Aetna
Reviews and Complaints

My Daughter lives in Cold Spring Kentucky, she has health insurance (aetna) thru Kentucky medicaid. She has been in and out(mostly in) of the hospital for the past week due to adhesion's on her small intestines that are obstructing her bowel which results from Crohn's disease that she was diagnosed with over a year ago. Her Doctor recommended an operation that would require removing "the bad" sections of her small intestines (adhesion's) that would eliminate the obstruction to her bowel that could otherwise become a life/death situation. Everything was in place for this operation to be performed on 04/13/2016 at St. Elizabeth hospital in Northern Kentucky. This morning as she and other family members were literally on our way to the hospital, her Doctor calls her to inform her that her Kentucky medicaid "aenta" will not pay for this necessary, crucial, urgent operation. My Daughter had to physically, mentally, emotionally prepare for this day just to be turned away because Kentucky Medicaid will not pay for it? What does this insurance pay for if it will not even pay for someone to have a procedure done that can give them quality of life? This is an outrage! She is a 32 year old woman with three small children who depend on her. The insurance company originally said that they would cover this operation, and literally the last minute, on our way to the hospital she gets a phone call telling her to turn around and go back home because they decided at the last minute, they aren't paying for it. This is totally unacceptable and something really needs to change. This company needs to be investigated, their practices/competency is deplorable! My Daughter's health and life are at stake here. ~Thank you for your time, Sheila Loga

july 17th 2013, i was set for back sugery.14 hours before showup time at the hospt.i received a call statting my surgery had ben denied.i was already given a out of pocket amount to pay at admission.ihad to take a leave of absence on july 12th because of the pain.aetna wanted other things done to ruleout other problems.this took 10 weeks of my 12wks.of protected leave.all other doctors said the back surgery was the best answer.after appeal it was denied again.my dr.did a peer to peer onjuly 16th and tried again on oct.3rd and was denied.if i had had the surgery, i was only tobe off work for 6weeks.now i am out of time on my protected leave.oh, by the way! some of the other things aetna wanted rulled out, aetna want cover!

Having a terrible time with Aetna with getting prescriptions. They just lie every time you talk to them. I finally got one to admit that the doctor had sent in a request and they had denied it after they kept saying the doctor hadn't submitted anything. I had the denial in my hands from them and told her that and she finally after a long silence said "Oh I see he did submit it and we denied it. It isn't covered on your plan".

I told her it was on their formulary and she said yes it is but your "employer specifically chose to exclude that drug"!

What employer goes through and picks and chooses specific drugs not to include in their plan?
They also are trying to get away with not paying for a pre-approved investigative procedure by saying it may not be covered under their pre-existing condition policy. Its a procedure to find out if I have something so how could I have already been diagnosed? Also that clause does not apply in group coverage when you've been continuously covered. They want a 3 page questionnaire filled out. Who was your prior policy with? YOU, AETNA What is the phone number? YOURS, etc. etc. Just a delaying tactic.
They customer service reps are rude and appear ill informed about their own product and their own policies.

My daughter has dependent coverage on my health insurance through my employer. In March of 2013, she became pregnant.
I downloaded my policy coverage and saw in the policy that pregnancy was covered.
I called AETNA to confirm that her pregnancy was covered. One of their representatives assured me it was.
My daughter's doctor called Aetna to confirm that her pregnancy was covered. The representative assured the doctor her maternity costs were covered and gave the doctors office an authorization number
Aetna paid the first 6 claims of my daughter's pre-natal doctor's visits.
The 7th claim they denied, the reason being her pregnancy wasnt covered.
I called aetna, they told me dependent's didnt have maternity coverage.
Basically they decided after 12 weeks she really didnt have coverage, after representatives on 2 separate occasions assured both myself AND her doctor (with an auth code) it was covered.
Now we have a huge financial problem. We can no longer go out and purchase a maternity plan with another insurance company as she is already 12 weeks into the pregnancy.
I have sent an appeal to Aetna. According to their website, it will take 30 days for them to even acknowledge anything one way or the other. In the meantime, my daughter needs pre-natal care.
What should be a happy, joyous time in our lives has turned into an insurance nightmare!

My medical follow-ups were refused, because Aetna failed to pay my existing claims. I contacted Aetna on numerous occasions and their representatives said the claims were satisfied. However, Aetna’s online resources reflect that the claims are not paid. Also, I’m refused medical follow-ups and being contacted by collection agencies for non-payments. The collection agencies forwarded this information to the credit bureau. Presently, I need medical attention & medication, but worried about accumulating additional unpaid claims. Aetna is causing me more medical problems and anxiety by refusing to satisfy the claims in question.

Being at age of 69.5 Aetna approved primary care physician directed me to get a shingles vaccination. His office doesn't keep the vaccine due to storage requirements. He said to go to a pharmacy to get the vaccination. I went to Kroger where I have had prescriptions filled for one time use (maintenance med.s require Aetna mail order). I got the $200 vaccination and Aetna denied claim stating Kroger wasn't approved as a provider. Perhaps it's due to me being a working senior on an employee plan they are handling my claim in this manner.

They are the rudest when you finally reach someone. They lied to me, and told me that my claim was approved, ONLY AFTER I told them that my reason being out was a nationwide LAW, so what was the hold up? I have been out of work, and without pay for 6 weeks now, and still no paycheck. So, 3 days later, I called to check on the status of my check, and there was NONE. So, I once again spoke to someone, and she said that they just approved it today. So, that where the lie comes in.
I bet that they would cut off my insurance if I didnt pay them, so where the heck is my money? Its Dec, and Christmas and I have depleted my savings account to live off of, hey, I didnt ask for breast cancer, you know, and the law states that if you get a masectomy that reconstruction is part of your treatment. I applied for this on Oct. 19, and now its Dec 13, and I have no money still.
HOW PATHETIC>AND SLOW>AND RUDE.

My Aetna summary plan description clearly states that 60 visits per year are covered for physical therapy. Nowhere does it state that after 25 visits the PT would be subject to medical review. I underwent radial head surgery on New Year's eve and have undergone painful and progressively active-assisted physical therapy since mid Jan. I have not reached my maximum medical improvement nor my max of 60 days. Aetna's online claim tracker shows checks issued to my physical therapy office. However, last Friday I receive a letter that RETROACTIVELY denies payment for my physical therapy after March 8 based on a Clinical Bulletin that is not referenced in my summary plan description nor was ever mentioned when the member services told my PT office that I was covered for 60 visits prior to my even starting physical therapy. Aetna's plan misrepresents its coverage and to my detriment I relied on their written words and issuance of checks. It isn't a new tactic, on Oct 24, 2003, Aetna settled a federal lawsuit with doctors over the same issues. I am appealing as high as I can go, but I can't even reach a case manager cuz they hide behind their automated phnoe system.

According to a report on the lawsuit: The settlement requires changes and commitments in Aetna's business practices to eliminate "the worst of the improper practices involved in managed care." Among the changes, which will affect all doctors treating Aetna patients:

Eliminating downloading and improper bundling and computerized denial practices.
Establishing the standard of a "physician, exercising prudential clinical judgment" for "medically necessary services, and allowing cost to be considered only when an alternative service is at least as likely to produce equivalent results."
Creating a dispute-resolution procedure, using an independent external review of decisions regarding medical necessity.
Providing a facilitator to assist physicians in enforcing the agreement.
Creating a $100 million fund for physicians to recover some of their damages.
Establishing a foundation "dedicated to promoting high-quality health care."
The agreement also requires Aetna to pay lawyers representing the doctors $50 million in attorney's fees, including $6.5 million in expenses.

SRC Aetna began collecting payments from my paychecks 5 months after coverage had been terminated. Now I am fighting them to get my money back and to stop the insurance deductions. They refuse to dis-enroll/un-enroll me, even though technically I was dis-enrolled last August because I have other coverage. Its been a nightmare and now I can't go to work because they are taking my entire paycheck. It has been a month since they filed an "escalation" and nothing has happened despite numerous phone calls. CVS my employer won't do anything. So I've filed a complaint with the BBB, soon I will file with the state insurance department.

Where do I begin? Without going through every instance of denial, over charging, incorrect billing etc. that AETNA put me through - I will just tell you to never do business with AETNA health insurance. I paid over $6, 000 in premiums and they would not even pay for a $275.00 lab bill for my husband who has never been sick before in his life - and was not even sick after that. I filled out form after form, along with his doctor, that there were no pre-existing conditions. This was just bloodwork. And after talking to representatives from the Philipines (with all the money they make, they can't hire Americans?) that are robotic and will not even listen to reasoning, I decided that it was best for my family to not even be covered by health insurance. Why pay all of this money when you get nothing in return? SHAME ON AETNA - SHAME ON THIS COUNTRY - for allowing American citizens to be ripped off and robbed of their dignity.

I was told that my medicare supplement F was only $128 and that it was guaranteed not to increase. It did and I feel I was lied to. It increased to almost $200. This was not supposed to happen. I bought this over the internet and phone from Medigap 360 with an agent that I never saw that went by the name of Brad Jenkins in Austin, TX. I am going with another company locally that actually comes out to talk to me in person and will not lie to me. Thank God I am still in my six month enrollment. The other company is a bit more expensive but I am not being lied to (actually I would be paying more than $128 but less than $200. Don't trust this guy. He sits in an office in Texas and waits for the inevitable phone call guaranteed to make him money. Go with an insurance guy who comes out to see you and works hard to keep your business since he in on commission and not salary.

I began having terrible pain in my right leg in March 2011. I worked as a server at UNO Chicago Grill in Orlando.I started in October 2010. I believe in insurance and thought it was an attractive perk. I signed up for the max and best quality immediately. I complained several times to my boss when I never received my card. Several visits and increasing pain was masked with pharmaceuticals. The meds were 10 and 15 dollar co pays according to my paperwork. Several denials and endless calls led to fasceous remarks that only $500 was covered per year, when plainly stated $500 per month. I was ridiculed at work because of the pain. Totally humiliated in fear of loosing my job I took medical leave. I'm 30 years old and in need of a total hip replacement. I'mmediatly they began denying claims and inundated with confusing denials and threats to drop. My employer said I no longer worked their. I offered to even roll silverware to help pay premiums. I lost everything depleted all my savings, unable to work, denied government help and unemployment, suffering in constant pain unable to walk and refused surgery by three orthopedic surgeons, only to be dropped almost a year later drowning in debt and medical bills unable to finish my last year of college. I'm growing weaker by the day and scared and disgusted, alone. Worthless. How is this right? My doctor wont even see me.

AARP Essential Premier Health Insurance Plan. Aetna charged me a 25% up-charge because of a $7.51 Rx that had a total annual cost of $30.04 to $37.55. I even paid 100% of the total cost. Now I don't need the Rx and Aetna refuses to lower my rate with a letter from my doctor. They require me to complete another 5-yr look-back application so they can look for a "new" pre-existing condition (just as if I were a new applicant) and they requires 6 months of additional up-charge premium before they will even consider a lower rate.

After four years of chronic, disabling gastric pain, last year my wife was finally diagnosed at the Cleveland Clinic and a method of pain treatment was strongly recommended by two of the best doctors in the world in this field. After months of appeals, Aetna's final decision was to deny her the care. Her only recourse has been and apparently will continue to be morphine, which is an incredibly poor substitute for long term care.

Now my young daughter has been diagnosed with fibromyalgia and another team of the finest doctors in this area of medicine has stated that an inpatient treatment program would give her the greatest opportunity to successfully deal with it. Again, Aetna has said the treatment was not "medically necessary."

Aetna practices health care denial, not coverage. They second-guess world-renowned specialists, and abandon patients to suffer in pain.

My mother passed away on June 18th, 2009. My father had AD&D insurance with Aetna through his employer. The Medical Examiner ruled my mother’s death an accident. My father recieved a letter from Aetna in September stating that all claims will be processed. Six months later, still nothing from Aetna! I told my dad to call Aetna to see what the hold up was. That’s when the nightmare started! Aetna was saying that they never recieved the correct paperwork. The Human Resource Dept. told my father that they sent over everything to Aetna.

It was back and forth, back and forth. Finally, my dad recieves a denial letter from Aetna. At the time, I worked for an attorney. He requested a copy of the policy. After going through the policy with a fine tooth comb, he contacted Aetna with evidence that Aetna should pay! Then Aetna sent out defferent print outs of reasons why they wouldnt pay. none of it makes any sense! Needless to say, I’m not going to let this go! We have hired an attorney to sue Aetna Insurance! Its not the money, because no amount of money will ever bring my mother back, its the principal of the whole thing.

The insurance company trying to get over on the little man! NOT THIS TIME BUDDY!

State Corporation Commission
Virginia Bureau of Insurance
PO Box 1157
Richmond, VA. 23218
Charles Sisk Jr. Fax [protected]

County of Delaware County
Consumer Affairs
201 West Front Street
Media, PA 19063
Roslyn Jackson

Aetna Disability Insurance Company
PO Box 14554
Lexington, KY. [protected] Fax [protected]

Commonwealt of Pennsylvania Insurance Department
Bureau of Consumer Services
1209 Strawberry Square
Harrisburg, PA. 17120
Attn: Brian Cristini

Pennsylvania Insurance Board
(Philadelphia Division)
801 Market Street, Room 6062
Philadelphia, PA 19107
Fax: [protected]

Bureau of Consumer Service
Insurance Department
1209 Strawberry Square
Harrisburg, PA 17120
Fax: [protected]
E-mail: [protected]@state.pa.us
www.insurance.state.pa.us

NAIC Corporate Office
444 North Capitol Street NW,
Suite 701
Washington, DC 20001
[protected]@naic.org
[protected]@naic.org

August 3, 2011

I would like to know how you can allow an organization such as Aetna Insurance to keep their license, and fraudulently take peoples money without any consequences.

I am once again writing to tell you that Aetna Life Insurance Company has again threatened to stop my LTD Benefits, stating that THEY found I am capable of doing some sort of work, even though my treating doctor has stated that I am totally incapable of work. (Letter from my physician enclosed).

Today, August 3, 2011 I received a call from Peggy from Aetna Life Insurance stating that AETNA has determined that I can in fact return to some sort of work and they will stop my checks of $244 a month.

This is AGAINST my treating doctors orders.

For two years Aetna has attempted to stop the benefits, WHICH I AM ENTITLED TO, for my LTD, which I paid for through payroll deduction. Today, they have determined (without ever even seeing me) that I can go back to work, and they are stopping these benefits.

In March 2011, my doctor was sent a Capabilities and Limitations worksheet which he filled out, (I am sending a copy), stating in writing “TOTALLY DISBALED.”

In April 2011, Aetna tried to say they were stopping my benefits because my doctor never responded to their letter. When I told them that he did in fact return it because I have the certified letter to prove it, they suddenly found it.

In May, 2011, another Aetna Rep called me and said they were going to stop my benefits because they never received an answer from my doctor. Again, I had a SECOND certified letter receipt stating that I had RESENT the doctors answers to them.

Again, they found that they had indeed received it.

In July 2011, I received another Capabilities and Limitations worksheet from them. (This is the same exact letter my doctor filled out twice and sent back to them since March), and again they stated they did not receive it.

Once again, I have a 3rd certified letter stating that I did in fact send it to them. My doctor got to the point that he said he cannot continue to fill these out every 3 weeks for me.

I am sending you a copy of my doctors signed sheet stating in plain English, “Totally disabled from employment”, yet Aetna is now playing God and saying I can in fact work.

I am seeking legal assistance in filing a suit against Aetna.

Sincerely,

Robert Hearn
Control # 622733

AETNA has sent me a brochure and email advising myself and family to take annual preventive check up with my Doctor last year end. I paid my premium for the entire year and went for the physical for first time. ( Annual physical is 100 % covered without deductible per AETNA !) Doctor prescribed a routine blood work and I went to Quest for lab. I did not take any prescription from the doctor nor was any problem reported except I took flu shot. When the lab results came out and reported that I have a little cholesterol ( Any adult above 40 has little cholesterol in these days !). AETNA denied my claim saying that it is a sick visit and I have to pay from my deductible for both doctor visit and lab . Thus I see the email and brochure that Aetna sent out is a scam between doctors and lab people to get more business and get your money . AETNA has no ethics in their business. Don’t ever join their plan.

Aetna has major problems with it's customer service and website which is not user friendly. I am working 3 part time jobs so I have very little time to contact Aetna. I wanted to upgrade my insurance but I'm told I need to reapply.. i've gone to website and have no clue where to go, I've called 3 times and the last they were supposed to mail me the form, . This was 3 weeks ago;. In fact, I have called Aetna on 4 different occasions and asked for things to be mailed and never received anything". Question: Are there any real people that work for Aetna!. Someone cashes my check every month with no problem;. The joke is that they send me emails requesting feed back and they never ever call me or respond'. Aetna-you deserve an "F" and I am looking elsewhere since you were too *** lazy to even mail me a lousy form I requested.

I have had my doctor's office fax in a prescription for celebrex twice last week, June 1st and 2nd. It has been a week and still my prescription for celebrex has not been received, according to the Aetna RX Home Delivery. Originally I was turned down for the prescribed dose that my docter recommends and now that I finally have the okay for a half dose, I cannot get them to fill it. I am over 60 and suffer from severe joint pain in the knees and hips. I have gone without this medicine for over a month. I am very frustrated with this HMO.

Aetna is without a doubt the WORST health insurance you could purchase. It's a rip off and a total waste of money. I got this garbage insurance through my workplace last August. I work part time and they took $89 a paycheck out for their worthless insurance. I have made 2 Emergency Room trips since August and Aetna has paid a grand total of $400 towards the bills. I am now $8500 in debt. They pay for NOTHING. I dropped them this morning and was told I have to keep paying on the policy until July 1. What a joke! AVOID AETNA LIKE THE PLAGUE!