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.
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.
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
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!
188.8.131.52 m5.aetna.com IE 3.x Windows 95 16 :56:9 9/28/98
|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!|
From: Pam B.
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
Subject: Don't Choose Aetna Healtcare
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
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.
Subject: AETNA/US Healthcare
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
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
Subject: Re: Medical-Insurance complex
On Tue, 28 Jul 1998 15:27:54 GMT, firstname.lastname@example.org () 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,
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."
From: "Stephen P. xxxx" <email@example.com>
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.
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
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
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
Subject: 1998CRE1563B INTRODUCTION OF
LEGISLATION TO ENSURE PROMPT CLAIM PAYMENT BY HEALTH
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.
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!
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.
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