Aetna

Patrica of Bellevue WA (08/24/08)
I have worked as a Registered Nurse and had been employed by Group health Coop for the last 16 years starting in 1991. I was encouraged to obtain the long term disablity from Aetna at that time and the fee for the insurance was deducted from my pay check for those 16 years. I didn't think I would every need it but it gave me the security to know that if I ever became disabled that Aetna would pay 60% of my income. i also encouraged each new employee to sign up for the coverage as I thought it was a great security blanket.

I was diagnosied with a genetic heart condition called hypertropic obstructive cardiomyopathy where the heart wall becomes thicker and the chambers of the heart become smaller causing shortness of breath. It is a progressive disease. I was able to continue work but had a heart attack in 2001 related to the condition but was also able to go back to work after recovery and some change in medications. I had no desire to quite work as I was 55 and felt that I could continue with my work as a register nurse.

I continued to work another 5 years Sept 2007 I developed congestive heart falure and could not walk without extreme shortness of breath and had a 20 pound weight gain due to fluid that collected in my extremities because of the heart failure. I could no longer perform my duties as a registerd nurse. I called in sick one day and just couldnt go back to work as i was extremely short of breath. My cardiologist said I should not go back to work. Which is documented and copies sent to Aetna.

I waited the 90 days as required to submit my claim to Aetna and it has been a nightmare every since. I filled out their forms and did all they request but they continue to have one more thing they need. At first they said I was denied as my cardiologist had not sent them the information that they needed. I called my cardiologist and he said that his full report was in medical records which Aetna had already received the form that gave them they right to get any of the medical data and reports that they needed.

After talking to Aetna that stated that they could not get the medical history. I drove downtown through traffic to get to the group health medical records department and was told that Aetna had requested the medical history but had not told group health where to send the records and did not pay the fee to get the records which aetna knew were required. I paid for the medical records and faxed them to Aetna from 3 different fax machines which when talking to them again they stated they never received. I then mailed them certified mail so that they could not denie receiving my medical history.

I call Aetna weekly and sometimes as much as three times a week and they assure me that they are working on my claim. I received a phone message from Monica 6-26-2008 that they expected to be approving my claim within 48 hours. She said because the claim would be so much that she had to turn it over to her technical advisor for review. I checked the mail box everyday waiting for the check and did not call Aetna for a few weeks. No check and no calls from Aetna.

I called to inquire about my claim to be informed that they needed my last 23 paycheck stubs which had been sent to them before from Group Health human resourses. When I called later they said that they had not received the information. I called human resouses and they said they had sent that to them a week ago. I called aetna and asked if they had received the information and they stated no but when I told them of the call to human resources they them said Oh yes Monica did received them I have never been able to talk to Monica directly, as when asked to be transferred to her I only get her voice mail and she doesn't call back. Only 3 calls from her after many voicemails and weekly request for 8 months.

I followed up with a call to find out that they did not understand codes on the paycheck which had been explained many times previously. It has been now 8 months of being told one stalling lie after another and I am very frustated. i can't afford the amount of money that the attorneys are requesting and i keep hoping that it will be settled soon and continue with my weekly calls and trying to provide every thing that they ask for but I can't help but feel that either they are the most incompedent group of people or the smartest at getting me to feel that they are working on this claim until I will just give up and they can win and not give me the coverage that I paid for over 16 years.

I am depressed and frustrated by Aetna's response and the way they continue to delay paying my claim. I guess I was foolish to trust that when you pay for coverage that they will be forthright and honest. I can't work or I would. I have not had any money coming in for almost a year now and have gone through most of my savings. I feel that the stress with this heart condtion will shorten my life and maybe that is what they what. i understand that with fraudulent claims that they must be careful but they and any medical person knows that with the heart condition that I have that I can not work as registered nurse with all the physical demands as I can't even walk to the mailbox with out shortness of breath. I wish that there was something I could do to make Aetna accountable for there actions as I would have a criminal charge against me I lied to them as they have been doing to me.

Michael of Shipman IL (07/06/08)
After months of delay and no comunication from AETNA I received a letter on the same day that I originally submitted my initial complaint. The letter stated that I was denied LTD benefits due to my occupation being sedentary in nature, which is not true. Ms. Sherry took it upon herself to determine from the US Labor Department of Occupation Titles (DOT) that my occupation was a Refferal Aide which is clerical in nature. The title assigned to me when I first began at Gateway Regional Medical Center was that of Referral Coordinator II. When I browsed the DOT I could not find such an occupation and only found Referral Aide which is apparently what Sherry used to determine my occupation and responsibilities. The closest that I could find in DOT was Social Worker - Psychiatric.

 I am an MSW that does face-to-face assessment with acute mentally patients that present to the hospital ER and are suicidal, homicidal, psychotic, intoxicated and / or using drugs... it is normally a volatile and hostile environment, which may lead to unpreditable and aggressive confrontations. These are not sedentary tasks that Ms Shaerry has assumed that I do.

It is my personal opinion that AETNA and it's employees have intentionally delayed making a decision and then denying my claim after months of waiting when they had all the documents and signatures which THEY originally requested... this comes very close to what I would consider fraudulent and deceptive practices.

Denied LTD Disability Benefits due to Ms Sherry using incorrect occupation title and job responsibilities taken from the US Labor Dept Occupational Titles; Lack of knowledge of serious illnesess and the effect / symptoms of those illnesses; loss of employment / income due to her procrastination and delay tactics; not taking initiatiave to obtain current / most recent test results other than those submitted in the initial claim back in February 2008; Thinking she has more knowledge and experience than the cardiologists, neuroligist, and psychiatrists who have been treating me and have stated that I am not able to work at this time thus entitling me the LTD benefits for which I have paid premiums.

Jax of Auburn WA (06/30/08)
I applied for long term disability with Aetna on 4/4/08, after completing the 90 day wait period on short term disability. During the application process, Aetna repeatedly claimed information or forms were missing from the paperwork submitted by my treating physicians. Additional paperwork was thn requested, and another 30 days would go by. Finally, on June 1st, I filed a complaint with the WA State OIC. The OIC jumped on the complaint within 24 hours and pushed the company to respond as required within the 6 weeks of claims processing allowed with WA state law. The company refused, still delaying the processing of my claim, holding it in medical review for another three weeks.

During this time, I spoke with the claims adjustor on several occasions, being provided 'all the necessary information needed to determine my claim'. On June 13th, I was advised by a rep my claim had been denied. I was called by the adjustor, Monigue later that day, apologizing profusely and stating a decision had not yet been made, and that I would have an answer by Friday. No answer on Friday. I confronted the claims adjustor on June 17th, telling her if I did not have a decision on my claim by June 20th, I was going to sue the company.

On June 23rd, I called Aetna (after the 6th such promise broken on returned calls), and was informed that my claim had been denied due to 'lack of functional testing' that I had previously been told was not required by the same adjustor that denied the claim...but that I could appeal.

I should know back from my attorney by Wednesday whether or not we go ahead with the lawsuit. It is my honest opinion as a licensed agent in my state that this company skirted it's legal duty in my state to timely process my claim, and further denied it illegally, which I intend to reclaim in court. I find it sad to read so many other complaints even far more attrocious than mine!

My credit went from perfect to poor from April to July, we are in danger of losing everything due to the negligence of this company. I may lose my job, not being released to return to work and unable to collect payment on premiums I paid in trust to this company. My spouse has to look for a second job, my teenage son had to get a job to help out, we had to pull our daughter out of preschool.

I am forced to self pay my medical insurance premiums at over $500 per month in order to keep coverage I need to seek treatment for my osteoarthritis (sustained in auto accident, I'm 36), degenerative disc disease, and the depression and PTSD resulting from my injuries. I have to forego physical therapy because I cannot afford the copays, live in pain because I cannot afford my pain medication, and cannot seek community resources because I technically still have a job.

Todd of Rising Sun IN (06/29/08)
I have been on long term disabilty since Oct.2005, ssi completly disabled me May 2007. I have had problems with aetna since the beginning . aetna wants the doctor to fill out forms every month as to my health.

my doctores have said every time that i am completly disabled ssi has that i am and yet aetna does not believe any one. I only get 173 a month from aetna my doctor charges me every time to do this he says ,i've told them ever time he is completly disabled. Now i'm not even getting the 173 from aetna because they want the doctor to fill out another form.

Donald of Amherst NY (11/21/05)
I have been on short term disability since june 25 2005, as required, when Aetna sent me forms that required my doctor fill out answering questions related to my disability. My std. was approved for 2 periods the second ending on 11/15/05. I had received the form Aetna sent to again extend the std. for another period, and took it to my Doctor, and he answered all of the questions and I faxed it to Aetna on 10/23/05. Reading this form indicated that it was apparent that I would also be seeking Long term disability.

Due to a lack of information about the date this would begin, I called Aetna and was told that another Individual handled Ltd. and that his name was Steve S. I was advised by Steve that there would be a 45 day wait for my Ltd to be approved,and that during this period I would not be receiving any income. As this was unacceptable, I asked what would be needed to get this Ltd process shortened,and what could I do to get the ball rolling, Steve advised me that he would review the last doctor report, from 10/17/05.

I received a call from Tiffany, advising me that I needed reports from the orthopedic surgeons who operated on both of my elbows, for what I believed was for the Ltd question, and that I would have to sign a release of information form for that information to be sent. I went to the surgeons office and signed the forms the following day. From Aetna I hear nothing, so on 11/5/05 I again call Aetna and spoke to Tiffany, She then advised me that my Std has not been approved past 11/15/05,I asked her why, and she somewhat rudely said that she still had not received the forms from the surgeons, and without them there would be no extension. I was shocked to hear this as again I thought that the surgeons reports were to eliminate the 45 day Ltd wait.

I have on several instances offered to go to any doctor of their choice for x-rays, exaimination or whatever would expedite this, I was told it was not needed my complaint, why does it take almost a full month for approval?

Vicki of Centralia WA (11/08/05)
I have been on LTD for quite some time, I was supposed to get 60% of my pay while on LTD. Aetna is my LTD company under contract, and they are to make up the balance to the 60% wage mark after Social Security Disability kicks in. Since SSD can take up to 18 months or so to kick in after you apply, Aetna was my ONLY source of income once I got sick. Unfortunately, they have such incompetent employees and such a lame company morality, someone sitting at a desk hundreds if not thousands of miles away decided I was not sick anymore and stopped my disability payments completely.

This employee did NOT contact me or my doctor before doing this, and once this happens, it is a 6 month appeal process. I had moved into a house, put a large down payment on it, figuring I was going to get well and get back to work at sometime in the future. Well, this action by Aetna caused me to lose my house, I also lost my car, and lost my belongings, which were in storage since I had no place to live and could not pay the bill. Aetna finally sent me to their own doctor, probably expecting him to agree with them since he was paid by them, but he got real mad after testing me for about 6 hours, and said not only was I still sick, but Aetna had made me SICKER by their pulling the finanacial rug out from under me!

I mean, how well can you get when your financial situation is put in the toilet by the very company you heard for years would 'help you when or if you got sick'? There was NO apology from Aetna at this treatment, they just started paying me again, but a bit later, they stopped again, that was about 2 years ago, and altho now I have SSD, it is not enough to live on without that Aetna payment, so I have had to change houses again, for a 3rd time in 5 years, trying to start over. I fully believe that I could have been back in the work force by now if Aetna had not started screwing with my disability payments.

Jessica of Newberry FL (10/22/05)
My father, let's call him L right now because his case is still pending, is 59 years old and his second career for the past few years is a correctional officer. He went out on disability through his employer, about three months ago. He has a heart condition (bypass last year), diabetes, back problems, carpal tunnel in his hands, degenerative arthritis, bone spurs, fallen arches, congestive heart failure, and COPD. He is unable to stand, sit or lay down for long periods of time. He is unable to run, walk fast, bend over, stoop, raise his arms over his head, or talk for extended periods of time.

My father did what Aetna required as far as getting his physicians to send in paperwork each week for his short term disability. From the very beginning dad had problems getting anyone from Aetna to call him back with questions he had about the long term disability process. Because he tires easily on the phone, I made some calls for him and finally got in touch with a very nice man who explained the process to me. He told me that my father had a 90 day waiting period before he could qualify for long term disability and fortunately the ninety days he spent on short term disability took care of that waiting period.

The man I talked to said at that time that dad had another two weeks left on STD and that his doctor's office needed to fax paperwork so dad could be certified and get his last two checks which are about $353 each. This man also explained the process for long term disability as well and told us that my father will receive no money between his last short term disability check (period ending 10/9) and the date that his long term disability is finally approved. I was told that once his LTD is approved, he would receive funds retroactive to October 10th.

My parents became concerned when October 9th came and went and still they had not received the last two checks. My father, who is ill at home, and has a hard time talking on the phone for long periods of time, made numerous phone calls and left voice mails that went unanswered. In a quest to help him, I also made phone calls, and a caseworker supervisor did call me, but she also called my dad and since she contacted him I did not call her back. My dad asked her about the disability checks. She kept talking about one check, not two. He insisted he was owed up until October 9th, she kept insisting it was one check he was owed and that they were waiting for his Long Term paperwork to process before he could get more money after that. This was confusing for dad who was told as was I that he was owed two checks, for weeks ending October 2nd and October 9th. In the meantime my father talked to this caseworker supervisor on approximately October 12th and the caseworker supervisor told my father a draft would be cut that day for him.

However on October 19th he still had not received a check and he called and left several messages, as I did, and I was the one who found out from an employee there who checked the file that a check had not been recorded as mailed out in the file. When my father talked to the supervisor again sure enough she confirmed that my father's case analyst, her subordinate did not do his job and cut the check and send it. My father said the woman seemed very upset, concerned and apologetic. To him, it wasn't an act, she was very upset. She assured my dad she would get to the bottom of it and call him and let him know a check was being overnighted.

He never received a callback from Aetna that day or for the remainder of the week. Finally, because he was desperate for his money (he and my mother had a mortgage payment due, medication and groceries to buy, not to mention my mother needed gas money to get to work), I called Aetna Friday and I was angry. I found out from a random employee who checked the file that a check was cut on Thursday but there was no way to tell when it was mailed out. Today is Saturday and still no checks from Aetna.

My mother doesn't make much money, my father's short term disability wasn't even 2/3 of his normal pay. As of today, Aetna has not sent the last two short term disability checks which would help my parents pay their mortgage, buy groceries or so mom could put gas in her car to go to work. My father is tired all the time and depressed because he feels like nobody cares about his situation. He's right, nobody ever calls him back. They make him wait....he depends on this money to get by. His health is getting worse because of the stress. My mother is depressed, cries all the time, is worried about how to pay the bills. And I spend many hours during the day making phone calls and sending emails on my dad's behalf because I know that he is just plain exhausted just from trying to get a live person on the phone to help him and give him information.

Gail of O'fallon MO (06/28/05)
I have fibromyalgia and for the last 3 years have had to take numerous LOAs (leave of absences) from work. In the beginning I had no problem with Aetna paying my short term disability pay but when it came close to the end of the short term disability and the start of the long term disability Aetna would deny my claim. THIS HAPPENED EVERY TIME!!! even when I had 2 doctors saying I should not work. I pay extra every month for LTD so I will receive 60% rather then 50% of my pay but probably will never be able to receive that benefit since Aetna denies my claims.

The last LOA I was on they refused my short term disability pay. Aetna's so-called nurse said I did not have enough clinical information. Both of my doctors said they had given Aetna all the information they had and that they felt Aetna needed. I explained this to the nurse and again all she would say is I need more clinical information. I even asked her to tell me exactly what info she is talking about or what other tests Aetna would like for me to have...but like a tape recorder all she would say is I need more clinical information. Therefore, I did not receive any money for a month.

I was in a no win situation because with fibromyalgia stress flares it up so while the doctors are trying to use medicine to relieve my pain Aetna's refusals would stress my out and keep the pain flared up. I would try to go back to work but repeatedly missed days due to the pain - I used up all my sick time and vacation time and began taking days without pay. My good credit became so bad that I eventually was forced to file bankruptcy.

I was called into a meeting with my management and Human Resource Rep and reprimanded for my absences and therefore received a very bad review which trigged a very very low raise. You see here at Boeing an LOA constitutes 1 situation rather than each individual day taken for sick time. Your job is more protected when you are on an LOA. I definitely was afraid of losing my job after 22 years of service. Both the above situations caused stress which in turn caused the pain to flare up. Since the beginning of this year a new rheumatologist prescribed a different pain medication for me and I have felt better than I have in years. Unfortunately, I still have to overcome bad debt record and bad absenteeism record.

Kellie of Palatka FL (2/11/04):
I had Aetna health insurance for years and really didn't have any trouble until I had a large claim. When I only used the insurance for basic health visits they were great. In September of 2001 I found out that I was pregnant. I called Aetna to find out all of my benefits and to find out exactly what I needed to do. They told me that I would have to pay the copayment and everythig else would be covered. I paid the copayment to the doctor and continued my monthly visits that were over an hour away from my home because that is the doctor that Aetna had approved in my area.

In late December my company laid me off. I immediately called Aetna to find out what I needed to do. The company representative told me that I had already paid my co-pay and that part of my severence package they would keep my insurance for six months -- this would be until June 2001. I was contacted by Cobra in April of 2001 and again called Aetna to make sure I did not need to purchase anything that I was covered for my pregnancy. My husband had full coverage at the time with another health company however Aetna told me that I did not need to do anything. I did call my husband's insurance and they told me that my pregnancy was preexisting and so not covered by them.

So anyway I figured that was ok because Aetna had told me not to worry everything was ok. This is my first child and I was young and believed what they said. I was so worried about not having insurance in June that we induced my son so if there were any complications I would still have health coverage. Now they won't pay. Orange Park Medical is calling me everyday to get the balance which is something like $10,000. I can't buy a house or a car because they have put this on my credit. Aetna refuses to pay them. When I call Aetna they tell me that OPM did not file with them in a timely matter and that's why they won't pay. OPM has a different story.

I am a middle school teacher and thus do not make a lot of money. My family cannot get a home loan because of this and we are in dire need of help.

Kellie should contact the state Department of Insurance, which may be able to help her.

Susan of Tampa FL (2/19/02):
I have been out of work for over six months for a severe stress disorder. I believe my diagnosis is PTSD. I am not really sure due to a copy of the paperwork I requested with my medical information has not been sent for over three months. I have asked a few times and I still cannot seem to get a copy sent to me. I do not know what the problem is.

I have not yet received my check for the last half of January it is now Feb. 19th. I had first called regarding this matter on 020502 and was told the check had been mailed on 012302 and to wait until 020702 and call back if I did not receive the check by 020702. I called back and spoke with an associate who told me that she would place a stop pay on the check that had been issued and issue another the next day 020802. I waited until 021302 and called because I had not received the check yet. I spoke to an associate who told me a stoppay had been put on a check but that a new check had not been issued. The associate told me to call back the next day and speak with Mike Dunsworth.

I called back on 021402 and spoke with Mike Dunsworth who told me there had been a check issued to me on 013002 but not on 012302 and he had that check in his office and would send it to me but a stoppay had been placed on it. He assured me he would have a check cut on 021502 and send it to me via overnight delivery, UPS.

I waited all day Monday and the check did not come, I had checked with UPS and they said they were delivering on Monday the 18th even though it was a holiday. I called back today 021902 and spoke with an associate who said a check was sent out 021502, but it had been sent 2 day priority mail. I had just been told on 021402 that I should have the check in my hand on Monday from UPS.

I have an eviction notice from my landlord. Who probably thinks I am incompetant, I have told here this check is on it's way now for over 2 weeks. I keep telling her it is going to be here and then I call Aetna only to find out it was not sent or that it is going to arrive even later. The irony of all this is that the address on the check that Mike Dunsworth had in his office was wrong it was 1400 or 14000. My address is 14011.

In the last four days I have received two other pieces of mail from Aetna with my correct address on them and all of the paperwork that was sent for me to fill out for my disability had the right address on it. What makes me even more upset is that one of those forms that I received that I returned to Aetna was an address verification form, which had my correct address on it. I figure if this goes on long enough and I keep a good record of it which I have started doing I will have a lawsuit. I will be sending a copy of this letter to Capital One being that they chose Aetna as our insurance company and I will be contacting the better business bureau and lodging every kind of complaint possible. I'm getting worse from all of this stress not better.

The second part of this letter is regarding my other case manager Susan B. It turns out that Dr. Hussain, my doctor, is or was Susan B's doctor as well. There is a conflict of interest here. I recently had a conversation with Susan B who advised me she could not advise me, due to her knowing Dr. Hussain. She is aweful to talk to and I dread calling her. This is what has been going on. On 013002 I saw Dr Hussein and gave her the disability form to fill out. I paid the 25.00 fee for the form and it was filled out and faxed to Susan B. I call Susan B to make sure everything is okay with the form and am told it was not completely filled out with enough information and that my case has been closed until she gets another five page form back from my doctor which she is going to fax to my doctor.

I call my doctor's office and speak with Kim, the receptionist who tells me to call Susan and ask if she can just speak on the phone to her. I call Susan who says she cannot help me without the forms. I call my doctor's office back to explain this and am told that I must pay another $25.00 for this form to be filled out. I had to send them some of the money I needed for food. It has been how long since I have received a check now? So now I have paid out $50.00 for forms none of which I have ever even seen, no matter how much I ask I can't seem to get anyone my doctor or Aetna to send me a copy so I can see what is going on for myself. This is costing a lot of money and it seems that I have no recourse which frustrates me.

On top of all that my landlord is charging me a $20.00 late fee and I will probably get late fees on my other bills as well due to I cannot pay them without money. My income has dropped by thirty percent and I do not know how I am going to afford to live if I am going to have to pay these late fees month after month because of problems with my check. Again I am told I have no recourse. I am and have been physically ill over all of this and I realize a big company like Aetna does not have to care and can do what ever it wants. The way I have been treated is wrong and I do not forsee it changing unless I take action.

Al of North Conway, NH (8/15/02):
I am a 30 year manager with Verizon that has an outstanding record and appraisal. Last February I finally went out of work on disability due to severe and chronic lower back pain. I now live on a strong regimen of pain medication and have little hope for an improved future. My company, Verizon, utilizes Aetna to administer their disability insurance program and my findings with Aetna have been poor. Although I have spoken to ten or more different case workers, I have only been met with unfriendly and contentious representatives. It is as if their entire culture is focused on being hostile with no desire to help me, the affected employee. Their ways are doing more to hurt me than to help me.

Each encounter with Aetna has caused me extreme nervousness, lack of sleep and fear. I am left feeling like they are out to get me and quite frankly, I suspect that this is their method of operation, which is shameful. Is there anything that can be done to help myself as well as others who are being treated like some type of piece of trash?

James of Evergreen, CO, wrote on Nov. 27, 2000:
I work for the Federal Gov't and switched to Aetna Insurance last year during open season. Since then I have had two minor surgeries. We have had nothing but trouble with billing and getting them to pay the hospitals and doctors. Two of the bills actually ended up going to a collection agency. They were resolved but only after an unbelievable amount of phone calls and threatening letters. All of the bills are one hundred percent covered except the ten dollar co-pay. It has been almost a year to date and we still are getting bills that haven't been paid.

We have never had anything go to collection in our lives and one year with Aetna has dissolved that record. When we call, they always are nice and understanding and say they will take care of it but they never do. Just a warning to you. Also many fellow federal employees are experiencing the same problems.

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