Aetna Health Plans

Dear Unilocal users and Aetna,
The below is a complaint I posted twice on Facebook. I decided to post also on Unilocal in the hopes of helping Aetna customers and future customers be aware that PRICES AETNA’S CUSTOMER SERVICE REPRESENTATIVES PROVIDE — even when they know the physician is in network, are given the exact CPT code, name of the physician and the name/​location of where the procedure is taking place — CAN BE MANY OF THOUSANDS OF DOLLARS OFF. If you’re like me, you have a high deductible so you need to be careful to determine if you can afford a procedure no matter how much you need it.
The first time I posted on Aetna’s Facebook page, I felt perhaps I misjudged Aetna since their Social Media Customer Service Representative promptly responded to my query. She was kind enough to file a second appeal on my behalf. Her attentiveness doesn’t go unappreciated. But one month later — yesterday, Aetna unfortunately still will not honor price quotes their reps provided me before my surgery.
As you’ll see below, the quote and the actual charge are widely different. I appealed the price discrepancy twice to Aetna. Customer service throughout an organization is incredibly important. I suppose Aetna doesn’t feel the same way.
Please see Aetna’s estimates:
On sept 8 at 12:47pm
Re: Surgery information: Aetna pricing info for procedure 42 440
Dr M Cohen to perform the procedure at the Cantor Ambulatory Center/​Weill Cornell I was quoted the following:
spoke with Luanne from Aetna:
CPT code 42 440– submandibular excision:
* Surgeon: $ 552.00
* Facility: $ 552.00
CPT code 85 025: blood work CBC with differential platelets: $ 4.92
CPT code 80 053: blood work CMP complete metabolic panel: $ 6.05
spoke with LeeAnne from Aetna:
CPT code 100 anesthesia:
* Anesthesiologist: $ 42.00
Aetna’s actual accepted charges from Dr Cohen and Cantor Ambulatory Center:
CPT code 42 440– submandibular excision:
* Surgeon: $ 8,000.00
* Facility: $ 13,954.80
CPT code 85 025 and 80 053:
* $ 312.00
CPT code 100 anesthesia:
* Anesthesiologist: $ 2,240.00
I understand estimates are not solid numbers but a difference of 10s of thousands is unacceptable.
I hope the above helps Aetna and its customers. I hope going forward, Aetna will provide better quotes as well as honor and stand by their quotes, so estimates are truly close to the actual accepted charges.

If I could give a 0 star I would do. A customer service is absolutely terrible & not helpful. I went in to see a female doctor to get HPV test done on April 2, 2015. A few weeks later the lap sent me a $ 125 bill & I totally forgot to check if this service should be cover by Aetna. My bill due about 5 weeks after The DR appointment date. It happened to be I checked my bill on the due date & I check on it very late that day. I called the Aetna customer service, but it was too late, it was not during the business hours, So I paid $ 125 to avoid late fee & I think to myself if it’s cover I should get refund.
I called Aetna customer service on the following day, I believed I spoke to 3 different people & they all gave me different answers. The first person said for this service I should be cover, but I was not because I’m in the between 21 – 29 years of age. She asked me if I can call my Dr to send her some sort of prove, she will refund (didn’t make sense to me, She & my Dr have the same info, my age is the same) So I made a phone call to DR to send her a prove, Dr said she won’t do anything like that.
I called back to Aetna & talked to a second person from Aetna, I explained what was going on & she called Dr office to find out if they sent the wrong code to lap then the lap sent the wrong code to them, so I was charged instead of being cover.
The result from the second person was the lap sent them the wrong code & Aetna will make the correction by paying the lap on the amount of what I paid & the lap will refund it back to me & I should be expect it to get my refund within 3 weeks
Until today (July 14) it’s about 8 weeks after my last phone call to Aetna, I have not received my refund.
I made a phone call again today, so now the third person spent 1h 15 minutes on the phone with me to find out what is going on. She said that she will call my Dr & lap to see if anyone sent the wrong code. She put me on hold like 5 times. The results was I didn’t get cover because I was bleeding while a female Dr was performing the service, that is consider I was high risk of HPV, To me that is STUPIT, Dr would not tell patience info. The only matter is what I got done is cover or not cover. On top of that I have the prove as papers work from the Dr that they got from the lap that the result was normal. It was not high risk like what she said. I told her that what she said was not true & I have prove from Dr.
After hanging up the phone with her, I called my Dr & lap. So the lap told me that no one from Aetna has never called them regarding this bill.
So now I know that 3 people I talked to was not telling the truth, they didn’t even check what was going on. But put me on hold many times, pretending they are working on it. I wasted about 5h of my time calling Aetna 3 times, Dr 2 times and lap one time.
This is totally terrible from what they are doing, I had to pay out of my pocket from what I should be cover & wasted 5h to deal with it & still didn’t get refund. No wonder why all previously comments gave them such horrible reviews.
This is pissed me off that I had to signed up on Unilocal & gave them the first review on Unilocal ever.

Went to a medical facility for an MRI, Aetna said the services would be roughly $ 375 due to the type of plan we had. Received a bill for $ 314.00, paid it full immediately. Two months later, received another bill for the same service in the amount of $ 227.00. The medical facility stated it was Aetna — they had made a billing rate error. Called Aetna, they claimed the medical facility initiated the rate error inquiry. End result — I filed 2 appeals with Aetna asking them to own up their billing mistake and they refused. Aetna’s CEO made over $ 30 million in 2013. Poor customer service if you ask me — all I asked is for them to own up to their own mistake and pay the $ 227.00. bill I received due to their billing error. I guess that’s not possible because all they seem to care about is lining their own pockets.

This is for Aetna’s disability coverage:
I would give negative 100 stars if I could. I’ve been on disabilty for over a MONTH for recovery from a shoulder injury. I’m STILL fighting with the agents and their stupid forms I have to keep filling out over and over. EDD CA covers 55% of my disability pay and Aetna covers 5%. I have to pay a fee everytime my doctor fills out forms for me that EXCEED THE AMOUNT I EVER GET PAID FROM AETNA. Not to mention, my initial claim agent was a livid jerk. Michael Wilming. He would call and leave the RUDEST voicemails not just for me but for all of my doctors and therapists. The one star that I am forced to rate this comapny with is for my current claims agent who is actually great. That does not mean that Aetna as a company shouldn’t burn in the firey pits of hell, but it does mean that there are at least some decent customer service agents there with decent souls.

I went to see my doctor. My doctor scheduled me a much needed stress test. The test is tomorrow. I made all the preparations and I took off of work in order to do this. I get a call today from administrations stating that my test has been cancelled due to the fact that my insurance is refusing to cover it. I feel terrible and I am scared that I am going to have a heart attack if I do anything physical.
Aetna is the worst coverage I have ever had in my life. I have paid out of pocket for everything so far. They have not covered a dime and they fight everything. If my doctor is worried about me and I need this test, then why is Aetna refusing and wasting my time.
No insurance is better than this horrible money grubbing company.

There’s a reason why Aetha is leaving California. Because they are just terrible. I love everything about my job except for the fact that 4 months ago, they switched the Aetna. We had to change doctors twice already because both of our doctors are dropping Aetna. Our last doctor told us that Aetna has doctors less than Medicare! So lame.

Everything is much more complicated /​difficult than need be with Aetna. And ain’t nobody got time for that!

They want me to pay a $ 70 a month co-​pay for birth control. This is because my work renewed with them on ⁰⁷⁄₀₁ so they are not subject to the ⁰⁸⁄₀₁ mandate. I was better off when I didn’t have insurance and Planned Parenthood provided birth control FOR FREE

I’m a very healthy person but coincidentally have had 2 issues to deal with recently which leads to all of this:
1) If you’re on an individual PPO plan, especially the somewhat affordable Aexcel PPO plan, they have strong limits on what is defined as «in network». Good luck finding specialists who are in network! You can call Aetna to find out if a doctor is in network and are better off doing that since navigating this aspect of their website is like using AOL dial-​up. When you do call them, you’ll get transferred to the Philippines and likely have someone who will take 30 minutes to find out if a doctor is in network. If you need someone specific, like a spine specialist, whether ortho or neuro, good luck! They don’t know! They can tell you a list of orthopedic doctors — but they won’t know the specialty. They’ll give you a list of 5 and when you go to call those doctors, you might learn that all 5 specialize in ankles. or some other random body part that you don’t care about at the moment. Or perhaps all 5 work at a children’s hospital and only treat pre-​teens. Ask for a neuro spine specialist and they’ll send you to a brain surgeon. Useless. 10 calls plus hours wasted led me to zero spine specialists and the need to go see the good, out-​of-​network ones that my doctor originally recommended, which will cost me $ 400 out of pocket just for a consultation. Glad I pay a monthly premium… and so glad the insurance industry somehow has our government by its balls.
2) After months of excessive, almost constant burping (I know, too much info…) I went through testing that said I have SIBO. Small Intestine Bacterial Overgrowth. There is 1 antibiotic that kills this bacteria after 10 days. Other antibiotics tend to not kill the bacteria and require weeks and weeks of trying different pills, so it is established that this one drug is The Drug. It is a new-​ish drug and costs $ 500. It therefore requires insurance approval. I’ve waited 2 weeks for approval from Aetna so I can get started with the pills and finally stop burping. Here is the transcript from today’s call to Aetna. My voice is in all caps so it stands out, not b/​c I’m shouting.
HI, I’M CALLING TO SEE IF MY PRESCRIPTION HAS BEEN APPROVED SO I CAN FINALLY FILL IT AND START TREATING MY CONDITION?
Let me see… oh — you have a «denial on file». [silence]
CAN YOU TELL ME ANY MORE? LIKE WHY I’M DENIED THE DRUG MY DOCTOR SAYS I NEED?
Well the diagnosis letter states «info didn’t show you have the required diagnosis for the drug and it also doesn’t show that you have tried 1 required alternative».
WHAT IS THE REQUIRED DIAGNOSIS?
You can be authorized if you have travelers diarrhea or hepatic insepathy… and failure for 2 weeks of 1 preferred alternative.
WHAT ARE THE PREFERRED ALTERNATIVES?
If you have diarrhea: azithromycin, cipro, or lactulose.
WELL SINCE I DON’T HAVE DIARRHEA AND HAVEN’T TRAVELED AND DON’T EVEN KNOW WHAT HEPATIC INSEPATHY IS, WHY ARE THESE THINGS BEING THROWN AT ME?
They’re just going by the criteria.
WHO IS THEY? ARE THESE PEOPLE WITH THIS CRITERIA EVEN DOCTORS WHO ARE SAYING I DON’T NEED THE 1 DRUG MY DOCTOR SAYS I NEED?
This is our medical director team and they are medical doctors who go by our criteria. You can appeal if you wish to.
SO YOU’RE TELLING ME THAT MY DOCTOR DOESN’T KNOW WHAT HE’S DOING, MY BEST FRIEND WHO’S A DOCTOR AND SAID I NEED THIS DRUG DOESN’T KNOW WHAT HE’S DOING, AND THE ENTIRE INTERNET THAT SUGGESTS THIS DRUG AS THE OFFICIAL TREATMENT FOR THIS CONDITION IS WRONG!!!
We’re just going by the criteria
AND SINCE I’M NOT SUPPOSED TO TAKE THE MEDICATION PRESCIRBED FOR SIBO BY ALL DOCTORS, I WANT TO KNOW WHAT DRUG AETNA SUGGESTS I TAKE TO TREAT THIS CONDITION?
Well if you had travelers diarrhea, the alternative would be 1 of those 3 that I mentioned.
I DON’T HAVE TRAVELERS DIARRHEA!!! THAT’S LIKE TELLING ME IF I HAVE CANCER I SHOULD GO GET CHEMO. I DON’T HAVE CANCER SO I DON’T CARE WHAT THE TREATMENT IS FOR THAT! YOU’RE TELLING ME WHAT ALTERNATIVE DRUGS TO TAKE FOR PROBLEMS THAT I DON’T EVEN HAVE! DO YOU UNDERSTAND HOW RIDICULOUS THIS IS? i WANT TO KNOW WHAT AETNA SAYS I SHOULD TAKE FOR SIBO, WHICH IS THE CONDITION THAT I HAVE!
You would have to ask your doctor that.
I DID — AND HE TOLD ME THE DRUG I NEED IS THE ONE YOU ARE DENYING AND HE SAYS THERE ARE NO ALTERNATIVES THAT WORK FOR THIS. CAN I TALK TO THIS DOCTOR AT AETNA WHO IS «GOING BY THE CRITERIA» TO UNDERSTAND HOW I’M SUPPOSED TO TREAT MY CONDITION?
No sir. There is no way to talk to our medical directors. You would have to appeal the denial.
WELL I’M APPEALING IT RIGHT NOW AND I’M SAYING THAT IT’S BULLSHIT. WILL AETNA AT LEAST PAY THE AMOUNT THEY WOULD BE PAYING FOR THESE OTHER DRUGS TOWARDS THE DRUG THAT I ACTUALLY NEED?
You would have to talk to benefits.
I’M SURE THAT WILL BE VERY PRODUCTIVE. CLICK!

As an insurance representative that spends countless hours each day dealing with insurance representatives trying to get pre-​authorization for services, I can tell you that Aetna is without a doubt the worst you can possibly get in terms of coverage and service. If you are a member, I pray that you are healthy and stay that way.

if I could give them 0 stars, I would. My girlfriend has Aetna, and a life-​threatening condition that specialists have failed to identify in 6 months. every test that the endocrinologist has ordered has been denied, labeled as «experimental.» how can an unidentified condition be treated by anything that isn’t experimental? basically, my girlfriend was in the hospital for over a week after being admitted from the ER. now, over 6 months later, she doesn’t have any better idea of what is wrong with her, and her symptoms are worsening. aetna actually lied, saying that they had consulted with the endocrinologist, but when we talked with the doctor yesterday, he said they never even tried to contact him, let alone had a conversation with him about my girlfriend’s medical condition.
this is a perfect example of why health care should not be a for-​profit business. because corporations like aetna will take your money and deny coverage in order to improve their bottom line, even if it means the deaths of human beings who could have been helped.
shame on you aetna.

Aetna plain sucks, if you can find another healthplan go with them. I signed up for the dental DMO and picked a dentist from there own website. When I try to make an appointment, they state they no longer take Aetna. No big deal, I will go to the website and choose a new dentist. Come to find out, it will take 1 – 1.5 months to switch me over to the new dentist. I called customer service and the attitude of the customer care rep was kind of like, «that’s the way it is and your stuck with it».

Aetna has horrible customer service, horrible coverage, and seriously moronic people who work for them. I’ve had countless issues over claims and medication orders and they have point blank lied to me. Or I’ve received the pleasure of dealing with complete idiots with low IQ’s who have no idea what they’re talking about and can’t understand simple questions about plan coverage and claims. They also have a habit of processing claims to their financial advantage even if that is illegal and/​or incorrect according to your plan and totally screws you over. Dealing with Aetna is a full-​time horrific job that will leave your blood boiling and will require mental health and blood pressure treatment that they certainly won’t aid in covering.
«No more get better» is the more accurate Aetna tagline.