was given the name of primary care doctors who could not give me the shot. One was a breast care doctor, one wrong number. Start-up Monday. One suggested the health clinic. I call again and told to go to CVS and get the shot. The first CVS says it won't happen and then the computer won't work. The next CVS says I have to be sixty years old. Another call to Aetna and I go to Walgreens. They say no I need a prescription. Another call to Aetna I break down and go to a primary care doctor. He says I have shingles but can't give me the shot - the shot that was my only reason for the visit.
The doctor was given to me by Aetna so I give myself a break from this headache and start back Monday. I go to CVS and get told I have to be sixty even while I'm holding the prescription. After a few minutes I'm told I can have the shot and Aetna will reimburse me. A new headache. I call Aetna and get double talk and misinformation. I carry the phone to the pharmacy and after the girl talks to him nothing had changed. He told me they would be reimbursed and then told her I would be reimbursed 200+ dollars. Thanks Aetna. You suck.
Reviewed Oct. 24, 2015
Viagra/ED Meds - Husband and I went to pharmacy to pick up his prescription, which is normally $45 for six pills. As if that isn't bad enough, we were charged $245 for the same SIX pills. We left the prescription there and my husband was humiliated. Upon inquiry to Aetna, he was informed that they will no longer be covering "lifestyle" drugs. WHAT? Since when are "marriage relations" unnecessary? We are clueless as to what to do. My husband is about to resort to some "unknown" drug company for "knockoff" brands. I'm afraid they are overall unsafe. According to Pfizer, we "make too much" money to have help in obtaining the medication. We are devastated and frustrated. No one seems to be able to help. And shame on Aetna for doing this to their customers. We have had Aetna since 2008. This is the lowest of the low as far as I'm concerned.
Reviewed Oct. 22, 2015
I have yet to have a preventive services covered by Aetna. Their marketing sounds great that you get eye exams, hearing exams, etc for no cost annually. However it seems that the providers I go to can never find the right codes to be able to have the exams covered. Today I contacted Aetna about one of those cases and the woman I spoke with was extremely rude and argumentative. Although the provider indicated to me that they had coded for a routine exam Aetna says that is not the case but they cannot give me specific information so that my doctor's office can make a correction. Although the doctor's office said they would be glad to do so the Aetna representative told me that doctors never do that kind of thing and I would just be stuck paying for the visit. Thanks a lot Aetna.
Reviewed Oct. 20, 2015
Aetna never seems to get any paperwork faxed to them whether it be from myself or my doctor. Then they shorted me a paycheck. When I called the rep continuously talked over me and told me I have to wait a certain time period before they can stop payment on that check and reissue another which may take up to another month. This company is a horror to deal with. Always some excuse with them and their customer service is ridiculous! No wonder they always have such bad reviews.
Reviewed Oct. 11, 2015
I got stuck with a $40 copay, because according to Aetna, STD testing is "diagnostic" not "preventative". This was after months of back and forth with customer service and filing an appeal, before I finally gave up. How is STD testing not preventative?
Reviewed Oct. 10, 2015
For my plan, they are now based on Medicare rates for reimbursement... what a joke. That means the cost of my visit is going up by 100 per visit and this is someone who I see several times a month. Aetna was previously sued multiple times for under reimbursement for out of network claims, and out of that settlement helped create the FAIR Health database... but apparently they are not obligated to even use it! I say sue them again and force them to use the FAIR database for appropriate reimbursement.
Reviewed Oct. 7, 2015
This company exists for the sole purpose of declining/denying claims. I cannot believe anyone would rate this company as even marginally acceptable as an insurance provider. I HATE Aetna.
Reviewed Oct. 1, 2015
So I break my collar bone and my sports medicine doctor recommends an ultrasonic bone treatment to accelerate healing... Aetna denies the procedure... but informs me that if I smoked or I was obese with diabetes 'COMORBIDITY FACTOR' they would cover it. In essence I am being penalized for taking care of myself. Go figure... Sort of going out and buying a carton of cigarettes and a few pounds of fudge. I'm at a loss.
Reviewed Oct. 1, 2015
My doctor had prescribed me a medication that need preauthorization. Once the preauthorization form as filled in the coverage was denied. Aetna denied it because alternatives were cheaper according to them. The thing is being a type 1 diabetic I cannot take the alternatives that they recommend. They also said I must take 2 of the recommended meds from their list before being considered for the one I was trying to get. This means I should take 2 drugs I can't take in order to take 1 that I can. After a per to per chat between my doctor and their medical director coverage was still denied. Their decision making process is obviously not medically informed since I now have to appeal the Medical Directors decision. All this because the drugs they mandate I take, I can't.
Reviewed Sept. 29, 2015
I am fed up with Aetna and its appeals process. My husband works for The New York Daily News, and under his Aetna insurance, we are facing a $1,500 bill for a preventative routine biopsy: The ultrasound clearly saw milk in a milk duct due to breastfeeding. The biopsy was done at Lenox Hill Hospital on Dec. 17, 2015, which billed Aetna $12,000 for the wrong diagnostic code: A specific medical diagnostic procedure. Aetna backed the hospital in my first appeal. I requested a second-level appeal by a letter via mail within 60 days. Aetna Appeals Department didn't get the mail. I then was told by an Aetna rep to fax it over. Aetna Appeals failed to get the fax. Then, a rep himself faxed my appeal letter. Aetna Appeals says the case is closed, because I didn't file a second-level appeal in time.
Reviewed Sept. 17, 2015
For some reason (I still don't know why), my coverage and benefits have not been updated. I have emailed customer service FOUR times now asking the same question, even sending screen shots of the outdated coverage and benefits. All 4 times I receive a pre-written standard reply telling me where to access my coverage and benefits. Nobody over there actually listens to you or is helpful. They even send customer service surveys and when you complain they do nothing about it.
Reviewed Sept. 14, 2015
Primary care Dr. referred me to a urologist for possible prostrate cancer screening. For diagnostic testing, and monitoring, Aetna denied a charge for a PSA test. Why doesn't Aetna just put me in the grave and get done with it.
Reviewed Sept. 8, 2015
My wife was critically ill last Christmas. We had to transfer her to a level 1 hospital, I called AETNA to ensure the new hospital was in-network. The agent assured me it was. After my wife's 7 day stay (3 in ICU) I received a bill from AETNA saying this hospital was out of network. I asked them to listen to the recording and filed a written appeal. They take 30 days to respond and you can't call the people making the decision on the appeal. You must speak with a regular agent who takes 20-30 minutes to get up to speed.
We received a letter back saying they listened to the recording and were applying an in-network rate to almost everything except for $2K. A few days later they then sent another letter clarifying their own ruling saying the phone call was inconclusive but would apply the in-network rate out of the goodness of their own heart. HUH? So they say the phone call was inconclusive but will honor the in-network rate.
I appealed the final $2K, they promptly filed my appeal as a complaint. I know this not b/c they called but b/c I hadn't heard anything and when I called in they figured it out. I finally heard 30 days after that they denied the final $2K. I asked for access to the recording and they told me I need to get a lawyer. A lawyer will cost as much as what I owe. Overall a horrible experience. Encourage your employer to find a better provider who actually cares about its customers.
Reviewed Sept. 8, 2015
They send letters and demanding information. When I call, they say no information is needed. Any claims information they tell you is incorrect. Ask for a supervisor and none is available. They do not return messages. Hold times exceed 30 minutes. Never use this company.
Reviewed Sept. 2, 2015
On March, we did our annual Health Screening required by AETNA. The coverage started on June, but they started to withdraw from my payroll $23.10 per pay period. I called several times and always they said it could take 7-10 days. Today, Sept. 2nd, 2015, I spoke with Tracey, but she said that is not their problem. When I asked for a supervisor, she transfer me to a voice mail. That was one hour ago!!! And still waiting... I don't recommend this insurance. It's the worst I ever had. Unfortunately, the insurance is provided by my employer. :(
Reviewed Sept. 1, 2015
My husband had Aetna Pharmacy with his previous employer. My doctor called in a script at the pharmacy and when I went to get it, I paid the usual amount $25 for the medication, my husband just before he got laid off. Then the following month had a refill done and it was the same amount so I paid it (after husband got laid off). Then we get a bill in the mail from Aetna Pharmacy that we owe them $110 for medication that they paid by accident. Well it's not our fault that those idiots at Aetna paid. They were quick enough to cancel the insurance but not quick enough to check the payments to the pharmacy. I don't think we should pay for their mistake. Now they are reporting this to the credit bureau and will affect my husband's credit report because of their stupidness and careless actions.
Reviewed Aug. 30, 2015
I left Thomson Reuters with long term disability for anxiety and depression. They gave me a pension plan and Aetna insurance in 2012. In 2013 I got Social Security disability benefits. October 2014 Medicare and was told by Thomson to refuse part B to keep insurance benefits till 65. I'm 53 years old now. Aetna only covers me like I'm getting part B. AETNA is not a supplement. It is primary and all I have. I need attention by a mental health professional. This problem keeps getting worse. I am insured for no part B. Thomson Reuters and I pay each month and the coverage is almost none and are they committing Medicare fraud if a lawyer wants to go for it help. They are making me worse.
Reviewed Aug. 25, 2015
I have had Aetna for over three years. They challenge every bill. They refuse to pay any of my bills for months on end. Last year I went to an Aetna approved laboratory Quest for a blood test. The lab didn't do the test my doctor asked for but did a similar test which my doctor approved. Aetna refused to pay the bill citing that the test was one they will not approve of! This answer after getting a different answer including "I do not know why they won't pay the bill Mr. **!" The last bill I received had been waiting for over eight months to be paid!
Reviewed Aug. 24, 2015
I signed up for Aetna Medicare Advantage in Nov 2014. The doctor of orthopedic surgery was on the published provider list of Aetna. When I arrived at the doctor's office in February 2015, the staff informed me that the doctor had dropped Aetna in 2012. A grievance/appeal was sent to Aetna and I received the response on Aug 20, 2015 stating that the doctor did not let them know he no longer accepted Aetna and it is not their problem. So how many other doctors does Aetna have on their database that really aren't covered? Talk about a scam, but they have no problem taking my monthly premium. I have sent a complaint to Medicare, hopefully they can stop this felonious activity.
Reviewed Aug. 23, 2015
I signed up for this particular plan after significant research. All my doctors accepted it. I pay nearly $850 per month for coverage. Every time I have a routine check-up, blood work, or an annual test like a mammogram, I am gauged with unexpected charges. Usually, they will say I never obtained a referral from my doctor even though I had. (My neighborhood lab would never agree to do a mammogram or breast sono without one.) After virtually every doctor's procedure or routine test this happens. There is no transparency with this company. I get a bill from Aetna that I have to immediately contest or appeal. They have set up their appeals process so this is standard protocol and no one is policing them. It is completely unethical. I see others are making similar complaints on this site. Someone needs to look into it immediately.
Reviewed Aug. 19, 2015
Before I bought this insurance I checked the site to make sure all my doctors were covered. They were. After I got on the plan, and went to see a doctor, Aetna denied the claim. I discovered that I couldn't go see her because her facility wasn't covered! I found I can't see any of my regular doctors, whom Aetna said they covered on their site, because their facilities aren't on the plan! I feel like this is misrepresentation and FRAUD on Aetna's part. I paid for the very best platinum plan and I am throwing my money away every month because I can't see my doctors. It gets worse with this new information - I discovered only ONE hospital in NYC is covered with this plan. I am extremely angry and feel I was duped into paying top dollar for such a shoddy plan.
Reviewed Aug. 7, 2015
Aetna tells you that all you have to pay for Urgent Care is $50 + 80% co insurance. When I called them to find an UC provider, they asked me to call a nearby one and check if they accept Aetna. Later on the hospital sends me a bill saying I have to pay much more. When I call Aetna they say "you should have asked the hospital if they contract with Aetna as opposed to just accept Aetna". This is bad on Aetna's part. They never told me that when I called customer service. They then intentionally make you send an appeal through snail mail - so you are not motivated to do so because of the effort it takes. That's the only way you can appeal for any wrong bill they sent you.
Reviewed Aug. 7, 2015
We paid 386 dollars per month for a family plan. We were on the family plan for three months. That totals to $1,1158.00 out of our pocket - and right into Aetna's. My routine physical at the doctor yielded a 100.00 bill due to Aetna's refusal to cover the office visit. Now the grand total is $1,258.00 for us - for a routine physical. An Aetna call center agent said my family care physician was a neurologist, ergo my routine physical examination was a "specialist visit" (I am not kidding). Ergo, that's why they kicked the $100.00 back at us to cover.
To make matter worse, my husband had a routine physical exactly one month previous to mine. He went through the exact same procedure, through the same medical group. He was not charged a thing. Aetna's determination of cost and coverage is inconsistent from month to month. Do not trust this company. Do not do business with them. Please get health coverage through a different company. Aetna does *not* take care of its customers.
Reviewed Aug. 4, 2015
I continued coverage w/ them after leaving the employer I initially received coverage with. They immediately denied any medication despite having been on various medications associated with the approved use prior, and took 2 months to accept my appeal (all the while I was essentially paying $400/mo for nothing.) After this first appeal, they contracted out The Rawlings Company to harass me surrender information about health insurance I had years ago (which I no longer have information about since it was my parent's plan), before my current coverage, threatening to cancel my coverage if I was unable to. Joke's on them. I already cancelled my "coverage" and they will not see any more of my money.
Reviewed Aug. 3, 2015
This is my second year with Aetna. Last year my family had a POS, and my husband, 2 sons and myself were covered for approx. $200 month premium (not including the government payment according to the Affordable Care Act). This year, only two of us needed to be covered, one of my sons and myself. The ACA insisted that my son have his own policy which cost us about $20 a month. My policy cost me $200/mo., the same that we paid for four people last year! I also switched to an HMO in order to keep costs down. I am 64 years old and am in excellent health and work out vigorously 4-5 times/week. I actually lead a healthier lifestyle than my son and consider the 1000% markup on my premium discrimination according to age.
The clincher came when I needed to renew my medication for a non-serious condition, one that Aetna had paid for last year. I need the extended release formulation, as the regular medication gives me serious heartburn and reflux. Aetna denied the extended release and I was informed that I need to try the regular. My doctor wrote a letter stating that I had tried the regular version in the past and had difficulty with it. The extended release was still denied.
The regular medication would put me at risk for esophageal erosion, not to mention extreme pain and discomfort. Since the cost of the time release medication is about the same as my monthly premium, I have had to make a decision. Guess what? I fired Aetna! I refuse to play their little bs games of levels of appeal. I can now afford to pay for the meds out of pocket. I refuse to give this crooked parasitic company one more cent. I would rather pay a fine than give Aetna the satisfaction of fleecing one more poor soul. I am fortunate in that In a few months, I will be eligible for Medicare. If I can stay healthy until then, firing Aetna will be the best thing I have done. I wish more people could do this and am very sad for those people who need medication for serious conditions and are stuck with this scum-sucking joke of a company.
Reviewed Aug. 3, 2015
I've had a series of dismal experiences dealing with Aetna, purely as a Plan Administrator. The website is balky and mostly useless. Changing even something as simple as the billing address is impossible. I needed to email my change - not possible online or even by phone. Our plan was once credited with someone else's $7000 payment. I had to spin my wheels trying to get Aetna billing to acknowledge and fix their mistake. I never got so much as a "thanks for noticing our SNAFU, oopsie, our bad" from anyone at AETNA. What is wrong with this company?
Reviewed July 27, 2015
I've had many insurance companies over the years. Aetna is the worse. My doctor who is with Aetna recommended a test I needed to have. First thing they do is deny the claim. Not only did my PCP doctor order it but my cardiologist also wanted it. Why is this company not investigated by the Local, State, or Federal Government? Now I have to appeal this claim. I bet they do this with most of their customers if not all. Is this what I have to look forward to with Aetna? I guess so.
I will be talking to my companies insurance administrator as well as filing a complaint with the New York Consumer Department. Their excuse was clinical studies have not proven that this service is effective for treatment of the member's condition. Why studies? Name them! If you can do not use Aetna. If you have no other choice like me you will have a fight ahead at every turn. Start writing to everyone you can. Also let's try to make this a nationwide issue again as I know people have done this before. Don't give up.
Reviewed July 26, 2015
Beware of this company. They do not deal honestly. They base their judgments on 4 min of recording after 3 years. They do not take into consideration the medication you're under and will be for the rest of your life because of injury on the job. They also have no clue what my job description was. Their logic and wording of their responds is written and It's my first hand knowledge that the company and Aetna care very little about you or me. Since filing a civil suit against the CEO and the HR VP in a federal court They have left the company. I've sat in on conversations where the doctor's reports are dictated to them by the heads of safety. I believe that they don't study the facts or look at the big picture.
Looks like from what I'm reading other have had the same experience. I asked for a copy of my signed contract and only received a blank form. Just get a lawyer to deal with Aetna and the company right off the bat. I was a high level employee and after a injury. They say I can work yet they paid me for 2 years. They also never paid a dime for any health expenses and cut you off ASAP. From a opinion to a termination all in 4 days. I will follow up with more helpful hints and will attempt to get help from RT news and Chicago Tribune. 500 people in Chicago who know me continue to make contact. They are taking your money too.
Reviewed July 24, 2015
Called an Aetna representative after finding my surgeon was not on their plan and was given a name of a surgeon for another specialty entirely. Second instance a different surgeon's staff called to verify benefits and was told they didn't have Aetna. He became very stern with the Aetna representative and said "I need to talk to your supervisor right now. As while this patient's Aetna plan may not provide coverage we do see patients with Aetna". Finally and fortunately, he talked to the supervisor. It was found that I did indeed have coverage. Seems to me their first response is to say "no we do not cover you".
Third instance checked their website today to confirm coverage, which in fairness to Aetna states in other words that it is updated frequently. However when I printed off the name of "approved" MD today 07/24/15 and called them they said "first we do take Aetna patients... but then... oh is this an Obamacare policy?" Then stated "we do not take Obamacare policies." That the information on Aetna's site is a mistake. Not hasn't been or needs to be updated just that it is a mistake. Really?
Reviewed July 24, 2015
On 12/3/14 I called the number to verify coverage that is provided on the front of my insurance card. I spoke with Mel, who instructed me to call the Patient Management number. I was provided with the number 1-800-333-4432. Upon reaching that department I spoke with Peggy. I informed her that I would be having a procedure on 12/9/14 to determine if further surgery would be necessary. I had been having recurring bouts with diverticulitis for almost a year. I told her I was calling from Alaska and that I understood that doctors and facilities were considered out of network up here. I gave her the doctors name and name of the surgery center. Peggy advised me that I had been assigned the case reference number of **. She also told me that number would be the same for additional medical procedures should that be necessary. She assure me that I was all set to proceed and that my insurance was in place.
After that procedure it was Doctor ** recommendation that I have surgery to remove 5 inches of my lower intestine. I was referred to Dr. **. On 1/7/15 I went into Dr. ** office to talk about the risks and whether I actually needed surgery. It was determined since I had been struggling for a long time and the antibiotics to treat the flare-ups were very hard on my system, surgery was the best option for me. My surgery was scheduled for 2/24/15. On 2/20/15 I went back to Dr. ** for my Pre-Op appointment. After that appointment I called the Patient Management number again to make sure I was still all set to go. I did not write down the name of the person I spoke with. I told her I was calling to confirm that everything was set up and I told her I was calling from Alaska. I asked if there was anything else I needed to do and she said no. I specifically asked what the maximum amount I would be responsible for and was told $4,000.00.
I got my bill from Dr. ** and was shocked to find it was for $8902.80. This is on top of the $2940.00 that Providence Hospital is charging for the Anesthesiologist and the $274.30 for Lab work and $429.93 for the Pathology Report and other small amounts for various other services. On 4/27/15 I called Aetna back to ask why I was being charged so much. This time I spoke with Aimee (Employee # **). She said that as Doctor ** was out of network, Aetna would only pay up to a certain amount and I would have to pay the rest. I told her that I knew that doctors in Alaska are out of network and had called prior to my surgery to be sure I was still all set and the number previously assigned was still valid.
She advised that had I asked for Provider Authorization he could have been considered in network and a larger portion of his bill would have been covered. Aimee also stated that whenever she is talking to someone from Alaska she always advises them of the need to ask for Provider Authorization for the Doctor. I believe I did what was reasonably expected of me and the Aetna employee should have advised me of any additional steps that needed to be taken when I called on 2/20/15. I specifically asked her if I had done what I needed to do and confirmed that my obligation would be at most $4000. I am appealing the decision by Aetna to pay Doctor ** only $7233.20 for his services on 2/24/15. I believe I did my due diligence and any error in this is on part of the Aetna employee who did not inform me that I needed to ask that Doctor ** be given Provider Authorization. They have denied the appeal.
Reviewed July 14, 2015
Other insurance companies, like MVP, BCBS, etc. do not push you into the donut hole until you have reached the $ limit, however Aetna does apply the higher prices to medications at the beginning of the new quarter during which the donut hole is reached, whether you have taken the expensive medicine or not that pushes you over the limit. This is not what Medicare intended. Also they do not have their own mail order pharmacy. They are using CVS. Checking retail pharmacies actually gives better pricing in the donut hole than mail order, which is not the mission of mail order, but at Aetna/CVS ANYTHING IS POSSIBLE.
Reviewed July 13, 2015
Going into labor, seeking nothing but the safety of my unborn child, and as directed by my doctor, I went to the nearest hospital for a safe delivery. My plan covers maternity care and birth 100% but Aetna does not want to pay or assist me in paying the bill because they do not consider labor an emergency. I have been a customer for years, and this type of treatment saddens me. I am working on my credit for my family, and now I am being slapped with huge bills that have now entered collections.
Reviewed July 11, 2015
A warning: if you are an Aetna subscriber and receive a letter offering a free home visit from a company called Verisk, do NOT accept. Verisk is not in the healthcare business. They gather data in order to minimize health insurers' coverage. I received a letter offering a "helpful, free" home visit. Aetna makes it sound as if Verisk will help you with making your home and life easier. They even want your significant other present. But be warned: they actually just want to figure out ways to deny your claims and raise your premium. Verisk is not a healthcare provider.
Reviewed July 10, 2015
My son has an Aetna HMO plan through his employment. In addition, he is covered under our Aetna PPO plan. His medical claims have been rejected by the Aetna PPO because they need to be submitted to the Aetna HMO first. I called in 2/5/15 and spoke with Senior representative (SUPERVISOR) Cheryl who looked over the claim and told me she would process them through the HMO first, then process the balance throughout the PPO. Cheryl said it would take 5-7 days to process through the HMO, then another 5-7 days to process through the PPO. She told me she would call me (took my phone number) in two weeks time - giving me the date of 2/20/15. Never received a call, I contacted Aetna again, spoke to Gail. She saw that I had requested the claims to be routed to HMO, then to the PPO. She said she would call 'within 24 hours". She never called.
We then wrote on the Aetna Navigator site an email on 3/5/15. They sent a response on 3/6/15 telling us that they have "escalated this issue to the handling supervisor". They sent us an update on 3/11/15 telling us "We are working with the HMO IPA department to obtain a copy of the necessary EOBs submitted to allow the claims to be considered through your [PPO] (By the way BOTH HMO and PPO are with AETNA!!). We will send another update to you within the next 5 business days to provide another update." *No updates received* These are for claims with AETNA. It's not like we are dealing with two different insurance companies!
I just got off the phone yet again to check on the status of our request. It is still "unresolved". What kind of incompetence is this??? Or more likely, a planned series of delays and willful ignoring of requests hoping to make the claimant give up. This is despicable, unprofessional, and shows that Aetna representatives lie and have no intention of following up on any requests, claims, or promises made directly by them.
Reviewed July 3, 2015
I tried to sign in for the over the counter program. It keeps telling me the ID and zip code doesn't exist. I have tried calling different numbers to find out what is wrong and they just keep passing the buck, I have been passed around so many times I just gave up. I will never recommend Aetna to anyone!! I am now looking into finding a different insurer. Aetna is lousy and it sucks!!
Reviewed June 30, 2015
Aetna claims that my annual physical bloodwork is 3 procedures not covered and that I owe $84.35 instead of paying the blood lab. I have gotten the same annual preventive blood work for over 10 years. This is my first year with Aetna - they are crooked and unethical. Aetna failed to pay preventive flu shot of $29.99 covered under health plan at Walgreens. Aetna failed to pay prescriptions covered by law with health care for birth control and hypertension purchased on the day of my flight to start my first day of work. They claim not to cover weekend days even though I technically was already starting work and Walgreens said they should cover 2 days before my start date. I would have waited to pay for these prescriptions following but I was worried about my blood pressure for flying across the country in the amount of $180.
In more than 13 years working in San Francisco, Aetna is my first experience right off the bat for unethical and unlawful attempts not to cover care that is said to be covered by terms known to my doctor (same one for +10 yrs, Dr **), blood lab (Quest Diagnostics), and Walgreens.
Reviewed June 27, 2015
This year Aetna changed my plan at the beginning of the year without notifying me. I pay the same premium but now all my deductibles duplicated, and the pharmacy plan changed, so now I have to pay for the medicine of my son $400 for each prescription. I cannot change insurance until 1 December and Aetna took advantage of it.
Reviewed June 23, 2015
Aetna supplies a fax number for people who make appeals. I have a situation where they will not resolve a payment issue with our doctor for services rendered 7 months ago! I have been faxing copies of the same complaint for 9 days now and there is still no acknowledgement from Aetna that they even received my fax. I publicly complained to their Facebook page and 2 days later, was told my problem would be 'forwarded' to the appropriate department. This is all fine, but I object to a company that refuses to even acknowledge you exist. I'm clearly very easy to get a hold of, they have my email address.
Reviewed June 15, 2015
My mom had Medicare with Aetna as a secondary insurance for many years. The new Obama care changed that to Aetna Medicare. The coverage is HORRIBLE. My Mom for the last few years had to get Prolia shot for Osteoporosis that she has suffered for approximately 10 years. When Aetna became Aetna Medicare we were told "nothing changed everything will stay the same". LIE!! The shot my mom was getting for years now they refuse to pay for it. The Dr is out the money and that is ridiculous. Meantime I had to fight for over a year to get approval for the Prolia shot so she deteriorated rapidly which can never be gotten back.
Second, for the first time my mom ended up in the hospital and a stay at a rehab nursing facility was required. She walked into the hospital and left using a walker barely. When she got to rehab she had a tendency to fall back every time she stood up being a fall risk. Where Medicare gives them at minimum 20 days and after that it is a 100 dollars a day Aetna gave her 15 days. Now she had a touch of dementia so it was taking her a bit longer and because she was a fall risk she wasn't allowed to walk around or move around unassisted so it slowed the process.
Aetna denied coverage passed 15 days. We kept her there another week and she then could walk on her own. I am an only child, I work two full time jobs and they just were releasing her to be on her own. THEY DID NOT CARE THEY RISK HER LIFE, HER QUALITY of life by letting her bones deteriorate and they refused to send a doctor or nurse to evaluate the situation for themselves. They kept saying "you can appeal" and it was a farce of a practice. DO NOT SWITCH from MEDICARE and stay the hell away from AETNA. They are part of the original Obama care with the death panels. Once you hit 80 they try to speed up your end demise. Remember the death panels in Obama care they had to revise 3 times. If you read the original copies of the bill you would have seen it as I did.
It scares me that those who pay for insurance their WHOLE life, work their whole life. When they need coverage they get minimized but those who pay nothing for insurance and live off the system their whole life get so much better coverage. My mom just makes her monthly bills and just wanted quality of life. Aetna could not even send a professionally trained health care Doctor or nurse to evaluate my mom for herself. They would not even watch a video. I paid for her nurses aide to go there every day for a week and work with my mom walking her up and down the hall, practicing getting up and down from bed, toilet, chair so she could get her independence back and in less than 4 days she showed remarkable improvements and by the time we took her our which was 23 days she was able to get around, go to the bathroom and get out of bed herself without losing her balance and falling back.
They were sending home when she could not do anything independently with less than two days notice to even get anything set up. SHAME ON YOU AETNA. It was inhuman. This is discrimination for people who pay for a service and they get less coverage than those who never paid anything. How is that fair? How is that right?
DO NOT EVEN CONSIDER AETNA. Run away from this company. Their goal is to collect the money and push you into the grave. If they stop getting customers, they go out of business. The demise they are trying to due to their paying insured, so do you want to pay for a policy they torture you or your representative to fight for the injustice for months or years. Once someone has been diagnosed with osteoporosis it doesn't go away so the treatment should be approved. If you have cancer do you think they should have the right not to treat it or a heart condition? They can just stop your medical treatment and 3 appeals later is a waste with bureaucracy paperwork. Hell of lot cheaper to have TRAINED professionals to make a determination by seeing the patient not from an office never meeting the patient.
Reviewed June 12, 2015
October 2012 I had my gallbladder removed. Had been sick for several months leading up to the surgery. It took me 3 weeks to bounce back to the point I wasn't sleeping all day everyday after the surgery. My job wouldn't allow me to return until the doctor released me 3 weeks after surgery. Aetna said 1 week was all they allow for this surgery and since the way it works is I have to be out 1 week for the short term disability to kick in. Technically they didn't have to pay unless there were complications like infection. If my doctor says I can't go back to work for whatever reason related to the surgery who is Aetna to say differently? Trust me if I could have gone back to work I would have.
Reviewed June 12, 2015
We tried pre-authorising a GP visit for my husband here in Hong Kong. We spent an hour on the phone to Aetna - couldn't hear the person at the other end as the quality of the line was so awful. The "24 hour" service number didn't have access to his policy details - they said we needed to call Member Services and gave us the number. It was the number we had dialed. Then they said they'd try to put us through to Member Services, but MS didn't accept our call!!! (It was outside of business hours in the UK which is where our office is based as we're from Europe.)
We gave up attempting to get pre-authorisation and went to our preferred GP anyway. The GP Aetna have a direct payment relationship with operates a Cantonese-speaking office out of a subway station, generally with queues a mile long. Under no circumstances would I or any member of my family use it. No wonder it's got the cheapest insurance policies going.
A week later I was admitted to hospital with cellulitis, phlebitis and sepsis. We didn't even attempt to get pre-authorisation! It was an emergency. Having spent many thousands of pounds settling the bills ourselves, I have submitted a claim - and heard precisely nothing after three days. I emailed the 'help' address on their website ecare@aetna.com... only for my enquiry to be repeatedly bounced back with a 'postmaster delivery failed' message. I am dreading having to pick up the phone and dial an international number - not a free phone number, by the way, unlike every other medical insurer we've had - and talk to someone on a virtually inaudible line.
AWFUL, AWFUL, AWFUL, AWFUL, AWFUL. Can't believe my husband's firm has gone with such an unhelpful, inconvenient, impenetrable provider. A disgrace.
Reviewed June 11, 2015
I had my first child in October of last year. What should have been a very simple process has turned into a nightmare. It states in my contract that we are responsible for a $500 deductible and a $240 in-patient hospital co-pay, which should mean that we pay $740 for my hospital stay when I gave birth. However, we got a bill for over $1,000, and I have made at least ten phone calls to Aetna and to the hospital billing department to resolve the matter. They keep telling me that they are "reprocessing" the claim and to give them 5-10 business days. I have been calling since January about this.
During the last phone call, I found out that they are now saying they have already paid the maximum amount allowed, and they have decided I owe over $7000! I am extremely frustrated. I am getting threatening emails from the hospital for not paying an incorrect amount, and one of Aetna's Customer Service Representatives was very rude on the phone. I just want an explanation. It seems that there is a disagreement between Aetna and the hospital over the amount Aetna should pay, but I feel they should handle that between themselves and not punish me for it. I am tired of Aetna's representatives telling me that they are taking care of it, yet nothing is happening.
Updated on 08/25/2016: I have posted on here before about the nightmare of an experience I have had with Aetna. Since the last issue resolved about a year ago, it has been fairly peaceful. Or so I thought. I have been with Aetna on my husband's insurance plan for over 2 years now. They have been processing and (usually) paying the claims without so much as a mention about any other plans I may have had. Evidently, my parents still have me listed on their Blue Cross plan in another state, even though I am married and on my husband's insurance, and Aetna seems to have just figured that out. I do not have any desire to be on my parents' plan, nor do I want my personal medical information being sent to my parents. Aetna has now decided that they are going to start sending my medical claims to my parents' plan, because all of a sudden they've designated Blue Cross as my primary insurance.
I spoke with a foreign Aetna representative on the phone earlier, had a very difficult time understanding her, and she kept repeating the same script answer. Because I have been listed on my parents' plan for a longer period of time than my husband's, then Blue Cross must be my primary. Then why has Aetna been paying my claims as my primary for TWO YEARS without speaking to me about this??? I don't understand what changed in the last two months, and no one with Aetna can tell me. I find it very confusing that they wait until 2 months before I turn 26 (and thus will no longer be eligible with parents' plan anyway) to start saying that I have "multiple medical plans".
I also believe it is no coincidence that this issue started shortly after I started seeing a chiropractor several times a month for back pain as a result of scoliosis. Aetna sent me a form trying to find out if I had been injured in a car crash, and desperately trying to pass these claims on to someone else. I am so angry and frustrated. My husband and I pay hundreds of dollars in premiums to Aetna every month for them to try to pass the bills on to another insurance company because they don't want to pay for wellness care. Unfortunately, I do not believe that any other insurance company would be any better. Health insurance in this country is such a scam and reeks of greed.
Reviewed June 10, 2015
I have been ripped off by Aetna due to their low-balling of customary or prevailing out of network rates (when they have no competent in network providers). I am inquiring if others are experiencing the same for a possible class action.
Reviewed June 9, 2015
Aetna don't treat me like an adult, who goes to the doctor, paid her bills and make her own claims and like to receive her money back in her account. Because of my husband is the primary insured the information about my medical services are sent to my husband as the payments for my claims. After protesting they corrected but keep going back to send it to my husband. The information available in their website regarding my claims doesn't provide the current status of the claim: if the payment is in process or was paid and to where was sent. I have to call and spend time clarifying every claim. The phone service is correct but my time is valuable. After reading other claims about Aetna actions in your website I feel like this is not the most important issue but still is not the best way to treat the adult family members of the main insured person.
Reviewed June 4, 2015
I changed my coverage to Aetna because it is the insurance provided by my husband's company. They refused to cover my migraine medication, resulting in a $500 copay. My Dr. and I demonstrated via paper trail that the generic medications do not work on me (I wish they did) and if I take them, my migraine is as bad as ever, almost to the point of going to the hospital for pain. In such scenario, a good insurance company should give a brand liability waiver, which would enable me to receive the only medication that works for me at the rate of a generic, since it is not a personal preference but rather a "the other medication does not work" preference. The Dr. and I demonstrated that it is not that the generic does not work as well, but rather does not work at all.
The customer service at Aetna kept giving the Dr. and I the run around of how to fix the issue, saying that we could, but ultimately we got to the bottom of it and Aetna admitted they will not pay for it even though I pay for my insurance plan each month. I am extremely unsatisfied with their service. If you are able, choose a different insurance plan. I have an international trip coming up and because Aetna gave us the runaround, it will be too late to resolve this before leaving the country (despite me taking care of this four weeks ago). If I could give them zero stars, I would.
Reviewed May 25, 2015
I signed up in December 2014 by the deadline for Medicare. I received a letter from Aetna saying: I won't be covered in January 2015 because I opted to have my monthly premium out of my monthly social security check. Social security didn't approve the premium deduction until Feb. 2015. Ergo, Aetna sending the aforementioned notice about Jan. 2015. For months now Aetna has been harassing me for the monthly premium of Jan. 2015. IS THIS LEGAL? DO I HAVE TO PAY? PLEASE LET ME KNOW.
Reviewed May 23, 2015
I have degenerative disc disease and had lumbar fusion L4/L5/S1 in 2010. Recently, while walking up the stairs I pulled a muscle and decided to treat pain at home with heat and pain meds. After four days I could no longer stand the pain so much that I felt terrible pain in my lower back that made me cry; it hurt so bad. I decided to go to the ER at about midnight as I could not sleep and felt that maybe something more serious was going on. Doctor at ER gave me pain meds and conducted spinal X-rays and suggested I see my surgeon for follow up because he could not see anything seriously wrong with X-rays. To my surprise I receive a bill from Aetna indicating they have refused to pay the ER visit indicating that in their opinion this was not an emergency.
I appealed their decision and they stood by their decision that in their opinion this was not an emergency and that I should have used another facility. Keep in mind there was nothing else open at midnight. My only option at that time was the ER, yet they still are refusing to pay for the ER visit. I am now having to negotiate with the Hospital paying for the visit myself. Aetna is the worst healthcare that you will ever pay out the nose for. A company that doesn't care about your well-being. Stay away!!!
Reviewed May 22, 2015
In my opinion...AETNA is the WORST company on earth. They make life VERY difficult for someone trying to obtain a prescription. I hope this company goes out of business. They exemplify what is wrong with America's health insurance industry. They are the poster child for bad customer service -- very confusing website and phone system, cumbersome forms, and are very expensive. I hate that I have them as an insurance provider and will be looking to switch to a better carrier soon.
Reviewed May 22, 2015
My daughter is required to use Aetna Specialty Pharmacy to get her Prograf needed to prevent rejection from a bilateral lung transplant. They do not bill her secondary and do not provide the generic she can use so she has to get name brand and pay $250 a month for that one med. If they would allow her to get it from our local pharmacy she would only have to pay $2 a month because they will bill her secondary and provide the generic she can use.
I have spoken to someone at the pharmacy to get a long term override and they denied it. I cannot believe a company would prevent someone from getting a life saving medication at a cost they can afford. This is a drug that she needs to survive or she will go into rejection. I have now contacted our state's Attorney General and will also contact our state's Watchdog group. I cannot say enough bad things about this situation.
Reviewed May 20, 2015
Early this year, my employer switched from Cigna to Aetna Insurance. With Cigna I had gone thru several procedures and ultimately surgery on my lower back, not to mention all the prescriptions, all with NO issues! Ever since we switched, I have had NOTHING but issues! Two years after back surgery, I'm in pain again and Aetna declines the prescription my doctor writes to help the inflammation in my back and hip joints! Then they decline the MRI first stating the doctor never got authorization, but when I called the doctor they had a case # proving they had called it in! Then they stated it was denied as the doctor didn't send enough info when the doctor had sent all of my info from my last several visits! This company is by far the WORST insurance company l had ever had to deal with. Why do I pay for a premium insurance plan just to have everything declined???
Reviewed May 20, 2015
When I was hired to my current employer, part of my hiring package was a detailed description of my medical insurance benefits. These benefits included IVF procedure with no exemptions. My spouse and I are infertile and sought IVF for family planning in order to conceive a child. However, after an audit by Aetna while my spouse was receiving fertility treatments, it was disclosed that since I had an elective sterilization procedure 24 years ago that my spouse who has never conceived a child was immediately dropped from all fertility coverage. I am appealing this decision and consulting an attorney. My spouse is being prejudiced against by Aetna against a decision I made 24 years ago in another marriage!
Reviewed May 19, 2015
I process claims for a local eye clinic. Aetna has always been slow at paying claims, but they have came to a halt in the past 30 days. I call and call and all I am told is "still processing". Are they broke? Why don't they seem to be able to pay for legit claims? I read some of the stories on here and cannot believe how horrible they treat their members. Good luck to all of you.
Reviewed May 13, 2015
When my children were little in the mid-90's Aetna routinely denied legitimate claims that I had to constantly fight, receptionist, non-medical people were deciding what was medically necessary and it got to the point - everything was unnecessary, even their routine vaccines and annual visits or illnesses. I became so tired of this that I had their police detective dad change his policy to another insurer. I was approached in 2012 by an agent for comprehensive care who assured me Aetna had changed substantially. I did not do my own investigation accepting his word.
Big mistake - again aetna denied claims refusing to pay providers causing me to be unable to continue treatment unless the bill was paid by me personally. All sorts of shady excuses were given to me. In addition, the co-pays for office visits were triple what I used to pay for coverage and the co-pays for medicines tripled and in one case went up over 700%. I have since dropped them. I will never use this corrupt company again.
Reviewed May 11, 2015
After starting a new job, had to choose Aetna instead of 20 years with bcbs. My medication was covered for 7 years under bcbs. Aetna declined to pay for my meds stating I need a sleep study. Which they will not cover either. I have narcolepsy and I have no trouble sleeping. It's while I am awake I need the medication to work and function. After losing my sight, having that miracle, and having 2nd miracle to make my quality of life what it should be, has been something that has allowed me to work and provide for my daughter. I am all she has. No family should have to choose between quality of life and financially destroy everything I have worked so hard to get back. Thanks Aetna for stealing my miracle and my daughter's mother from her. This healthcare should not be able to override my doctor right to get me healthy and keep me that way.
Reviewed May 5, 2015
After paying for health insurance coverage each pay day, Aetna has the nerve to force me to have a blood test to prove whether or not there is nicotine in my blood system. WTF?! I pay for the health insurance coverage whether I smoke or not. I bought the insurance when I smoked. I no longer smoke, but even though I pay the premium for a smoker, I am required to have someone stick a needle in my vein to prove whether I do or not, so they can surcharge me $1,200 more if it is positive. It won't be positive, but I object to some insurance company forcing me to have a medical procedure for their benefit! Thank you Obama for making health insurance so affordable to those of us who actually work for a living! How much campaign contributions did you get for that 2200 page fiasco anyway?
Reviewed May 1, 2015
I simply need to change my address. Thinking that a phone call might be quicker than setting up an account and entering the information online, I called Aetna Medicare's toll-free number. After punching in multiple numbers in the voice mail process, I got a recording that the office is closed today. It's Friday, May 1! Since when is May Day a business holiday in the US? So I tried going online, setting up the account, and clicking on "change address." I got a message, "Call the number on your card." So hoping the previous phone message might have just been an automatic kick-in when the lines are overloaded, I phoned again, and got the same recording. Then I tried going to the "Have you had an experience with Aetna?" customer review section, and got a "password failed" message every time I tried to log in with the correct ID and PW I had just set up and used to access the customer account site a few minutes previously.
I googled "Aetna offices closed today" to find out what's going on, and found nothing. So Aetna just disappears on a business day and doesn't let anyone know. Unprofessional, unbusinesslike and unacceptable, and much like many other huge companies or government entities that have a monopoly or near-monopoly in their field that I have ever dealt with, such as cable companies and the IRS. As soon as I can switch to a more responsive and responsible company, I will do so. As for this feedback, I don't expect any reply, or if I do get one, I anticipate it will be an irrelevant, general blurb from the electronic supply room such as "The health and satisfaction of our customers is Aetna's most important priority." Getting rid of Aetna is now my most important priority. Have a lovely long weekend, Aetna. I'm gone.
P.S. In filling out the rest of this form, I got a screen showing my address as still Queen Street in Honolulu. I left Hawaii for Massachusetts a year ago, and Aetna has been sending mail to me at the correct Massachusetts address I used when I first arrived here. So why do you still have my previous, one-year out-of-date Hawaii address in your computers? This explains why the office is closed, as May Day/Lei Day is indeed a state holiday in Hawaii. But why are you still carrying me as a policy holder? I notified Social Security, the State of Hawaii and Aetna that I am no longer a Hawaii resident.
Reviewed April 28, 2015
I did not receive my bill in January 2015. Received a notice to pay the bill due date April 1, 2015. I pay my bills online, the payment got to your place April 2. And I receive the check back stating I have no insurance after never missing a payment all these years. I am 72 yrs old, I have no other insurance and I had to pay more money when I retired in order to keep the insurance I had. I feel I should be reinstated with my pay record and time vested with your company. I am very upset and need answers from your higher powers.
Reviewed April 27, 2015
Went to medical facility for an MRI, Aetna said the services would be roughly $375 due to the type of plan we had. Received a bill for $314.00, paid it full immediately. Two months later, received another bill for the same service in the amount of $227.00. The medical facility stated it was Aetna - they had made a billing rate error. Called Aetna, they claimed the medical facility initiated the rate error inquiry. End result - I filed 2 appeals with Aetna asking them to own up their billing mistake and they refused. Aetna's CEO made over $30 million in 2013. Poor customer service if you ask me - all I asked is for them to own up to their own mistake and pay the $227.00 bill I received due to their billing error.
Reviewed April 26, 2015
My two sons have asthma. They are prescribed "Advair Diskus" medication monthly to prevent the asthma attack, and Aetna does not cover it. The pharmacy benefit indicates that $10 for generic and $35 for brand. I was told that asthma medication is not covered. Therefore, I have to pay $100 for the prescribed medication instead of $35. I have had health insurance for more than 17 years, and I have never had this problem with other insurance. This is totally a rip off and deceptive insurance business. I have Aetna HMO, which I pay 202.51 and my employer pays 448.57 every two weeks, which mean the insurance cost almost $17,000 annually. I only use the insurance for my son's medication, and now Aetna does not covered.
Reviewed April 26, 2015
Aetna makes health insurance so much harder than it has to be. The website is useless and unclear. Trying to find answers to simple questions such as how much Aetna covers of visit takes hours to answer and they seem to expect you to have time to sift through pages of fine print in order to track down answers. Contacting their customer service representatives through e-mail or on the phone is a horrible experience; they can never give you a simple answer and they make everything more difficult. The bills they send are so unclear and I still can't figure out if I owe physicians that I've seen money or if these claims are pending, or if Aetna will cover it.
Reviewed April 22, 2015
I'm writing this on behalf of my mother who has Medicaid through Aetna Better Health. We've been on a mission trying to find a dentist who will see her. For the last 5 days, the left side of her face has been swollen due to a tooth infection. I went online and their website works whenever it wants. It's definitely not user friendly nor is it updated. After much trial and error, I was able to download a list of dentists from around the area that accepted her insurance. This is not an exaggeration, I literally called 17 dentist offices and NONE accepted that type of insurance, even though they were listed as a "provider" on their website. What I wound up doing was pulling a list from Google and going directly onto each website and checking out their insurance options.
I finally found a dentist office but once they saw my mom, she was deemed too critical of a patient and said they couldn't help. I didn't want to use the Aetna Better Health website again so I called their customer service line and it's all automated. If you managed to get someone live, they'll just place you on hold and either forget about you, or transfer you right back to their automated options. I was forgotten so I called back and tried their automated phone service, I jotted down the information to another 15 dentist "providers" and once I called, same issue. They didn't handle patients with that form of insurance. Only ONE said different, but they weren't taking new patients at the moment.
On my last attempt to get my mother the care that she needs, I said what if I paid out of pocket (meaning MY money, not hers) and they said it was illegal. That if Aetna Better Health found out that she was able to pay for a service out of pocket, the aid would be taken away from her because she's able to pay for it. Mind you, I said I'd pay for it, not her. So she's better off getting a worse infection than having me pay for it. They make it impossible to receive any form of help and it's a waste of time since their information isn't updated.
Reviewed April 21, 2015
I went for an annual physical with my new doctor. They ordered a basic blood panel to check cholesterol, blood sugar, etc. We went to LabCorp and had the tests done. Got my results, etc. I then receive email from AETNA that the blood work draw was not covered. Since when is basic blood panel NOT COVERED? One of the worst insurance carriers around, I would go back to Kaiser in a minute if it was an option!
Reviewed April 21, 2015
Former insurance companies covered Androgel. Aetna insisted I get injections. That was fine, my doctor wrote a prescription but when I went to have it filled, it was not authorized. My doctor, my hometown pharmacy, myself and my wife have tried calling them on several occasions to no avail. Delay and make everyone jump through hoops until you give up seems to be the tactic. We have been given different stories and passed from person to person each time. From the middle of Feb. until today with no help from Aetna. Twice when I went in for other prescriptions I couldn't get them because the website that the pharmacy goes to for prescription authorization was down. It is my opinion the Aetna cares more about its bottom line than those it insures.
Reviewed April 19, 2015
I paid my premium for December 2014. However Aetna applies the premium to November's bill that was already paid. Their records reflect that I did not pay December's bill and therefore all the bills for December are being declined by Aetna stating that I did not have coverage. I called Aetna and the worst Supervisor who refused to help. Each bill I had to write an appeal, some are being paid. However Appeals Unit is not correcting the effective date of coverage. I believe that there is corruption inside Aetna, and they are in serious need of an audit.
The District Attorney's Office needs to get involved. Because they denied a bill by a doctor in December, the doctor is refusing to give me another appointment. Aetna is denying me medical care by their clerical error-it rises to the level of a criminal review of Aetna. They have the intent, they know of their error and they are refusing to correct it. By denying the payment of the claim, Aetna is saving money but medical care is being denied. My situation is in NY, the NY District Attorney needs to investigate and prosecute.
Reviewed April 17, 2015
Aetna Health Insurance claimed to be secondary insurance for my wife's coverage for over a year straight, fighting it all the way when they were Primary the entire time. My wife had BCBS since she was a girl through her parents. Her parents are now retired and we added her 01/14/14 to my Aetna that I get through my work. We assumed that Aetna was primary since I was the husband and the other insurance was coming from her retired step-dad and was due to expire 3/19/15 when she turned 26. Aetna had no problem being Primary at first, but then in March we discovered my wife was pregnant and we had early complications and the bills started pouring in.
We got a call around April-May 2014 that because my wife was covered under BCBS that Aetna were changing themselves to Secondary. That's when all the chaos started. I spent well over 50 hours without exaggeration over the next few months on the phone with BCBS and Aetna on 3-way calls and talking to executive resolutions. Two separate times Aetna somehow convinced BCBS that BCBS was Primary and BCBS pushed payment through for the claims. Later the BCBS account would be audited and BCBS would change back to Secondary and take their money back from the hospitals. Next the hospitals would contact us by way of sending us unpaid bills for outrageous amounts and the process would start all over. Aetna had me so convinced that BCBS was Secondary and that BCBS was refusing to work with them that at one point, I put a review similar to this on BCBS' Facebook page.
It wasn't until after we started getting collection letters from hospitals with $0 money paid by insurance provider; while fully covered under two providers that I started doing online research. I was checking to see if I could get help from an attorney on this; and or to figure out what these companies grounds for dispute was and what could be so complicated that it would take this much effort to resolve. About 30 minutes of research told me black and white - Aetna was Primary, BCBS was Secondary because the retiree rule falls before the longer/shorter rule. I sent these findings to my Executive Resolution Specialist at Aetna and she said they were still Secondary and Blue Cross was still Primary but that she would forward the information I found on the internet over to their policy department for review.
Two weeks passed and I did not hear anything back from her. I sent a single line email "any updates?", instantly I got an auto response saying my Exec. Res. Rep. was on a leave of absence (obviously not her fault but an update from someone letting us know that our case would be taken over by someone else would have been nice; or if it would have been taken over of by someone else). I called the Executive Resolutions line after hours and left a long thought out voice mail with all the proper information start to finish.
The next day my wife got a call from a different Executive Resolution Specialist. Not only did the guy who was supposedly from their highest level of customer service not even offer an apology, he proceeded to act like it was our fault that this all happened, that if Aetna would have known that my wife's step-dad was retired, that none of this would have happened and that yes, Aetna is Secondary. He acted as if there wasn't hundreds of pages of notes about this situation in our Aetna account.
As much as I am happy that this nightmare is coming to an end, it could be only a matter of time before someone at Aetna changes their status back to secondary without warning, causing bills to go unpaid. I am so disappointed with the corporation that starting with the 2016 year we are planning on opting out of my employers Aetna insurance policy and instead taking my wife's BCBS policy that she is eligible for through her employer. The only thing that would change our mind would be compensation from Aetna for the frustration like waiving my wife's deductible for the 2014 calendar year. Unfortunately I am not going to spend another minute on hold with them to even ask for any compensation.
Their customer support is almost as bad as their hours of operation: 6 am - 3 pm, Monday-Friday Pacific - literally my wife and I's exact work schedules so most of our conversations with them were on our lunch breaks or paid time off during our regular scheduled work hours. I give Aetna a 0 star for refusing to pay our medical bills and trying to pass the buck on BCBS causing us sleepless nights, hours of crying, and many many hours on the phone. Then when being confronted about it, trying to turn it around and pretend we didn't do our part to resolve the situation sooner.
Reviewed April 14, 2015
Ridiculous customer service especially for people who require life-saving medication. I am sitting on the phone right now, after waiting 45 minutes for someone to get me an answer and they still cannot get this approved. I ordered a refill of this product 3 weeks ago, and they never bothered to call and say it was on back order. Now what. I can't get an answer from them, and it seems they can't even figure out if the product is available. It is not on the blacklisted products list on the FDA.
If I don't get this medication within 5 days I am at very high risk for stroke, heart attack, blood clots etc. This company couldn't care less. They don't tell you if or when your order is coming. Don't bother e-mailing them- you get no answer. If you call you will be put on hold for forever and well if you get sick because they can't figure out their ass from a hole in the ground when it comes to providing a service I pay dearly for in premiums.
Reviewed April 13, 2015
I went for an annual doctor's appointment as I typically did. I was charged by my doctor $150. I called the medical group and was told, I had no coverage with that doctor - WHAT! She has been my doctor for the past 5 years! Apparently, with no notice to me or my employer who pays for the plan, Aetna changed my plan, of which my doctor was not a member.
I appealed and asked them to re-consider the coverage. They denied the appeal, saying "well, we billed it correctly." Not one mention that they didn't give me or my employer notice that my plan changed and that my doctor was no longer my doctor. WOW. I'm glad to see that y'all followed your procedures in billing me for a visit that I would not have otherwise taken had I had notice that y'all - without my knowledge or consent - changed my doctor. I must send them a thank you letter for screwing me twice with minimal effort. FYI, my employer is considering changing my plan even though it will cost more.
Reviewed April 10, 2015
I made a bad decision when selecting AETNA Student Health Insurance. If I were able to make this decision again I would not select this insurance agency. They simply do not cover anything. Due to specifics within my plan, AETNA did not cover anything (ANYTHING) for a $600 Ear Nose and Throat Doctor bill. When I called the agency they laughed at me for not having read the multiple pages of tiny print that specifies the actual worthlessness of my plan. To make matters worse I am unable to function in life without the use of hearing aids. AETNA does not cover anything in regards to this disability. If you have an option, I strongly suggest staying clear of AETNA.
Reviewed April 9, 2015
I have degenerative disc disease and had lumbar fusion l3/l4 in 2013. L4/l5 disc was herniating so I had injections. It finally went to protrusion so held off on surgery. Felt terrible pain in my lower back that made me cry; it hurt so bad. Dr. wanted to do MRI. Aetna denied. I also have fibromyalgia and rheumatoid arthritis. My rheumatologist prescribed me **. Aetna denied me this medication. Aetna is the worse healthcare that you will ever pay out the nose for. A company that doesn't care about your well-being, they are just in it for greed.
Reviewed April 8, 2015
Aetna is treating my going to see the Nurse at a CVS Minute Clinic as a visit to a medical specialist with the associated $40 co-pay. Actually even CVS did not know that their Nurses were Specialists, because they only charged me a $10 co-pay when I went in. Had they told me the co-pay was $40, I would have waited to see my family physician. Prior visits to CVS were treated as seeing a Nurse with a $10 co-pay, but now, beware of Nurse Specialists at CVS. Next year, Aetna will be out of my picture for good.
Reviewed April 5, 2015
I am an aetna employee and have the aetna hsa as my insurance coverage, and put my own money in this account to pay for health care related expenses. We were told this included anything health care related including otc meds, but this was a lie. They just denied paying for indigestion meds and drops for dry eye. They also stopped paying for the asthma medication that keeps me alive. 1st thing tomorrow i will be filing an official grievance and next year will buy my insurance from a competitor of my own employer.
Reviewed April 5, 2015
In Jan 15, I had went to my eye doctor for my routine checkup and had an optical field test ran so my doctor charged the 20 dollar copay because they didn't know if Aetna was going to cover the test or not. Next day, I was charged 72 dollars for the field test and I had paid it then in February, I had noticed that I was reimbursed for half of my payment and was told that Aetna was supposed to send me a check for the balance because they covered the amount of the test. I had called Member Services to tell them that I was told that I was supposed to receive a check for the balance of 28 dollars and three reps told me I was supposed to receive it in 7 business days, never showed up, had to waste my time going off on reps because they told that I wasn't supposed to receive a check at all because the test was covered.
Their manager was stupid because she thought I was a liar but then she saw the check number and then wanted to act like I didn't know what I was talking about. Still had to wait until the middle of March for it. Now I'm just receiving a letter telling me that I owe them 18 bucks because of overpayment on the coverage of the test. I'm done with these fools. They shouldn't be selling insurance at all. I'm gonna find me another insurance to go to.
Reviewed March 30, 2015
Back in August of 2013 (when I didn't have Aetna), I was diagnosed with thyroid cancer. My thyroid has since been removed, but I have severe, recurrent hypothyroidism that requires I stay on a high dose of levothyroxine (Synthroid, for instance - it's what the thyroid makes to keep our bodies, brains, and hormones regulated and active. Without it, we feel fatigue, nausea, lose vision, etc). I cannot control my thyroid stimulating hormone (normal is .4-4, and mine is 200+ daily). The problem is that I don't absorb oral Synthroid like most people. I have Celiac disease and Crohn's, so I need an IV or IM (intramuscular) form of Synthroid. And since my TSH is so high, I'm too much of a surgical risk for a port or PICC (not that Aetna wants to approve one, anyhow).
My husband's insurance switched to Aetna in June of 2014. Since then, nothing has been covered. Nothing. They denied my IM Synthroid, and that keeps me in the hospital. After three appeals (after Aetna "lost" my verbal appeal during my 9th cancer hospitalization), I was finally approved for the IM Synthroid. It took Aetna between August and November of 2014 - almost three months - to "approve that it is medically necessary." Once I was on it, I was doing a bit better, and was only hospitalized twice, not 9 or 10 times. However, the medication ran out. When it did, a specialty pharmacy rep told me, "Well, you have invasive cancer and your doctor said it was terminal. You're going to die anyhow."
So my medication wasn't approved because I'm going to die. Obviously, I wouldn't let that stand, so I kept trying. My endocrinologist and GP wrote appeal letters. Three were denied because I should just "take pills" and "this case isn't life-threatening" (funny - I thought cancer kind of was. And uncontrolled TSH certainly is). Finally, after seven weeks, we received an overturned verbal appeal in our favor this morning - I can receive more IM Synthroid. Aetna just needed an hour to get everything into their system, and I could call about expedited shipment for the medication.
But when I called five full hours later, I was told that they aren't giving me IM Synthroid. They don't have it in stock, and it's indefinitely out of stock. They never said this to my doctor, who was livid when I told her. She was told I'd have the medication almost immediately. I have spent all afternoon on the phone with Aetna, and was hung up on when I tried to file my first complaint. During the second one, the rep placed me on a 20-minute hold and never returned. Not only this, but because my TSH is so high, it's causing heart problems and breathing problems. My blood oxygen saturation is 67%. But Aetna won't approve a sleep study for oxygen because "it's not needed." Probably because I'm going to die, so why waste the money - right, Aetna?
There's no reason this horrible company should exist if they are going to treat members like this. We don't pay $13k a year to NOT receive help. So they must be enjoying their profits while I suffer, unable to breathe, walk, drive, or focus. I'm not finished fighting with them.
Reviewed March 26, 2015
Since 2011 I have been suffering from kidney stones. In 2014, I have three major surgeries due to the stones were stuck. Aetna was good taking care of these bills. Now in February of 2015, my calcium levels in my body were elevated. I was diagnosed with a tumor in my parathyroid gland, close to my voicebox. My endocrinologist recommended a surgeon in Florida who only specializes in parathyroid disease.
I checked with Aetna who confirmed the group was "in network". I contacted the surgeon in Florida and got the process rolling. I was recently advised that the pre-certification was denied due to "in network" means New Jersey where I live but if I lived in Florida, the procedure would be approved. I have never heard of such a thing. Now I have to figure out where I am going to come up with the funds to pay for this procedure out of pocket. I only want the best but Aetna feels a general surgeon in New Jersey can handle it.
Reviewed March 25, 2015
I'm writing on behalf of a handicapped brother who is very debilitated by several diseases, particularly diabetes. His Medicaid forced him to chose a provider. His Aetna rep referred him to a Dr. ** . When my brother got there he was told that doc hadn't been there for 7 years. In addition, no doc within 30 miles will accept Aetna patients.
Reviewed March 11, 2015
I will be forced to withdraw from at least one serious drug because of the neglect I experienced with Aetna. I was terminated and I spent 7.5 hours on the phone and not one person I talked to could tell me why. So I have to re-enroll saving Aetna all that money and caused trauma to my heart, body and soul, and no apology even. All a big cover up for probably a simple mistake by a computer programer. If they make simple yet hurtful mistakes like that, think what could happen. They cover the wrong operation perhaps even causing the mistaken identity. What is a proofreader or copywriter Aetna?
Reviewed March 11, 2015
This is the worst insurance I have ever had. I needed an mri for My shoulder and they denied me so here I am in pain, have to wait longer for another appointment for later. In the mean time I cannot pick up anything due to a doctor that has not seen me! The pain is terrible but they do not care about you only not having to pay. Heath care with this insurance is a joke and so is everyone there. Their customer service is the worst I have talked to. They will take your money but when you need something done they will not let you. I would shop for a different company.
Reviewed March 7, 2015
I was insured with Aetna in 2014. I did not receive any information on renewing my coverage for 2015 during the well-publicized open enrollment period. I was already considering a move to a different insurer due to Aetna's horrible coverage. So I called in early Nov and said "I did not receive any renewal information. But am I correct in assuming my coverage expires 12/31/14?" They replied "Yes. Your coverage will expire. You would need to reapply online for 2015." At that point I decided to go with another insurer (Florida Blue).
Then out of the blue, on ~ Dec 23, I get a letter from Aetna stating something to the effect of "Sorry we did not send information but we are offering to extend your coverage until March." I IMMEDIATELY called and said "I do not want you to extend my coverage; I have a new insurer." They assured me that my plan would reflect the 12/31/14 term date. I decided to follow up in writing, and received a response back on 12/27/14 saying "We show your coverage expiring 12/31/14 and no further deductions will be taken."
What do you know, while they did not deduct on Jan 3, 2015, they deducted for double the premium on 2/3/15. Then, even after I alerted them that they were improperly deducting, they hit me again on 3/3/15. These actions are tantamount to criminal theft. I urge consumers to steer clear of Aetna - trust me, they will do more harm to your health than good!
Reviewed March 7, 2015
Very high deductible is almost impossible to reach meaning we pay aetna almost $4000 a year for almost nothing. Any visit to the dr, whether routine or emergency, is completely uncovered by aetna. Also we were told no prescription would ever cost us more than $10 but have found that there are very often "exceptions" to this, esp. with expensive meds. It feels like our pockets are being picked and we have no choice, as this is the only plan provided by employer. This should not be called insurance and should not be legal.
Reviewed March 5, 2015
In Texas, my district switched from Blue Cross Blue Shield to Aetna at the beginning of 2015. When getting my meds, different 'sections' gave me different information. After going back and forth for TWO WEEKS, having my doctors office fax over repeat 'physician authorizations' --- because apparently prescriptions are not good enough-- I was about to run out of my meds. One 'section' says I'm good to go and transferred me to the 'section' which is responsible for shipping. Yeah. I was NOT 'good to go'. Their explanation? The other 'section' did not have the right information. Eventually, I got that sorted out -- after my co-pay more than doubled.
Why am I writing this review? My neurologist prescribed an assistive electronic stimulation device to help me walk. Knowing my previous experience with them, I called to see if it's covered. First, they could not look it up in their system without the code. Seriously??? I had the name and everything....but NO. AETNA could do nothing. So I googled the code while still on the phone. Got a CPT code, surprised them. No surprise then, Aetna will only cover the 'procedure' if it is 'medically necessary'. No matter what I said about it not being a 'procedure', that's how they refer to it. And basically, if I'm not going to drop dead without it (and let's face it, I'm still alive), no coverage. So, now I'm looking for a second job to save up for it. Hopefully, I won't fall and break my neck in the interim.
Reviewed Feb. 24, 2015
I've had 2 back operations, in the last one on outpatient they discovered my back is cracked on both sides at bottom. 2 years later I finally decided the pain was too much. I keep falling, legs and feet aren't working. Went to a specialist, when he hit my knee, nothing. Wanted an MRI, they said no, must do therapy. I can't even exercise at home any more. If they hurt me, I'm getting a lawyer! Where's the government on these issues? Nowhere! They have good insurance!
Reviewed Feb. 24, 2015
Aetna very recently denied Rx coverage for my Enbrel - they want me to take methotrexate for 3 months & then they'll decide. Funny, they just paid claims for not 1 but 2 cervical ESI's - which are NOT FDA approved for the cervical spine - and need I add, they paid for my Enbrel for close to 3 years back in 2010. Not a word was said about the methotrexate requirement, which by the way is a low dose chemo med. I have psoriatic arthritis, not cancer **.
Reviewed Feb. 21, 2015
I lost my anxiety medication 10 days before I was able to pick up a new prescription. If anyone has gone through withdrawal of getting off of these medications you know you wouldn't even put your worst enemy through that. If you don't know what it is just google it. There are countless pages of how painful it is. So in order for me to get the medicine I would have to pay out of pocket for $140 compared to the $7 insurance covered meds would cost. I don't have that much money. I have never asked to get a prescription early. Yea losing it is on me. I get that but I'm pretty confident I'm not the only person in the world to make such a mistake. I also get some people may try to abuse any system in place to get refills quicker and sell them or abuse the drug. Like I said I have never done that and my history with the insurance should show that.
My gripe is 2 things... 1 that the representative on the phone showed no remorse or sense of caring in the least. We are humans right... I explained how awful the withdrawal symptoms were to her but it was as if she was talking to a drug addict and was disgusted by my plea for help. It was just a very heartless display. I put more if that on aetna itself because I assume they train people to ignore sob stories. My 2nd gripe is that they have no back up in case this does happen. It is basically you lose it you're screwed. We don't care about you. I have insurance through my company but I do pay a lot per month. It's not like I'm being forced to use them like they act like I am. I am going to switch... unfortunately I think the other options aren't much better... sad.
Reviewed Feb. 21, 2015
I am dealing with nearly 2k worth of bills that were conveyed to me as covered. Aetna communicated with my medical professionals before each procedure and confirmed coverage, but then refused to pay anyway. I went through the appeals process (they only allow a one step appeal, so make sure you write the appeal yourself because the representatives do not give a proper explanation. And make sure you include all evidence in that one appeal).
I had evidence of a phone confirmation from my OBGYN for an IUD procedure. I called before the procedure as well. Both calls confirmed coverage. I presented this evidence after my appeal was rejected (for no justifiable reason) and was told that they could not appeal it with Aetna but that they would file for some sort of state appeal. A year later, and I'm still getting billed.
My last month of service, they ignored my doctors' bills and claimed they never got them... Conveniently, this was AFTER I had already paid my deductible and out of pocket max. Their customer service is unfriendly, incoherent, and useless. Even the supervisors have no power or answers to logic. They discontinued my service because I had cancer and claimed it was because I make too much money. I am an adjunct professor, so that means I get paid below the poverty level....
I'm with Ambetter now, and their customer service is the absolute best. They pay my doctors immediately and so far have not disappointed me. I'm glad I'll be having surgery under their coverage instead of Aetna. Sunshine health has much fewer options for providers, but are much more reliable.
Reviewed Feb. 20, 2015
I actually work for a dermatologist office and we obtained a prior authorization from Aetna before the services were rendered and we received the prior authorization approval in a letter directly from Aetna with a prior authorization number. Aetna originally paid the claim and then 9 months later, Aetna retracted their payment and denied the claim stating no prior authorization was obtained, which was evidently not true considering we were sent the prior authorization directly from Aetna. I had sent numerous reconsiderations and appeals and Aetna is upholding the denial stating they received my reconsiderations and appeals after the timely limit, which again all of our documentation shows it was sent within the timely limit. I've been working with our Aetna Provider Representative but am still getting nowhere with Aetna.
Aetna is fraudulently denying this claim and yet they are not being held accountable for their criminal actions. It's not fair or just that a provider's office has 180 days to appeal a denial but Aetna can do what they want, when they want and there's no time limit for them and they are not held accountable for it. I asked our provider representative to intervene one last time and if I continue to get nowhere with Aetna, I'm going to have to see about taking legal action against Aetna. Aetna should have never retracted their payment and denied the claim. We did our job by getting the prior authorization and now it's Aetna turn to do their job. Patients and Provider's offices should not be penalized for Aetna's incompetency.
Not to mention this fraudulent denial but we get hundreds of denials stating a patient's ID number has changed as of 7/1/2014 but whenever a patient is informed by our office, they state they were never sent an updated ID card or even notified by Aetna that their information has been changed. This is an Aetna scam so that they can deny claims for the ID number and are hoping that once we flip the balance out to the patient, the patient will wait so long to contact either Aetna or the Provider's office, that even if the information is updated, it's too late to have the claim reprocessed. It's a shame that Aetna is supposed to help people but they only make bigger problems for patients. And it's criminal that they can just get away with fraudulent denials and improper procedures for notifying patients of changes to their policy.
Reviewed Feb. 19, 2015
Last week I contacted RX Home Delivery via email with a concern that my primary HIV medication was no longer visible via my online ordering portal as provided through AETNA. My message stated it was critical and urgent for someone to get in touch with me ASAP due to the fact that I only had 10 days left of my Epzicom. I reiterated that living in Ketchikan, Alaska would dictate immediate action so that my RX would arrive on time.
As of Monday of this week I had not heard anything so I contacted my doctor in Florida to expedite a pharmacy order and stress the critical nature of my situation. I received confirmation from my doctor on Tuesday morning. As of Wednesday, today, I still had not heard from AETNA. I sent another email to the complaint department explaining what has transpired. No answer. I called the pharmacy department and was informed that I could not have received Epzicom from Aetna RX Home Delivery.
However, when I provided verification that they have provided it to me for the past 1 & 1/2 years. She then said she saw they had. However, she needed a prescription sent prior to processing my order. I expressed that my doctor had sent the prescription on Monday. She stated that she had no record of such. When asked if they could follow through with contacting my doctor, I was told it may take up to 21 days to process my meds; I now have meds for only 6 more days.
I informed her that this was unacceptable and I had never missed a dose of this Med. and missing one dose can create major complications in reference to my treatment of HIV. I was in formed that I could talk with the tech department and let them know if my problems. I told her that my ability to deal with this issue was quickly waning and hung up. As of 7:00 PM, I have heard nothing from AETNA regarding how they might help me with a potentially life threatening issue!
Reviewed Feb. 14, 2015
I have a history of chronic pain from back surgery. Only thing keeping me going were injections. Aetna decided to deny, after 2 years pain so bad, they'd pay for pain pump which doesn't work and cost thousands of dollars, but if they'd have paid for injections, maybe I would be ok. They lie about providers in network. Customer service is horrendous. Appeals process was handled by a pediatrician instead of pain doctor. Don't trust Aetna. Don't sign up with them!!
Reviewed Feb. 12, 2015
I have been having several issues with Aetna. I needed an MRI, then I needed an MRA, I was constantly denied. Because I have Systematic Lupus, my primary physician said, that I should get the Shingles vaccination, but Aetna says NO! I have to be 60 years of age, but I am 53. The manufacture says that you can be as young as 50 to receive the vaccine, but I am still denied. The vaccine costs over $330.00.
Because I have Lupus, I must have lots of blood work done every 6 to 8 weeks to be monitored so that I can also be put or tried on the right medication. Aetna only allows certain things to be done in a year's time. The Rheumatologist also suggested that I get the Measles vaccination, since there is an outbreak in Arizona. We both know that Aetna will not allow any of this. I have already tried continuously to get them to bend the rules for the Shingles vaccine. The Rheumatologist does not want to see me anymore. I feel that she is denying me proper medical attention because of Aetna. What can I do? Or can anything be done?
Reviewed Feb. 11, 2015
After a year and a half with Aetna prescription coverage, I am saying adios. I just read another complaint from a client who no longer can use her current pharmacy and going elsewhere is creating hardship. I have been denied on a third of the meds I was taking before joining Aetna, now three more have been eliminated from the formulary. They are "prior auth." - crazy and my doc is pretty disgusted.
Just got a letter yesterday, they will no longer honor Rite Aid drug stores. I guess they have plenty of money, cause they sure aren't getting anymore from me. I spoke with another company today who assured me they cover all drugs I am taking. No prior auth's either. I immediately signed up. I will know next month if they are for real. If I have success, I will kick myself for not leaving sooner. Yes, it took about 45 minutes on the phone going over my list of meds, but that's nothing compared to the headache Aetna gave me. If I post the new prescription company name, it will look like I'm pushing them. Just believe that there is better out there.
Reviewed Feb. 5, 2015
Got coverage through emperor, waited for cards, nothing. Called, was told it had been sent Dec 28. January 9, called, told a new one had been sent on Jan 3rd. Called again on Jan 22, was told it may be stuck in the snow up north. It's now Feb 6 and no cards. So you pay for coverage but can't use it.
Reviewed Feb. 4, 2015
Aetna has been my provider since 2013, under a PPO plan. They "discontinued" that plan, according to the MCO service I used to select replacement--effective December 31, 2013. Before the Medicare enrollment deadline, I elected to enroll with the replacement coverage with them, which was to be effective January 1, 2014. Because I am on an absolutely limited income, I had the MCO representative repeat that to me, and I repeated it back to him, twice. He confirmed my info already in their system to ensure it was current.
He told me it was an HMO, and as such, needed to have a PCP name. He said, "But you can add that later." I replied, my PCP is the same as for 2013, and told and spelled my doctor's name; and explained that I didn't want any issues because I need to make appointments in January; and that I cannot have any coverage lapse because I could get sick in between. He assured me, no problem, no lapse will happen. He also informed me that I had the option to have Aetna direct bill me for my monthly premium, or continue to have it paid through deduction auto pay by Medicare. I opted to let the auto deduction continue.
I have so many other challenges to deal with already, and it's one less thing to deal with. Sooooo, if I had listened to that okay to defer naming my PCP, I would have bitten in glutes with Aetna's PCP referral requirement. How slick is that??? I became extremely critically ill and was hospitalized in January and again in February. Well, Aetna started calling me around end of March/early April 2014, claiming January 2014 premium hadn't been paid by Medicare. I asked if February's & March's had been paid and the representative confirmed "yes.”
He claimed Medicare didn't pay January because of some paperwork backlog--didn't say on whose end. And if I don't pay the premium, my claims for January would be denied. I replied that Aetna should have the error corrected directly with Medicare. He then claimed they won't pay because the paperwork wasn't done in time for the January premium. So they hadn't contacted Medicare and wanted the premium from me. And if I paid, they'd retro cover any claims for January. Made absolutely no sense.
Businesses routinely do retroactive transactions--including Medicare. In April I returned a call from Aetna, and while we were in discussion, she states she notices I have not selected a PCP--so I corrected her, filled her in on the application I'd done, and AGAIN, gave and spelled my doctor's name. She entered it into the system again because they'd had another system glitch WHILE we were speaking. She said, her system showed my coverage had been terminated. She kindly dug deeper and explained, "You're not terminated, but the 2013 coverage was ended.” She reconfirmed that my 2014 policy was still in place and started on JANUARY, 2014.
I have several specialists I also must see for continued care. During follow up care visits between those 2 hospitalizations, 2 of my doctors' office staff told me they could see TWO insurance coverages for me--both with Aetna--the plan from 2013 was STILL in force & paying billings and one starting January 2014. So I actually had OVERLAPPING COVERAGE with Aetna. That explained why they resisted my suggestion to contact and resolve it with Medicare. So, rather than moving that payment over--they were trying to get paid AGAIN directly from me.
On another follow up visit in middish April, the doctor's office told me the 2013 coverage had now dropped off. It seems that my January premium had been auto withdrawn for the 2013 plan. I remember there was such a mess within Aetna with this sudden plan discontinuation and transition new plan for 2014--of course the 2014 price had increased both price & restrictions. My PCP billing department started calling me around August 2014 about non paid claims for January. They said they had billed my insurance as usual from 2013. I told them what I knew from doctors of the overlap, and they were to try for Aetna to reprocess the claim.
Been back on the phone today with Aetna for 1 hour with 3 different reps from 2 departments. Got nothing but scripted answers, and loophole logic. Despite, their own confirmations to me that ALL THE OTHER APPLICATION INFO I GAVE for the 2013 was intact and still in their system. Yet they only acknowledge the notes from my mid-April conversation where I had--again--named my PCP.
Another irony in this mess, is that my claims history SHOWS where they paid for my 2 other doctor's billings--of lesser amounts--for services in JANUARY 2014. But the bigger bill of $1,200.00 they denied. And that billing was from within my PCP's office for an EKG done on the spot & that had to be diagnosed by her Cardiologist and practice partner---because my symptoms indicated a possible heart attack during that visit. The last rep I spoke with today in Enrollment said she could only request that they reconsider the denial because they did pay other claims in that January 2014 window. And she said she would mail me an appeals/grievance form to file with them. I confirmed that she would do both; and she agreed and reconfirmed twice with me that she would call me to inform me of the results of her internal request.
Aetna is more than a joke, it's a dysfunctional obscenity!
To me, Aetna uses its insurance provider licensing as a license to steal! They are guilty of creating financial hardship, and mental and emotional duress for its customers. And this is the kind of stuff that results in class action suits.
Reviewed Feb. 1, 2015
I have been covered 2 years with Blue Cross on my adult ADD medication. When TEA switched teachers insurance to Aetna, they would no longer cover my medication. I hope TEA brings back Blue Cross.
Reviewed Feb. 1, 2015
I am a retired space scientist. My former employer changed all employees/retirees in January 2015 from Blue Cross plan to Aetna plan. Mine is the top one available, Aetna Medicare PPO Premier Plan. It ostensibly puts control of health matters into the hands of the physician, but Aetna actually tries to influence and delay every action.
On December 25, 2014 I went to Emergency Room at local hospital, with severe abdominal pains. ER physician ordered an abdominal CT scan which indicated a mesenteric mass in the abdomen, probably a carcinoid tumor. I have same primary and specialist physicians before and after the switch from Blue Cross to Aetna. Visits with specialists were scheduled for Jan 9 and a chest CT scan scheduled for Jan 13. Aetna denied the scan because the said Medicare required first a pulmonary function test (which actually had already been done in December 2014), but they never contacted me or the specialist who could easily have set Aetna straight. The CT scan was performed Jan 16. Cancer surgery had been planned for Jan 21, with octreotide tracer scans scheduled for Jan 19 and 20. Because of lack of planning time between scans and proposed surgery and since Aetna insisted on pre-approving surgery and viewing surgeon's detailed notes, the cancer surgery was delayed until Jan 22.
I was in hospital for five days. When I was dismissed, the surgeon gave me prescriptions for pain, constipation and nausea if needed. Pharmacy would not fill prescription for nausea medication since Aetna insisted on having to pre-authorize it. Aetna's "fast" approval route takes at least 2-to-3 days (and by the way, Aetna does not work weekends). Pharmacist said they'd try to get Aetna's approval, but 2 days after discharge I had vomiting and, of course, no medication. The authority for medical decisions under my plan is supposedly with the physician. But Aetna's constantly meddling and delaying and denying service makes an already stressing cancer surgery an even more distressing experience.
Aetna Health Insurance Company Information
- Company Name:
- Aetna
- Website:
- www.aetna.com