Aetna Health Insurance

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Norman of Amarillo, TX June 23, 2009

I have an Aetna Select health insurance policy through Cobra. This Spring my primary care physician dropped out of the Aetna network. Aetna did not advise me, or any other insured members who used him as a primary care physician. When I learned, quite by accident that I no longer had a primary care physician, I called a physician in the network and asked that he be my primary care physician. I needed a physical exam at the time. He, of course, wanted to meet me before agreeing to be my physicial. I met with him. He agreed to be my physician and offered to do a routine a physical at that time.

Rather than making an appointment to come back, when I was already there, I got the physical and he submitted the paperwork, showing himself as my primary care physician. I have since received a new insurance card listing him as my "pcp". However, since he was not shown on Aetna's records as my "pcp" at the time of th physical, they won't pay for it. I will pay the doctor for the physical but will argue with Aetna until I run out of breath! This is typical behavior or a greedy for profit company.

Aetna is relying on a technicality to deny coverage for a normally covered routine physical condicted by an approved doctor in the Aetna system simply to save money. I can afford to pay the doctor. But, how many other small claims are denied by this company for no good reason other than to make more money? My claim is small, under 200.00, but when they deny a few thousand small claims because of technicalities, they make a lot of money and many who submit those claims suffer because they can not afford to pay for the services themselves.

mildred of brick, NJ May 26, 2009

I am sending this on behalf of my mother.

i had just gotten out of hospital for congestive heart failure, and had made a payment of 94.00 on a balance of 198.00. after several months, it dawned on me that i had not been being billed for the last 4 months. upon calling atnea the said that i had been canceled for not paying full amount. i than faxed them a brief letter explaining what had happened, i haven't heard anything from them. i am 82 years old and am living on ssi.

Romilda of madera, CA May 22, 2009

Beware. Even though my policy stated that the colonoscopy screening was covered Aetna did not pay. If you have a diagnosis of diverticulitis the testing is billed as diagnostic and the insurance will not cover the screening. This information was not included in my explanation of benefits provided to me by Aetna This common condition is being used against uninformed patients like me to rip us off. I had no signs of colon cancer and was advised to eat lots of fruits and veggies which I do already. A very expensive piece of advise! "Thank you for using the Aetna Navigator website to contact Aetna Member Services. This is in response to your claim question on 04-27-2009 in the amount of 1759.35. This claim was billed with a medical diagnosis, not as a routine preventive colonoscopy. We must process claims as they are presented to us. Since this was billed as a medical diagnosis, the deductible does apply...." My out of pocket expenses up to now are 1021.98 that is just to the hospital. The added stress of making phone calls and trying to understand why insurance wouldn't pay. Distraught breaks and lunches spent on the phone. Getting no where.

dennis of phoenix, AZ May 19, 2009

hello i went to get a loan the other day and found out that i was not aproved for the loan when i asked why they told me that i have one outstanding bill for the some of 1371 from back in 2006 after some work on my part i found out what it was i went to the doctors for a cold one night on 11/02/05 everything was fine at that point in time and then i lost my job a few weeks later.

then i just found out that after i lost my job aenta went back and said i no longer had coverage at the time of the doctors vist but my pay stubs and the aenta documents that shows that i still was paying for aenta for almost a full month after i went to vist the doctor they covered it at first they covered the bill and then a few months later took it all back and stuck me with the bill i can get any answers for aenta on why they did this or what to do about it other then they told me to just pay the 1371 because that would be the easest thing for me to do they cant tell me why i was never told about the bill not being covered and why they never sent me a end of coverage summary preety much if you get aenta your paying for nothing i have no clue what to do about this they wont even talk to me they say they cant talk to me for some reason when asked why they cant even answer that one thing for me if anybody can help me please let me know thank you for your time

Judy of Ludington, MI April 22, 2009

My mother was placed in an Assisted Living facility for medical reasons in January 2007. We contacted Aetna prior to her placement and were assured she was 100% covered. We have submitted numerous claims and they have all been denied for various reasons. All proper documentation has been submitted. My mother passed away in February 2008. >p> After many attempts to receive reimbursement of her out-of-pocket expenses, Aetna still has not paid. We have now been informed that only the medical portion is covered, not the room and board (which was what we verified would be covered in the first place). My mother/her estate are out approximately 60,000.

Dalena of Pahrump, NV April 22, 2009

Dalena of Pahrump NV (04/22/09)
aetna wouldn't give authorization for my husband to have a nuclear stress test in April eventhough he had a history of heart disease, triple by-pass, heart attack in previous years. They could find no reason for the test so instead he had regular testing.

My husband died Feb 23, 2009 at the age of 62 of a heart attack and they found two 100 % blockages plus another blockage.

Lynne of Riverview, FL April 8, 2009

Lynne of Riverview FL (04/08/09)
Claim was submitted for emergency room visit on 11/22/07; It was initially submitted under wrong ID # and denied. We called Aetna in January of 2008, got the correct ID # and had the hosital, Wayne Memorial Hospital, resubmit. The claim has still not been paid, despite numerous calls to Aetna over the course of the past 17 months. Each time they tell us it has been re-submitted for payment, but will not confirm, and to date is still unpaid. We have even conferenced in the hospital billing department with Aetna to assist in resolving it.

We are still receiving a bill from Wayne Memorial Hospital in the amount of 3708.40.

Sharnita of Battle Creek, MI April 3, 2009

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