Aetna

 Stay Away

From

 AETNA

US HealthCare

Richard Huber, President

Aetna Inc. • 151 Farmington Avenue • Hartford, CT 06156 USA • (860) 273-0123

Learn From My Experience !

 With all the talk of rising health care costs, one would hope that the service we receive would at least attempt to approach the cost we are asked to bare. My name is Bob and I'm employed by a major consumer electronics company in Northern New Jersey who uses Aetna to administer our health coverage plan. I'm just plain sick and tired of hearing what Aetna can't do - what can they do?

Following their reported "down sizing" about two years ago, many of my co-workers noticed a distinct decrease in Aetna's performance, particularly in their ability to follow instructions and process claims in an acceptable time. Requests to our employee benefits office fell on deaf ears.
If you are even considering using Aetna as any part of your health care coverage - PLEASE RECONSIDER!

Over the past 13 months more than 50% of the claims I've submitted have been mysteriously "lost" in Aetna's system. Their typical response is that they have no record of ever having received it. You are asked to resubmit the claims and begin the process which typically takes 30-45 days. These verbal responses were sometimes contradicted by responses from their automated system that indicated that payment of the claim would be delayed or denied for reasons that would / could not apply. And despite these responses, a check would sometimes appear in the following days mail. In another case, one of the "missing" claims was electronically submitted by one of my wife's doctors.

It's obvious that Aetna and its systems (manual and electronic) don't have a clue to the status of any given claim when asked! Under payments and disallowing certain covered procedures are also very common. In my particular case, my wife happens to work for a medical practice and is able to cut through all the "BS" terms and deal with their incompetence.

I did discover that claims mailed via certified mail always seem to make it through the system. After hearing this story again while on vacation, I decided to go public with this and alert would be Aetna customers. So what is one to do? Well, for starters I will be filing a written complaint with the Department of Insurance in the respective states where Aetna does business. I also suggest you direct all such problems to Aetna's president, Mr Richard Huber at the address below. And after beginning this Web page, I decided to see what other Aetna customers thought of their service. A quick scan of the USENET groups turned up over 37 such horror stories. What follows are a few excerpts from several I found.

E-Mail Me if This Helped You

Richard Huber, President

Aetna Inc. • 151 Farmington Avenue • Hartford, CT 06156 USA • (860) 273-0123

Update!

You would think that after all the letter writing and complaining I've done, Aetna would really try to do it correctly. We recently submitted a claim for an injury my son sustained at summer camp. The necessary paperwork was submitted which included radiology bills and charges for the emergency room. Aetna decided to pay the radiology bill, but declined to pay the emergency room bill, stating they needed additional information. Via my benefits office I complained that they obviously don't read the cover letter or the diagnosis on the emergency room bill. Magically, the bill was reimbursed with a check in about 7 days. This only proves that the squeaky wheel gets the oil ! If you are reading this and you are having similar problems, complain like hell to your Congressman or state representative. Please tell them about this page!

I will post new info and similar horror stories as they are received.

I guess I have Aetna's attention - as seen below, here's records as recorded at my ISP of a recent visit to this page by Aetna!

206.156.35.5 m5.aetna.com IE 3.x Windows 95 16 :56:9 9/28/98
206.156.35.5 m5.aetna.com IE 3.x Windows 95 17 :3:56 9/28/98
206.156.35.5 m5.aetna.com IE 3.x Windows95 12:12 10/2/98
206.25.230.7 h3.aetna.com IE 3.x Windows 95 9:53:5 10/29/98
206.25.230.7 h3.aetna.com IE 3.x Windows 95 11:52:3 10/30/98

October 31, 1998: Just received a very encouraging E mail from a reporter at a major newspaper in Chicago. He is writing a feature story for a Sunday edition that explores the corruption and underhanded ways insurance companies treat their customers. He plans on referencing my page in the article! According to the e mail he too has had some communications with Aetna employees who are very disturbed on how they are told to handle certain matters! Stay tuned for additional info as it becomes available! 


Hey Aetna - Look What People Are Saying!

From: Pam B.
DATE: 4-6-99
SUBJECT: AETNA is bad news and tried to do me over.

I do not know how anyone working for AETNA can live with themselves. I have inquired into our claim for 2 days now. Formerly we were with Prudential until my husband's employer wanted AETNA to save money. Since we converted to them and not by choice, it has been one nightmare. I get IVIG treatments which cost $10,000 for one treatment. These are specialized IV treatments that take 3-4 hours. My doctor is registered under a group policy and they tried for the longest time to make her out of network and processed my claims that way. I yelled at them for 2 days and in my last conversation I just said if you want to take me to court go ahead but one thing remains unchanged. If you start to mess with my health, you are messing with fire. You can mess and tease me about other things but not my health plan and provisions. I need those IVIG treatments to live or I will die. Aetna, you are trying to FORCE me into taking a doctor of your choice, not mine. The doctor you want me to take has no control over the IVIG treatment I get. I may go months without one. If that happens you will be in court so fast your head will spin. I finally found a rep. who knew what she was doing and got her name. She said my doctor was found in network and so forth. I told her if she would not of been in network, AETNA wanted to pick my doctors for me. She said that is wrong. I then said after the trouble AETNA has put me through I want a letter stating that she is in network and signed by AETNA. The representative agreed to this. I told her, as well, I NEVER received one EOB for payment of bills. I also told her I do not read minds. She is forwarding the EOBs to me for payment. The one thing I find that AETNA understands is the word SUE. Sue as in I will sue you if you play with my medical health. I told them this and they straightened up in no time. In the beginning I heard 3 different stories that could not be backed. AETNA was trying to change the policy when all they were hired to do was to oversee the policy as it already stood. AETNA is so messed up that I would discourage anyone from taking them. If you enjoy doing their work for them, fighting day and night with them, having your health care put in jeopardy then they are for you. Otherwise, AVOID them at all costs. Check out your healthcare provider before making any decisions. This way you save time, money and mental anguish. If they get on your nerves, e mail me. I have
the name of a representative who is top notch and puts things in writing for you so you have proof that your conversation is good and it is documented.
 

 Subject: Don't Choose Aetna Healtcare
From: "Westley L. Hespeth" <hespethw@all-speth.com>
Date: 1998/08/01
Newsgroups: alt.health.hmo

In this era, services are less and the cost is more. More an more companies try to give you less services for more money. Sometimes they look for way to get the money and provide no service.

In my case Aetna Healthcare refused to pay some of the normal healthcare expenses incurred by my then 1-year-old daughter based upon simple a mis-communication.

While I was a member of Aetna for approximately 1.5 years my daughter went to the same doctors office. For a one-month period of that 1.5 years Aetna refuses to pay my daughters $ 122.00 doctor bill. Why? They claim that I was informed that my doctor was not the correct doctor that my daughter should be using. Not to my knowledge!

I finally got wind of this much later on after I started receiving bills directly from the doctor. At that point I made it loud and clear which doctor was my daughters doctor but' they still refuse to pay the one bill.

My current employer provided me with a report on how various healthcare providers rated in different areas. No to my surprise, Aetna has a rating of "below average in "Getting HMO's
approval for healthcare".

The bill that they refused to pay was for a regular doctors office visit an immunizations. Not anything extravagant !

Take it from me, if Aetna is one of your choices, strike them from your list.

Another....

 Subject: AETNA/US Healthcare
From: "Jackal" <jackel2001@aol.com>
Date: 1998/08/07
Newsgroups: alt.health.hmo

If anyone is interested in an example of why the care that is received in many medical offices is a quick, impersonal, and poorer than it used to be, take this as an example.

I am a physician practicing Internal Medicine. I recently received a certified letter from Aetna/US Healthcare informing me that as part of their re-credentialing process (we have to fill out all of teh forms and re-apply every year, even if nothing has changed), we were to copy every page in 10 charts, and mail it to them for review within 10 days).

This may not sound like a big deal, but when some of the people have been my patients for many years, the copying job ran over 1000 pages, each had to be copied by someone in the office, a page at a time, and then mailed to them. The process took more than a week, one of the two people that work in my office was no longer available to take care of patient needs, and the cost
to my office, just in labor, ran to more than $300. During the course of this, the copier (which was never designed for that kind of load) broke, and cost another $320 to repair.

During this period, patients were kept on "hold" and appointment had to be rescheduled, so everyone suffered. When this was explained to US Healthcare, they were uninterested, as long as they received the paper.

REMEMBER AETNA / US HEALTHCARE's approach to patients' problems the next
time you are asked to choose an insurance company.

And Another....

 Subject: Re: Medical-Insurance complex
From: mythago@twisty-little-maze.com (Laurel Halbany)
Date: 1998/07/28
Newsgroups: or.politics

On Tue, 28 Jul 1998 15:27:54 GMT, clw@teleport.com () wrote:

I would just recommend that if any of y'all have the opportunity to choose Aetna as your insurer, you run as far as you can in the opposite direction. (Once, my SO, a normally peaceful person, got so irritated with their crap that he told a claims clerk he believed they deliberately understaffed their claims department to discourage people from filing. There was a long pause,
then she quietly said "You're right about that.")

See, they don't *refuse* to pay. They delay payment, then claim the doctor must have somehow misfiled. Or they ask you to submit a second claim form under the pretense that the original bill did not completely describe the medical condition. My favorite was when a woman at my SO's workplace was asked to provide proof that the chemotherapy (for her breast cancer) was "not an elective procedure."

And Another

 From: "Stephen P. xxxx" <smcxxxx@megabits.net>
(Name Withheld by author)
To: <frunner@hotmail.com>
Subject: can't stand Aetna, HMO
Date: Sat, 15 Aug 1998 07:18:30 -0500

We have Aetna HMO. I hate it, not only do they loose claims they also do NOT send out EOB's so we know what they pay. I have had Aetna since January 98 and hope to get out as soon as possible. Many of the Doctors in the Central Florida area have dropped out. Needless to say it is hard to find Doctors that are still in the plan. My son has an esophageal muscle problem. His Doctor, an Aetna doctor, referred him to a specialist in Tampa. Aetna refused and said to send him to speech therapy, he is 17 and has NO speech problems. Several years ago I had to have an emergency abdominal bypass, now Aetna is telling me I can no longer get my prescriptions filled. That they are short term drugs, my Doctor(in the Aetna plan) is now fighting that. My husbands job is suppose to come under a new contract in October, I pray we get better benefits.
Margaret
Florida

How About This!

Thanks for sharing your information. I had been insured by Aetna from 1/96 to 12/97 under a corporate self insured plan which was a PPO - I live in CT. I had been healthy my whole life and during those two years insured by Aetna I had to undergo 5 emergency treatments, 3 of which were surgeries.

My own antibodies attack the muscles behind the eyes cutting off blood supply from the brain through the optic nerve. I have been battling a condition if not operated on you can go blind. Aetna has indicated that these procedures were not medically necessary when they pre-certified
them and they were all done in emergency room. How can anyone with a conscience say they were not medically necessary.

I have been battling with them for 2 years now on payment of claims. Like yourself, the documents were lost, faxes lost saying in e-mail something is covered and then not paying it. Two weeks ago I received from them a letter saying I have exhausted all of their appeals and
everything is denied. I never received utilization reports, doctor's opinion as to why they were not medically necessary. When I would call I get put on hold for 45 minutes. I have written to Mr. Huber, with no response, Mr Cardillo, EVP, no response, the State Insurance Commission
and they cannot help me because I have a self insured plan through my employer. My employer has been no help either. I really am disgusted with the whole matter and it leaves me with nothing to do but consult a lawyer.

It is a shame we pay for a service and we do not get the good delivered for it.

Thanks for listening.

"Live Well..Laugh Often...Don't Forget to Smile!"
http://expage.com/page/deniseeyesite 

But Why Are They So Screwed Up....

 Subject: 1998CRE1563B INTRODUCTION OF LEGISLATION TO ENSURE PROMPT CLAIM PAYMENT BY HEALTH
From: roboposter@us.govnews.org
Date: 1998/08/06
Newsgroups: gov.us.fed.congress.record.extensions

What had been 44 claims-processing centers across the country were consolidated at about 25 locations, and the number of employees handling claims was reduced by more than one-fifth. Employees with 15 years of experience were replaced by people with less than a year's experience, said R. Max Gould, Aetna U.S. Healthcare's head of customer service.

And What Are People Saying After Viewing this Page?

 Thanks' I'm in the process of moving to N.C., My husband's employer offers only US Health. I think I'll check out carefully what MY potential employer has to offer before we switch!

M.S. Rochester N.Y.

PS: We've had a great experience with HMO'S Here through Blue Choice


Anytime you have a problem with your heath insurance company complain to your State Insurance Commissioner. cc. the Governor, your State Assembly person and Senator and your local newspaper. We get lots of people who call us about problems and we have found that by raising a lot of noise you can get a lot accomplished.

M. H. Executive Director
Nevada Diabetes Association for Children and Adults
Diabetic Educational Center
'A Non-profit Global Community Resource'

 

E-Mail Me if This Helped You!