I am on the phone with them a couple of times a month to question a claim decision or to follow up on something I've appealed before. I don't think I submit a large amount of claims, but it seems that every single thing I submit is denied or short paid for one reason or another. Usually it takes awhile to get it figured out but eventually it does...it's just super annoying and a HUGE waste of my time.
An example.
Last year I saw Dr X. His office submited the charges. Aetna refused to pay because they said that Dr. X was not covered under their plan and that if I would just look under the docFind link on their website I could find a huge list of everyone who is covered. I told them I had looked there. The woman told me to look again.
I hung up and looked again.
There he was.
Listed as covered.
So I called back and talked to some man who told me to look under the docFind link. I told him I did. I even walked him through the steps I took to find Dr. X. He put me on hold forever and came back and said he would resubmit it because it did indeed look like Dr. X was covered. A couple of weeks later I got a letter from Aetna saying the claim had been reviewed again and was denied.
Again.
So I called.
Again.
The woman told me to use docFind because Dr. X wasn't covered. I asked to talk to a manager who told me Dr. X wasn't covered. I walked the manager through the steps and he said it was a mistake. I told him that his company's mistake shouldn't cost me. He told me to appeal the decision but that there was nothing else he could do.
So I appealed.
Aetna denied the claim.
Again.
So I went online to the docFind and printed off the pages showing Dr. X's name. That's right. Dr. X was still listed as in-network even though supposedly his contract with them had expired well over a year prior and I had been talking to them about this claim for over 6 months (which one would think would be plenty of time for them to update/correct their website - in fact, just for fun I went in tonight to look one more time. Sure enough 15 months after this all started Dr. X is STILL listed as in-network).
Then I appealed.
Again.
I sent in 20 pages of documentation. This time the appeal went to my employer. A few weeks later I received a letter from my employer saying that my appeal was approved and Aetna was responsible to pay. They paid 10 months after the charges were incurred. It had taken me hours of time spent listening to hold music and hours of time gathing information, but I swear when that letter arrived I thought I was going to run through the snow naked I was so happy.
So several weeks ago I started going to a new chiropractor (Dr. Y). He was recommended by someone I know, and before I made my first appointment I went to docFind to make sure he was covered. Sure enough, there he was.
So I went to my first appointment and second and third. Each time I happily paid the copay. And today I received the first notice of the claim. They told me I would need to pay 30% of the total bill - not just the copay. WTF? So I emailed Aetna and asked for clarification of why I had to pay 30%. Their email back to me:
Dear Ms. Cmuser:
Thank you for using the Aetna Navigator website to contact Aetna Member Services.
This is in response to your claim question on yourself for 12/03/08 from Dr. Y for $XXX.
We have processed this claim according to your non-preferred level of benefits because this provider does not have a contract with Aetna.
Search for Aetna providers by logging in to Aetna Navigator and selecting Find Health Care in DocFind.
Blah, blah, blah. You have got to be kidding me. This cannot seriously be happening to me again. But it is. I went online tonight and there is Dr. Y listed as in-network. This isn't the only type of problem I've had with Aetna. Everything from them saying I couldn't have two physicals in one year (I only had one - they paid for it after I faxed them proof) to them saying blood tests couldn't be covered because they weren't medically necessary (they were ordered by their in-network PCP, but I guess that doesn't qualify - or at least it didn't right away. They paid for them after I sent them paperwork and a letter from my doctor). So, tomorrow I will call Aetna. I will start all over again. Then I will report them for being the lying scoundrals they are. What's the point of having insurance if you have to fight them all the time?
23 comments:
I went through this same exact thing (I have Altius)! They said it was the doctor's fault for not manually removing her name from the insurance's web site, not theirs. I appealed and won, and after all of that, her name was STILL on their web site! They wouldn't remove it even though they knew she wasn't covered! Ridiculous.
Completely agree. We've dumped Aetna now and are happily over on Blue Cross of MN now. Way better coverage.
I hate them as well. I've had a fetal demise and the keep directing me to Doc Find to find a doctor to do the procedure...which of course it tells me absolutely nothing....now I've been told that they've approved a non-in network provider, at the "preferred level" but won't tell me how much that covers... everything takes several days just to solve. Seriously, fetal demise you think would get you somewhere with these people.
My discontent with Aetna is not as serious as yours, so I'm sorry my issue sounds trite. However, please know that I'm sincerely sorry for you, your family and your issue as an average hard-working American.
And I share your issue with the carrier and the health insurance industry in America in general. It is completely out of control without any governance and is running the average American into the ground and killing this country.
I recently had a dental issue - a crown cracked. I called my dentist and he fixed the crown within a week. Only after the crown was fixed did I learn that Aetna Dental wouldn't pay for it. Apparently, that crown (tooth number 13 ???) was put on 5 1/2 month ago and my policy only covered crowns applied <=6 months.
After my dental office learned that Aetna wasn't covering the crown, they appealled.
I learned of the appeal only after I received a letter from Aetna that they weren't covering the claim. I called and discussed the issue with someone who answered the phone. When reviewing the decision the drone mentioned the term. Noone on Aetna's side ever questioned why the dentist office didn't call them before the procedure or discussed what a temporary solution would be for 6 months until coverage would be acceptable. The easier way out was to victimize the victum - the average American.
I tried discussing the issue with my company's HR department. They all but laughed at me and literaly stated that the insurance carriers are "a million miles away and do not care for anything but the dollar." They then went on to call me a naive kid and for me to simply pay the dentist the $600.
Bottom line the insurance companies, medical professionals and corporations do not really "care" for the American.
Aetna truely does suck.
Just to clue you in on how they behave from the other side. A relative of mine is an in-network provider, contracted through Aetna. She is about to go ahead and get out of their network because they pay a seriously low amount. She gets the co-pay plus what Aetna pays, which totals to literally below half of her normal charge. So, I don't know if they are that way with all of the fields they cover, but that basically *could* mean that a large majority of people in the "in network" list either won't be there too long or are not good and despirate for clients.
This is a case of "you get what you pay for" I chose Aetna for my business because they offered by far the lowest cost and what seemed to be a descent network. As an employer with older employees (some with health issues) other insurance was unaffordable for my business and my employees.
All was fine for a while but now the network has gotten progressively worse. I am fully aware the the medical providers are dropping their contracts with Aetna because of reimbursement rates. I can't blame them for wanting to get paid a fair amount for their services. But I couldn't afford insurance otherwise. So we are stuck with Aetna and a worsening network.
I've had a pretty bad year with ruptured bilateral Achilles tendons, a broken shoulder and a deep vein thrombosis. All becauseof an antibiotic I took called Levaquin. Anyway, I started a year ago with Oxycotin, then went to vicodin and now I am so much better that my doctor switched me to Celebrex a non-narcotic pain reliever which is gentler on the stomach than alleve or tylenol. They denied the medication saying that tyhey have a new rule that anytime you receive a new prescription which you have not been on before the DOCTOR has to call and explain why you need it. So, my Doctor is suposed to take an hour out of his barely compensated day to listen to music and then beg Aetna to give me my meds. In the future, should I need any medication the doctor has to call and explain to a bunch of non-medical personnel why it is justified. Are you kidding me? It has begun. The government/insurance companies will be determining which prescriptions we may take. Some hack behind a phone is now in charge of my health care. Anybody with a brain can look at my medical records and see what has happened to me and they should be glad I am only on celebrex. they also denied physical therapy for a broken shoulder even though the insurance was accepted by Aetna. Same thing with MRI's and such. bastards. Am I in Canada?
AETNA SUCKS!!!! I'm on my thrid review process for a high blood pressure med. This med works the best for me, but they want me to try several types before they pay for it!! Now, for the third review process, I have to pay $500.00!!!
Andy Rocuba, Forest City Pa
Aetna is a disgraceful insurance company. I have a policy with them that costs me about 9 grand per year. Yet they often deny claims for things they say they will cover in their benefits - for example, AETNA tries to avoid paying for the health and welfare of our 2 year old daughter that's under one of their plans even though the things that our daughter needs are covered (that's why we CHOSE Aetna). They lied in the coverage benefits brochure.
Even the hospital and doctors in the hospital that our girl goes to tell us that they have these nightmares with Aetna all the time.
The bottom line - if you're an HR person - DO NOT PICK AETNA FOR YOUR EMPLOYEES. Your employees will end up wasting literally days of work time, and personal time chasing down Aetna as it tries to weasel out of legitimate claims for services.
We currently have thousands of dollars of medial debt due to Aetna's incompetence, and dishonesty, yet we PAY AETNA $9000 PER YEAR FOR COVERAGE.
How slimey is that? AETNA SUCKS.
I'm in HR but have no decision making authority on our carrier. Everything has switched to Aetna.
I have spent months of my life appealing health coverage for my daughter (hearing impaired, legally blind at the time, and trying to get the Occupational Therapy she needed to catch up to hear peers). It took over year to fight but I finally won.
I spent months more on a hospitalization that was supposed to be preauthorized (the hospital said it was) but Aetna said it wasn't. I ended up getting half what I was entitled to.
Now as my disability carrier they are denying another claim. I'm in a hostile work environment and they cannot see why my depression, anxiety, migranes, heart racing, high blood pressure, etc. do now allow me to be in my occupation.
As much as my job sucks, it much be must worse to be an Aetna insurance adjuster.
Wish me luck with more appeals. And, rest assured, my benefit department will hear yet another complaint from me about Aetna.
To: Jackie Barley (Aetna Insurance, Designated Hit-Woman) Date: 09/02/11
Subject: LETTER of APPEAL to request that Aetna & AAFES cease and desist in their systemic attempt to murder Robert FitzGibbon. Such appeal is submitted as required by the illegal, idiotic, illogical, asinine Aetna Appeal Process, designed to provide cover to Aetna’s illegal, immoral, corrupt, murderous actions.
Ms. Barley:
Per the suggestion of the idiot woman who spoke with me this morning ( Ms. Wilson) regarding the illegal and immoral acts of Aetna and it’s designated employees, this communication is the basis of the asinine “appeal” that I have been forced to participate in.
Let me be blunt, since Aetna refuses to reveal the content, conversation, participants, dates and days of the “consultations” that take place regarding Aetna’s legally obligated pension payout to me, it is impossible for me to complete an accurate, supporting appeal letter by which I would “appeal” a decision that I have not been privy to, or involved with making on any level.
It is kind of hard to appeal what I don’t know, so if the dipshits at your company want to get together and inform me of what new great “medical evidence” they have that has cured my genetic epilepsy, my brain-damage, my Complex-Post Traumatic Stress Disorder, Clinical Depression, uncontrollable blood-pressure, memory damage, the psychological ramifications of my illnesses and the flip of my car off the 200 foot cliff,…I’d love to respond and “appeal”.
So, as soon as your company grows a pair of ethical gonads, and wishes to reveal the content of those illegal conversations, I’ll be better prepared to write another stupid appeal letter,…that you Satanist Thieves may be forced to accept.
I also need to inform all of you that I’ve charged yourself, Ms. Wilson and all unknown Aetna & AAFES persons found to have participated in conversations, communications or activities related to Aetna’s efforts to prematurely kill me, all of you have been accused of Attempted Murder by myself… and, to the best of my knowledge, investigations and “consultations” regarding the charges are ongoing.
As I communicated in the attached appeal letter and media release, I have filed charges in El-Dorado County, California and the EDC Sherriff’s Department is working the issue. (We shall see) And I have also filed charges through the FBI regarding the violations of the Federal RICO statutes, by Aetna & AAFES personnel. It is my understanding that based upon my communications with Senator Barbara Boxer’s office; the government is remarkably interested in this type of immoral behavior by companies such as Aetna on a national basis… as well as a potential preliminary FBI inquiry getting underway. (FYI, KCRA-Television in Sacramento is also investigating Aetna’s illegal activities)
Send me something to appeal, and I shall do so.
Robert FitzGibbon
PO Box 118 / Greenwood, California / 95635
....post continued....
To: KCRA Television / Call for Action
Subject: Information Packet/Aetna-AAFES/Pension Issue-APPEAL DOCUMENT
Date: 09/02/11 Phone: 530-889-
Claimant Name/Address: Robert FitzGibbon – P.O. Box 118 / Greenwood, California / 95635
Ms. Friday:
Thank you so much for the compassionate, ethical reaction to my plea for assistance. I can understand that my story may seem overly-dramatic…however, when you suffer from seizures which can cause you to simply blink out of known existence, and which put you into an oppressive position of “second-by-second” distress over financial, mental or medical status, well, it is not a soap-opera to me. In fact, everything described in this document is of life-threatening consequences to me and millions of other disabled people as well.
The fact that I could (at any second) stroke out, seize out, or suffer a heart attack from this corporate / government abuse is almost unbearable. Aetna thinks that in spite of having access to both my medical records, and the medical advice from their own Doctors, Aetna thinks they can simply call me up every few months and claim to be able to cancel my pension and steal my financial security? I find this to be both an illegal and immoral act. And, in my opinion, both Aetna and AAFES commit an aggressive act of attempted-murder each time they do so.
Additionally, based upon admitting that Aetna & AAFES meet regularly via phone or “in consultation” (always without I or my representative allowed to be present), and by refusing to reveal what was discussed regarding my disability case, Aetna representative, Jackie Barley, has openly admitted to potential violations of federal RICO statutes by herself, her chain-of command, and any other AAFES executive participating in these collusive meetings.
It is a proven fact that I am permanently disabled. It has been proven beyond any doubt that my disability is documented, and that my condition is incurable, both from the long-term damage inflicted by the corrupt AAFES work environment, the brain-damaging auto accident, and the incurable genetic epilepsy which leads to uncontrollable, documented seizures (see attached video).
post continued..............
It is a fact that my condition will never change to the degree that I can again be allowed to drive, operate machinery, be dependable and/ or be responsible for myself or another, ever again.
It is a fact that I will never be “whole” or “able-bodied” ever again.
Aetna & AAFES are aware of this fact, yet continue to behave in a manner illogical to their stated goals of “re-qualifying me”. How could I have become “disqualified” once Aetna and SS “qualified me” and documented the permanent nature of my disability?
Aetna & AAFES know that based upon my condition, once I was documented as disabled, I will never be whole again…therefore every meeting they hold or conduct… is a meeting that involves discussing how to violate the law, and illegally reduce my pension and earned benefits.
Aetna & AAFES executives are aware of my condition when they “enter into consultations”. In fact, they are violating Federal RICO Laws by convening such a meeting. Aetna & AAFES are aware that my medically documented status will never change to an “abled-bodied” status, and therefore they are individually aware that under the Federal Settlement Agreement, as well as my contractual relationship with Aetna, that I am entitled to the pension owed to me by my disabled condition. They know they owe me the pension either way, so all actions that spring forth from these “consultations” are nothing but the execution of the two company’s illegal plan to defraud myself and millions of others.
However, non-physician executives from Aetna continue to claim every few months that I no longer qualify for the disability pension, in spite of all the medical evidence, documentation and logic…which leaves only one motivation for them to continue such behavior.
Aetna & AAFES are aware of the medical result of such ongoing tension and stress. Aetna is perfectly aware that if they call and harass a certain percentage of claimants who are truly disabled, that eventually that stress and distress will lead to an early death. So essentially, Aetna and AAFES collude in meetings to reduce my benefit, take my pension, and stress me to the point of death, stroke or heart attack, which on an actuarial basis, lowers Aetna & AAFES’s costs, thus improving their profits and the material gain derived from getting a certain % of their clientele to drop dead.
It is my understanding that after making this charge to the El-Dorado County Sherriff’s Office, the detectives are taking my claims seriously and are bringing my case before the Prosecuting Attorney for review or action.
...post continued....
Had a similar situation (they preapproved therapy sessions, paid some of them, then stopped and claimed that they weren't covered after all) and went through months of phone calls, correspondence, confliciting stories from whoever I happened to talk to that day, and rounds of appeal, including two with the state appeal board who just tossed it back. Finally took them to small claims court.
Had never sued anyone or had anyone sue me, so I was leery of this. But in my state, they make it easy (all on-line) and inexpensive (~$50 filing fee).
The night before the hearing date, I got a call from the local person they farm these all out to and was offered a full settlement of everything I was owed plus my court filing fee. That rep was the only reasonable person I ever dealt with through the whole sorry affair, explaining how the payment would work, following through as promised, etc. I mentioned that if their service reps were all like that, they wouldn't have nearly so many disputes.
The reply: "Yeah, that's true, and I wouldn't have a job, either".
Small claims court is now my highly recommended route to go!
I've been fighting AETNA for over three weeks trying to get a prescription filled. First they tell me that my test strips are not covered, even though my insulin pump is, which only works with the non-covered test strips. Then they tell me, oh, yeah, they are covered but we need prior authorization from my doctor. What is the point of prior auths? If the doctor writes a prescription, doesn't they mean that they authorize me to get the prescription? Why do I need to call the insurance company, then the pharmacy, then the insurance co, and back to the pharmacy to get a stupid prescription filled? My copays are paid, so it should be a no questions asked when I ask for a prescription to be filled. I'm still waiting on the prescription. They also stopped covering prenatal vitamins that my wife was taking. They don't cover any prenatal vitamins. Now doesn't it make sense to keep people and their babies healthy. What if a baby is born sick because the mother doesn't take prenatals. The insurance company will pay more in the long run. Why can't they be proactive. Keep people health and not sick. Stupid AETNA. AETNA SUCKS!!!
AETNA DOES SUCK!!!! I left one company because of Aetna. My new company had BC/BS...it was wonderful. Now they switched to Aetna. And I am now back in Aetna hell. I wish there was a way to bankrupt this company...I would love to see them to go under and never come back.
Same thing happened to me! They are horrible.
The morons at CA Technologies chose Aetna years ago, and they still stick with this cheap ass provider today. Not only that, they pay us with a 20% discount if we provide Aetna with some of our personal health information like BP, weight, waist size, etc...all so Aetna Actuaries will have data to improve their margins, and drop those that either don't comply, or don't meet health guidelines.
I pray that either CA, Inc. gets bought out, or they change their medical coverage next year as Aetna is NOT A BENEFIT !!!
I'm guessing there are huge kick-backs from Aetna to CA Exec's in some form or fashion, that justifies the continued hemorrhaging of cash to Aetna...whats worse is that while its completely immoral, its likely completely legal!
Another aetna horror story. I am currently pregnant. According to my arena copay plan everything is covered except a $50 copay upon my initial prenatal appointment and $500 per day copay for my hospital stay. Fine. But the charges have been much much more. First of all, during pregnancy they do routine blood tests. For every Blood test I have been charged $50 through a bill from quest saying this is the amount aetna will not cover. Then I went for my standard 20 week ultrasound. Guess what, aetna tried to bill it as an unessesary proceedure! They attempted to charge me $750 for a pregnancy ultrasound! Luckily my appeal was accepted, but how could they even attempt to not cover it. Then today was the last straw. I am having a scheduled c-section. I was told to come into the hospital for pre-op testing, which consisted of a blood test, weight check, and bp reading. Get this FIVE HUNDRED dollar copay. And this was not made aware to me until I was actually at the appointment. So I had no idea that I was going to be charged this amount. WTF! I hate these people. I seriously wish terrible things to happen to them.
Aetna lies...they wont pay my disability claim due to lack of evidence..Really? I asked them if they wanted a blood sample. Stage 3 breast cancer, double masectomy, and now reconstruction. Reconstruction is a LAW, and Its been a month, and they have not sent me a dime. I told them Jan 2, and its the 31st, and not one penny. I pay them to be insured, wtf? They suck.
I'm very sorry for all of you, at least it's not only me. I've been fighting a Jan 4 claim for months now, something that has always been paid, a provider that has always been covered, they denied. I asked why, they said it is not covered under your plan. it was covered before, every time, it is an office visit with proper diagnosis code. they say no. I said, "did my plan change?" no it didn't change at all. "then why is it not covered, it was covered before?" Before was a mistake. 2 plus years of coverage was a mistake? looks like it is covered in my plan brochure also. I am so stressed over this I will have more medical bills just from dealing with Aetna!!! so what is the solution? my employer chooses the health plan. I used to have Connecticare.
I just talked to their customer service to confirm whether naturopaths are covered under our plan. The first person I spoke to said they were not, under any plan under Aetna. She reiterated this numerous times even after I'd showed her ND claims that they had paid on my behalf. She also told me massage wasn't covered at all. I hung up with her and called back 10 minutes later, and spoke to someone else. he had never heard of naturopaths and asked me to spell it (really?) but then did confirm that NDs are covered (if they're on the preferred provider list). Massage is covered to (60 visits in a year!) if it's related to a medical issue. Way to be consistent, Aetna! Good lord.
Aetna sucks. End of story.
Post a Comment