Friday, February 11

Aetna Again

Yesterday I got a call from the nice office manager at the pulmonologist's office. She wanted to let me know that they had received "yet another" request for information from Aetna, as she called it. She called Aetna to inform them they had ALREADY submitted the information. And the Aetna lady clicked around her computer and finally acknowledged, oh yes, they had already received all the information they have been requesting for so long, but it had not been properly entered into the computer system. It would take some time to resolve, she said.

So after ALL THIS, it turns out Aetna already HAS all the information they're "waiting for" from the doctors. They just didn't put it into their system right!

Can you hear my frustration causing my brain matter to leak out my ears? Perhaps now we'll get somewhere, though.

At least that's what I was thinking until another form came in the mail only a few hours later. Identical to the one I filled out a year ago, asking for information on this "pre-existing condition," including doctors I saw and medications I took. This time, however, the date of service was not October 28, but rather, October 1. I didn't see ANY doctor on October 1, leaving me to wonder, what condition are they asking about?!

I would say I give up, but it turns out the $800+ bill was from the hospital for use of their pulmonological diagnostic equipment. The pulmonologist himself has a bill for $300+ they've been (kindly) waiting to send me until after the insurance finally gives them an actual payment or denial . . . and the insurance has been stringing them along for 15 months, as well.

Did I mention I hate Aetna? I hate them with the fire of a thousand suns, as my friend Suso would say. No calamity is to great to befall them. Bah!

40 Comments:

At 8:40 AM, Anonymous Anonymous said...

Hey, have Aetna for your long term disability company if you hate them now! They have jerked me around for a couple years, I am on a medical disability, part of my income is to come from soc sec, the balance is to be paid by Aetna, except Aetna finds EVERY excuse in the books NOT to pay me, this has caused me to have my house foreclosed on, my car reposessed, my mental health pushed out the door, my physical health followed--they have made me sicker than I was originally when I had to leave work (their own doctor they sent me to even confirmed that they were making me sicker)! Now they want my doctor to sign a form saying I am still to be on disability, except now I can't afford to GO to the doctor, can't pay the doctors bills I already have due to no money from Aetna, so it is a vicious circle. I am in the nice position now of having another house foreclosed on because I can't get the 2 years back payments Aetna owes me from them, let alone the monthly income they owe me under contract from my workplace bargaining unit. Nice to know a company is run by an incompetant board of directors and manager, nice to know that your "lifeline" if you are ever sick or disabled refuses to pay for years! All those who have a chance to choose another LTD company, do, because your life and health DEPEND on it! I laugh every time I see their new medicare supplemental health insurance they advertise on TV--good luck all you fools who sign up with Aetna, just TRY to get them to pay a dime! I hate Aetna more than all the grains of sand on all the beaches in the world!!!!!

 
At 10:13 PM, Anonymous Anonymous said...

For those who have significant complaints about Aetna and their service to customers, file a complaint on this website:
http://www.ripoffreport.com/default.asp
it is kind of a 'bad business' public report!
They already have several complaints logged against them.

 
At 10:42 AM, Anonymous Anonymous said...

My husband is having the same problem. His doctors sent records six times before Aetna acknowledged receiving them & now is doing the "they weren't put into the sysytem propery - it will take NO LESS THAN 30 DAYS to correct the problem". We have no health insurance, as far as I can tell. They're just ripping us off for premiums and won't pay for anything.

 
At 11:10 AM, Anonymous Anonymous said...

All three times I have tests ordered by my Doctor, Aetna has refused to pay. Only after months of phone calls to both Aetna and the doctor has anything been resolved. Now I am afraid to go to a specialist for my condition because I already spent three months salary on my premium and I don't have the money to pay for the treatment that they are going to refuse to pay. I think Aetna has a policy of denying all claims, and your premium is simply buying you the right to argue with them. My Aetna healthcare plan is the most expensive pile of nothing that I have ever purchased.

 
At 8:09 PM, Anonymous Anonymous said...

I hate Aetna, too. And if I had a choice in healthcare (instead of being forced to choose Aetna by my employer) I'd drop them in a heartbeat.
I have a choice of staying in-network or going outside. My insurance cards say that my wife, daughter and my self have a PCP but my son's says, "No Election Required". I figured that was because he was so young. It's been that way for three years. Suddenly, we get told that we need to pay an out-of-network copay for my son. For three years nothing was ever said. Aenta told me, "He doesn't have a "PCP" chosen. I told them, "My card said no election was required." Aenta responded, "Well, 'required' doesn't mean 'required' and 'is' doesn't mean 'is.'" I've exhausted my appeals with them and my only option is to sue them.
Yeah, right. Sue a health insurance giant.
This, after they also stiffed me for an "out-of-network" kneebrace that my in-network-doctor" gave me for treatment of an injury.
I hate Aetna. I hate them I hate them.

 
At 6:06 PM, Anonymous Anonymous said...

As you can guess, I've come across this page while looking up something about Aetna. It's almost impossibel toe ven find a number to call for service. I pay nearly $200 a month for this crappy insurance and yet, everytime I trya nd use it, wellll.... no one can ever verify my insurance and I have to pay out of pocket and try and get reimbursed by Aetna. I'm so sick of it. On top of that, I can never seem to get any Customer Service from them, they don't give a shit and they let you know that when they answer the phone. I hate it. I'm dropping htem when open enrollment comes and I will opt for no coverage, I'd rather pay out of pocket.. which I am already doing anyway. I hope they go belly up soon.

 
At 11:28 AM, Anonymous Anonymous said...

I agree with all the statements on this page. aetna's customer service sucks they could give a shit about you the person. meanwhile i have 2 dr's that have taken me off work, my company says i can't work while under dr's care. the doc sent aetna a 6 page detailed report saying i may have an anurysm and aetna said no that is not good enough we are not paying??? WTF? HOW CAN THEY OVERRULE WHAT THE DR. SAYS??? anyway does anyone have any info on how to fight them and get the benifits you pay for???

 
At 1:49 PM, Anonymous Anonymous said...

I hate Aetna too, I became a double amputee, my LTD is Aetna, I was told, I had to apply for SSI, and if I did Aetna would not pay for benefits for not trying. I agreed and once I became eligible for SSI, they found all kinds of excuses to cut back on their share on these benefits. By the time this mess was over with, I ended owing them money, with me paying all the Taxes.

Also, I found out the reason, and it was because the company that was paying for this benefit had changed carriers.So I guess they felt they were no longer obligated to me and other emplyees on LTD.

 
At 6:29 PM, Blogger aetnasucks said...

I unfortunately work for the evil entity known as Aetna. Some things you should know. If you call in for yourself as a member for an issue, the rep helping you is not under any time constraints. If someone from your doctor's office calls in for you, the reps who answers those calls are under a time constraint of 296 seconds. That's right. As a member calling on your own behalf, they can take as long as they need. But if they call from the doc's office, that rep has less than five minutes to help them. If they don't do it in less than five minutes they get nasty, abusive emails from their supervisors or they get pulled aside. Reps are allowed a total of 11 minutes a day to use the bathroom (aside from breaks and lunchtime.) If you go below on any of these stats, you don't get a raise. Aetna doesn't even do cost of living raises! If you don't meet your stats, too bad. (Even if you have a doctor's note that says you have a condition that causes you to use the bathroom more often.) Take mind that when you call up and scream at the rep, the rep you are screaming at has NOTHING to do with the way your stupid claim processed or any medical denials that came through. Those were done by the medical claims review department or the processors, which there are no phone numbers for. So not only do we get to put up with less than human treatment from the supervisors (who are "never there" when a customer wants to talk to them and almost never return calls to those who leave their numbers) but we also get screamed at all day long from irate providers who want to know where their money is, because let's face it, the doctors care more about their money then they do about the patients anyway. Is Aetna evil? Hell, yes. Are the doctors equally evil? Oh, yes. Yes indeed. I place blame on them both. Needless to say, I'm already on the lookout for new employment.

 
At 9:07 PM, Anonymous Anonymous said...

Warning- BOA employees- Aetna’s Short Term/Long-term Disability benefits are the worst. You pay for it- oh yeah, you pay. Try an employee of over 10 yrs filing one claim and not get pd for the last 4 months. (one denial as the dr didn’t put my resting blood pressure rate down!) Don’t believe what they tell you about the IHD (Integrated Health Disability “Model”). It’s suppose to help manage your medical and any potetntial disability you might face. It’s a lie! It doesn’t work! They’ve been my company’s medical ins provider for years and the only info they conveniently find hurts me. literally- hurts me. I’ve almost lost my car, my mortgage is months past due…They play legalese word games, if you ain’t a lawyer you’ll need one….look up complaints against Aetna Life Insurance on the web. I located where they’ve been fined tens of thousands of dollars (recently in Texas) for violations. They are Evil—- be warned.

Comment by Oh No They Didn't - September 22, 2008 at 8:36 pm

 
At 1:04 PM, Anonymous Anonymous said...

I have had Aetna for a year and a hlf now and they were suppose to reimburse me for the money I paid for my braces a $187 check is suppose to be mailed to me. I have received maaybe 3 checks. I am going to call them for the thousandth time, but the last time I called they said the issue was going to be resolved. If if was there money they would want it. They are so not on their ob!!

 
At 10:34 AM, Anonymous Anonymous said...

Finally got married; and one of the best parts is a chance to be on his insurance and ditching stupid Aetna.

 
At 4:52 PM, Anonymous Anonymous said...

TO AETNA SUCKS who works at AETNA. I agree with you 100% everything you say is true. It's one of the worst companies I have ever worked for...I am currently looking for a new job. If you like to be micromanaged by at least 5 managers, strapped down to your desk for 8 hours a day, get unfair raises and evaluations and treated like crap and pay the same and somtimes higher Aetna's insurance premiums.... do apply for a job at this joke of a company runned by a bunch of greedy idiots

 
At 5:22 PM, Anonymous Anonymous said...

Referral APPROVED: that's what the form said when my wife asked if her primary care physician could send her to a specialist. She went, then they denied payment of the bill..."Yes you had the referral approved--but if you read your policy you also need OUR PERMISSION TOO..."...
What kind of hocus pocus BS is that...BUT I think I've got them...in MA they need to respond to our complaint within 30 days...Their response is postmarked 35 days...so now they're liabile for TREBLE (3X)the claim...We'll see hot THIS works!

 
At 11:59 AM, Blogger laine25 said...

I am having a problem now with Aetna, they won't pay for an office visit with my doctor. This was the first office visit. They did pay for the tests she ordered but not the office visit--what a joke! Now they want me to pay for the office visit. I am going to fight it and get a lawyer next. I'm tired of being ripped off by banks and health insurance companies. Afterall, I pay a co-pay out of my pay. Better off not to have insurance at all if they won't pay charges.

 
At 12:01 PM, Anonymous Anonymous said...

Aetna is the worst insurance company. They refuse to pay for my office visit to my doctor, but they did pay for the tests she ordered, i.e. blood tests. They are looking for a pre-existing condition. I did not have insurance for over a year and have no pre-existing condition. Every month money is deducted from my paycheck and now they won't even pay for her office visit. I have been on the phone with them all morning long. I am changing jobs so I don't have to deal with Aetna. I will ask my next employer who they have and if it is Aetna I won't take the job. They are totally inefficient and I'm very angry. Their customer service is a joke.

 
At 9:38 PM, Anonymous Anonymous said...

I hate Aetna !!! I went to a doctor for a second opinion and they sent my first doctor the letter addressed to the second doctor so I get a phone call from my doctor asking me why I am going to another doctor. When I called Aetna they were no help at all. they just transfer me from department to department and don't help at all I wish my employer would not have chosen them. I have talked to them more in 3 months than I talked to my previous insurance company in 28 years. I hate them all.

 
At 5:07 PM, Anonymous Anonymous said...

From your Doctor's Perspective. I am a physician who sees patients in an office that participates with Aetna. The company does everything in it's power to maximize its own profits at the expense of patient care.
As Aetna has increased your premiums to higher levels, the company has reduced paying doctors for caring for you. Result is, every doctor that takes Aetna has to see more and more patients in one day to break even. Therefore, each patient is only alloted about 8 minutes with the doctor. The rest of the money is profit for Aetna. Aetna CEO grosses over 18 million dollars.
Example two. Aetna routinely interferes in your doctors care for you. Aetna will keep denying medication that your Doctor feels is medically best for you. They will only cover medication that will cost Aetna less. They will keep denying it until your doctor gives in. No medical reason to change medication. Again, More profits for Aetna at the expense of patient care. Again. Aetna CEO grosses over 18 million dollars annually while your premiums increase. Facts every patient should know about Aetna insurance.

 
At 11:13 PM, Anonymous Anonymous said...

I hate Aetna as well - their customer service sucks. I used to have United Healthcare and they are so much better but since our company was bought out by another company - I had to go with Aetna and when you call customer service at Aetna - they are the RUDEST and the most inept customer service I have ever had to deal with. HATE THEM and their benefits SUCK.

 
At 3:14 AM, Anonymous Anonymous said...

In my opinion, this is a criminal organization. It is a travesty that they are playing doctor and toying with people's lives.
My wife and supposedly get our first four doctor's visits on a 40.00 co-pay basis per our Aetna PPO. My wife was getting cortisone injections for $40.00 each on her first two doctors visits. I too, received three cortisone injections for this $40.00 amount. Suddenly, Aetna began billing us over $1,100.00 for the same treatment, claiming it was being processed as a surgery. We simply wanted to know why they changed their processing of these visits and wanted documentation showing what they did. Since we have found their appeals department to be unresponsive, we went straight to our Washington State Insurance Comissioner. Aetna not only ignored our main complaint, but included documentation from one of my appeals-completely unrelated, a different case number, a different procedure, and a different person! Included in their response was office coding that read like pure gibberish-a string of alpha-numeric data meaningless to the customer. To understand their processing method, we have tried for months to get a copy of our policy. We have been refused a copy of our policy despite repeated attempts. Aetna lied to the Insurance comissioner and said all we had to do was to request a copy and it would be mailed to us. Every attempt to secure a copy of our policy has been ignored, disregarded, or met with silence. They outright denied our direct request, saying the request had to be made from our insurance broker or employer. These entities were also denied repeatedly. Unfortunately, our state Insurance Comissioner must not have had time for his staff to read Aetna's response to our complaint. Even a cursory glance would have shown this response to be completely unsatisfactory. Yes, the response arrived within the mandatory time limit, but the response was worth about as much as a childs crayon drawing.
Our many appeals to Aetna have been painstakingly detailed, well written, and thoughtfully structured to advance our argument. A great deal of time has been spent on these appeals. Long story short, it is heartbreaking to not only see our hard work ignored, but also to see our life savings disappear from paying off these racketeers.
If anyone reading this shares my anger and frustration, please remember that this mess called Aetna is not the fault of the lackeys talking to you from the Phillipines or one of the other off-shore call centers. It is the fault of the well-insultated sub-human socipaths who direct this hellish travesty impersonating an insurance company.

 
At 2:24 AM, Blogger rd said...

Aetna has me seething again and i was glad to find your blog.
I went through THE EXACT SAME BS with the Pre Existing Questionnaire Form. I am not the lawsuit type, but am thinking this routine incorrect processing really needs to be addressed. As well as their premium raising tactics.

As for the Form:
First they said I didn't send it in. Then they magically found it.
But only applied it to one of ten outstanding physical therapy claims.
Then they said my provider didn't send it in.
And then turned around and said Oops, we had a computer glitch and the form was never sent to your provider.

I went through the same garbage for my annual physical. It took me ELEVEN MONTHS to have Quest paid for the associated blood-work.

I am a healthy person who did not even hit her deductible. They have raised my premium four times. From $116 to $173 / month. Not what I signed up for. I think there needs to be a Premium Lock in Law.

I really feel for all of you who have actual medical problems and have to deal with this nightmare of an insurance carrier.
Something needs to be done about them ASAP. Hopefully before my next annual physical billing nightmare begins.

 
At 2:25 AM, Blogger rd said...

a favorite chapter from My Year with Aetna:

They covered the tetanus shot medication, but not the administration of the shot.

I was not aware that patients now have the option to self-administer injections.

 
At 8:14 PM, Anonymous Anonymous said...

Everyone may be interested in this. I say we all join in a class action suite against them. Call the atorny at the bottom to see if there is merit...

Link:
http://www.pomerantzlaw.com/the-firm/latest-news-accomplishments.html?action=latestNewsDetail&SuccessID=10


Based on the allegations in the Complaint, Plaintiffs seek: (1) to enjoin Aetna from continuing to engage in impermissible audit and recovery practices; (2) to stop Aetna from enforcing clinical policies that are substantively baseless; and (3) compensation for Providers who have been coerced into making payments to resolve or defend against Aetna's unlawful overpayment actions, or who otherwise have been denied reimbursement for validly provided healthcare services.

Counsel for plaintiffs are continuing to investigate these claims, and other related claims that may be added to the litigation. If you have any questions, please contact D. Brian Hufford, Esq. of Pomerantz Haudek Grossman & Gross LLP, by phone (614-410-6501) or email (dbhufford@pomlaw.com).

 
At 2:28 PM, Anonymous Anonymous said...

Aetna..I went thru a bad divorce and changed my address with them,yet they still sent out 3 insurance checks to my old address,then my xhusband opened,forged my name and stole the money.It took a year and a half of me calling before they realized that we were divorced and he stole the money.Theyve done nothing to help me.I ended up with an abcess on my gum&had to have the tooth pulled! mental pain,suffering,anguish anyone....ive got two jerks to deal with aetna and my x. help!

 
At 12:18 PM, Anonymous Anonymous said...

Anyone having trouble with Aetna in how they process out of network providers?

 
At 3:31 PM, Blogger Clay said...

I had terrible service trying to get two standard prescriptions filled with Aetna. I spoke to three supervisors and none of them could assist with a tracking number or anything else, even though the order had been placed and they showed it received 16 days prior. All they kept saying is that I had two wait another week before asking for a replacedment. The service was terrible from beginning to end and I had to call my physician to fill a separate prescription since Aetna couldn't do anything but tell me to wait I spent over a half hour on the phone with Supervisors and then they told me that there phone line closes at 3:00pm in the afternoon West Coast time. Worst medical insurance I have ever had!

 
At 12:36 AM, Anonymous Anonymous said...

I just got rejected by Aetna for a pre-existing condition. They completely wasted my time and energy since I had informed them of my pre-existing condition during my first conversation with them. I wanted to know at that time if my pre-existing condition reduced my ability to be insured by them. They were very vague and didn't provide me with information on their policy of pre-existing conditions even though I made repeated requests. They encouraged me to fill out the application. After I filled out the lengthy and detailed application and sent it in, they rejected me for my pre-existing condition. What?!! What a waste of my time! Now they say I can appeal their decision. They say that If I appeal then they would review my medical history. What?!! Didn't I just supply all that information on the extensive application in the first place? I don't want to waste my time going through that all again when they already have my history. It makes me think that they don't even read those applications. They skim them and when something pops out at them they don't like, they immediately reject you. Not only did they reject me, but they told me if I got the application in by a certain date they would let me know if I could start with their insurance on February 1. I got the application in by the deadline but they didn't have the decency to let me know if they were insuring me or not as of February 1. In fact, they waited a whole week to before letting me know I was not insured. I hope my experience with Aetna that I have shared about their unprofessionalism will help people in the future steer away from Aetna when shopping for health insurance.

 
At 1:34 PM, Anonymous Anonymous said...

I just got through another nightmare with Aetna. I'm currently on leave from work for aggressive chemo ) and they have been difficult at every turn. Two days ago they tell me that they have not received any documents from the hospital and are about to cancel my leave which could get me fired from my job. All of these were faxed over weeks ago but I again have to jump through hoops at the last second to save my ass. When I called a few hours ago they tell me they got a fax but have no idea who its from or what it is. Panicking I call the hospital and get in touch with the right people who let me know they just got off the phone with Aetna and that every thing is fine they had the information the entire time. The coordination at the hospital has been spot on but for Aetna has either dropped the ball through incompetence or been willfully negligent, I don't know which would be worse.
As I'm sure that others who are ill understand this is just unneeded stress when dealing with a major illness or other important family matter. I can only hope that the people that cause so much pain one day understand what it feels like to be on the other end of the poking stick.

 
At 9:23 PM, Blogger Brad is Madness! said...

Aetna really really sucks. I was co-paying $255 a month..and was saving about $45 per month on prescriptions ran thru my Aetna insurance. No customer service to speak of, no savings, just all around JUNK as far as their "coverage" goes.

 
At 6:45 PM, Anonymous Anonymous said...

Do you reject Aetna and all its works?

I do

 
At 3:01 PM, Anonymous Anonymous said...

My primary care doctor, dentist, dermatologist and eye doctor will not take Aetna due to low doctor reimbursement, yet our family premium is roughly $22,000 yearly. Worst insurance next to no insurance.

 
At 1:12 PM, Anonymous Anonymous said...

first what you need to do, is file a complaint with your state attorney generals office many are aware of the situation and are tracking complaints for possible legal action. Second file a complaint against the clinician, its' a personal complaint against their license, which they can be suspended or lose their lively hoods, if it's a doctor do the same. don't just complain take action

 
At 3:00 AM, Blogger Jason Norin said...

Being able to communicate and understand your customers clearly is equally important as having a 1800 Number for your company.

 
At 11:37 AM, Anonymous Anonymous said...

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.

 
At 11:16 AM, Anonymous Anonymous said...

Aetna is a JOKE indeed. They turned down a refill on a critical pain reliever because itg was 'too soon' yet the dates on the prescription indicated clearly it was 33 days from last refill of a 30 day supply. Then they sated when it becomes refillable the price would be $140. We told them it was only $100. They could not figure why. We asked the pharmacy to input the code numbers from the phamaceutical company discount coupon that stated "Never pay more than $15 for this medication". Then Aenta said - OK it will be $40. We asked what about 'Never pay more..." did they not understand. We were told to call customer service. We did. The Aetna customer cxall center immediately connected us to an offer for a Free Cruise Sweepstakes. What kind of circus act comedy club nightmare of an insurance company is this????

 
At 5:10 AM, Anonymous Anonymous said...

Love aetna..pay me 2700.00 mo.never late.

 
At 3:13 PM, Anonymous Anonymous said...

Aetna is not the best and while I was doing the wellness test, after I had already provided a user name and password, I went in the next day, found out someone else had been in my records, I am shocked to say the least, what difference does Obama care make now?? If someone is going to just go around viewing personal medical records of everyone, might as well sign up for it, am seriously considering this, I am appalled, I had to change my password not once but twice, and I also informed aetna I would not be doing anything online with them ever again.

 
At 11:15 AM, Anonymous Anonymous said...

The best way to get some satisfaction is to annoy them! It is simple to do, message them thru Aetna about your problem. When they respond securely hit. reply and send it blank, then hit back and repeat sending blank replies about 50-100. This irritated them so badly the representative at AETNA actually violated the Federal HIPAA law and tried to file a formal complaint about me with my work. In doing so she disclosed the contents of my confidential and private healthcare email with Aetna! Once you get this reaction from them go to HHS.GOV to the OCR Portal and file the federal violation form. If enough people do this a case action may have a chance and the feds will fine Aetna up to 1.5 Million!

 
At 3:35 AM, Anonymous Anonymous said...

When you say clinician, do you mean their doctors that are denying your claim? I think someone/attorney should start a class action..After 10 years of LTD, they denied my claim...

 
At 1:51 AM, Anonymous Anonymous said...

If I discover that my condition has deteriorated beyond recovery by the time they give in, I am going to track down as many of their executives as I can, and together we're going to make national news.

 

Post a Comment

<< Home