Aetna Health Insurance

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Monica of Fox River Grove, IL March 23, 2009

Monica of Fox River Grove IL (03/23/09)
I had to go to the hospital emergency room at 1:15AM because of extreme and excruciating pain in my lower back and right leg. The doctor assigned to me decided that I would need surgery to my lower spine. Fearful of such surgery, I decided to seek a second opinion from a chiropractor. The chiropractor verified that I had chiroproactor insurance coverage from my primary insurer, Cigna, and also from my secondary insurer, Aetna. She also assured me that she could cure me of the pain problems that I was having. Cigna covered 14 visits to the chiropractor without the slightest problem. Aetna, on the other hand, has been a nightmare to deal with.

My secondary insurance plan clearly states that I am covered for a total of 20 visits to a chiropractor within the plan year. That apparently wasn't enough for them. They covered the first four visits without incident. The next three, they refused to cover of the basis that I did not have a medical reason to see a chiropractor. But then, they covered the next seven without incident. I attempted to get them to cover the three visits left open but they refused.

Out of the blue, I received notice that they reversed themselves on the first four claims that they had previously approved and wanted their money back or else they would turn me over to a collection agency. My response to that was to file a class 1 appeal. The appeal was rejected, (surprise, surprise) and the basis of the rejection wasn't that I didn't have a medical reason to go to a chiropractor but rather that the chiropractor engaged in activities which Aetna claimed were inappropriate. Now, all fourteen claims were rejected and they will soon want all of their money back I'm sure. There is something wrong with this company. I don't know if they invested heavily in AIG type investments and are hurting financially but their conduct is anything but rational. I am in the process of submitting a level 2 appeal which I expect will also be rejected. I must do this by April 21st.

I have been forced to waste considerable time and effort in an attempt to ask this company to do what the medical plan states that they should be doing. They have a moral, ethical, and legal obligation to abide by the precepts of this medical plan sponsored by the BP Corporation and they have apparently chosen to do otherwise for some unknown reason.

Laura of Denton, TX March 18, 2009

Laura of Denton TX (03/18/09)
I have been in treatment for depression and manic mood disorders for a year. This requires frequent trips to my psychiatrist for med checks. In addition, my father died very unexpectedly which made matters worse and as a result it was suggested that I might try grief counseling. Two months into the new year and three months after I paid the deductible, Aetna has refused to pay for any more mental health visits and claims that I have exceeded my maximum allowable dollar amount for the year. I wonder just how much help they expect me to get with a 2400.00 max?.

The expense of counseling and psychiatric visits are very high and my husband was just forced to take a cut in pay. I can barely afford the meds that I take let alone pay out of pocket for med checks and lab tests! I don't know how these people sleep at night. And there just does not seem to be any way to get theses companies to foot the bill for this condition and if you want to fight them the work and cost involved is unreal. I feel trapped but oh well. Just wanted to vent.

This may cost me my mental health and if it does the blood is on their hands.

Neil of Oklahoma City, OK March 17, 2009

Neil of Oklahoma City OK (03/17/09)
I applied for Short Term Disability help through my company's STD program with Aetna. I learned today that from R. Staple, my claim was denied because she claimed the clinical evidence did not support my claim although my doctors outlined the incident, the limitations that I suffer, and the treatments that I needed to under go before returning to work. I can no lponger afford medical treatments for this injury. At work I was returning to my desk when a fellow employee ran into me and twisted my lower back on the left side. I had previousley undrgone surgery to remove a portion of my disc at the L5-S1 level 8 years prior.

The MRI showed that a tear and bulge has manifested on the left side as a result of the employees very hard, intentional hit. I suffer from very high levels of pain becuse of the previous injury but this latest injury has mad e the pain double. Sometimes the painkillers don't even work. My Worker's Compensation claim was denied by our carrier, although the employee admitted to hitting me. I ended up filing with our Companies STD program to avoid a long litigation period and time off work and further physical deterioration and need for extensive treatment for this incident. I have lost the ability to sit for long periods as required.

I have decided that the only recourse is to hire an attorney and sue all involved, including the employee that injured me. It is also possible that I may ahve to file an assult charge against him jsut to recover some of my costs. I had previousley read the complaints about Aetna STD and hoped that they weren't true. However, the excuse for denying my claim was mirrored exactly as I read them. Aetna STD and LTD disability are the biggest rip-off scams of our time. I am begiining to wonder if they are even run by reputable people, if you get my drift. I can't help but think that my company may have been possibly involved in this decision as we are a self insured company and utilize Aetna to administer bout our STD program and our Health Insurance.

It is companies like Aetna (STD) and Gallagher Bassett(our Work Comp carrier) and their adjusters who drive the Personal Injury industry in the US. If it weren't for these denials of legitamite claims the hard working people of this nation would not need to hire attorneys. If Barack Obama cares so much about the working people of the US, lets see him attack this problem. It is causing hard working people to lose everything they ahve worked for and stripping them of their dignity.

The economic damage to me and my family is outrageous. I am in the process of losing my Health Insurance, which is the only way I have been able to get any type of treatment, my SUV will be repossessed soon, it is currently not running as I can't afford a fuel pump to get it running. I have been forced to eat and live with relatives, often only eating every other day, as I can no longer afford my own place or to feed myself. I can't sit for long periods and will be forced to ask my doctor to return me to work on a regimen of strong painkillers to just make it through the day and try to save what I ahve worked for and a little dignity. The only way to fix this injury is to have a spinal fusion which I am trying to avoid if at all possible.

Terri of Chicago, IL March 10, 2009

Terri of Chicago IL (03/10/09)
I contacted the customer service dept. of Aetna, but to no avail. I used to have Blue Cross, but my company switched to Aetna. I went to pick up my prescriptions yesterday and Aetna is charging me a 40.00 co-pay for one (Vivelle) which is outrageous. My doctor wrote this up and didn't specify that a generic would be appropriate. The other medicine, Phentemine, which I was taking thru Blue Cross and of which Aetna was aware of up front, Aetna is refusing to cover at all.

This is my first dealing with Aetna since my company switched. I talked to a Joanna, Customer Service Rep, who spoke to Joe, another Customer Service Rep, and they again said all I could do was file an appeal, which I did over the phone with Joanna. Joanna said it would take 7-10 days to hear back and if Aetna denied my appeal, they said I could file another one. I told them this was ridiculous. I am not waiting to file another appeal. It is not fair that a patient should be forced to pay such a high co-pay and in addition, to have to pay full price for another medicine which was always covered. 

Aetna is a nightmare to deal with. They want to play doctor and they are not physicians. They have no right to dictate to me what medication I should take and then refuse to cover a medication when I and my company are paying such high premiums. I have reported Aetna to my HR Dept. I plan to also report them to the Better Business Bureau. I want Aetna to resolve this to my satisfaction and that is not what they are doing. They don't have any problem with collecting the premiums, but they seem to have a big problem in paying out on prescriptions. I am very concerned and if these problems continue, I will make sure these concerns are addressed in Washington also.

I have dealt with Aetna in the past and they have been a nightmare. I had a folder two inches thick full of complaints the last time. Now, I have to deal with them again because my company switched insurance carriers. The first time I go to get a prescription, they want me to pay a high co-pay and on the other, they would not cover at all, even though Blue Cross covered it prior to this. The damage is I cannot get my medication because of these people. I am sure this is only the beginning of things they refuse to pay for even though they have no problem collecting over 569- per month. What is going on? There should be a class action suit against this company. If an attorney gets one initiated, I definitely would get involved. Enough is Enough!

Susan of Arlington,, MA March 2, 2009

Susan of Arlington, MA (03/02/09)
I am a graduate student at Boston University. Last year, I paid over 20000 out of pocket for expenses not covered by Aetna Student Health. It was impossible to get accurate claims information. Reimbursement for out-of -network expenses was not received, except for two small reimbursements out of more than twenty visits claimed. I am a widow with a daughter in college and two children at home. Aetna regularly refused claims saying that we had other insurance when we didn't. Then, when I was eligible for MassHealth, they refused to cancel my policy, so the state computer indicated that we had other insurance and didn't need state benefits! It was the consummate Catch-22. I understand that New York filed a suit against Aetna, and I hope Massachusetts will take legal action as well.

I used most of my retirement fund for health needs which should have been covered, in addition to the 25 co-pay which is excessive for three people. Now, I am unemployed and could use the 27000 I spent on health expenses last year. I could live for six months on that money. As it is, I may have to sell my home.

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