Aetna

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Ron of Mckinney, TX June 24, 2009

I had a dental procedure which damage the lingual nerve in my mouth affecting my speech. I am a TELEPHONE SALES REP no one can understand me the way I speak now. Aetna denied my claim saying I am able to proform my job. I sent a appeal letter 30 days ago they have not even assigned it to an appeal adjuster for consideration. Well I have a surprise for them. That letter was sent by and attorney if they do not respond with in 45 or July 12 they are getting a nasty BAD FAITH lawsuit on there hands. I will take them to the cleaners. I work in insurance I know the laws of my state and I'm going to make them bend over!

Marcus of Sacramento, CA April 8, 2009

I was injured at work in 2005 and then laid off. after being on workers comp for over 6 months i received papers from my ex employer to file for long term disability plan that i was paying into through my employer. They were taking deductions out of my paychecks to pay for this plan. After a couple of denials and appeals that i eventually won took over 2 years to fight for them. they finally reinstated my benefits. Still 5 months later after summiting when my workers comp and state disability were exhausted they continue to pay me as though iwas still getting workers comp and state disability.

My attorney has sent letters requesting Aetna to back pay me and start paying full benefits as i am not receiving anything else but hve not gotten any response.

Iam currently seeking medical treatment through workers comp and am unable to return to my own occupation. I paid into this plan to help me through anything like this if it happened to me. Now it has happen and I have lost my credit due to having to file for bankruptcy the lender on my home has foreclosed on my home now. I am currently trying to work out a loan modification but Aetna continues to delay in paying my full benefits.

I am not even able to pay my utilities much less eat with what Aetna is currently giving me. Any help to get Aetna to pay my benefits would be greatly appricated

Melany of Lexington, NC March 23, 2009

I have been an employee of Kimberly-Clark Corporation for 24 years. On November 5th of 2008 I injured my back at home and was unable to return to work. My job is a physical job. I have been diagnosed with sacroilitis and also have some arthritis in my back. I am only 47 years old. I also have suffered with Fibromyalgia the last several years making work very difficult. My condition is preventing me from being able to do the physical work and in turn I can no longer do my job.

Aetna is denying my claim despite receiving the requested information from my doctor. I also have paid for 24 years to have the LTD insurance benefits. I have received an injection in my back which has helped with the pain. I am now no longer in constant pain but if I try to take on physical tasks such as mopping the floor or standing to cook supper, or even sitting at the computer for long periods then I have pain again. It is not that I am completely incapicitated but I know that I can no longer do the job I was doing.

According to what I have read about disability, it is defined as someone who can no longer do the job they were doing prior to the injury or illness. That is me! I can no longer do this type of work and my company does not use part time or intermittent help. Three weeks ago, Aetna (Asia) contacted me and told me she would be calling my doctors to get more information from them regarding my claim.

Next I get a letter from Aetna denying my claim. When I called them about it they told me to have my doctor send in more information (a progress report). I told them why do I need to do this when Asia just spoke to my doctors last week? I asked that Asia call me back. She never did. In the meantime I once again had my doctor fax the information to Aetna to Asia's attention. I have heard nothing now for three weeks. I, like some of the other folks, am getting close to the end of my std period and approaching the ltd stage. I need help.

The stress that this has caused me in addition to the pain in my back and the pain related to the fibromyalgia is not necessary. Why did I pay all these years to have the extra insurance when I continually get denied on my claims? My disablity person, her name is Asia, will not return my phone calls.

I am currently using up all my vacation pay to help pay our bills. In another week or so that will be gone. I don't know what to do. I could probably start seeking a desk job but I would only be able to work part time. My back and fibromyalgia will not allow me to do more than this. If I am fortunate enough to find a part time job then my husband and I will suffer a substantial loss of income and I will have to resign my employment with Kimberly-Clark and thus forfeit my claim to disability.

David of Tucson, AZ February 6, 2009

Short term disability denied 3 times. First time denied due to miscalculated time off from job. That was corrected by me after several phone calls. Denied 2nd time due to non updated clinical information which was faxed to them but Aetna claims they never received it. Third time denied due to clinical findings that didn't support their conditions of me being out and not being able to get a hold of my doctor after only one phone call. All of this has happened before I was approved for long term disability.

UPS supervisor and employee of 21 years. As a result I will not be getting paid my short term disability. Aetna called me in mid December to say they denied my claim for short term disability. After several phone calls and having to make another appt to see a doctor just to obtain information to fax to them in order to be paid for Christmas. Bottom line one mistake after another has caused me stress from ultimately being denied because their specialists have denied it due to clinical findings.

Patrick B. Fermanich of Marinette, WI November 3, 2008

I had been receiving checks from Aetna and I followed up on my doctor sending information about me not being able to return to work. Than a representative stated that they had made a mistake in denying my certification. I have been talking with my PLant nurse and Human Resources people at the Marinette Kimberly-Clark mill. They have stated that other people are not getting checks. I asked why?

Aetna is denying certified payments via me being off from work as stated by my doctors. One day one of my doctors sent 23 fax related resources on my medical problems in going back to work. Aetna lies to me by saying they made a mistake and than when I call or they call they say they are denying my claims. I need the money I have bills to pay.

Ralph of Jacksonville, FL September 23, 2008

Aetnas Short Term/Long-term Disability benefits are the worst. You pay for it- oh yeah, you pay. Try an employee of over 10 yrs filing one claim and not get pd for the last 4 months. (one denial as the Dr didn't put my resting blood pressure rate down!) Don't believe what they tell you about the IHD (Integrated Health Disability Model). Its suppose to help manage your medical and any potential disability you might face. Its a lie! It doesn't work! They've been my companys medical ins provider for years and the only info they conveniently find hurts me. literally- hurts me. I've almost lost my car, my mortgage is months past due

They play legalese word games. Can you provide me any in-site or suggested direction? Tonight I still have a roof & food.

Patrica of Bellevue, WA August 24, 2008

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 Gene Briskovich of Shipman, IL July 6, 2008

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 June 30, 2008

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 E. Nordstrom of Rising Sun, IN June 29, 2008

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.

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