Aetna Health Insurance

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Scott of Old Saybrook, CT December 15, 2008

Scott of Old Saybrook CT (12/15/08)
I called Aetna the first week in November, to cancel my Dental plan (not medical) so I could switch to my wife's, since we go to the same dentist. The current plan I had did not cover anything with that dentist. I was told it was cancelled on Nov 17th, but I still have not received a 'loss of coverage' letter (STILL no idea why that's needed). Until I get it, I can't switch to my wife's insurance and therefore, can't go to the dentist (I need to have a tooth fixed from previous work they did). I was told the letter should have arrived last week, but did not.

At the risk of spending another hour on the phone (5 total, so far), what else can I do to put a fire under these [reps]? I don't understand why it takes this long for a letter to be mailed (or faxed, which I also provided to them). No one I spoke to could confirm the letter being sent out.

I have some work that NEEDS to be done soon on a previous root canal--a new crown and some infection that needs to be cleaned up. Until I have new insurance, I can't have it done. It needed to be done a month ago--I have so far canceled several appointments. The pain is increasing, but I can't afford to pay the costs myself and risk getting no coverage at all. What is going on with sending a letter?

Andrew of Standish, ME November 30, 2008

Andrew of Standish ME (11/30/08)
I don't understand how Aetna is allowed to operate the way they do. In 2006, I had a problem with Aetna paying a bill that they clearly owed. It took two years, and the involvement of the state's insurance board to finally get them to pay. However, it took a lot of stress and grief on my part to stay with it. MY ADVICE: Put every request to them in writing. I called Atena repeatedly over those two years, and everytime, I was told that it was their error and they would fix it. They never did until they were forced to pay. It's now Nov. of 2008, and I was just denied the cost of a visit to an Express Care facility, even though I had an immediate medical need. This time around, I am sending my compliant to the Bureau of Insurance immediately and I will put all complaints in writing until they pay the bill. Why are they allowed to continue these practices?!

Kanwarjit of Tucson, AZ November 25, 2008

Kanwarjit of Tucson AZ (11/25/08)
In January 2008, when my husbands employer switched medical plans from United Health Care to Aetna, I called Aetna to ensure that the medical group I was seeing Pediatrix-Obstetrix Medical Group was covered in my insurance plan since I was pregnant with triplets and was considered as a High-Risk pregnancy and had to be seen by a Doctor specializing in dealing with multiple pregnancy. I was informed by one of [their] representative that they surely were In-Network and that I could continue going to them.

It was only in March that I started seeing bills pouring in from Obstetrix and on approaching their billing department I was told that Aetna only paid them 70% of the billed amount since they were outside network. I called Aetna right away to inquire what was happening and they then told me about the medical group being an outside network for them. Had we know that Aetna was that unreliable, I would have noted Customer Rep names, contact information and may be recorded the whole conversation. I dont understand why I was given false information to begin with.

I as a member of Aetna Medical group did my part by calling in and verifying the information but was still given incorrect information. I explained my situation to the representative and they asked me to have Obstetrix resubmit all the bills and was told that Aetna would take care of it and I could look for another Doctor within network. To avoid any further complication I went ahead and changed my Doctor even though I was almost 7 months far along in my pregnancy. It was very stressful for me to go ahead and have the doctor changed at the last minute but there was no way I could afford all the bills. Pediatrix forwarded the outstanding bills over to the collections agency.

As such with triplets, We are under a huge financial burden. My husband had to take a loan against his 401k and pay the disputed amount (approx 4500) so that his credit history is not messed up because of Aetnas fault. I would really appreciate if you would Please look into this matter at the earliest and take necessary action in resolving this issue at the earliest.

During my high risk triplet pregnancy, I was running around switching around hospitals, had to pay 5000 from my own pocket because of mis-information provided by Aetna.

Rebecca of Plainfield, IL November 19, 2008

Rebecca of Plainfield IL (11/19/08)
My husbands company just switched their health insurance coverage to Aetna. We have had only used our coverage twice in the last year and both times Aetna refused to pay.

The first time my husband had a fever and it was a Sunday. There were no doctors offices open. He went to the immediate care in Plainfield. He was treated. We received a bill for the entire amount. I called Aetna to ask why we were responsible for all of the charges and they said it was a coding issue of the immediate care facility. I contacted the immediate care facility and they said that everyother insurance company accepts their coding and said they couldn't change it. I called Aetna back and they refused to pay the claim because of coding.

The second experience was that my two year old son had a 105 degree fever while we were on vacation. It was also a Sunday and we got in the car looking for the nearest hospital. It turned out my son had an ear infection. After about a month we got a bill in the mail from the hospital but we assumed that the insurance hadn't posted payment yet. 11/18/08 we got another bill and an explanation of benefits from Aetna. They wanted us to pay the entire 777.00 and they would not cover anything.

In the general remarks it stated Aetna covers emergency treatment when the member has a medical condition that causes sudden symptoms that are severe enough that a person with an average knowledge of health and medicine could reasonalby expect that not receiving immediate medical attention would put his or her health at serious risk. After review of the clinical documentation submitted, a Medical Director has determined that the emergency room services received do not meet these criteria. I immediately called Aetna customer service and they said I could appeal.

I don't know one person that would ignore a 105 degree fever in a toddler. I have also read numerous other reports on this sight and it seems pretty apparent that Aetna does not want to pay their claims.

There is obvious stress involved. Also we had already paid upwards of 200 for the first claim that went unpaid and now we face paying another 777 out of pocket. What is our health insurance for? It also could impact our credit score.

Chris of Los Angeles, CA November 12, 2008

Chris of Los Angeles CA (11/12/08)
I went to a network doctor for a plantar's wart removal. That's it, simple. I used a network doctor even though I have a PPO, so I could save money. The doctor said they checked and I was covered for the operation. The doctor did the operation in his same office.

I was fine after the operation - until I got the bill 3 months later. It seems the doctor was in the network, but not the hospital i was sent to for the operation. What hospital? I was in the same office at the same address. I have explained this to Aetna, but to no avail. They keep saying I went to an outside facility.

Also, I have a PPO so I don't have to be pre-approved to have the work done. Aetna says the charges are not reasonable yet they haven't even tried to work with the doctor's office or explain what reasonable is. They just say they won't pay because the hospital was not in the network. Again, what HOSPITAL? if they have a problem they should check with thier network doctor!

Somehow, even though I pay my premium on time every month, Aetna feels it is my reasponsibilty to pay the WHOLE bill - they won't even pay the 60% they owe. I am now in 2nd appeal but I already know what the response will be. I've asked them to speak to the doctor but they just keep telling me I have to appeal - no help at all is forthcoming from them.

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