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Mm of Southern MD (10/15/08)
My 16yr old daughter was injured in a sport at school. She is unable to stand very long, bend, sit, lift, can only turn her head to one side and has sharp pains shooting down her legs. An x-ray at the emergency room indicated that nothing was broken, but that she had scoliosis and spina bifida, in addition to a sprained neck. She is on very strong pain meds and muscle relaxers, and still cries herself to sleep in pain every night. This is unusual because she has a very high threshold for pain and never cries! Now she is also experiencing problems in her arms and her spine is swelling.
Her doctor ordered an MRI of her spine and much to our surprise, Aetna denied authorization. Her doctor called them personally and they are allowing an MRI of the bottom of her spine ONLY, due to the discovery of the spina bifida. The doctor has already filed appeals. What about the rest of her spine and neck? If there is damage to ANY part of her spine it could affect the rest of her life! Do they not even care about children? Why do we even pay for insurance?
Does everyone know what the top aetna execs got paid last year while their customers were struggliing to get adequate healthcare and pay the denied bills? We will be changing insurance companies in January and if there is permanent damage to my daughter's spine....aetna will be in court. I don't know what has happened, as I used to think that they were a good company. I warn everyone I know now to STAY AWAY FROM AETNA!
Judy of St. Petersburg FL (10/09/08)
A simple flu shot at my local pharmacy turned into a 4 hr marathon one day and 2 hours the next. I had an easily-solved problem, but Aetna's service department was so uninformed, they couldn't help me or my pharamacist. I haven't really used my plan, so can't say it's a bad one, but their customer service is simply so awful that I wouldn't recommend Aetna to anyone.
Basically, what I found was that the lowly service people MUST protect their supervisors to the point where the customer spends hours talking to various people, none of whom you can call back, none of whom can help. When I demanded a supervisor, threatened to report Aetna to my employer, Insurance commissioner, Florida State elderly rights and my local TV station, I finally got a person who gave me the simple following answer. The drug store had no way to bill Aetna on line for my flu shot under my medical coverage & it wasn't covered by my Rx because it wasn't a prescription. I went somewhere else for my shot. No biggie except for Aetna's customer service ineptness.
Two trips to my pharmacy after Aetna promised to unblock my name. Six hours on the phone. Their bad information led me down this frustrating path. I just want to warn others about how Aetna will treat you once they've got you as a customer.
Indira of Clemront FL (10/09/08)
My husband had begun suffering from a severe and unusual headache that would come on suddenly, lasted for hours and was so severe and unsual that whenever it occured, he would literally have to grab the side of his head on which the head is and go down in pain. At first we were scared and not sure what was happening or going to happen.After several attacks of this kind we decided to go to the emergency room. We didn't want to take the chance, thinking it could be a stroke, or some other serious problem. The ER diagnosed him, with a pinched nerve in his head after several hours of testing.
However, in his medical records, it was mistakingly recorded as a Headacheby the ER doctor of South Lake Hospital (Clermont Fl). has tried to re-code the visit and resubmit it back to Aetna but they ignored that and billed us an invoice for $984.00 This ER visit was 10/29/2007.
To date, I have been trying patiently with customer service reps and supervisors from Aetna for help, explaing every detail - from the severity cause for the ER's visit to the doctor mistake of putting the wrong code but they all refused. They have stated that - we choose to go to the ER for a headache and that will not be covered! Sure, I totally understand that concept - but this was not done with intent as they are stating, and it is very obvious that they prefer their patients assume and put their lives in danger, by staying home even when the systoms seemed so dangerious, instead of being sure and safe.
Tabatha of Lavallette NJ (09/24/08)
i cant get my son seen by any doctor for his adhd because aetna wont cancel his plan. i have insurance of my own for him and doctors wont see him now cause he is covered by 3 insurance plans now.
my son cant get the help he needs and its interfearing with school and his daily life
Karen of Medway MA (09/11/08)
2/27/08 Went to ER late night with severe strep throat. Was already diagnosed but antibiotics were not working. Instead of getting better my throat was completely white (no longer jsut spotted) and more alarming, I was having difficulty breathing as the swelling was causing my throat/airway passages to close. Once seen at the ER they immediately gave me a steroid shot and something else to help open my air passages. They suggested admitting me... I declined since I had 2 young children at home. They switched my antibiotic to a more potent one. I went home and 1 week later it finally resolved.
I am the primary card member and had coverage on this date. My ER visit should have been $75. Instead I have a bill for almost $1500 because according to Aetna I did not meet the criteria for an emergency visit I've appealed their decision and have not heard back. It angers me that my throat was closing and I was having great difficulty getting air... yet they do not see this as an emergency. I wish I had agreed to being admitted... this is absolutly ridiculous!
One more thing... I had several throat cultures for myself and family in relation to this illness. We went directly to the lab where we had throat swabs taken. WE DID NOT SEE ANY DOCTORS, yet Aetna charged each of us office visit copays since the building that houses the lab also contains medical offices, so they use a code saying it's an office visit though it obviously isn't. Aetna is the worst company for covering any type of claim. I feel terrible for all those people that are not capable (old, impaired, unable to speak english, etc.)of jumping through all hoops that Aetna uses to avoid paying legitimate claims.
Sarenne of New York NY (09/04/08)
I updated and renewed all of my insurance information on time, however, when I went to the pharmacy over a week later to pick up a prescription, I was told I was not covered. When I called Aetna, I was told that they are very busy, and that it takes time to process the renewal. I would have to wait until they could process it to pick up my prescription or pay out of pocket and attempt to be reimbursed later on.
Considering the amount of money I pay for comprehensive insurance for my family, this is unacceptable. I paid, on time, and stopped receiving benefits because they are too busy to process my information in a timely manner! I was told that since I called, they would attempt to expedite the processing of my information, and would let me know within 48 hours if it was successful. I wonder how long it would have had no benefits that I paid for had I not called.
Natascha of Farmingville NY (09/01/08)
My health insurance was terminated as of June 30, 2008 because my payment for July was received on August 4, 2008 exceeding the 30 day grace period. My issue is that I was never made aware that my health insurance had been terminated. I scheduled a non-urgent doctor appointment in August that could have waited. I was made aware a few days after my appointment that I had no health insurance and was billed for over $300.
After calling Aetna on August 19th and asking what the problem was they said I had been terminated and not covered since June 30th. I asked and demanded to know why I was not told and why a termination letter was not mailed out. I also inquired as to where my check was since it was the middle of August and I had not yet received a refund. They said that an invoice was created on August 14th. On August 20th I received the termination letter and refund check, almost a month after the 30 day grace period.
I have no health insurance coverage and I am stuck paying a bill of almost $400 for an office visit that was not urgent or necessary this month.
Laura of Burlington VT (08/21/08)
I just want to give some advice to people dealing with Aetna: 1.) Always ask to speak to a supervisor. Have you claim dates/amounts with you. Also, have a copy of their coverage info on hand. 2.) Tell them you are going to call them every day or week until the bill is resolved (even if you are not). 3.) If there is a liason at your work or school for the insurance company, be very persistent with them. 4.) Let them know you filed a complaint with consumer affairs. Tell them you are going to speak to a journalist at your local newspaper about them (and actually maybe try to do it)--I got payment after offering this. 5.) Check with your state laws. If they are being violated by the attorney general, you may be able to file a grievance with your state. 6.) Put in an official request for your health insurance records.
America's life expectancy rate is lower than most other developed nations...our pitiful lack of adequate health insurance coverage. Health care is a human right.
Vance of Whittier CA (08/15/08)
refuse to have upper mgr. contact me after many attempts email phone, we are nowhere. i cannot understand why the fsa people, rx home del., healthcare cannot work together, it has been 6 weeks + they cannot get my rx order right, ineed my meds MY LIFE DEPENDS ON IT.
My credit cards are maxed out . i am a diabetic, prone to siezures etc.no meds = hospital=lawyers
Vance of Whittier CA (08/15/08)
after being told i had to use mail order to get my meds,no longer able to use local drug store due to some policy, they have been unable to get my order correct, they sent me a 30 day supply of meds, said it was a 90 day supply will not refill because they say i have 90 supply allready , no mgr. will return calls, i went a week last month without meds, cannot happen again
i am a brittle diabetic i test my glucose 10+a day,inject insulin 5-7 times aday, i suffer from hypoglycemic unawareness,high blood pressure,etc....i am prone to seizures and loss of consciousness, not to mention the economic impact of over charges, billing mistakes etc,
Laura of Burlington VT (08/13/08)
Aetna/Chickering Group student insurance is deplorable. I am convinced that their rule of thumb is to either pretend they never received a bill or reject paying a medical bill and hope you won't argue them. Every single medical claim filed with them has at first been rejected by them, and then re-processed several times over several months. First, I was diagnosed with growths in my uterus via ultrasound after having pelvic pain. I had surgery to have them removed and biopsied to rule out cancer (which it luckily wasn't).
Despite the fact that the diagnosis was performed on-site and I have no medical history of polyps or fibroids, I was informed for months that it was a pre-existing condition and so not eligible for coverage. I had my doctor forward his tesimony to assert origin of diagnosis twice (and still was told by Aetna that it wasn't received). I had to argue with them on a weekly basis for months. It is worth noting that every time I called them, I got a different story about how they came to the determination that it was a preexisting condition. Finally, after threatening to write an article for the newspaper and testify at my University review of them, they paid. It took them 6 months to cover this surgery.
But then they didn't pay my anesthesis, also claiming it was due to a pre-existing condition! How can you cover the surgery, but not the anesthesia? Again, many weeks of arguing. It's exhausting.
Since then I have had notable other problems with them. I have a medical issue that makes my daily life difficult. My doctor wants me to get a durable medical advice that is expensive but would offer me relief. It would allow me to work on atrophied muscles every night to make them competent again. They put the prescription through for a predetermination. Months later, I still didn't have an answer either way from my insurance. I called multiple times and each time was told they were processing/reviewing the claim. Then, finally I was told a letter rejecting my claim came out weeks ago and was mailed to me. I never received it. They said they were going to mail it out again, and again, it was not received.
Each time I inquired over the phone as to the reason of my rejection, I got a different answer. Currently, they are refusing to pay my acupuncture bills, even though their coverage very clearly states that they will pay 80% of an acupuncture visit for a confirmed medical disorder with a doctor's referral up to $300 PER MEDICAL ISSUE (granted the acupuncturist is in network). Now, I did max out treatment for one medical issue, but then started receiving treatment for another. When I called to clarify this, they said the billing codes suggested the two disorders were similar (note: my two disorders were endometriosis-a gynecological disorder-and tendonitis). However, I gave them the benefit of the doubt and my acupuncturist resubmitted these bills after making sure the billing code matched my diagnosis (I think a number was off). That was over two month's ago and they still have not paid.
Every time I call to follow-up, they at first say they never received those resubmitted bills. After arguing they always, miraculously, find them. Then they tell me they will reprocess them and will get back to me in a few days or a week. They have told me that 4-5 times in the past two months. They never get back to me and when I call, it is always like I never even put that request in in the first place. And, as usual, I keep getting different explanations for why this is. One insinuation I received from representatives is that they want to make sure these health issues exist. My referrals are in the database by the doctors of these two very different conditions! It is astounding!
I have to put off acupuncture treatments until the situation is resolved (until they cover me). Acupuncture offered me serious relief from health issues that at times severely impair my day-to-day function. Furthermore, the medical device was denied to me, and I have to again live with a health issue that affects my daily life and makes it hard to perform my duties as a graduate student and research assistant. I got a B+ on a class I should have gotten an A on but was suffering these disorders due to lack of the proper treatment my doctors deemed necessary for my health. Finally, I have spent massive amounts of time on the phone in an attempt to resolve these matters and get the coverage I am clearly due.
Yvonne of North Las Vegas NV (08/12/08)
I had a Surgical procedure-Thromboendarterctomy,on 11/24/2004 which was approved by Aetna, and a year later they claim that I wasn't covered. Now if I wasn't approved there is no way I would have had the operation and of couse I would be died today, and now I'am being sued for the second time by bill collectors.The first sute was paid by Aetna, now allstate is suing me and I can't afford an attorney. Idon't know what to do I live on a fixed income.
Dr. then on my first visit after surgery, he told me that I was his first mistake that he cut the nerve to my tongue and, that I WOULD NEVER TALK THE SAME AGAIN and I would have to go to a speech pharmacist to learn to talk all over again, I was devastated , and I trusted cause he said that he had done over houndred of these surgical procedures, how dare him do this to me.
Farley of San Antonio TX (08/05/08)
I had used Aetna home prescription delivery for previous medicine. Apparently the doctor knew to write the prescription for a 90 day supply that time. For a second set of medicines a few years later, he only wrote the prescription for a 30 day supply. I had no idea Aetna required a 90 day prescription, so they sent me a 30 day supply at the 90 day cost.
If you look on their website to find copay amounts, it says a 30 day retail supply is $35 and a aetna mail order supply for 90 days is $105. But if you only get the 30 day supply from them you are still charged $105. Well, apparently you get fried for using Aenta prescription home delivery for anything. It's totally not worth it. Just go to your local favorite pharmacy and have your prescription filled. Aetna home prescription does not save you money, in fact it might cost you considerably to use them. My advice: STAY AWAY! from Aetna Home Prescription Delivery.
I've lost over $250 due to the inflexiblity of Aetna Home Prescription Delivery.
S of Falls Church VA (07/23/08)
I had a 20th week ultrasound performed to check for abnormalities in my baby (I had this same thing done on my first baby). After having this ultrasound, my doctor determined that the baby's nuchal fold thickness was on the higher end. She referred me to a specialist and I had another ultrasound done by the specialist. Aetna rejected both of the claims stating that it was experimental and investigational.
When I had called aetna initially when I found out that I was pregnant, they told me that ultrasounds were covered at 90% for my plan and that there were no limits on the ultrasound as long as it was medically necessary. I did not perform these ultrasound for any other reason other than medical reasons. I'm being given the run around by aetna and my doctors office, both of them are blaming each other and i'm left in the middle.
I had to pay my doctor $500 for the ultrasound she did, and I'm sure a bill is being sent to me by the specialist for $572.
Gennadiy of Bloomfield NJ (07/22/08)
Aetna's new way not to pay the claims is to apply copays to everything. When contacted, Aetna reps say there is no changes to the policies, however there is a clear difference in claims processing. The same identical policies with the same identical in network procedures now have copays applied as a way of lowering Aetna's portion of the bill. While it might seem a small issue, all copays do end up into nice sum of money Aetna does not pay.
Patients portion of the bill is considerably higher.
Steven of Worcester. OTHER (07/19/08)
I was asked to see a patient employed by Starbucks Coffee in Exton, PA by his mother who lives in the UK. The patient had been suffering for 5 years with recurrent, chronic gastritis. As an employee of Starbucks, the patient enjoyed health insurance supplied by Aetna. His Aetna aproved PCP had referred the patient for endoscopy. three years later, the endoscopy needed to be repeated. Unfortunately, Aetna had refused to pay the bill so the patient suffered for a further two years unable to access proper health care because Aetna had not paid the bill. His mother, in desperation, asked me to see her son in the UK and Starbucks, very kindly, agreed to let the patient have sick leave in order to visit the UK.
I telephoned both the Aetna aproved PCP and the Aetna representative at Starbucks, Mr. Franada. Mr. Franada agreed that Aetna was wrong in not paying the bill for the Main Line Endoscopy Centre as the patient had been referred by an Aetna aproved PCP. (The doctors name appeared on the pathology report as the referring physician!)Mr. Franada also agreed that the patient would be covered for treatmant in the UK, (less his co-pay). Needless to say Aetna have not paid the Main Line Endoscopy Center invoice as promised and are only paying $164.10 of a $1201.94 invoice for the treatment the patient received in the UK.
Aetna's treatment of the patient is a complete abrogation of their duty of care. The patient suffered for two years because Aetna refused to settle a bill at the endoscopy center. Indeed, had they settled this bill in the first instance they would have saved themselves the cost of multiple ER admisions, doctors' office visits and would have saved the patient two years needles suffering and risk to his health. Furthermore, the patient's visit to the UK and my involvement would not have been necassary.
The patient suffered from a chronic infection of the gastric mucosa with an organism called Heliobacter Pylori. This is a simpe condition to treat but, because the patient was unable to undergo further endoscopy, (because the invoice for the first visit was unpaid), the patient suffered for a further two years and, eventually, had to visit the UK to access proper health care. The bill for the Endoscopy Center remains unpaid and, should the patient suffer a relapse or reinfection, he will again be left without access to proper medical care. H. pylori infection is a major risk factor for peptic ulcer disease.
Research has indicated that infection with H. pylori increases the risk of gastric cancer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and possibly pancreatic cancer. These risks were increased by Aetna's unacceptable treatment of this young man. Of far less importance, my invoice for $1201.94 remains unpaid! I can stand the loss, the patient is a young man of limited means and with inadequate health cover.
Catherine of Baltimore MD (07/15/08)
My PCP recommended that I undergo a colonoscopy for screening purposes. I contacted AETNA and was assured that the procedure was fully covered. the physician also told me that it was his understanding that it was covered and that it was, in fact, illegal in the State of Maryland for him to charge other than what AETNA paid. The procedure was performed on February 6, 2008. AETNA paid nothing.
Now, I am being billed over $700.00 for the procedure. AETNA denies having ever spoken with me. Plus, each time I call I get different answers. The physician denies any knowledge and says that there must have been some sort of a misunderstanding.
Bad feelings. I am in the process of filing an appeal.
Jeffrey of Apo Ae OTHER (07/04/08)
paying for health insurance from a ghost. I have called, asked my management in KBR, went on line and still I have had dead end street after dead end street. I have paid for coverage for 6 months and I still can't get any information from the company about my benifits or how I can prove to a health care official wether or not I have health coverage. I went on line and filled out the registration form several times and each time it sends me to another link wich tells me the resource I am trying to reach does not exist.
Theft from my payroll deduction money's for longer than 6 months and also I was told I have no choice but to purchase the insurance or not work for KBR.
Najah of White Plains NY (06/14/08)
I have for the last 2 years been recieving medical bills from various labs and hospitals for medical work done. I have contacted aetna over and over and over again and even spoken with various supervisors who always inform me THIS TIME the problem is resolved. I have now recieved several thousand in medical bill that now state we have tried several times to bill your insurance company and they have not responded so this is now your responsibility.
I have now been notified that by 6/24 they will be sending the matter over to a collection agency . At this point I dont know what else to do or where else to go. I cant get anyone to just pay the bills they were responsible for.
The stress of this ilone is enough but now I am beong threatened with collection agencies and I have already recieved one letter from a collection company. Why can anyone resolve this problem?
Claude of Laurel MD (06/13/08)
I tripped on uneven sidewalk over 2 years ago and injured my knee. There was pain and swelling and I was sent for an X-ray which was unclear. My doctor wanted an MRI. He also brained the fluid from the knee. I went to an orthopedist who drained the knee again.
The request for an MRI was denied for the first time. The knee swelling was drained a third time and a second request for an MRI was rejected. The doctor requested a third time an MRI which was approved but for the wrong part of my leg and the nuclear medicine person could not do an MRI on my knee. My knee became infected and required weeks of antibiotics.
A second orthopedist was also of the opinion that an MRI was needed and submitted the proper request. Guess what! a 4th rejection from AETNA. I suspect the AETNA pays people in an office somewhere in the Carolinas to follow some rejection script that they don't understand and to reject requests based not on need, but on financial issues.
Don't know the damage since MRI would be needed to determine what is wrong. Emotionaly is wears away, and the pain continues. THANKS AETNA FOR YOUR COMFORT AND CONCERN
Eugene of Downingtown PA (06/12/08)
I have medical insurance with Aetna. When we first had the plan it was great and now they have not paid a claim from January 2008 and there are about 50 claims. I have 200 deductible per year. The plan that I am under is from Amtrak. I am a very ill man and need your help. When people check my medical coverage they report that we are well covered. The Doctors are threatening me with being turned over to a collection agency.
Dr's will not want to treat me with all of these bills going unpaid.
Karen of Woodbridge VA (06/08/08)
In my complaint with Consumer affairs dated 6/2/08, I would like to add the following written by my doctor yesterday: I evaluated your dental models again and in the transverse dimension, you have a 4 mm transverse deficiency in the maxilla. According to Aetnas Clinical Policy Bulletin on Orthognathic Surgery (dated 02/28/2006) you meet their criteria. On page 2, under C. Transverse discrepancies, 2. Total bilateral maxillary palatal cusp to mandibular fossa discrepancy of 4 mm or greater. You meet that criteria! Therefore, they must cover at least the maxillary surgery on that basis alone. In addition, you have a probable non-union in the maxilla on the left side that can be corrected at the same time. Obviously, both jaws need advancing to correct the airway concerns.
The complaint is my surgeries fell under Aetna's guidelines the entire time which was stated in the pre-certification and models sent to Aetna back in January. Aetna looked for every reason possible to deny the surgeries instead of looking at the facts that my case did fall in their guidelines. They have now put my health at risk with having to undergo another surgery along with financial hardship having to fund for another trip back to Texas for the surgery and more hospital fees that could have been avoided.
Meantime I have to suffer in pain while the joint surgery heals to undergo the jaw surgeries. I also have the risk that my joint surgery may fail due to the jaws not being corrected not to mention my restricted airway at 4mm is life threatening. This negligience on Aetna's part has put my health at risk and will cost further hardship both financially and for my family.
Eric of Hesperia CA (06/07/08)
i went in for blood work on 8/10/07. i gave my ins info to the front desk lady. i have united commercial food workers union and aetna. 10 months later i get a bill for 62.20. aetna wont pay claims over a year old. i sent the information in the mail a second time about my insurance info. I keep getting these bills in the mail. it seems like busnesses dont bill ins til its too late.
Karen of Woodbridge VA (06/02/08)
I have been denied part of my surgery by Aetna Insurance. Dr. Larry in Dallas, Texas has diagnosed me with Bilateral TMJ arthritis and disc dislocation, Maxillary hypoplasia, Mandibular hypoplasia, pain, non union of jawbone, and decreased airway. Aetna approved the TMJ joint surgery which I had on 5/6/08 but still has denied me the remainder of my surgery which is Multiple maxillary osteotomies with bone plate stabilization and grafting, bilateral mandibular ramus osteotomies with bone screw stabilization.
I presently have a 5mm ROM and no lateral movement and a 4mm restricted airway which 11mm is considered normal. I have lost all jaw function and also suffer from non-union of jawbone that Dr. was going to correct with grafting. My upper palate is so narrow that it affects my speech because my tongue does not fit in my upper palate. My doctors feel my misaligned jaw is causing my joint problems and function problems and if not corrected my condition will not get any better. I am unable to eat because of my 5mm ROM.
At this time Aetna has just denied my second appeal using cosmetic reasons as the reason for denial and feels braces can correct my problem. I am in my third set of braces and each time have had a major relapse when the braces are removed. I had a Lefort surgery and Arthroscopic surgery which both have failed.
Dr. W is well known for taking on complicated cases as mine and has high hopes that he can correct my medical problems and improve my quality of life. He stated to Aetna that my 4mm airway is life threatening. I have also provided Aetna letters from five other doctors stating my surgeries are medically necessary. I contacted over 20 doctors in the DC area last year and all informed me that my case was too complex for them to handle and referred me to Dr. Larry W. Last week my local doctors updated Aetna that my 5mm ROM and no lateral movement has not shown any improvement. Despite all of this Aetna continues to deny my surgeries. I spoke to Virginia Insurance Commission and he informed me that under Virginia State Laws my surgery is required to be covered, but my insurance plan is self insured so he stated he could not help out.
This has put a finanacial strain and hardship on my family because I have endured over eight complication surgeries and now denied part of a surgery that is medically necessary to put these complication surgeries to an end. I have spent hundreds of hours on the phone with Aetna trying to get approval and now since they didn't approve my entire surgery when I get approval I will have to pay again a plane ticket back to Dallas, Texas, hotel accomodations for up to two weeks. I also will have to endure five more months of suffering in pain that could have been avoided if Aetna would have approved all procedures. I have been on continuous painkillers since December of last year and will have to continue on this medication since my jaws are not lined up properly causing major muscle spasms. At this point I feel Aetna should be prosecuted to the fullest for not approving me surgery despite the 50 or more pages of documentation that was sent in warranting why this surgery is medically necessary.
Jesse of Pretty Prairie KS (05/30/08)
On Feburary 2nd, 2008, I missed work due to lower back problems and filed a short-term disability claim through Aetna, my disability insurance provider. I have had 2 lower back surgeries in the past, and suffer from chronic back pain resulting from degenerative disc disease. I saw my doctor and he requested a leave for several weeks to get my pain under control, and I was unable to return to work while I was taking the medication he prescribed me (Opana). At this time, I filed all of the necessary paperwork for my medical claim to receive my short-term disability benifits. The Doctor's office submitted office notes specifying my condition and stating why I would be off work for the time being.
I did not receive any contact from Aetna for several weeks, and when I did call in to check the status of my claim, my case manager, Judy Vasquez, was very unhelpful and rude. Several weeks later, I received a letter stating my claim had been denied due to lack of medical evidence that I should be off work. My doctor was outraged by this and said there was no reason for them to deny my claim. While I was still off work, I was injured by an accidental gunshot while removing a rifle from the gunrack of my pickup, and hospitalized for 6 days, from April 1st to April 7, 2008.
I was lifewatched by helicopter from Pretty Prairie, KS to St. Francis Trauma Center in Wichita, KS and spent the next 2 days in the trauma intensive care unit. I spent the next 4 days in the hospital with a chest tube in my lung, broken ribs, and slight liver damage. The gunshot had torn through my lung, torn my diaphram, grazed my liver, and shattered 3 of my ribs. We contacted Aetna to see what we needed to do to file another claim for this injury. It took MANY phone calls and almost 3 weeks before we got a straight answer from them regarding the status of my claims. They then informed us that all the time off would be filed under one claim, and that we would need to submit all new information for this injury and time off under the appeal for the first claim. We submitted over 50 pages of information. They requested all of the records from the hospital, including complete records, discharge summary, history and physical diagnostic testing results, progress reports, admission records, office notes, and restrictions.
After gathering all of this information from the hospital and trauma doctor, we submitted it to Aetna Insurance Company. I am still waiting to hear the status of my appeal. It has been almost 4 months since my origional claim, and over 7 weeks since my second injury and claim. They have not responded to phone calls and messages my wife has left repeatedly. When her or I do speak to my claim manager, she is extremely rude and unfriendly and seems to be bothered by our questions. When I saw my doctor again recently, he could not believe we hadn't received any benifits from Aetna Insurance Company yet. My doctor asked if we had involved an attorney yet and we are currnently unable financially to do so. Due to the lack of benifits and information, we have come under extreme finincial distress and are relying on donations and the goodwill of our church congregation and others to get by.
This has been an extremely stressful situation, physically, emotionally, and financially. We are doing everything we can to jump through the hoops that Aetna Insurance Company has asked us to do. I feel as though we are not receiving the attention we deserve to this matter. I also feel like Aetna is not taking our situation seriously. My doctor stated that Aetna is stalling, and that if they take long enough, we will just quit trying. That is not the case. We need every penny that is due to us from this time. Aetna is not providing the services that they should. They do not realize the gravity of the situation.
I get the feeling from Judy Vasquez, and others that I have talked to at Aetna that they don't feel like they should help us. They don't seem to act like this is a serious case that should be approved? I pay for this insurance to be covered for incidents like this, but they are NOT providing the services I have been paying for. I would like to see some sort of investigation to look into this case and see what the outcome is supposed to be. I am still off work at this time, due to the damage to my lung and to my ribs. It is unknown at this time when I will be well enough to return to full duty and work my normal 12 hour shifts. I am pleading for help from wherever we can get it. I need to know how to plan for the future and our continuing crisis.
Due to the circumstances caused by the inactivity of our insurance company, Aetna, we are in utter and complete financial distress. Since we have not received any payment since the beginning of February, we have fallen behind in everything. We have scraped by, buying only the necessary groceries, paying the minimum on our bills, and letting our credit cards and other debts fall delinquent. This could have all been avoided with prompt and accurate attention to our situation by Aetna. The emotional distress caused to myself and my wife has been extreme, and it is taking a toll on us mentally and emotionally. We can barely afford fuel money for my wife to go to work, providing the only income we have. I do not want their lack of attention to affect our economic future, but I'm afraid it has already.
Elisa of Bristow VA (05/29/08)
I spoke with claims dept location at el paso, tx. I filed a claim from 8/2007. I received reimbursement for 8/6-11/30/07 and 1/1-1/31/2008. 12/1-12/31/07 was missing. my claim for the months mentioned was denied twice before and put in for a third approval after numerous calls. claims dept insisted that i was not approved for services received. After many e-mails and phone calls, they realized that services for the said months had been approved and they over looked that. each time my claim was denied , I had to wait 10-45 days between each time the claim was submitted (for 8/1-11/31/07 and 1/1-1/31/08). I received payment for that claim at the end of april 2008.
On 5/6/08 i sent in the missing month of Dec for reimbursement,by fax with a note attached that it was the missing month and please process. I was told Iwould be reimbursed 7-10 business. after those days passed I called member services and was told my claim denied. I asked why and once again they realized that the service was approved and I should get reimbursed. Aetna does not contact clients when claims have not been approved.
On 5/16 I resubmitted the claim by fax and cheked in 10 business days (5/27 and 5/28) and online the claim said in progress . on 5/29 today the claim was once again denied for no apparent reason. I spoke to Nakia in member services and after being on hold for 32 minutes was told that they were resubmitting my claim and this time it would go through. once again she admitted they had made a error and see where this claim was previously approved.I was told once again that i would have to wait 7-10 business days for my claim to be processed and I quote Ms Nakia Sophia from claims put your claim through and it will not be denied this time I will watch your claim and check the status each day until the check is done I wanted to know why I had to wait 7-10 more days. I expreesed to Nakia that there should be no wait time and that they do have a way to process this without the 7-10 days wait.
Managers and Supervisors do not want to talk to members, but force you to deal with Aetna staff that has no authority. I requested an address where I could send a letter to in reference to my claim and was told I could only have a P.O Box and that was all they are authorized to give members.
Currently my husband (he has Care first insurance) is getting 6 months of chemo for sarcoma( a rare cancer) We are not able to make ends meet as it is.I expected to get reimbursed, for my claim so I could pay bills that are piliing up. Aetna doesn't seem to want to reimburse members for claims , even if they have been submitted correctly. They seem to want to hold onto your money longer and hope you give up trying to collect on out of pocket expenses from claims that are constantly denied. Some people do not have it in them to keep on resubmitting and fighiting for what is right when they have sick loved ones to care for.
Sarah of Baltimore MD (05/28/08)
Aetna has repeatedly denied medication claims and has refused to pay for routine doctor visits. I have had to jump through ridiculous hoops just to get simple perscriptions paid for. They will not pay for vaccinations I need. When I first started with them six years ago, I was very happy with their service. Now, I am disgusted. I do not know what has happened to them internally within the last two years, but something drastic has changed. They deny even the simplest claims. How can a health insurance company deny vaccinations? Perscriptions? Doctor visits? Is there any recourse to this? I am looking for answers.
I have had to pay thousands of dollars in out-of-pocket medical expenses for a variety of routine doctor visits, vaccinations and perscriptions. I have had to use public resources usually only available to the uninsured because Aetna will not cover simple vaccinations. I have spent untold frustrating hours on the phone trying to sort through matters with Aetna. I have been without essential medications for long periods of time because Aetna abruptly discontinues covering these medications.
Dawn of 203 Windsor Ct PA (05/24/08)
I am insured under a NJ Aetna Health Plan. Under the famiy building Nj law, I am enititled to infertility treatment. Aetna has denied this. They are subjecting me to preauthorization to see if I meet criteria to reproduce. This is in violation of the above law.
i cannot have a child w/o infertility treatment. i am not pregnant.
Gerald of Huntington Beach CA (05/15/08)
Delayed, Lost, then Delayed, then Lost, 3 more times for a Long Term Maintance Rx
Without Rx for several months, and out of Medication
Lovey of Locust Grove GA (05/06/08)
I have sent a certified letter in October 17 2007 requesting a refund of my money. In January I sent another letter regular mail also requesting a refund. I worked for Delta Air Lines and I no longer work for the company.
On the 18 September 2007 I contact Aetna to inquire about purchasing insurance both medical and life for myself and my daughter. The package was sent to me and after reviewing the information sent, I was unable to pay for due to no longer working. (package received 26 September)
I contact Aetna 29 September 2007 and spoke with a gentlemen name Steven and explain to him at this time I am unable to purchase the insurance I had while working at Delta. I ask him if there was other options. While looking online I found the refund policy. Now I am sending this via email due to the lack of response from the department in which refunds are handle. I worked in the refund department for Delta, I know that there is sometimes a 90 day turn time.
Donald of Louisville TN (05/01/08)
I've had Aetna Ins. for about 3 years, for the last 2 years I've had to be on dialysis. The first year my bills were paid, now I find that none of my treatments for 2008 have been covered leaving me with 25,000.00 in bills. I've talked to serval people at Aetna and so has my wife and over the first years they were helpful and polite, now I find I get the run around and the rudest people I've ever dealt with and considering I was a police offer for 31 years thats a lot. I don't know what will come of this but if it does get settled and I have to stop treatments I will die . They also told me they don't have a clinic with 50 miles of my home they will cover.
Timothy of Pittsford NY (04/30/08)
I have hospital indemnity coverage through SRC, an Aetna Company which states that if any family member is hospitalized we receive a payment based on the total number of days spent in the hospital. My wife was hospitalized on February 15th, 2008. Since the beginning of March I've been trying to get the company to pay me the benefit they owe me.
Each time I call I get a representative that either doesn't know what they are talking about or they purposely say things to get me off the phone and when it doesn't happen I get frustrated. Either way, I eventually got through to a supervisor, her name is Tasha Hill and here is where my final and most legitimate complaint comes in to play. On april 14th, I faxed the exact form she requested to her direct fax number, got confirmation of the fax being sent, and then called and left a message stating that I had faxed the form and if there were any issues to please call me. I got no call, so I assumed my problems were over.
It's now April 30th and no check has been received. The reason i say that is in the intial welcome paperwork I received from SRC, an Aetna Company it was stated that your payment will be mailed to you approximately 7-10 days after receipt by SRC. On top of not receiving the check after 16 days, 2 representatives this morning told me they don't even see the claim being processed.
I have bills that are waiting to be paid with the money I was counting on from this benefit.
Sam of Edina MN (04/24/08)
Aetna refused to cover my wife's Ultrasound of 20th - 1st and only 1 ultrasound of her pregnency. Most other insurance companies like Unites health cover pregnency and hospitalization cost 90% in true sesns..Aetna made us pay almost 30000 $. The whole American Medical system and Insurance companies are a bunch of thieves ! Poor people bear the brunt of this.. America needs to consider 'Outsourcing in Medical treatments' and stop suing doctors mindless sums . Its the only way to reduce treatment costs !
Jenna of Reading PA (04/22/08)
I have aetna as my health coverage carrier. The problem that i am having is I took my son for his 24 m well check up on 3/27/08 that was the soonest that the doctors office could get him in... My sons birthday is 2/13/08.. The insurance company has Denied the claim for service because he was 25 months old at he time of service even though the whole reason for taking him there was so he could get his 24 m check up and shots done..
When I call the insurance company they told me that the y do not cover 25 m check up just 24m and i try to tell them that this is his 24m check up and that i could not get him in any sooner. Are insurance companies really allowed to do this.. Cause now i am stuck paying the 200 dollar bill that should have been covered fully by the insurance company.
200 dollars might not seen like a lot to some people but in a middle class family that is a lot.. Now i will have to struggle to pay this bill so i am not turned over to the credit bureau. I just wish i knew how to make this aware to more people so the same thing doesn't happen to them.
Michelle of Sewell NJ (03/24/08)
It all started in 7/06. Yes, almost two years. After realizing I would need to seek some treatment for my unexplained infertility, my eyes were widened to the fact that Aetna has not one employee who does their job or tells you the same thing twice. Initially I was told I had no benefits at all for infertility treatment. After much crying and not understanding, I asked for a supervisor. It was then that I was told I did have coverage. Two stories there. As my treatment progressed, I realized I would now need to inject myself daily with medication. I wanted to see if it would be covered. Again, I was told no. After pursuing the issue further, as usual, it was confirmed that I did indeed have coverage for the meds. Again, I must note that this is after MANY hours of phone time and MUCH crying on my part.
Now it's on to the pharmacy. They couldn't manage to ship my meds in time, which are time sensitive, of course. My doctor was fortunate enough to have other patients who no longer needed treatment and they donated their meds until the ones that were due to me finally arrived. That lead to another problem. The next month they said I couldn't have them yet because I just got some; didn't I have any left? Well, because they mailed it late, now they were denying the next round of treatment. Hence, more tears, anguish and stress. Really not something who is trying to have a baby needs, which I did tell them.
I finally get pregnant-yeah- but unfortunately I had a miscarriage. Here is where it gets crazy. I had to treat again, obviously, and they told me that I should have medication left over from before the miscarriage. Well, I did, but only until I found out I was pregnant. It was then that I threw them away since I no longer needed it. I was denied any new meds and was told to pay out of pocket, thousands of dollars, and maybe I would be reimbursed on appeal. Thank God I didn't do it. My appeal was denied. They told me it was considered lost or stolen meds. Of course, it was neither. Next round of meds they accidentally took $130 out of my checking account for co-pays they said. I have been on these meds for months with no co-pays. They said my plan must have changed. It didn't. They finally figured out that I was due a full refund. That was 2/19/08. I still have no money. They claimed they gave me a refund on 3/4/08. Apparently they had a system glitch, yes, that's what the supervisor called it. They were going to overnight it 9 days ago. still no check. I called today and was told they are still working on it. Of course they always say sorry, but is that paying my bills?
I'm out $130 and countless hours of time. I would like a copy of my notes on file by Aetna. Of course they won't give them. Do I have any way to resolve this? It's completely horrible that this is how people with problems/injuries get treated. I don't need to be reminded all the time there's something wrong with me.
Paige of Sunbury PA (03/08/08)
Most recently, went to Williamsport Hospital for a possibly broken ankle. My claim was denied with no reason and I just received a bill for $447. Every claim I have made has been denied (Aetna claimed I did not have coverage when I did or they claimed it was a preexisting condition) and when I fought it they changed their mind.
Melissa of Alexandria LA (03/04/08)
My son fell and tore ligaments in his right ankle. We visited the emergency room the night it happened and made plans to follow up with an orthopedic doctor as soon as possible. I called my insurance company, Aetna, after I found that no ortho doctors were in our town. Denisca (sp.) in member services verified that the closest ortho doctors in-network were around 70 miles away from me. She said we would apply for pre-certification because of limited availability. I gave her the name of the doctor I had an appointment with, and she said to call back before the appointment to see if it had been approved. So, I called this morning to find that it had been denied because Aetna says there are providers in my area--a direct contradiction to what their own employees told me a few days before. I called the doctors (two in the same practice in my town) provided by Aetna. Neither one of the doctors is an ortho. Of course, I have to go pay out of pocket to the ortho doctor and get his office to try to get Aetna's decision overturned.
This is the first time I've used this policy, which I got through my job. I'm not impressed at all so far with the customer service. No surprise to me that they'll take my premium money, but won't be there for me when I need the coverage. I'll be paying out of pocket for at least one visit to the ortho doctor. I can afford it now, but if Aetna continues to deny coverage, it could be an issue. I'm a single mother and earn a decent wage, but it only goes so far.
James of Bloomington IL (02/19/08)
I have a BIG problem with Aetna Insurance company for my health coverage. This has been an ongoing problem since 07/28/2005. They have consistently refused to pay for medical bills incurred for my daughter (1) charge; (28) charges for my wife Diane; and (38) charges for myself. Now as of today, 02/19/200, I have received notice I am being turned into a collection agency. Aetna uses the excuse that they have not received EOB, or explanation of benefits, or that I did not get a referral to see another doctor from my primary physician. I have done so on every count, and they continue to deny me coverage to see a specialist for my Rheumatology. My insurance card which Aetna issues states no referral is necessary. When I do get a referral they deny and state no, it's out of network. I send in the EOB's myself by fax, and still they drag their feet. It's ridiculous. As always I keep copies of these, too. I have always been in good standing with my credit, but this will not help me--getting turned into a credit agency.
This was for a billing of $725.00 from my rheumatologist which was okay'd last year after I had a referral from my primary doctor. This time, as requested, I had a script from my doctor and faxed it to Aetna to show them. They then informed me that they couldn't okay the coverage since it was out of network. Now they are refusing to pay this bill from 08/24/2007. This was turned into CB Accounts Inc., Nat'l Communication in Peoria, Ill. Ph. Number is 866-867-0179. I have always had good credit, and this will affect it greatly. I am in dire need of assistance and hope and pray you can assist me. This stress has caused my rheumatitis to flare up more than once and have been put on two medications since being diagnosed last year. Please help me or direct me to someone who can help me. Thank you.
This has caused me to incur bills of $725.00 for this last rheumatology visit in 08/24/2007, and a current bill from Carle Clinic in Bloomington of $1,818.62.
Rene of Landenberg PA (02/17/08)
Aetna Medical insurance will not pay for oral surgery that is medically necessary even if their benefits documentation says they will. Last Summer my twins had impacted wisdom teeth removed under general anesthesia. This procedure was recommended (by my dentist after x rays) to be done by a surgeon as soon as possible since the teeth were causing pain and in danger of pushing their teeth completely out of alignment.
Upon arriving at the surgeons office for the preop visit, I even asked the administrative personnel to make sure this procedure didn't need to be precertified or anything. Their response was that for Aetna insurance no precertification was necessary. However Aetna has refused to pay these claims for 8 months now, stating that the prodedure was not a medical necessity. What they tell me now is that they don't consider this a medical necessity because it wasn't damage done by a car accident or something.
Kelly of Philadelphia PA (02/01/08)
During my husband's recent open enrollment, we switched from Keystone to Aetna. We were told when we called Aetna to confirm coverage for maternity care that they had a program similar to Keystone, and we would be paying a copay for the doctor's visit only once. I then asked specifically about ultrasounds because I would be almost 6 months along with a twin pregnancy, and they said they are covered when referred by your doctor. Later after enrollment I find out: yes, they are covered, but each time I have to pay a $40 Copay. The same goes for any diagnostic testing (ie. the Non-stress tests or blood work). I am very glad I had Keystone for the beginning. Now I am angry and think everyone who knows they are pregnant or is planning a pregnancy should know about Aetna and how they use terminology to cover up what is very bad maternity coverage. It has made us rethink whether we really need tests our doctors order, and we have canceled appointments hoping that everything will be okay.
Please don't make the same mistake we did. Aetna does not have a Maternity coverage program that is any different than the regular coverage they offer. Mom's to Babies is a joke; it has nothing to do with financial coverage. Just some nurse calling you to ask how you are. I have a doctor and friends to do that.
All of the diagnostic testing and ultrasounds will result in over $1000 more in copays then if we had stayed with Keystone and enrolled in their maternity program.
Somer of Eugene OR (01/28/08)
I called Aetna before I took my children and myself in for flu shots to find out if they would pay. The girl told me yes, 100%. I asked if I went in to my doctor's office flu clinic for just shots and not to see the doctor would I be charged a copay? I was told NO Charge for just shots when the doctor was not seen. Then I get billed copays for all 3 of us.
I called Aetna back was first told that the doctors billed it as a doctor visit. Called the doctors and they told me no, it was just billed as shots. No doctor. Called Aetna back and was then told that they charge a copay no matter what. So I ask for a supervisor. Got her voice mail and left a message that said she would call back in 24-48 hours. Two weeks later I still had not heard from her. So I emailed the Customer Service. I was sent this email:
Thank you for using the Aetna Navigator website to contact Aetna Member Services. This is in response to your claim question on Cheyenne for October 23, 2007. Your plan requires a copayment be taken for any office encounter even if no office visit charge is billed. It appears that your doctor's office policy is not to take a copayment when there is no office charge billed. However, this is not your plan of benefits. You were told 2 times that the shots would be covered at 100% after the $20.00 copayment was applied. I have forwarded your request to the supervisor of the account. However, you did not provide a phone number that she can return your call and we do not have your phone number on file. If you have questions, you can reach Member Services by logging on to www.aetnanavigator.com and select Contact Us. You may also call the toll-free number on your member ID card. Sincerely, Internet Response Team Aetna 12159058.
I told them that the first 2 had said no copay charges for shots only, and asked for a supervisor to call me. They emailed me back:
Thank you for using the Aetna Navigator website to contact Aetna Member Services. I am sorry you were dissatisfied with Aetna's service. We strive to give our customers the best service possible. I have sent your return telephone call request to the supervisor of this account. Please allow 24 hours for a return call. If you have questions, you can reach Member Services by logging on to www.aetnanavigator.com and select Contact Us. You may also call the toll-free number on your member ID card. Sincerely Internet Response Team Aetna 12188095
It has now been another couple weeks with no calls from Aetna. The first time I called before going in for shots in October I asked about a copay so that I wouldn't have to go through this. So I have had 3 different stories about what and why I am being charged. I didn't write down the exact dates I called, but for any future things I will write down everything and have them send me a email to confirm what was said. The fist call after I was billed was about December 21 2007. Then I emailed Jan. 4 2008 and Jan 7 2008. I just emailed the BBB and complained so I am now waiting to see what happens. I also want now to drop Aetna and find a different insurance not through work, but have been told I have to wait to drop it until next December.
We live on a very limited budget. If I have to pay the $60 in copays it has to come out of my food budget. I stress out now about having to go to the doctor at all. Because Aetna ends up making us pay for everything.
Mary of Everett WA (01/23/08)
The dr wrote all new prescriptions for my mother, and my mother gave them to me. I called Aetna and was told I could fax them to 1-800-416-9264, but to put my mom's ID# on each prescription. I did and sent the fax right away since she was almost out one of her medications. I called my mom a week and a half later to see if the medication arrived. She said no, that she had just received a call that there was a problem. When I called to inquire about the problem, I was told that Aetna does not accept faxes from a non dr office, that they would cancel the order. This took over one week to notify us that there was a problem!
Bottom line, Aetna has poorly trained employees, they treat you like you are at fault (they told me this), they don't take initiative or follow through, and things don't happen the way they tell you they will happen. I'm livid, and not done dealing with them. I will definitely file a complaint, but I'm sure that will fall on deaf ears...they just don't care that they inconvenience you and delay needed medication, because they say it's not their fault. This is the edited version.
Antonio of Barnesville GA (01/21/08)
I have been insured with aetna through my job for over two years. I started having dental problems and found out that they only pay $500 dollars per year and they denied most of my claims, so I tried to cancel the insurance in October of 07 and found out that aetna had automatically dropped my coverage on May 8th, 2007, but were still taking it out of my paycheck. I have been calling since October to get them to stop and trying to get a refund. It is now January 21st 2008, and it is still being taken out of my paycheck and I haven't received a refund for those eight months that I paid and had no service. Every time I call all they say they can do is send emails for a call back but I received only one call since October. I was told to contact the state insurance comm. and a lawyer which will be my next step.
I've lost money that I could have used because they don't want to refund my payments, bad credit because of medical bills I cannot pay out of pocket, and constant pain because of dental problems that are getting worse.
Benny of Lithonia GA (01/09/08)
I have Aetna Home Delivery for all my maintenance prescriptions. I filled out and mailed the reorder form and my check. On 01/07/08 I received a automated call stating there was a problem with my prescription and they needed to contact the doctor. I received another automated call on 1/09/08 stating that they could not contact the doctor's office so they would not be filling the prescription. I called and was told since the doctor office couldn't be contacted they were cancelling my order. I asked which one and was told it was for a new prescription for Soma (muscle relaxer). I told them I was in a traffic accident and this was prescribed the following day to help with the pain by relaxing the muscles. I was told the only thing they could do is for me to go to the doctor for a new 30 day subscription and take it to a local pharmacy. So, it is almost 3 weeks since the prescription was written and it still has not been filled. This is a continual problem with Aetna and their home delivery process.
Jojo of Moonachie NJ (01/07/08)
Aetna tries to get out of paying almost every claim we submit with the exception of our PCP. I have spent and wasted many hours and had many stressful moments because of this horrid so called health insurance company. They even tried to get out of paying for my hubby's emergency appendectomy...took me 2 months to get them to pay. This is not acceptable; they have been sued for not paying claims in the past. Guess they don't learn lessens easily! What goes around Aetna, comes around! I also reported them to Dept. Of Banking & Insurance!
Undue stress and money we put out which we should not have had to!
Miriam of Magna UT (12/26/07)
I have had this insurance for a couple years now. Every time I have used it they have denied my claims. I have had to fight for the benefits I pay for. It has taken me months to get bills straightened out because they claim not to receive paper work or proper referrals. They have gone after me for preexisting conditions, which I have proven are not, and then they turn around and denied the claims again for the same reason. I am mortified to use my insurance. I have stayed up many nights stressing about my coverage. Right now I am going through a high risk pregnancy. I had an ultrasound done when we first found out I was expecting. I had an IUD in and we had to find out if it was a tubal pregnancy, etc. I was shocked to find out it was paid first time billed.
Early November I had another ultrasound done, my 20 week ultrasound. The day before I had it done I called Aetna to make sure all paper work was in order and that the provider was in network. They told me I would be fine. Well, the ultrasound was denied for being an experimental procedure. I called told them it was not, it was a normal ultrasound. The gal that works for Aetna said give us 10 days to get it reprocessed. It looks like it was a mistake on our part. Then today I called them to see why it is being denied again; now they claim that they cover only one ultrasound per pregnancy; and now I have to go back and make the place that did my first ultrasound re-bill them under different codes, then get the 2nd ultrasound re-billed as well. Then they claim they will pay for both. Now I'm afraid that they will put up a fight to pay either one. I am saddened to say that I am not the only they give so much trouble too; many of my co-workers are going through similar situations.
I am physically ill over all this. I have prenatal care pending. I need to get all my bills up until now covered before I get more things done.
Cheryl Lynn of Rockville MD (11/19/07)
Aetna Health are not paying my primary care doctor any money since she is out of network. I have $2,500 & $7,500 for out of network use. The charge was $800.00; and they didn't pay her a dime--no money to my back specialist.
I have to pay these medical bills out of pocket.
Noel of San Diego CA (11/07/07)
I applied for health insurance for my family and an agent contacted me. She received my application and check payable to Aetna. She said my check will not be cashed if my application is denied. I received a letter from Aetna Oct 3, 2007 saying that my application is not approved but I found out on Oct 17, that my check was cashed by Aetna. I've been trying to contact Bridgette and she does not respond to my calls and email.
Friede of Mesquite NV (11/02/07)
I have cronic back pain that requires injections to my back which Aetna covers they even cover the doctor that will perform them however the trouble is that the surgical center that the doctor uses is not covered. I am not sure why you would cover a doctor that can see you and diagnose you but cannot treat you. I called to find out what to do and they gave me a number for my PCP to call to get an out of the network approval to try to get the surgical center covered so I called the PCP to get it started. The PCP called and try to get it approved but they were asking for surgical codes which they didn't have because they were not the doctor that was performing the procedure so she thought that she started the claim but what I later learned is that according to Aetna she didn't. I then called the doctor that was going to do the procedure to let them know that they needed the codes and to call them with that info which she did. Then they called me back to tell me that the claim wasn't started so I called the PCP back and she called again this cycle went on for three days. Finally I called Aetna back and said that this system isn't working and they needed to figure it out because everyone was calling them and they had no record of it. They also told my PCP I had been terminated for my health care which was not true. They are laughing all the way to the bank cashing my premiums so I should not be terminated.
Aaron of De Pere WI (09/05/07)
Aetna/SRC has been delaying the processing of my claims and in some cases, not processing at all. I've been going through this with SRC/Aetna for over 8 months. I contacted my state office of the Commissioner of Insurance. At that point, Aetna/SRC processed some of my claims. However, once Aetna/SRC realized that my employer is based in Maryland, the have continued their non-processing. I keep filing and each time I follow up, I'm told they will be resubmitted, but when calling back, they never have record that I spoke to anyone.
All of these claims were for mental health maintenance prescriptions. I was diagnosed years ago with Bipolar Disorder, ADHD, and General Anxiety Disorder. As a result of not getting reimbursed for prescriptions, I am now not able to afford these medications. This has impacted all aspects of my life. My job performance has suffered; my mental health is at an all time low. I was engaged to be married but my fiance has since called off the wedding. All aspects of my life have gone downhill as a result of this.
Lisa of Marathon NY (05/18/06)
I was in the process of starting allergy injections and was not familiar with the insurance. I called to verify my coverage and they said that I would not have a Co pay due to it was not an office visit. I all the sudden started getting bills for my Co pay. When I called Aetna I was told that it was very unclear and did not come out and say that there was a copay and she did see where i was told that there would be no copay and that she would re submit the bills and if any problems she would call me. I waited a week and never heard anything.
I called again and was told the same thing that this women saw where there was a note saying i was told there was no copay and sent a message to please process the claims and she also said it was unclearly stated in my coverage and not to stop getting my shots that i needed them and it should be ok. I called today and was told no they are not covered and it was an error and they were not going to pay for them and the lady laughed at me as i was telling her that i dont have all this money to pay to catch this up, but would find a way.
I went into the doctors office and told them what had happened and they looked at the notes from billing and said the billing person had also called aetna and was told yes she was told there was no copay but that was and error and we will not cover the injections fully.
Now I have one bill and will be getting more to pay for the days that I did go and have to stop getting my allergy injections. I was tested for over 60 things and had reactions to all of them. I am taking medicine for my allergies and alburterol and advair for the asthma that i suffer from that the allergies contribute to. I now wasted all this money for treatment that I can not continue to afford to pay for so can no longer get.
Lori of Southampton PA (05/16/06)
Aetna has repeatedly denied/ignored requests for medical services and medications needed to treat two herniated cervical discs. They claim they have not received proper request forms in spite of repeated submissions of requests. It has been 4 months since my initial injury and I have filed two formal grievances.
Ongoing severe pain and emotional stress related to lack of responsiveness of Aetna. Inability to access services needed for physical therapy. Inability to access medications prescribed for treatment of condition and pain management. Need to spend countless hours of time in trying to resolve these issues, and still finding no resolution to the issues.
Theresa of Marietta GA (02/13/06)
My son is insured through my ex-husband's employer, United Airlines, with Aetna HMO. He switched from BCBS PPO during open enrollment of Oct. 2005. The policy was effective 12/01/05. As of February 13, 2006, Aetna has yet to provide an insurance card. My son had a doctor's appointment a few weeks ago which necessitated a lengthy phone call by my ex to both United Airlines and Aetna. He was told at that time that the policy information would be expedited. He paid out of pocket for my son's prescription on the promise that he would be re-imbursed for the expense.
When he attempted to settle the issue, he learned that his policy was indeed expedited but that of his two sons was not. At that time, the policy information did not indicate the two sons were covered. This was 5 mos. after enrollment, 2 1/2 mos. after the policy was effective. My son has an appointment with the specialist he was referred to during the previous visit. This appointment requires a precert which I am unable to get as the insurance company still does not indicate my son is covered.
After talking at length with United Airlines, I was advised to have the doctor's office contact the insurance company as research would show that both boys were indeed covered. Not feeling confident this would work, I attempted to verify coverage myself beforehand.Sure enough, when I spoke to the rep at Aetna, I was told my child was not covered. After spending more than 45 min. (something a doctor's office will not do) on the phone, I was finally told that it did show my son was covered but that he was listed as pending. I was told by Aetna, to have the doc's office call for verification despite that yet another attempt revealed that this information is not readily available without a prolonged conversation, hold time and in depth investigation into the matter. I was then told that if this did not work, I could pay out of pocket and Aetna would reimburse me although she would not fax me a promise of this.
To follow this advice is to set myself up for the insurance company to deny this claim. Ultimately, I am unable to take my son to the specialist unless I am willing to pay as an unisured pt. or wait until they have sorted through this and issued a card. It has already been 5 mos. since enrollment and 3 mos. since coverage was effective. This is inexcusable for a company so large as Aetna to provide such incompetent customer service.
I am paying my son's bills as an uninsured patient because I am unable to provide proof of coverage and although Aetna does confirm this by phone, the amount of time necessary greatly exceeds the reasonable amount any doctor's office will spend.
Ellis of Hartville OH (02/08/06)
I received a computer call about my Rx. I was told to call them or respond at that time, I was then put on hold for 45 mins. Heidi came on and was very nice but couldn't help me. Then Barbara came on and she also was polite and told me they were out Of my medication - AVANDIA - that I take for my Diabetis. I also am out, they do not know when they will get a delivery. I will have to now try to get it locally, but Aetna wants you to use Home Delivery so how long will the local pharmacist have to wait to get approval if I was on hold for 45 mins and they called me. I know why people are upset witht the medical insurance industy and the drug industry, not is it expensive, it is time consuming and difficult to even deal with them. I may try Canada. A trip up there every three months may be worth it.
Gail of Flourtown PA (12/23/05)
My daughter was quite sick while we were out of state on vacation, so we took her to a walk-in clinic. We were told by the clinic that they accept Aetna and our copay would be our doctor's office copay of $10. After 3 months, we received a bill and collection notice from the clinic indicating that we still owe $90. Apparently, walk-in clinics are classified as urgent care and Aetna's copay soars to $100. Aetna was very unhelpful when I called for clarification; apparently you just can't get sick when you're on vacation, or you'll pay for it - they had no other suggestions.
I am also upset with the walk-in clinic which misled us and I will never visit one of those again. I think Aetna should have paid the claim as a standard doctor visit, which is what it was. They have way too much red tape, so no normal person could ever figure out all of their loopholes, and I suspect most other Aetna members have gotten stuck with such an unexpected bill at one time or another; I wish someone had warned us (which is why I'm filing this complaint - I hope it helps someone out there avoid this mistake). At $1000/month for insurance, I think the least Aetna could do is pay a lousy $90 doctor bill for a sick child.
Dana of Albertville AL (06/27/05)
I have been diagosed with fragments of torsion dystonia and torticollis nonspecific.I was treated with botox(date of service was May 3, 2004) but aetna refuses to pay. However this treatment is covered for this diagnosis.This stated in their policy, they even sent me a copy. They stated they would not pay for botox for investigational or experimental services, specifically tension/migraine headaches and myofascial pain. My doctor sent a letter explaining my diagnosis of fragments of torsion dystonia and torticollis nonspecific, and that this was the reason botox was given and while I have the headaches this was not the reason the botox was given.
She resubmitted office notes and highlighted salient portions of the record. She asked them to reconsider. They sent a letter denying the appeal. They gave no reason for this and a phone number, above mentioned, and I called, a operator answered and could not tell me why. This is a legimate claim and I just want them to pay. Included in this claim is the medication, shot on left side, shot on right side, and an EMG. They say they won't pay for services or supplies determined by aetna to be experimental or investigational, however they paid for the shot on one side but not the other, nor the medication botox.When I asked why the operator could not tell me why. They have given me no further answers.
An attorney stated something about the plan being self-insured so I could only sue for the unpaid amount not any other damages. He said the other damages is how you can pay attorney fees.The current bill is $1846.00. The attorney said it would cost me more than that for the attorney alone. He stated Aetna knew that and knew it would cost more than the claim to get the claim paid if we took them to court.If I had that money I could pay the claim. I can't pay the claim nor an attorney.Not counting the principle of the matter.Please help.If they have done it to me they have done it to someone else.I am now covered by my husbands insurance which does cover this, the same company I had before my employer switched to Aetna.But I can't get treatment until this claim is paid.
Celine of Marlton NJ (08/20/04)
Aetna would not pay for my medication as it was not called in by the doctor himself. I will now have to wait 72 hours or longer to have this filled! Yet. what I do not understand, this was called in by his office. Okay Aetna, kill me. Even though it is not cheaper, you insurance companies have a very distorted outlook that paying an exorbitant amount of money is better than paying a few dollars!
I am lining your pockets while you are giving me horrific care! I hope you all suffer at some time in the future!
Allison of Carteret NJ (08/10/04)
My husband was treated at Riverview Hospital in Jan and Feb of 2004. The hospital billed his primary insurance company (BCBS) and received payment quickly. Riverview then sent the remaining bill along with BCBS explanation of benefits to Aetna in March 2004. As of today 10 Aug 2004, Riverview has sent the same bill to Aetna 5 additional times. I have spoken to AETNA myself and was told on 20 May that all paperwork was received and the claim was in processing. We received a bill from Riverview requesting payment because they had not yet received anything from Aetna. A couple more phone calls to Aetna were placed. On 30 June, I was told that all paperwork was received and being processed.
Received another bill from Riverview on 15 July saying that we were now 120 days overdue. Contacted Aetna on 26 July 2004 and was told that they still didn't have the BCBS Explanation of Benefits from Riverview. Talked to Riverview Hospital that same day and was told that they faxed everything over again. An Aetna rep (familiar with what has been going on) confirmed that they received everything. Received a notice on 5 Aug 2004, that Riverview is sending the payment to collections.
I contacted Riverview on 9 Aug 2004 to find out what information they had on file about this bill, how many times they have faxed things to Aetna and how many times Aetna has claimed to be processing this bill. In the meantime, I have found that BCBS has also sent over the EOB to Aetna. I contacted Aetna on 10 Aug 2004 and was told that they were still awaiting the Explanation of Benefits from Riverview. Aetna's rep claimed they were going to contact Riverview again. I explained to her that Riverview has faxed the bill along with the EOB several times over the past 6 months.
I also pointed out that how can an insurance company keep losing all the paperwork. It seems that everytime this bill went to Aetna - it magicaly disappeared. I also explained to Aetna that now all of this was going on my husband's credit report. Aetna's rep told me that there was nothing they could do until they received the EOB and bill. The rep also told me that they have no records of ever receiving all the paperwork from Riverview Hospital. And that if Riverview had to report us to the credit collection agency then that is what they have to do. It was not their fault.
I have had the worse headache that has been going on for the past 3 months trying to get this resolved. Now because of AETNA, this bill is going to go on my husband's credit report. This is hurting our chances of getting a house because of this. How can they get away with this? No one in Aetna seems to care....
Kellie of Palatka FL (02/11/04)
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 . They company representative told me that I had already paid my co pay and that part of my severents 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 husbands 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 that 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.
Joe of Gulfport MS (11/13/03)
They refuse to pay for Provigil for my son's behaviour problems. After complaining about this to the state insurance board, Aetna put most of my medical claims on hold as a revenge. They say they are waiting for info from me about any other insurance I may have. (I don't.) I answered this on their website. I mailed the forms in. I called them with the info. I mailed the forms in. I mailed the forms in.
My son's prescription costs are $380 a month. The medical bills that they are supposed to cover, but have on hold for months now, total several thousand. The doctors have started demanding payment from me.
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October 16 2008
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