Aetna Health Insurance Reviews

I have actually been billed $400 for a simple urinalysis by Aetna because the doctor who did it sent the test next door to the hospital instead of down the street to an independent lab. Now, the hospital is an in-network hospital but Aetna only pays 90% of what is done in an in-network hospital and only after a $400 co-pay is met. The only things that go towards this co-pay are out of pocket costs for procedures, none of the thousands of dollars in co-pays, medicine, and independent lab procedures will apply to this deductible. If the same test was sent to the independent lab they would pay 100% of it.

Additionally, if you have to deal with them, they are incredibly hard to contact and get correct information from. I have had to deal with their customer support email team fairly often because I cannot sit on hold on the phone all day while at work. The support I have received via email is awful, combative and extremely unhealthy. Mostly, they try to redirect you to do more work and refuse to provide you with accurate information. Expect to send 7 emails to get one real answer to a question.

Their DMO Dental plan is equally terrible. It is so bad that in fact only one dentist within 60 miles of me will accept it. I do not like this dentist but am forced to go there to avoid getting slammed with out of network charges. Aetna frequently declines to pay the estimated amounts that they should pay for dental procedures and instead tacks an extra $100 or so out of pocket on. Again, good luck dealing with the nightmare that is their customer service if you want to find out more about this or feel that something has been done in error.

Furthermore, I have actually had healthcare specialists be reluctant to take my insurance because they have told me that Aetna is extremely hard for them to deal with or get money from. High co-pays, terrible communication, and a ton of misinformation abounds whether you are a patient or a doctor. Most of my physicians have told me that they believe this is one of the worst health insurance companies out there. They happen to be cheap for companies to purchase but the quality of care is incredibly sub-par.

If you are considering getting Aetna insurance of any kind, don't. Shop around and pick something else. If you already have Aetna insurance, switch as soon as you can and if you have ANY procedures or tests done of any sort, make sure that you get and retain itemized records from the doctors and as soon as Aetna releases your claim, review this thoroughly. If you see anything that doesn't make sense, start calling. Don't be polite, they won't be.

Aetna has told me that I cannot return the medication, even though I haven't even opened the package it was mailed in, and they refuse to refund me the difference between the generic co-pay and the name brand co-pay. They claim they told me in February 2012, when I was in contact with them before, but they did not. They have no documentation that was sent to me stating this, or no real proof that I was told. After my first discussion, I was told that someone would review my issue and call me back. I didn't receive a call, so I called them again. I was told that they called on July 11th, 2012, which isn't true which my phone records show. I had another medication that I usually got in generic form and one time they didn't have the generic, called me and asked me if they could replace it with the name brand. Even though that co-pay was exactly the same as the generic, I was still notified and I had had to give approval before the medication was sent to me.

Now, there is a $70 difference between the brand name and generic co-pays and I don't even get a phone call before they sent me the medication. I feel that this is ridiculous! If I had known that they no longer made the generic, I would have not gotten the medication and spoke to my doctor about prescribing me another medication. I feel that this is retaliation from my appeal I filed with them in February. Since then, they have done this and even though they approved my prescription for Lidoderm Patches in February (prior to the appeal); when I tried to reorder them, I was told they will no longer cover them. I've spoken to several supervisors including Rochelle, Miles, Tiffany and Darius and still have gotten the runaround. Everyone tells me different things. This is very unprofessional!

I was able to return the call to get a better understanding and to try to understand why this was the first I had heard about my claim being denied and why I would just find out I have been on an unpaid leave since May 16. They did said they sent additional information for me and my doctor to complete to my address. I informed them that I had not received anything and this was the only phone call I had gotten. When they read the address to me, I explained that was an old address and I had updated my address with Bank of America's HR department as of April 30. They told me Aetna should have had updated records a week later.

I have submitted an appeal and have been told it can take 45 days for them to resolve. My doctor has been on standby, trying to find out what else is needed. I call everyday several times day, only to be told it's still processed in the meantime. I am on an unpaid leave, which is causing an extreme financial hardship. I am the sole provider for two children, whom I am barely feeding. I desperately need to see my doctor and cannot go to my appointments, because I no longer have gas money or co-pay to go. I feel I am being punished, because Aetna dropped the ball and simply didn't update my address in a timely fashion as they should have. It amazes me that they believe 45 days is an acceptable time to resolve someone's issue that is this severe.

Anyway, Aetna decided they were going to deny his hospital stay because the tests could have been done as an outpatient. The hospital has appealed. We have appealed; ePeople which is a liaison between my husband's company and the insurance has checked into it. I have written the insurance board and they stated that they were concerned but that Aetna was a self-pay insurance through my husband's company, that I should call the Employees Insurance Labor Board.

I was told there that whatever their rules were was the way it is. If I had gone through the appeals, that was all I could do other than get an attorney. Also, our Aetna policy states that we would be out no more than $6,000 annual. I pulled up their denied things and our medicines and we had paid over $7500 last year. There has been no response to that. We do not qualify for low-income help, but we are charged with a hospital bill over $37,000 that we will probably never be able to pay off. We are both 57 years old and we are extremely distraught over the situation.

I went with Reliable Canadian Pharmacy. My inhalers were paid for on a Friday. They were mailed out on Saturday. I was phoned by RCP by email and phone with tracking numbers. They accepted PayPal, which Aetna does not (they don't like the stop gap). They accept payment plans and genuinely care about their customers. It took less than 9 days from the word go with RCP that took Aetna over 2 1/2 months plus my paycheck to even begin the process. If the lawyers on this site want to contact me concerning what I consider exceptionally illegal actions by Aetna, please free to do so. If I, as a lay person, had taken the funds they did out of a person's account, I would have had felony charges, flat out, brought up against me.

There is a way out of Aetna. I sleep so much better, use less meds and if you want a complete list of my complaints, please contact me. They were honestly making me physically ill. I am so grateful to this new company! Go generic. Vote with your paycheck and get Aetna out of your life!

As of today, April 27, I still do not have my insurance cards. I have called three times. The first time I called I was told it takes up to four weeks. The second time I was told it should be any day now. The third time, oops, it was my company's fault for not giving them my address. Seriously? They were able to send me the information to start having money taken out, and they had my phone number. So now that we have full coverage again, I called to drop it. I was told it may take another pay cycle or two to stop it. I have absolutely no faith that it will happen without me calling every day. There seems to be a huge communication issue and I don't trust that they won't just keep taking their chunk of my salary.

Stay far away from Aetna. They do not take responsibility for themselves nor do they follow up to be sure their files are accurate. They are a joke and seem to exist only to gather money. It is not a service. You would do just as well to have a savings account for medical expenses.

I say a deal is a deal, and I shouldn't have to pay additional premiums for the coverage. But Anthony **, a Senior Benefit Associate at CSC, stated in an email to us that "The Retiree Medical Plan insurance carrier has increased the premium costs of some plans to points that exceed the subsidy the company provides for retiree coverage. In these instances, the company continues to subsidize the plans for 2012. However, the difference between the company subsidy and the total premium charged by the insurance carrier will be incurred by retirees electing those plans for 2012. As a result, a plan option that was available at no premium cost in 2011 may have a premium cost in 2012. Since plan options are subject to change annually, your 2013 plan options may include additional or fewer plans, and those plans may require higher or lower premiums versus 2012."

The additional information on changes to the Retiree Medical Plan was emailed to us by Mr. Anthony: "For 2011, several of the CSC retiree medical plans had to be either discontinued or significantly amended due to federal Health Care Reform regulations. CSC made the decision to continue to offer the plan to eligible retirees, and also, it made several plan amendments, including a change to CSC's cost sharing methodology (to a fixed monthly subsidy toward a fully insured plan), as well as improving the plan's lifetime benefit limit to an unlimited lifetime benefit limit. Even if you previously or currently have retiree medical coverage through CSC at no cost to you, the Plan historically and consistently reserves the right for CSC to revise or discontinue this Plan at any time."

My husband paid into this retiree health policy, and we were under the impression that we wouldn't be paying for this policy at a latter date. Now, we are being charged $143.86 a month for something that was paid for as a "prepaid policy" years ago. I say a deal is a deal, and I shouldn't have to pay additional premiums for the coverage.

Phone rep worked really hard getting to the bottom of the issue and ended the call promising me it would go out overnight mail at Aetna's expense. I received a call two days later that my prescription had been voided. It seems this time it had expired. What the pharmacist read was "Do not refill after". What the doctor wrote was "Do not fill until after." I was irate and reminded them of the assurance of overnight delivery. It didn't happen. I got the meds eight days after my initial call. These same meds which are sent with a pharmaceutical warning not to stop cold turkey due to potentially serious affects! Believe me, my family can verify the warnings are accurate! I have step-by-step instructions addressed to the pharmacist to be attached to my last of the three prescriptions. Don't say I didn't warn you.

I knew my employer medical plan coverage ended on November 1, 2011. My job had ended earlier in October, and I was starting a new job on November 14. However, given the pain and the fact that I had 10 days of Aetna medical coverage left, I sent the prescription to Aetna Rx Home Delivery, PO Box 829518, Pembroke Pines, FL 33082. Within 3 days, I checked my prescription status online, and saw no status. I called 800-227-5720 to find out why, and an Aetna series of excuses began, "We can't read the prescription", "The doctor's office hasn't returned our calls", and lastly, "This prescription should have gone to Aetna Specialty Pharmacy". Meanwhile, my coverage time is ticking away.

Aetna Specialty Pharmacy didn't fill the prescription, until mid-November, and is saying that I am liable for $706.00, because my medical coverage ended on November 1. This is in spite of the fact that Aetna had the prescription in hand over a week, before my medical coverage lapsed, and originally covered me for the charge (I had also approved a $150.00 co-pay over the phone). If Aetna had not been so inept and slow in filling the prescription, all would have been fine. I am being made the victim for this company's not being able to read a prescription, blaming my doctor's staff for not returning calls, and wasting many days trying to resolve the problem.

Local pharmacies do not carry Orthovisc, so mail-order is required. Had a local pharmacy carried the product, I would have been covered immediately. My point is that I should not be liable for delays by Aetna in filling this prescription, especially when they had the prescription in-hand. Aetna's ineptness even extends to its ultimately sending the medicine to the wrong office, despite the fact I'd specified my doctor's correct office address (he works in two locations). An unmistakable pattern exists here, and the blame lies with Aetna, not me.

I am (as of January 29, 2012) in a second appeal with Aetna. I have enclosed a copy of Aetna's Level 1 Appeal Decision dated January 3, 2012. Aetna sees nothing amiss in its maintaining that I am liable. Aetna apparently can find no liability on its staff's part, in making me wait for the Orthovisc until my medical coverage had lapsed. I need the help of the Commonwealth's OCA in bringing about a fair resolution to this matter, and I appreciate whatever OCA can do to assist me.

Regarding my second complaint, my dentist has sent me a bill for over $1,400 for bridge work completed, well before my insurance lapsed at the end of October. In fact, Aetna was called by the dentist's office regarding what they would cover. I paid my portion already, and now Aetna is balking. This company is out of control, unethical in the extreme, and needs to be stopped. I have never had similar problems with any other health provider, including BCBS, Guardian, and others.

I filed STD and FMLA on 10/28/11. Two different doctors documented the need to be off work. On 11/20/12, FMLA approved for me to be off unpaid due to illness. On 1/10/12, STD denied due to illness not supported. I filled an appeal for STD. It started on10/28/12. Five months later, I still have no answer, no pay, and no vacation time because I was forced to use it. Thanks for making it so wonderful for me Aetna.

I am single and self employed (I operate a licensed daycare out of my home.). I have a mortgage and numerous other bills. I cannot afford to pay this $4,000 plus balance that I thought I was being reimbursed for according to the rep I spoke to at Aetna prior to having the foot surgery.

Aetna has determined that this was not an emergency situation and considers this a medical rather than dental procedure and transferred the claim from dental where it would have been covered to medical non-network wherein they did not have to provide coverage due to the fact that my $1,000 deductible for non-network had not been fully exhausted. My dentist’s office even provided a letter explaining that they believe this was an emergency situation. I appealed the decision and now have been notified by Aetna that they stand on the original decision. Had I done what is indicated by Aetna's letters, I would have gone to an emergency room and incurred a larger expense only to be referred to a dentist. I believe that Aetna should pay the $300 remaining on the bill for the alveoloplasty procedure. I have already paid $143 toward this as this was what the 2nd dentist told me would be my portion of the dental procedure. I do not feel that Aetna is operating in a good faith manner on this claim.

Their website claims to have a 24-hour e-mail service which seems to be a false statement since they don't answer. When you send an e-mail, there is not confirmation of being delivered, they can claim not having received anything. The information on your personal page doesn't help, with explanations and links not being available at the moment, which is really a standard, permanent answer because you always get this. It's clear that they are trying to get away with not paying. Aetna is a scam and somebody needs to take action.

When I was six years old, I fell off my bike and consequently, my tooth was dead and have had to have numerous surgeries on that tooth. As someone who brushes at least two times a day and flosses every day, this has been the only tooth I've had such problems with. A couple years ago, I needed a crown (which was extremely expensive) and was told that it usually lasts ~10 years. Unfortunately, it came off within two years, along with my entire tooth. So for a couple of days over the weekend I had no front tooth (which you can imagine looks awkward and isn't a sustainable appearance) especially for someone who teaches 110+ kids on a daily basis. I find out that the procedure that is necessary for me to have is a complicated $6,000 surgery, none of which is covered insurance. When I have no front tooth, this is not merely a cosmetic surgery and is necessary for me to have.

For someone who works 70+ hours a week for my 8th grade kids, it is so heart-breaking that this "real-life" problem is making me question if I can afford to stay in teaching. Other adults have said that this is the "reality check" I needed to finally grow up and realize I can't remain an idealist and that I need to go back into finance. I've fallen in love with teaching and with my kids and truly believe that the achievement gap can be closed. Most of my students have my cell phone number so that they can call me when they have any issues come up, academic or emotional, since so many of them come from broken families. It is incredibly difficult, however, to take care of my personal needs and health on such a low budget and with insurance that requires me to pay 100% of a medically necessary procedure, one that I cannot afford although I am a productive member of society. This is almost three months (70+ hours a week) of my entire take-home pay. How is it that insurance covers 0% of this? I'm truly struggling to understand this. Thank you for your time and help.

After much fighting, I got the bill paid. Six months later I went back for more work, and they denied the claim saying it was not in network. They said it was only good for six months. Upon review of the initial paperwork, buried within the body of the letter, was that description. Question, why would I only add a provider for six months when he is very necessary for me due to a disability, and there is no suitable replacement available? After two phone calls and emails, I have been basically told to go screw myself.

To sum up their response: It's my fault for not reading more clearly and taking responsibility for myself. If I want to appeal I can send and they'll look into it. No phone numbers, no contact people. I want this route earlier this year and even sent all the information certified mail for which I have the receipt, and they told me they never received it.

I am typing this blog so that anyone considering Aetna health care for themselves or their business please reconsider. Their customer service is the worst I've ever seen and they will do everything possible to get out of paying a bill.

So when I received the generic, my wife immediately called the Aetna pharmacy. There was much finger pointing through many phone calls between Aetna and the doctor's office about how the script was filled out and if it stated name brand only. We have spoken to numerous reps to try and get the right medication sent to us and made many requests for supervisory follow up. It has taken an act of God to get the override approved which just happened last night around 7pm with the help of a very empathetic rep who stayed on the phone with me for 56 minutes and was extremely helpful. Unfortunately, she informed me that a senior representative would not waive the overnight fee for the medication but I reluctantly accepted that because my son only has a day or two of medication remaining at this point.

My wife and I were informed by many reps that a supervisor would call us back and nobody has followed up with us even to this day. After being informed, the override was approved last night. I called this morning (1/24) to ensure the order was shipped. However, the expedite request has not even been opened yet. I was told by one rep they would "do me a favor" and get me a 30 day supply approved and it would cost me $32.23. All I had to do was contact CVS and pick it up. Well, I contacted CVS and they told me it was a script for 14 days (not 30) and would cost me over $300! So here I sit with no medication, no way of paying $300 and complete frustration regarding the incompetence of Aetna's employees. Nobody seems to give a *** and you get a different story from each person depending on where you call. It's not their son who's at risk so I guess that's why they don't care. Aetna pharmacy needs a serious overhaul and has hit rock bottom with the customer service they provided me.

The Kelsey clinic is convenient, organized, and excellent at customer service and patient care! In my opinion, they are one of the best operated medical clinics I have ever seen. If they want a little higher reimbursement rate than other places, they deserve it! This is just the beginning of my protest. Please join behind me if this is affecting you and your family. I believe I read that it is affecting 500,000 patients in the Houston area! Start placing pressure on your HR departments to get rid of Aetna!

They also insist that we use Quest Diagnostics in the Dallas area instead of Lab Corp. Quest is a rip off. For a normal physical, I have over $300 in charges from Quest even though they accepted insurance! Lab Corp did send a bill but it was much more reasonable. This is supposed to be preventive care that is supposed to be covered.

I personally think they owe everyone explanations on how they determine what is covered and what is not. Calling in for a refill certainly should not be declined!

Let me make this clear. My doctor says I cannot return to work. Aetna, who has never seen me, states I can. Let me make this even clearer. My injury is to my shoulder, elbow and back. Aetna denied my claim. Then when it was appealed, Aetna is the one who reviews and determines if the appeal should be overturned. How’s that for irony?

Be careful if you are using Aetna Insurance. They will deny your claim for reasons they feel warranted. I am obtaining an attorney to sue Aetna, but why should a customer that paid for years into an insurance program be denied benefits when they are needed.

The State Corporation Commission in Virginia says it holds no responsibility. The commonwealth of Pennsylvania Insurance Bureau offers no advice or response. The Pennsylvania Insurance Board also offers no assistance or answer. The Bureau of Consumer Service, Insurance Department says to contact local officials. The NAIC Corporate office offers absolutely no response. Even a letter to the White House went unanswered.

So Aetna can do whatever they want to people, wherever they want to do it. Collect money for Insurance, knowing they do not have to pay out if needed and are allowed to practice this illegal activity in the general public without consequences of punishment. This is what our government is telling us.

I am not going to stand by and allow a company like Aetna to illegally and fraudulently strip me of what I am owed. I will write, call and do whoever or whatever is necessary until this lying business is punished.

Recap: I asked you to resend the order. You said, “No can do. Procedures, you know." I escalated to second level management. They said, “No can do. Procedures, you know." I escalated to third level management. They said, “No can do. Procedures, you know." I escalated to fourth level management. They said, “No can do. Procedures, you know." I asked if there was any way I could get my needles before I ran out and had to skip my insulin and end up in the hospital emergency room. You said yes. Go to the doctor, get a new prescription and then go to a pharmacy and obtain them. What the heck good is Aetna if you can not fill a simple order? And what the heck are you paying four levels of management for if they can not rectify a customer complaint? I asked to be connected to Aetna customer service. A "Rich" answered and told me I should be ordering the needles via "Sterling" and not Aetna mail order drugs and they would be free. I have been paying $26 for a 90-day supply through Aetna mail order drugs for over a year. So between "Rich" from Aetna and "Sarina" from Sterling I will get my insulin needles free before I run out. No thanks to four useless levels of management in your mail order drug house. Please thank Rich for doing a superb job.

There are no consequences yet but there will be if I do not get an honest answer and a refund for my wasted money for diabetes supplies that Medicare should have been paying for. And don't tell me to fill out a stupid complaint form. I did that before and all I got were excuses. My next stop if I do not get satisfaction will be Medicare and IBM who has asked you to administer this plan. And no, I don't want some slick attorney calling me about this. I want a responsible manager acting responsibly.

By the time Aetna okayed the drug, I was too aggravated and feeling better. I never filled the prescription. Net result is that Aetna delay/deny tactics saved them money at my expense. I was in pain longer than necessary. I may have a higher degree of damage to my esophagus lining and I paid 100% of the cost of the OTC drug. Today, Aetna denied an essential test my doctor ordered. Their denial could result in deadly results to me.

What Aetna is doing is exactly what they spent hundreds of millions of dollars to tell us how the government would ration and deny care when in fact it is Aetna and the health insurance industry who have been carrying out such practices for years. Their only concern is profit, profit, profit and to hell with you or I, or any other insured member.

So far, I have been able to reprocess the first claim successfully, however, I have made 6 phone calls to Aetna to have them reprocess the claims. Now, they are saying that I never called to reprocess the claim and they the will re-submit the claim again and that I will have to wait another month for that to happen. As for my daughter's claims, the first time they processed the claim, they said that I had to pay the deductible, and now that we submitted it for reprocessing they outright rejected it saying that she has been terminated from my plan. They are just giving me the run around. It couldn't be more obvious that they just want us to jump through hoops, so that we either pay or simply give up and stop seeing the doctor. This is getting extremely frustrating.

Aetna has twice referred to the request for the scan as "experimental" to my diagnosis. This leads me to conclude that their priority is not preventative care for my sake but denial solely on the basis of cost which is laughable seeing that chemo and radiation would be 10 times the amount of a PET scan and may never be an option should I be denied this treatment for too long a period. Aetna is the future of medicine in America under Obamacare. Deny, deny and ration (another word for denial).

Then Aetna declined to pay any services with the comment, "Coverage Not in Effect at Time of Service". Why does Aetna accept money from my husband's work, and also from our family (deducted from his check) to pay for coverage, only for them to search for reasons to deny claims? They also denied claims for me a year or two ago stating that I had to prove that I was previously covered before joining their plan. Absurd!

The employer selects the plans for their employees, only to allow the insurance companies to require we (the employee and family) actively prove our coverage upon receiving claims. Aetna will always try to deny claims first, and not because they have a valid reason to do so. It is borderline fraud and 100% greed. Maybe Aetna should stop paying so much money to lobby congress and buy politicians, and instead re-invest their hundreds of millions of dollars into providing service and finding valid ways to lower their operating costs.

My older son is in college and every year Aetna makes us jump through more hoops and fill out more paperwork to prove that he is a full time student while Aetna, through the college, tries to bill us again for more coverage for him. Now they are sending me more paperwork and documentation requests to prove that my dependents are actually my dependents stating that the dependent coverage will be canceled unless they receive all the paperwork and documentation in 3 weeks! I am fed up with Aetna trying to squeeze every buck out of us and take away what we are paying for with the endless forms, paperwork and documentation they require.

I followed this up with two calls and a visit to Syracuse University. Syracuse University health representatives told me that they could not cancel the policy and that it was something that Aetna would have to do. I followed this up with another call, an email, and a letter to Aetna. As of today, 11/4/11, Aetna has charged me $1,138, of which they claim to have refunded me $270 (it is not showing up in my bank account).

In essence, Aetna covered me from 8/1/11 to 9/1/11 (my work insurance covered my medical expenses starting on 9/1/11) and is charging me $1,138 for it. The company is refusing to reimburse me the balance of the dental insurance (I paid in full for a full year) and the September payment of $270 and the October payment of $270 that they have supposedly reimbursed, but as of today, it's not in my bank account. In total, I should be refunded $840 (1 year dental at $328/12 months = $300.67 + $540 medical for September and October). This is one more example of a big corporation ** the consumer.

I have had two separate instances where I have gone to search for a provider and found none of the doctors they list or give by phone accept this insurance. I need to see a psychiatrist for extreme depression and Aetna found one psychiatrist within 30 miles of my area who can only see me in January. Meaning, I must wait two months to receive treatment. The website is misleading and has false advertisements as many doctors do not participate with Aetna. Even the rep I spoke with agreed to that.

I must not continue paying for insurance while I am being delayed treatment for extreme depression, a serious condition that should not be ignored.

Fast forward to present day, I now have daily pain and suffer from limited range of motion with in an hour or two of waking in the morning. The specialist I saw last week ordered two x-rays which were still inconclusive. He then ordered an x-ray on the wrist with no pain for comparison. He was then able to notice some faint abnormalities but not enough to make any diagnosis. So, on 10/14/11, he ordered an MRI. Then, the Aetna ** shenanigans begins.

My initial MRI was scheduled for 10/19/11, but that has been scheduled because I cannot get approval from "Med Solutions" which is the 3rd party organization Aetna uses for MRI approvals. In fact, the initial claim has been denied because, and I quote, "Patient should receive 6 weeks of treatment and if pain is still present, a follow up x-ray should be given. Then if nothing conclusive is found on the x-ray, an MRI can be given." **? Does this make sense to anyone? How can a physician correctly treat an unknown issue?

At any rate, the doctor's office has gone ballistic and has appealed the decision. Now, I am waiting another 48 hours for Med Solutions to get off their proverbial ** and make a decision. If it is denied again, I do not know what course of action I should take or if there is even a course that I can take. Aetna is more than willing to deduct my paycheck bi-weekly for insurance, but then, I am forced to deal with this ** when I need to use what I am paying for. Aetna is a joke.

I tried to schedule a treatment. And guess what? Aetna decided they wanted a new pre-certification. Why? Why do you think? My coverage elapses on October 31st. And they know that if they can demand a bogus new pre-certification, they won't have to pay anything! I paid 800 dollars to stay on the same plan with the same coverage. Now they claim that switching from my group policy to Cobra with the same buy up plan requires pre-certification. My hematologist's assistant said that this is ludicrous and he shouldn't have to resubmit since my pre- certification runs clear through November 2011. My benefits, coverage, and eligibility are all identical, as my coverage is simply continuation. They are merely delaying so they can pocket my 800 dollars and rip me off just a little bit more.

Everything is going up except wages for the low and middle income wage earners. Economy is so bad and yet corporate America thinks that because they are suffering they need to raise their prices on everything. Our wages have not increased for at least the last 3 years. We are barely able to pinch pennies now. How can we stop the gouging?

If an attorney is willing to take this claim pro bono, sign me up!

Claim ID **, with services on May 20, 2011, for charges of $179.44 and Claim ID **, with services on May 20, 2011, for charges of $25.67, was allowed in full. Aetna was to pay the entire amount of $205.11 to my provider and here it is, mid August and that has yet to happen.

I received two late notices from my provider for payments as they have not yet received it from Aetna and I'm expecting a third notice here shortly with the possibility of having my wages garnished.

Each time that I have tried contacting Aetna through their website, I was told via a secure email message numerous times that they would fix the problem and expedite payment. But each time I was told this, payment was never made because they had stopped the original check ** for whatever reason after I had inquired the status of this claim. They have yet to answer my question as to why this check was stopped. Aetna then told me that they would reissue another check, the amount that was indicated in the email response was in fact the wrong amount and this has been going on back and forth with their Internet response team ever since I filed this claim.

A Ms. Donna ** from Aetna finally contacted my provider as I had asked them numerous times, so that they could explain to my provider that it was Aetna's fault and not mine that they have yet to receive their money. Well, Ms. ** gave the wrong amount over the phone, it was $147.68 check number ** issued August 12. Apparently, and as mentioned, this has been going on back and forth for some time now.

I don't know if these people even know what they are doing or I've been placed on their "blacklist" or what not, but as I mentioned earlier, I have problems with Aetna every time I file a claim and I dread or even avoid going to the doctor all together because I know what I'm going to face when I have to file a claim. This has caused me so much stress and mental anguish that I'm seriously considering dropping my insurance plan.

Your cooperation and assistance regarding this matter is highly appreciated. Thank you for your time and understanding regarding this matter.

Michael J. **

I called in early August to find out how much coverage was left on my Dental plan. I have had some dental work done over the last few months (root canal which resulted in an extraction). On top of it all, one of my impacted wisdom teeth started to become infected and painful and I was told that I should have it removed. I called Aetna to see how much was left on my dental coverage. I was told my yearly benefits were already used up, but a wisdom tooth extraction plus general anesthesia was covered by my medical Aetna bc of the sedation. 90% coverage plus 10% out-of-pocket. With this being said, I went ahead and scheduled my oral surgery appointment. Everything revolved around this date-work-etc.

Two days before the surgery, I called Aetna (my gut told me to double-check) and they told me that the person I spoke with gave me wrong information. They said her name was Michelle and she read off the wrong benefits and there's nothing they can do. I still cannot believe or fathom the idea of them providing wrong information. It was unbelievable. So now, the surgery is cancelled as I can't afford to pay out-of-pocket on a whim. I wIll endure more suffering.

I spoke with them at 9:00am today and I was told that a director would call me back by 5pm, and I have yet to be contacted. I wish I was still a member of Empire Blue Cross/Shield.

Now AETNA is requesting a refund of an overpayment of $800.00. We sent them $57.00 and asked them to collect $753 from their insured. This does not meet their demands and now they want their money and the patient is not responding to our certified letter requesting the refund.

I got a confirm fax and called the next day but was told they didn't receive it and to fax again. This happened 5 times until they finally told me that they received it but needed it to come from the doctor but that he could call the medical member’s direct line and expedite it, since I was going on 30 days of having to pay out of my pocket for my medication.

He called the number I was given and he was told he needed to fax the letter directly from him. He did this and when I called the next day, I was told they didn't receive it. I gave it 1 more business day, but had him call the following day to get the fax number again to confirm. He was told then that he did not need to refax, because he could do the certification over the phone. He did this but, just to be careful, re-faxed the letter.

I called that day and spoke to the certification department and was told that not only did they receive it, but within 24-48 hours, it would be cleared up and everything would be covered. This was on 8/10. I gave it until today, 8/15/2011, and was told today that they did not receive the fax or a call. This was after they told me directly on 8/10/2011.

This is absurd and is extortion. I have written to the Florida Commission for Insurance Regulation, the Better Business Bureau and I am looking into a more national level. But for now, I don't know where else to turn to and I'm desperate. I can’t afford my premium and my medication. I would be willing to drop this if they would do what I know they should and can do. Clear my certification, considering how they told me they had it last week and suddenly they no longer have it! Exploitation cannot be accepted, especially in the insurance industry.

If each person filed a complaint, Aetna would then have to deal with it. They would be under more scrutiny for their improper denial of care, which by the way is a major reason the accreditation agency will go after them. Their denials have to be looked at more clearly because they do not list these as denials even though it is considered a denial of care.

When the accreditation agency comes in with a colonoscopy tube to look at Aetna's illegal denials they will be fined and can even lose their accreditation, which in turn would force them out of business because they need to be accredited.

So I am hoping anyone who sees this will google NCQA and file a complaint. Good luck.

According to the federal and state law along with their accrediting agency (NCQA), they are required to send a denial letter to both the patient and physician. Needless to say, I was told that in their "scripting" they do not have any answers other than it is not denied but rejected and they can't do anything. After 5 hours on the phone with multiple people and enumerating on my very dangerous withdrawal symptoms, they issued 14 days of pills. I was told it is now in the system. Unfortunately, the pharmacy is still only getting denials.

We switched to a different Aetna policy because Aetna has also "rejected' all my bills for breast cancer (I guess they think this is something like a face lift that I wanted). So, I am sitting on top of tens of thousands of dollars for that. Of course I won't pay and they will. But it will take attorneys and a lot of aggravation (not good for someone with cancer) and a lot of bills that they ultimately will have to pay for. What is really problematic and so illegal is that Aetna has to provide statistics every month to NCQA, Medicaid and Medicare. They are lying to the federal and state governments on their stats. By refusing to deny (only reject), their statistics look better or even good. This is the only way the federal and state governments can take a look and see if they are properly authorizing care, which of course they are not. They likely have had patients who have died because of these dangerous tactics to save money and it will take a great deal of auditing to find those deaths associated with rejections of care.

The reason it is required to send out a denial letter to both the patient and physician is so that both know and can either order a different medication or explain to an uneducated clerk why this med is needed. It is really simple when a person pulls out a gun and shoots you. You know you have been shot. But when a company like Aetna plays these death games, those stats get hidden somewhere in a rejection.

I have filed an NCQA complaint. I will be filing a Medicaid and Medicare complaint as well. Although these blogs are lovely to vent, someone really has to go into these places and clean them out. They are way more dangerous to patients than anyone can really comprehend. How many people have to die before someone will do something?

First, they didn't tell me before my claim was denied that I gave them the wrong paperwork. Next, I requested the proper forms to be faxed to my doctor's office in order to fix their mistake right away. Of course, they denied the claim for my STD (short term disability). The fax was never received at my doctor's office, so I had to find the right form online and fax it myself to my doctor's office. I have been calling every day to assure everything has been fixed and will stay that way.

Today, 8/2/2011, I called bright and early thinking everything would be approved and taken care of. Well, I only got approved for half of my leave and was told I never requested the 7/4/2011 - 8/11/2011 for STD, so the 15th through the 11th was covered but not for STD; they made it LOA. My boss at Boeing called me and said I'm on grounds for termination as well because of all of these.

Aetna did not notify my Boeing manager via email that I was requesting time off, which is what they are supposed to do. Nonetheless, I was screwed by this company and might lose my job and my apartment. Thanks, Aetna! Thanks a lot!

I was charged the same amount of co-pay ($80) for the previous refill of the same prescription drug for a count of 90 tablets with doctor's instructions to take a whole tablet daily for 90 days.

The Rite Aid pharmacist said that Aetna is billing me the same amount ($80.00) in the most recent refill, because the doctor's instructions to split the tablet caused the prescription to last 90 days.

Is this a fair or even a legal practice? And is Rite Aid have any culpability?

There is a program that he would like go to GHG in Florida, but it is out of network. I have tried to ask Aetna to allow him out of network benefits as a onetime exception; to try to get him clean before he overdoses and dies. He is only 21, and had to drop out of college because of his substance abuse.

I had multiple conversations with Aetna, his case worker Brenda ** and her manager, Wendy. Last week, they told me he had to be evaluated at a hospital before they can make a decision to make the exception. He checked into Florida Hospital on Friday of this week, and completed the evaluation.

When I called them today, Brenda is refusing to escalate. She will not grant out of network benefits for him. The 12 step program does not work for him; he needs to try something different.

I got my copay assistance through Opus and in turn, my copay would only be $5.00. They never sent the information in to Opus and now I owe Aetna Specialty Pharmacy over $1,000.00! They are telling me that I have to pay that first and then I can get reimbursed by Opus. I don't have $1,000.00 and I can't afford to pay up front the $375.00 every month. This was their mistake and now they are trying to say that Opus will not pay them. When I went through Medfusion Pharmacy in Dunbar, WV, they paid them. They are the ones that even got me the copay insurance.

Ryan, the supervisor, told me that they should have never told me that they would bill Aetna. I am at a lost here. If I don't get my medicine, I will become very sick and they will admit me into the hospital. I really need your help.

Upon sending in another 30-day supply claim two months later, Aetna changed the claim amount from $249 to $25. This is fraud, by the way, as the claim amount is for $249. They paid only $6 dollars of the claim. After calling them and writing an appeal, they now say I was overpaid on the first claim and want $134.40 dollars back. What a joke this company is and a rip-off. First they don't pay; then they pay, then they state you were overpaid. Does anyone have control over this company?

I really don't understand because it comes from Umass Boston that knows exactly how important are the primary prevention strategies in order to avoid the development of diseases which has been the topic of many discussions of the health care reform.

I started the application process end of May to get a quote for 8/1/2011. Firstly, the sales agent was of no help. She never picks up her phone and lets it roll to her voicemail. She has an email address but since messages pertain to insurance info, it never can send any emails to one. After the quote was received, Aetna's underwriting dept has their third party called RSA to bug the heck out of applicants to provide additional medical information. I explained to the first person (so-called nurse) at RSA that I was not able to obtain a PCP appointment until 6/21/11 so I would not be able to provide the missing medical info until at least end of June/beginning of July. I thought that would be the end of that. No. Every two days until 6/21/11, RSA kept calling me requesting the missing info. Each time I had to explain I would not be able to provide it until the end of June/beginning of July! I found out their notes expire every two days so they kept bothering me.

Suddenly one day, a RSA nurse told me that my application would expire on 6/22/11 though I was initially notified by them only on 6/7/11 and the notice said I had 30 days to provide the missing medical information. To me, this meant I had until 7/6/11 to provide it and I also confirmed with an Aetna underwriting rep. that I was correct. Well, what happened is that on 6/21/11, I did see my PCP and was able to provide some of the necessary medical information: height, weight, and blood pressure reading they insist must come from a health professional! To my shock, there was an email dated that very same afternoon saying that Aetna already approved my application but the rate was adjusted up! In other words, the quote I received of $485/month became 50% higher at $970/month instead! And I only had two days to decide if I wanted to accept or reject it. If I did fail to reject it by 6/23/11, they would have the right to debit my bank account (because it's mandatory on the application to provide payment details)!

So Aetna not only gave me the runaround and harassed me about needing more health information which obviously was not necessary since their inglorious, inept underwriters had made a decision for some time already but worse, they were hoping I'd accept their extortionate offer! Or perhaps by offering such an extortionate high premium, they were hoping I'd decline so I would not be such a drag on their profit line. Well, tell me how in the world that anyone who is unemployed and has to face paying massive amounts of other expenses can afford to pay Aetna's extortionate premiums as well?! Certainly, I could not and since I surely didn't want to forget and not reject this offer within the two-day period for fear Aetna would be deducting $970 from my bank account, of course, I had to reject their so-called offer!

Bottom line: Aetna is a parasitic health insurance company that is akin to the mafia. Apparently, people who work for them especially their underwriters must have thick skin and thick skulls because if they did not, they'd have compassion for the millions of people whose lives they're playing around with all for the sake of higher profits. Worse is Aetna mirrors the general philosophy of the entire US health insurance field.

Aetna should be ashamed of such a sloppy web design. I truly hope that it is not a deliberate attempt at making it difficult for the members. And I am still unable to determine my copay for a specialist visit.

The problem is they expect me to pay them from when I applied on December 15, 2010 even though I was not approved yet. I called at least 7 different employees in a range of capacity and departments / supervisors, etc. All had the same story that I had to be billed from December 15 unless they were able to change my plan to a far more expensive one.

Whereas I would be covered 100% like promised, my rates would go up and only covered 90% and the other 10% by me. Then I was told 3 different plans I was supposedly on by 3 separate employees. Oddly, each one asked me, "Which plan are you signed up for sir?" I said, "Don't you know, is it not on your computer screen?". Each time I was then placed on hold and then the employee simply got back on and would again say, "You are on such and such a plan if you sign in after January and this other plan if we bill you from December. Which would you like to do?" Are they for real?

I just want the plan I signed up for. One woman kept asking for the exact name of my plan. It is not printed on the member's card yet they claim they know the name themselves and could not understand why I did not. I remember it to be something like the 3500 [some other numbers or letters] plan. Why is this important at this time? I do know the benefits and do have the original application which is all that matters. The reason I tell you all these seemingly erroneous details at this time is because this is their problem solving skills or rather resolution and disputes handling skills. These employees are painfully, obviously under the gun for putting people into the plan that will either force them out of Aetna, if that is the goal or they will have you pay for something of a higher premium than promised.

I truly believe this and know that there are Aetna employees that know this as well. Why does this feel like extortion? Their only feeble excuse is that "if" I had been approved even weeks after I signed up then all claims starting with the beginning of the application would have been paid, hence I was technically covered. But not knowing I had coverage prevented me from seeking any medical care, obviously as I was told I was not covered. Nobody bothered to make this clear nor did it ever get mentioned till now. I don't recall where or if it is in writing anywhere.

So in effect they have stolen just a little over $200 dollars which is not the end of the world, though I hate to support criminals, even the white-collared ones like Aetna. I thought Aetna was reputable and was a good insurance company but after talking from one rep to another, it became increasingly clear that this company is based on deceptive practices and the employees are all just following orders to support it. This is an indisputable irrefutable fact and someone needs to step up now to the plate and file a lawsuit and let a judge decide what is considered fair and what is considered extortion based business. Why is it that if injured, I have the sinking feeling Aetna is the one insurance company that you would rather sue at court than paying them up. Their bean-counter knows that the majority of people simply will eventually "go away! " This is Aetna, for all those involved and for anyone contemplating using their service.

I am requesting any and all legal advice, as well as filing a public lawsuit or class-action. I am also requesting all employees of Aetna to discreetly call me or write should you have even the slightest information that Aetna is not on the up and/or has done business in an unscrupulous manner. Even if unsure if it is illegal, all information will be used to stop this company before any more good people get hurt. We are dealing with people's lives. This is important - your name will always be kept confidential unless you yourself decided to let it become public. This you have a written commitment on, right here. Thanks in advance for all those that can help out.

On a class-action scale I am quite sure Aetna makes untold millions of dollars on deceptive practices. For myself, I have lost one month premium and possibly not have a good coverge if you don't pay up the money they want. They have already billed it so I put out the money unless they credit me for one month. Even two weeks is acceptable, "provided" they will not switch my plans. I want to be on the 2010 plan I requested that I was approved for on December 29, 2010. I should therefore not have to pay for December 15th till January 11th, when I actually was notified in writing. Other loss is I could not seek any medical attention as I had not been officially approved. These smaller consequences is herein the problem. They know no one will sue them and they make money out of it. I would sincerely like to change that.

I have a law background and as a trial preperation expert have never lost a case for a client. I can back this up with references to the appropriate party. If a lawyer takes the case I will put it together but need someone with the license. I am only a legal researcher/paralegal. I will prevail only because I know I am in the right.

The ERCP was not successful in stopping the pains along with the vomiting. About a week after the ERCP was performed, I received a letter from Aetna stating that their record showed I am not disabled and should return back to work, which to me was funny due to the fact that my doctor wouldn't release me back to work. So again I am disputing a claim with Aetna so that I can be paid short-term disability. Meanwhile, I am still sick, undergoing tests every week to check my blood, and MRIs. I am still doing my part as the patient and faxing every piece of my medical chart to Aetna just to find out they didn't receive half of the information I sent to them. I have every receipt from every fax I have sent. I would call their company about 3 times a week and they would refuse to give me what exactly they needed to support my claim. I received a letter in August stating that my claim could take up to 45 days to be decisioned . In August, my doctor finally agreed to laparoscopic surgery to remove the gallbladder. The soonest I was able to have the surgery was in Sept. My doctor gave me two weeks for recovery and I promptly returned back to work on October 17th. I then submitted all my medical info stating that I was able to return back to work and gave the doctor's release more than 45 days past the date of the original letter I got, saying it would only take 45 days. Again Aetna failed to receive the information I had faxed. But this time I faxed the information to two different numbers.

I continued to call Aetna and they stated that they have still not assigned me to a case manager. I then called and left voicemail after voicemail to managers in the Aetna office but I never got a call back. So I continued to leave voicemails for managers. Finally a manager called me back, left a message on my voicemail stating that my case was still under review. I then received a letter in the mail stating that Aetna would have a decision made on my claim by Nov 7, 2010. That date came and went. I'm still calling trying to get info about the money I am owed. Then made a complaint to my direct manager at work about the company we choose for our associates. I then received an email from Ann **, stating that the decision will be made by Dec 28, 2010. She stated that she had attempted to contact my medical provider and they were not responding to the messages she had left. She said she had to have one of their physicians contact my doctor. So I called my doctor and he completed a peer to peer with Aetna's physicians. I called a week after to see the status of the claim but Anne had no info to update me with.

When expressing my feelings about the way I was treated. Anne could only repeat herself like a robot saying she is trying to get me a fair claim and that if she had to make a decision today, she would deny the claim based on the info she has received. This completely infuriated me due to the fact that they didn't receive all the paperwork I faxed over to them on my own time. And when I finally found out that they didn't have all the information I faxed, I explained to Ann that I would be more than happy to fax it again. She advised me not to fax any further info because it would delay my claim longer. She stated all she needed was to talk to my doctor. Today is Jan 4, 2011 and I just got off the phone with Aetna requesting to speak to my case manager and she conveniently was not available. Aetna has ruined my life.

I called again on 10/19 and spoke with Natalie. She last said it was returned to provider, then said it had all the correct codes and should be processed. She said she would mark it “urgent” under ICD9 code and it would be processed within 3 to 5 days. It is now November 23 and I have heard nothing. I have emailed them again. Most people would just give up. Apparently forms are not being processed. I pay $600 a month for insurance and this is what I get. Nothing! I have a health care account with IBM and I do not have a choice on my provider to use these funds. Otherwise, I would be changing my insurance company.

The consequence is that I have missed my last two follow-up appointments. I’m waiting for payment on this charge. I would appreciate an opportunity to pursue this as this is why our health care insurance is so high and I have no choice. I just wanted to be a better Aetna customer and they won't even communicate what the problem is. I have to continually call them. I think it is a scam, for most elder adults would just give up. I will pursue this until I get some type of response that is correct. Thus far nothing they have told me has been correct.

Christine informed me that it would be $40.00 and a new prescription for 1 month would be required. This was also verified by Sara in member services. Moreover, I could order 2 months for $80.00.Then began my struggle with my doctor's office to fax a new prescription exactly as they wanted. This took many days and many phone calls to the pharmacy (to see if they received fax and would be processing medicines) and to the doctor's office. During this time, I spoke to Nicole and Doris **.

Finally, I was informed by an automated phone call that cost of prescription was $600.00. This was verified by Kenyatta. I asked to speak to a supervisor and they put me through to Vicky, who stated that prices can change from day-to-day. She double checked the price and the co-pay for 30 pills would be $241.00 (since I had $172.40 in account before donut hole, I calculated that $241.00 plus $172.40 + $413.41 total for 30 pills). Why am I angry at Aetna? Because they do not train their employees properly. I was batted back and forth with misinformation from the pharmacy to member services. Moreover, something stinks badly when you go over how they decide to price pills when a person gets in the donut hole. Subsequently, I called a Canadian pharmacy that informed me that for 84 pills (generic), the cost was $274.00, and for 28 pills (brand) $165.00. Quite a difference from the price charged by Aetna RX.

I had 60 days from receipt of this unexpected letter to request a 2nd level of appeal. I sent a certified request for this on 9/28/10, after researching the application of varying co-pays and drafting a response. I received a letter on 10/21/10 informing me that my request was "Too Late to Appeal". Interestingly, once again, this letter was dated 10/6/10, some 15 days before I actually received it and 12 days before the postmark on the envelope. I have written another letter to Aetna pointing out that they seem to delay mailing important time-sensitive letters to customers, hence cheating them out of the Aetna-stipulated timeframe for responding.

I reiterated that the initial letter was received by me on 8/25, could have arrived no earlier than 8/16 when I went away, and that, based on those dates, my request for the 2nd level of appeal was well within the timeframe they state of 60 days from my receipt of their "adverse benefit decision". The CSRs at Aetna don't appear to actually read the contents of correspondence, as this was noted in my 9/28 letter as well, so I don't expect a favorable response with regard to considering my 2nd appeal request. Moreover, even if they do agree to consider it, it would be a complete surprise if they did not uphold assessing a specialist co-pay for visits to a family practice Physician's Assistant.

It's a small amount of money, but a big point as it is one more way for the insurance company to increase profitability by paying less for the less costly service of a lesser qualified provider while reaping additional benefit by charging the insured more by considering a PA to be a specialist because it is not an MD or OD working in the limited fields of family medicine, general practice or pediatrics. It's galling.

Over the years, it worsened (2009). With Aetna insurance, I had another MRI showing more damage to my back. So a month later, I start Spinal Rehab. I have had 3 facet injection procedures with no relief from the pain in my lumbar region. Still in Spinal Rehab (now at 1 year) and Aetna is paying for this, I have had my 3rd MRI showing even more damage to my back (5 annular tears in 5 discs, 6 bulging discs, osteoarthritis, stenosis in L2,3,4,5 and S1,etc..etc..) and I was referred to a neurosurgeon and had a consult for surgery (L-Fusion, etc) and was pre-authorized.

Surgery and Pre-Op was scheduled. The night before, my doctor's office called me at home stating Aetna sent them a letter denying payment for services for surgery. Mind you, I have been on medical leave awaiting this for two months, the company I work for that supplies this insurance does not have light duty jobs, you must be able to lift 50 lbs. continuously or you don't work there.

Aetna claims its reason for denial is in their guidelines, my back problems "show no instability". Seven years of severe back pain and living on pain killers in hopes of a less painful future taken away by guidelines and someone's opinion? Where does this leave me now with my employer? I am appealing it now, any suggestions?

Surgery and Pre-Op was scheduled, the night before my doctors office called me at home stating Aetna sent them a letter denying payment for services for surgery. Mind you, I have been on medical leave awaiting this for two months, the company I work for that supplies this insurance does not have light duty jobs, you must be able to lift 50lbs. continuously or you don’t work there. Aetna claims its reason for denial is in their guidelines, my back problems "show no instability" 7 years of sever back pain and living on pain killers in hopes of a less painful future taken away by guidelines and someone’s opinion? Where does this leave me now with my employer? I am appealing it now, any suggestions?

In fact, after getting off the phone with a representative, they still have not approved the extension, and my case worker 'does not return messages after noon until the next business day.' This means I will hear nothing from Aetna until Monday, the 27th, at the earliest, and if approved will get a check the following Monday. How long does it take to read through doctor's notes and say, "Yes, this is the same condition and her doctor has ordered an extension on her leave?" How long am I expected to go without necessary medications while Aetna shuffles paperwork and orders more doctor's visits (which I have to pay a co-pay on that I don't have, because I haven't received a check from Atetna)? In my experience, this has been the worst company I've ever dealt with as to getting claims paid. No one should have to suffer through the uncertainty and financial hardship I have had to put up with while waiting on an insurance company to approve an already existing claim.

I live in constant pain and have limited mobility and usage of my hands. I filed an appeal with Aetna and have yet to hear from Aetna in regards to my situation. I was told that they were to have a decision by September 2nd. I called to check on the status and I am told it is still under review. I am a single mother with a small child. How am I supposed to survive? I have no income. My employer has not supported me. I keep getting blown off by Aetna. I have an attorney hired for the short term and nothing has taken place. What do I do?

This is getting out of control. Please help us rein in these price gouging insurance companies. My wife and I have to buy our own health insurance and with this increase we will be paying over $15,800 a year to pay our premiums. We now pay more for our health insurance than we pay for our house mortgage. Could you investigate these exorbitant price increases?

The doctor’s office has been wonderful to work with and I would recommend them to anyone. The problem is with Aetna and the verification of coverage. I also called and verified that this would only be a $20.00 copay before proceeding with the scheduling process. It amazes me that the insurance companies can get away with this treatment of people who pay the premiums. I have called the Aetna service center and had a representative hang up on me. I do not know how I am going to pay this bill. This will cause a financial hardship on our family. I am hoping that the doctor’s office will allow me to make payments. I do not know how I am going to pay this bill.

Thinking about selling our house as we are both sick over this. Just want to leave this all behind and live somewhere else. It's a choice we are considering. You would think that this should be an easy resolve ... not a chance. Aetna refuses to talk to my attorney so off to court we go! Just want to get the word out. It could happen to anyone and probably will. Make sure you have the resources to pay an attorney.

Aetna had denied to pay for the last nine sessions of therapy despite numerous appeals by the therapy office and different paper work submissions. I even have a medical advocate from my husband company working on this but they don't seem to be making progress. Aetna just seems to be coming up with reasons not to want to pay for these services. As of today, I cannot go to therapy due to an outstanding balance since I cannot afford to incur any further expense that I may have to pay. I cannot understand how Aetna can say this is not medically necessary after surgery. Without therapy, I will not heal properly and may have further injury occur. Please bear in mind as of today, I am still walking with the aide of crutches. Thank you.

I have received multiple documents stating they would pay the bills. Today, August 9, I received a letter stating my claim is now under investigation and I might be responsible for $75,000 in medical bills.

Over the last two years, every one of my lab visits has been mis-processed. Every time, they try to blame my doctor's office. I decided to do some research, and my doctor's billing, and insurance clerk showed me the computer program that generates the claim submissions. They were all identical, except for the dates of service, and for the exact tests they were doing, for those lab visits. The clerk also showed me the claim submissions for all my visit appointments, which were clearly marked as such.

When I brought this up to Aetna, they actually could not argue with me any more because I was right. They had to go back and reprocess all the claims, and pay their fair share without charging me the co-pay. Recently, I suffered a muscle tear in my shoulder, and was prescribed some physical therapy. I called Aetna to see if a co-pay was needed for the therapy sessions, as opposed to the doctor visits. They said yes, a co-pay was required. I complied, and presented the therapist's office with co-pays for two doctor visits, and five therapy sessions.

Now, here, the doctor's office made an error, and charged me another co-pay because the did not post one right. When I was able to prove my payments the next day, I was scheduled for a refund of the one co-pay. In the meantime, Aetna mis-processed three of the five therapy sessions, stating that no co-pay was due. The doctor's office dutifully refunded these three co-pays as well as the one in question. I cannot cash that check until I know it is right. I called Aetna to get an explanation. It has now been two months and they still have no clue. I called them again today, only to find out that the first agent did not even re-submit the claims at all.

I just want the truth. If the co-pays are due, then they are due, and all I want back is the one in error. If they are not due, then I want all five of them back, plus the one I was overcharged. The doctor's office is as frustrated with Aetna as I am. Neither of us can move forward until they get their act together.

Lastly, I know that the agents have lied to me. With all the problems I have with these people, I started getting smarter. I ask for supervisors, and get the standard "No Supervisor Available" line a lot. One agent told me that they don't have supervisors. I regularly am told that the supervisor will call me back in 24 to 48 hours. Rarely do I ever get a call back. The one thing that really irked me though, is when I insisted on speaking to a supervisor, I was transferred to someone who gave me the same non-responsive comments. But, I got her name. Two days later I called back, and guess who I got on the phone? None other than the "supervisor" for the previous call! I reported the two of them to someone, whom I am hoping was a real supervisor.

For the cases I am reporting here, my damages are minimal. They amount to $150 of co-pays that I may or may not be due. I also have the $30 I know I am owed, but the Doctor can't release until this mess gets cleared up. For both my doctors and myself, the way we are treated by Aetna agents, is horrible. We are not treated as valued customers, service providers, or anything. We are simply interruptions in the agents' day.

They can spend millions of dollars on sending out unwanted advertising, yet they refuse to send a customer a simple eMail notification that a referral is about to expire. Yet, they are the ones requiring the referrals, and they are the ones putting the expiration dates on them without letting us know when they are!

This wastes time, energy, and money, not to mention the sheer frustration of working with people who do not care about health. All they really care about is their bottom dollar!

Doesn't this violate the mental health parity law? Client has to pay out of their own pocket for all mental health services but company will not acknowledge that there is no coverage.

This is not the first time we have had to literally argue with Aetna to get a prescription. Also my husband was taking testosterone shots every ten days. He is going through Andropause. It similar to menopause for a woman. His testosterone levels were down below 200 and they are supposed to be 800. All of a sudden, Aetna denied his prescription. He called and they told him that they would no longer cover it. We were told that we had to pay out of our pocket. He asked them if they denied women estrogen if they were going through menopause. He was told no. We had moved and my husband had to find another doctor to see if he could try and get a prescription for something else. His doctor has given him a testosterone gel and he is going to get his first prescription. We will see what happens.

Two weeks prior to me having a procedure on m 6/7 cervical which was a revision of a pre-existing condition, and which had been approved, yet someone just decided to forget about the fact that I was waiting to be admitted to pre-operation almost five hours while some fat cat medical advisor forgot to send the authorization to the hospital. I pay a lot of money through my company and subsidized also by there contributions in maintaining my insurance.

Furthermore, I do not appreciate calling member, services and talking to someone in the Philippines half way around the world knowing that they have all this pertinent information on me. I think your company sucks! When it comes to the privacy and consideration of the money, you collect for you lousy service

At the Emergency Room, the Doctor told me I was suffering from a bad case of Strep Throat. He finished treating me and I went back home. I had missed two days of work due to my throat infection. A few months later, I get a bill from the hospital saying that I owed them $715 dollars. I felt there had to be a mistake, so I called and found out that Aetna had declined to pay the claim for service rendered. I spoke to two different employees in the financial department of the hospital and both of them said that Aetna was the worst at paying claims. They said Aetna is the only company that requests every single piece of paperwork relating to your claim and they scrutinize it in an attempt to not pay.

He told me that my claim was denied because I went to the Emergency Room for a non emergency situation. I was told that my only course of action was to file an appeal in writing. I wrote a very detailed letter as part of the appeal process and submitted it to Aetna. After a few weeks I received a letter from Aetna that once again they chose to decline my claim. The letter stated that an "Average lay person" would not have felt my health/safety was in jeopardy and would not have deemed this an emergency.

The funny part about their reasoning is, it is incorrect. I have spoken to several "Lay people" such as co-workers and people have come in contact with and everyone has said they would have gone to the Emergency Room. This is the reason I felt my situation was an emergency. When I was 16 years old, I had an infection in my throat known as Epiglottis. I had the same type symptoms, including the lump in my throat, as I did in August 2009. My parents took me to the ER and within a few minutes, I passed out due to lack of oxygen. I was rushed into the operating room and en emergency tracheotomy was performed.

My parents were told by the doctor that if I would have been a few minutes later getting to the hospital, I would have died. I spent 2 weeks in the hospital with a tube in my throat so I could breathe. I now have a nice scar on my neck as a reminder of my ordeal. How am I to know what they are going to consider an emergency prior to going to the emergency room? If I knew what was wrong, I might as well have prescribed my own medicine too. I equate my situation to someone that is having chest pains, shortness of breath and other symptoms. He goes to the hospital thinking he may die from having a heart attack, but is told at the hospital that it was just gas. So I guess in this case Aetna would not pay because it was a non-emergency.

The bottom line is, I work very hard for a living and have earned a good job that has health coverage. I am not one that misuses the heath care system or takes advantage of anyone. I just feel that I should not have to be scared or hesitate to go get medical attention because of fear that I won't be covered. Based on my situation and reading other comments, I feel that Aetna has their profit margin as their number one priority and not its members. I plan to appeal this with the State of California HMO appeals process. If that does not work, I will contact the California Insurance Commissioner. I will also contact and make complaints to anyone and everyone that will listen.

Since we have found their Appeals Department to be unresponsive, we went straight to our Washington State Insurance Commissioner. Aetna not only ignored our main complaint, but included documentation from one of my appeals-completely unrelated, a different case number, a different procedure, and a different person! Included in their response was office coding that read like pure gibberish, a string of alpha-numeric data that is meaningless to the customer.

To understand their processing method, we have tried for months to get a copy of our policy. We have been refused a copy of our policy despite repeated attempts. Aetna lied to the insurance commissioner and said all we had to do was to request a copy and it would be mailed to us. Every attempt to secure a copy of our policy has been ignored, disregarded, or met with silence. They outright denied our direct request, saying the request had to be made from our insurance broker or employer. These entities were also denied repeatedly. Unfortunately, our state insurance commissioner must not have had time for his staff to read Aetna's response to our complaint.

Even a cursory glance would have shown this response to be completely unsatisfactory. Yes, the response arrived within the mandatory time limit, but the response was worth about as much as a child’s crayon drawing. Our many appeals to Aetna have been painstakingly detailed, well written, and thoughtfully structured to advance our argument. A great deal of time has been spent on these appeals. Long story short, it is heartbreaking to not only see our hard work ignored, but also to see our life savings disappear from paying off these racketeers.

If anyone reading this shares my anger and frustration, please remember that this mess called Aetna is not the fault of the lackeys talking to you from the Philippines or one of the other off-shore call centers. It is the fault of the well-insulated subhuman sociopaths who direct this travesty impersonating an insurance company. The time and emotional energy expended on the appeals process has driven me to exhaustion at times. I feel as if I am funding a gang of crooks as I see my savings dwindle.

I was advised that I had 10 calender days to get the paper work to them for a reconsideration (something else Agostine failed to tell me). I was told that claim was denied on April 19, the same day I spoke to Agostine. So I called the doctor's office and advised his assistance that paper work will have to be sent back over to them, except this time explain in plain English what is preventing me from sitting all day. I also advised that she needs to include a rage of motion. She stated she would. I waited and called Aetna on April 30th in the morning and was told nothing was ever sent in to them. So I called back to my doctor's office and spoke with his assistant again. She told me that the day we talked on the 19th that she did fax over more documents and also called Agostine and left a message for her to call him back, but she never did get a call back. She faxed the documents back over again on the 30th, I waited until the afternoon and yet again I called Aetna. To my surprise this time they received the paper work. I asked to speak with my case worker, but could not. The rep called her on the other line and per the rep she was going to go back over the paperwork and it would take a few days and she would reconsider.

I called back on May 4 and was advised by a rep that no updates have been made and that they would put in a request for Agostine to call me back. I asked the rep at that time if she had put notes in regarding Agostine calling back the doctor's office. Nothing, they said once it's been closed then they don't reach out to the doctor's office. I asked her why they don't return calls, she could not answer that. Anyway today I got a call back from Agostine. She explained the nurses are still reviewing this and she will call me once a decision is made. So tell me why are nurses reviewing the information when a doctor advised how long I need to be off? I thought doctors know what's best, not nurses. So at this time the waiting game continues and I have to worry about having an income until my back heals.

1) the premium was higher than mentioned, and

2) they listed ear infections (sic)--I had one during the previous month--and sore throat as pre-existing conditions.

I phoned Aetna's customer service on 4/27 and said I did not want their plan. The person said I needed to write to them and to get the broker to call them. I left a message to Andrew and said the same thing, telling him to get in touch with Aetna. On April 28, I checked my bank account online, only to discover that $361 was deducted by Aetna on 4/27 (in addition to $340.65 by Midwest, my present insurer, on 4/20). I filed a complaint with the BBB; however, I feel that we have here fraud in disclosure, fraudulent and unauthorized debit, "forced selling" on an amount that I did not accept, deceptive practices, plus now, extortion.

The non-anticipated debit of $361 put me under financial stress after payment of residual taxes for 2009 and estimated tax for 2010, during a slow business month. And they now want to keep that amount for anywhere from 7 to 10 business days, obliging me to transfer money to cover my end-of-month bills! This is the message I received from Aetna to that effect on April 28 in the afternoon:

"...We received and forwarded your request to cancel your individual coverage to our billing and enrollment department for processing. Unfortunately, the initial payment in the amount of $361.00 was deducted from your checking account on 04/27/2010. Please allow 7-10 business days for your account to be canceled and to receive your refund. The refund will be issued directly back to your checking account."

I was released from the hospital on the 3rd day, still in pain, still unable to walk properly, sit or lay comfortably. Aetna now denied the short term disability because they said the paperwork did not support my claim for not being able to work. When I spoke with them on the phone, I asked, “Do I have to be dead in order to qualify?” The lady said a nurse had looked at the papers and said I was okay to go back to work. A nurse, who looked at a paper, never saw me, never examined me but looked at a paper!

What makes her more qualified than a doctor? Now I have to file an appeal. I wish I could sue them, but I don't have the money for it. Aetna is the worst when it comes to short-term disability. Due to them declining my short-term disability, I will be behind on bills again. My husband can't work because he's a quadriplegic and they say America is the land of the dreams. Right now it looks more like land of my nightmares. I will have to go back to work even though the physical therapist might have to send me to a specialist because therapy is not working, and it's actually making it worse.

My second complaint is regarding the copay amounts for the therapy sessions that we did have. Aetna has retroactively changed the amounts of the copays, and credits have been issued to me; however, the amounts are not consistent and Aetna now is refusing to give me a detailing of what the copays were or show me where in my policy it states what the copays are. They are now saying that they made a "mistake" in covering the therapy in the first place, so they are not giving me the information or further credits to make the copays consistent. A complete detailing of all the problems I have had with Aetna can be found on my blog.

I have spent hundreds of hours trying to rectify the problems I have had resulting in many hours of lost work. The financial impact is in the thousands. I kept my daughter in therapy and did not pursue alternate insurance based on the information that Aetna employees gave me stating in no uncertain terms that my policy covered more therapy, so I continued her in therapy thinking that it would be covered and then was not covered. In addition, I believe I am owed credits for the copays that I did pay but Aetna is refusing to give me the details on what I should have paid.

Then, I requested an appeal, which was immediately denied. After getting more info from my doctor, they said I had the wrong disease and I had to try another prescription first. But after the appeal came back, they said they wouldn't have considered it anyways because I didn't have the disease they said I would need. They refused to tell this to me or my doctor until after the last appeal had been mailed to me. I had to pay $218.40 two times for my patches the next month because I cannot wear clothes without my patches because of my skin sensitivity. I am on food stamps and did not have the money to buy my patches but I had to because I couldn't wear clothes or leave my house with acceptable clothes and I told Aetna that and they didn't care.

Then, about two weeks ago, I went to drop my prescriptions off and was told there was a block on my prescription card because they said I had another BCBS insurance plan and that medicare coordination of benefits told them that. I called coordination of benefits and they said that no, BCBS was deleted from their system when it expired a month ago. They stated that Aetna have not updated the info and they were making a complaint for me. I tried to get my prescription filled Friday and they had to write a ticket and didn't call me until Monday to say it had been a mistake. I waited three days without medication and had withdrawal effects.

I called Medicare and they allowed me to switch prescription d plans starting on May 1st. So yesterday, I went to get my prescriptions filled. I find out on another Friday that they put the same block on my prescription plan, stating that I still have BCBS, which is false, so they never took the block off after approving my meds two weeks ago. So, now again on a Friday, I have to wait three more days to get my medicines for a problem that is an inappropriate block that shouldn't be there. On top of that, the operators were extremely rude. One operator, Dino, started laughing at me when I started crying because of having to go through this again. He started arguing with me, yelled at me and told me he wouldn't transfer me to a manager after I asked 10 times. I called back and asked to speak to the highest manager, who still couldn't fix the problem, or see that they have already verified that I don't have BCBS insurance anymore.

I have just heard that CMS is upset with Aetna based on problems like these. I have made two complaints now and luckily my new insurance starts May 1st, however, I have to wait until then. Also, my new insurance, Community CCRX, will approve the lidodoerm patches wihtout pre-authorization or step therapy. I have to wait three more days without my meds and Dino, the operator alluded to the fact that I am having these problems because I have decided to leave Aetna and they are "punishing" me. I cannot believe they would treat me like this after clearing the block and fixing the problem, just a week ago. This insurance will lose its contract from Medicare, from what an operator there told me, and it's well deserved. Do not choose any Aetna plans for medicare part d or insurance. They will deny, deny, deny and make you jump through hoops.

I have had to pay out of pocket $218.40 two times for my lidocaine patches that they decided not to cover, plus I had to stay in my house one week because I couldn't handle the feeling of clothes on certain areas of my body because of my disease. I am on food stamps and I was foreclosed on because of this purchase and now I have had to move into an apartment. The physical damage was from feeling the pain on my sensitive areas without the numbing patches.

I called the following week and discovered that: (1) my prescriptions were on hold, but got no reason for that and also that they had eleven prescriptions for me. I said that there should only be seven and explained that an additional four had been faxed, because Aetna said they only had three the previous week. This person assured me that if duplicates had been received, they would automatically be kicked out of the system. I then insisted they read me the list of prescriptions. They read the list and sure enough -- there were four duplicates. My prescriptions were still on hold and I did not know the reason.

I called several times and got no help. I finally tried the doctor's line and this person kindly told me that all my prescriptions were on hold, because they did not have a list of all the medications I had taken before I took Nefazadone. So I called Aetna again and they verified this, however, they had never told me this before. Please note that I have been taking Nefazadone since 1997 and none of the insurance companies or Plan D's had ever required me to provide this info. In addition, prior to signing up with Aetna, I called Aetna, told them which plan I was planning to use and asked whether Nefazadone was covered. They assured me that it was. However, after waiting to get my prescriptions, I discovered that I was required to have my doctor send a list. He did that and then ended up having to resend the same info over the weekend from his home.

In the meantime, my prescription for Asmanex Twisthaler was getting very low, and Aetna told me that it would be a minimum of two to four weeks before I got any of my prescriptions. So, after much hassle and worry, I was able to buy a one month supply from a local pharmacy. Please note that I asked if Aetna would please send me all my prescriptions except the Nefazadone. That person refused in a rather nasty manner. In fact, nearly everyone I spoke to at Aetna was extremely unhelpful, unprofessional and even threatening, saying that if I sent only one prescription at a time (to make sure it got filled and the whole order did not get put on hold), Aetna would discontinue my insurance. My doctors and I were not happy and I was quite worried about ever getting my prescriptions.

Finally, my prescriptions arrived. They were sent 2nd day air at my insistence because I was about to run out of several other prescriptions. This included three Asmanex Twisthalers, which turned out to be filled incorrectly. I got 3 boxes of 60 metered doses. I should have gotten 3 boxes of 120 metered doses. I did not know that until much later. A day or two after, I received my full prescription order, I got a letter from Aetna saying they would not refill my Asmanex Inhaler until March. Since this was one of the duplicates and it had been removed along with the other three duplicates. I assumed this letter was yet another Aetna mistake, since so many had already been made. They said something about calling them and I did not do that, because I had spent hours and hours on the phone with Aetna and had been treated horribly. I assumed there was no way they would send me a second set of Asmanex, since they had to know it was a duplicate.

Surprise! Aetna sent me two more Asmanexes earlier in late March. I called to complain and was told to call customer service. Well, they wrote down all I said, but said they do not take complaints, and I had to write to this address. (Oh, Aetna, you are so clever, you know that a lot of folks won't take the time to do that, so you make more money this way.) I have been in and out of town and so it has taken me a while to write this letter, however, here it is.

3) These two twisthalers are USELESS. They expire on July 11. They cost me $102 and I did not order them.

Also, given all the problems you have caused, you did not call me to see if you should send this order. Surely, you could have checked your notes and discovered that you had gotten a duplicate and had to remove it and that you sent my first order and then wrote me a day later and said you could not fill the new order, which was in fact a duplicate.

The person with whom I spoke about this problem was the first nice person I talked with at Aetna. First he told me that the order should have been split and I should have gotten everything sent except the Nefazadone. No one ever offered to do that. He was astonished that other Aetna staff people lied repeatedly to. Second, he said that the first Asmanex was filled wrong. And then he said he hoped I could get a refund on the two inhalers that were sent and which I will not be able to use.

Aetna, you have caused me a lot of trouble, cost me money, lied to me, and treated me horribly. I have had three previous Part D's and I have never had any problems with any of them at any time or any of my previous insurance companies since I have been taking Nefazadone. This is a formal complaint and I am asking that you send me a prepaid post office form that I can use to return the Asmanex that I did not order and also a check for $102 to reimburse me for the prescriptions that you sent and that I did not order and that I can not use. I have been charged $102 for a prescription that I did not order and which will expire before I will need it. In addition, my doctor is not sure I will need to continue taking this prescription, tests are in process.

For three years or more, I have had aides at least three days per week, increasing to five days weekly after a bad fall in the shower. The aides bathe and dress me, help me stretch and exercise and tend to my skin care. The nurses have overseen my overall care and health, changed my super ** catheter and provide much-needed expertise and advice to keep me as healthy and strong as possible. Removing and/or reducing these services makes no sense in view of my age (72) and the constant progression of my illness.

We have been getting a constant runaround from Aetna. We were first told to file an appeal, which was then thrown out because Aetna claimed there had been "no denial" for us to appeal. What about denial of services? Next we were told that my doctor needed to call Aetna and request the services that had already been authorized, and that I had already been receiving before Aetna took them away. (This after numerous futile phone calls and an appeal which was thrown out! ) Now, my doctor, too, is getting the Aetna runaround. His office has been trying for the last five days and cannot get through to make the necessary request for services! Meanwhile, my care has been compromised since the reduction in home care took place four weeks ago!

My care has been compromised in that I cannot shower, dress myself or take care of ADLs without assistance and have been relying on the kindness of neighbors in my adult community to help my wife assist me as best they can.

I never received a policy manual from Aetna. I fought with them for a long time. Feb 2010, I received a copy of my policy manual, not the original. I began going to my family chiropractor. He was able to help me in ways, I never thought possible. I am able to function somewhat like a normal person. Now, I was told by my dentist and my doctors that treated me, while I had cancer, that my teeth were rotting out due to all the chemo and radiation that I have been through. Aetna will not pay for dental implants because they say they are cosmetic. I have letters of recommendation that state, in order for me to eat properly, I would need dental implants. I have been fighting with Aetna for a long time. They still refuse to cover my implants. I would not recommend them to anyone.

They are trying to get a free month's premium out of us for nothing! I'm not about to roll over and take this, yet fighting them is an insanely time consuming process. No one we can get on the phone can answer a question, and we've been waiting for a call back from a "supervisor" for the past two weeks (with repeated calls from us to them in the meantime). This is only the last and most blatant piece of extremely incompetent or purposefully fraudulent activity we have been exposed to through Aetna; she is leaving Cobra early just to get away from them. Bring on the single payer system - it can't be any worse than this! We have lost the premium amount (close to $200) and the medical coverage for the month of 3/10 (amounting to about the same).

As a result, Aetna specialty pharmacy withheld the Remicade for 10 weeks, I missed two infusions and had a complete relapse. In addition, they are back charging me for previous infusions because they state, they did not bill correctly. Consequently, I now have a debt collection company trying to collect thousands of dollars. I changed doctors and my total out of pocket was $40. In the meanwhile, I had a total relapse. Pain and suffering from psoriatic arthritis that was cin complete remission. I gained twenty five pounds and suffered for months.

Later, I received a bill for $200.00 from the NBMC and another bill for $50.00 from the Hospital Lab. Aetna didn't pay it because it was a preventative appointment. They said, they only cover it if I was sick or if the doctor found cancer in my pap! Then I needed glasses company, I checked to see if Aetna would cover my Eye Doctor appointment, again, they said yes and I'd have to pay a $40 co-pay. I got a bill today for $130.00 Aetna will not pay it because the doctor isn't in Aetna's Network!

I have paid Aetna $223.36 from my paycheck over the past 3 months! And they won't pay a penny on anything, I make an appointment for. I am cancelling my insurance and I'm sure they will not do this but requesting everything that they have taken out of my checks to be refunded back to me for lies and deception and disloyalty to me as a customer. Aetna [is bad]! Do not become a customer to them! In fact don't get insurance at all it's all a rip off! Well, I'm stressed out just when my credit is starting to get better. I now have more debt building up and my credit will never get better cause I can't pay these bills on time!

I just received a notice from Aetna that the visit was billed as an office visit for $104 and a physical for $274! Well, last time I checked, doctors weren't making house calls, so I do not understand why I would be billed separately for an office visit when I had to visit the office to have a physical. This is ridiculous, and just one more reason that people that have insurance can not afford to go to the doctor. I am furious to say the least. I am now facing yet another $104 bill for something that should be paid by my insurance. I am seriously considering totally cancelling my health insurance. It is not worth the money I pay!

I said, "This is wrong; give me your supervisor." Of course, I was told she was not available, and was reassured if I left a voice mail, she would contact me that evening if not the next day. Of course the call never came. On 02/05/10, I called twice to speak with Ms **, and you guessed it, she was in a meeting. I then asked for her supervisor. I was told she does not have one. Of course she does. Now seeing that I am on a leave of absence for work related stress, this adds to it. They think we will give up. I will not. My lawyer is fully aware and will back me on this. I have earned my aol. To be denied is wrong. It's not my fault paper work did not get there. I did keep Aetna aware of all my issues. They knew and it is all noted. So today, I will call all day until I get a supervisor on this. They want us to give up, and many do just that. Keep fighting as I am doing. How will I pay my mortgage next month if I have to wait 45 days for an appeal? That was not my fault.

Back to the call with Aetna, I then asked about the status of the other 6 drugs and they said they had a total of 11 drugs for me. I told them they should only have 7. So we went through the list and it turns out that the 7 meds that were originally faxed by my doctor were received and the other four had been added to the order. They denied having duplicates; however, I walked the Aetna rep through the list and helped them remove the duplicates. I then asked if any of them had been filled and she/he said,"No."

He/she said they could not fill any of those prescriptions until I got prior approval for the Oone prescription based on my doctor's letting them know I had taken other generics in the same class as Nefazadone. It seems Aetna's rules are these: If a customer sends in an order and one of the meds needs prior approval or there are any questions about any one of the prescriptions, then all of the prescriptions are held until the "problem" prescription has been approved. I did not know that "Nefazadone" had been classified by Aetna as a "problem drug" until I talked with 10 different people on 1/19.

I was scheduled to see the prescribing doctor for the "problem drug" on 1/20, so he managed to get the Nefazadone problem straightened out (I hope; I am waiting to receive it). While talking with one of the 10 people from Aetna on 1/19, one of them graciously made sure that the other six meds that I ordered on 1/5/10 were sent by FedEx with no charge to me. Today, an Aetna rep called and we reviewed what had happened. First he refused to believe that duplicate prescriptions had not been removed immediately by Aetna. Then he explained that Aetna has 14 days to fill an order and that they don't fill an order if there is a problem with any of the prescriptions. He said when there is a problem, they never call the patient or the doctor.

They send the patient a letter. And then the patient can contact the doctor and get the prior approval. Guess what? I have never gotten the letter. It appears that Aetna does not care that sending a letter radically extends the time needed for an order to be filled. Or how long it would take for me to get a letter, then get the prior approval and then wait for them to fill the order (14 days) and allow 7 to 10 days to receive it. I just started with this plan and it is the worst Plan D I have ever had. Based on this experience, they are not consumer friendly and they obviously are not interested in doing all they can to serve their customers. And there is no way to find out about their "order system" before you sign up. Having spent 30 years in marketing research, including medical areas, I am appalled that Aetna is doing such a poor job.

So, I continued with the cobra. Delivered my son in Dec 2008. Found out later that my insurance had been cancelled the end of Nov (my son was born the 9th of Dec). Call Aetna and was able to get it reinstated for $321. They covered my delivery. And then in April 2009, I get a bill from the hospital for $10,000! That's $8,000 more than I was to pay. Aetna had asked for the money they paid back. I have my statements saying that myself and my son were covered through the 31st of Dec 2008. Now I have a debt of over $10,000. Thanks to Aetna. Owing over $10,000 for the birth of my son when I have the paperwork proving I was covered.

I requested a review of my policy and a refund based on Aetna's three (3) mistakes that cost me $5,400 more than I should have paid for the last 20 months. They said they can change the future policy, but that the past is the past and I do not qualify for any refund due to their three (3) mistakes. Are they not responsible for errors made exclusively by themselves? I am in shock over this. This should not happen to good, upstanding citizens that pay their bills and try to follow the proper path. Now I am out $5,400 and have been told that once they review my reapplication, I must wait six (6) months for the new and correct monthly payment to go into effect. Are you kidding me! If I committed grand larceny, I am sure I would go to jail. Unbelievable!

The pharmacy told the rep that there would be no problem with getting me the medication. So I sent the prescription into the pharmacy and a week later, I got a call from the pharmacy stating that I cannot get the 90-day supply of the medication filled through them due to a state law stating that a controlled substance may only be issued at 30-day intervals. They offered to fill the prescription at a 30-day fill and the gentleman in the pharmacy stated that they would not charge me for a 90-day supply if they could only fill it for a 30-day supply. I didn't believe him and made him check with Billing.

When he got Billing on the phone, Billing stated that yes, the charge would still be for the 90-day supply even though it could only be filled for the 30 days required by law, not my law, the states laws. Why do I get punished for this? Now, I either pay $187 for the prescription at the drugstore or I can mail in a prescription once a month and pay a 2-month co-pay for one 30-day supply of the medication. The pharmacy rep was stunned when I told him that I am sure they will not allow me to get a 30-day supply for only one co-pay and he did not believe me until he verified it with the Billing dept.

This is not the first or the second or the third or the 15th time that I have called and spoken with someone in Member Services and/or the pharmacy and have been given wrong answers to my coverage questions. I am basing my coverage on the information that they give me and it is usually wrong. I never know when I am getting an answer that I can depend on. I still have to submit my claims to a supervisor for processing due to the fact that the processing center does not know how to process a special handled claim reimbursement. The service that I have received for the past 5 years from Aetna has been horrible and slack at best. I have documentation that can be given with any questions regarding these events with any request. Please ask.

About four weeks later, I got a bill from my doctor saying that Aetna was refusing to cover that bill because it just so happened on that day that I went to see my doctor, my insurance plan was invalid. I was not covered. So after some debate, they decided to pay it. Last week, I received the same bill from my doctor, saying Aetna again refused to cover the bill. This time, their reasoning was that my exam is not covered under my plan. I find this comical because I called to receive oral consent to see my doctor. The insurance rep told me it was covered. And now all of a sudden, it is not. With numerous phone calls between Aetna and my doctor, it has been determined that Aetna just does not want to pay.

The rep I spoke with first said the visit wasn't covered but then 15 minutes later, she said it was indeed covered but she didn't know what to do. I demanded to quit my plan and get my refund check but she said I had to cancel my plan within 31 days of signing up. That too is hilarious because another representative told me my plan was not activated for the first 30 days. So essentially, after those 30 initiative days, I had one day to decide if I liked my health insurance coverage or not. I could not use my plan for the first 30 days, so how in the world was I suppose to know if I wanted to be under their umbrella of insurance if I wasn't allowed to use it? To me, it's a complete scam running rampant through colleges and universities.

I asked Aetna what they covered and they said accidents and sicknesses. Well, I have car insurance and they cover accidents and sicknesses. Well, if I'm sick, I can't get prescriptions to be healed because they don't cover prescriptions. So really, what the heck am I paying for? Someone help me. I don't know what to do. And I know I'm not the only one out there who feels this way.

I do have a pretty back brace (in Ice age Blue) for post surgery that they paid for that is sitting on my dining room table as a center piece. Supposedly there is a peer-to-peer appointment set; however, I cannot seem to get the specifics on when. I feel I am being pushed out till next year as my co-pay and out of pocket have been met for this year. Doc office states they have other claims for lumbar spinal fusions approved by Aetna for other patients.

Aetna partially complied with filling two of the three medications, but refused to fill one of the medications (I believe it was the long-acting diabetes medication). We had no choice but to send him with what medications we had. Eventually, he ran out of the medication Aetna refused to fill. When I asked why they would not refill the medicine, the Aetna representative stated people sell their medications overseas! I want you to know that as a direct result of Aetna's incompetence, my husband was unable to pass his physical because his sugar was elevated. He was shipped home without work after several weeks. I want you to know I called Aetna and really gave it to some poor lady who had to listen to why I was angry.

I want you to know Aetna does not need to worry about my husband and I selling his medications abroad. My husband leaves for work overseas without much more than a week's notice and we try to abide by the mail order policies. My husband is expecting to leave overseas once more. Today I have requested refills on your website. Please send the medications. We anticipate leaving Houston in mid-December. A copy of this complaint was filed with the ombudsman and Consumer Protection Division of the Texas Insurance Division, as well as the Texas Better Business Bureau.

This medication is needed; it's not like I can rid myself of the disease without it. Right now, it is a mild case with 80%-90% success rate with these 2 medicines. The doctor said if I start the medication now, I can wipe out the disease in 24 weeks. But the longer I wait, the longer it will take as the disease grows stronger. Thanks, Aetna. I guess when I get liver cancer or need a transplant, I'll be denied coverage too.

I was eventually told by a supervisor the checks were to be overnighted. 3 days later I made a call as to the status of these "overnighted" checks. I was told they do not overnight, but that the checks had been sent out in the mail. I received the checks 9 days later. The mail can be slow, but not that slow. To be blunt and to the point, I was lied to. If not for the fact this coverage is provided by my employer account were self insured, I would never recommend their service ever!

I am currently in appeals process, but as hard as this has been just for them to get info I have continuously been faxing, I don’t see this working out in my favor. Isn’t insurance supposed to help? Consequences: unable to pay mortgage, car payment, utilities, and all regularly occurring monthly bills since no payment has been received in the 3 month period I was out of work.