Aetna

We’ve had them for about a year now, and I’ve never been so frustrated with a company in my life.

Example: My hubby was having chest pains, and thought he ought to have it checked out. We went to our primary care physician for a referral. We went to the specialist, had the tests, and it turned out that he was fine.

A while later, I get a bill from the specialist for several hundred dollars, with a note on the bottom saying that Aetna had denied our claim because we hadn’t gotten a referral from our PCP. I called them, told them that we did have a referral, and was assured that it had just been a clerical error, and the problem was taken care of.

A few weeks go by, and we get another bill from the specialist. This time, I call our PCP and ask that they fax me a copy of the referral. I then call Aetna, and tell them that I got another bill, and that I was told this was taken care of. The woman I speak to says that they never recieved a referral. I tell her that I have the referral right in front of me, and she asked that I fax it to her. “Good,” I think, “Problem solved!”

Soon, in the mail comes another bill from the specialist, who is threatening to put us into collection for the money. I call his office, and explain the situation, then I call Aetna. The man on the other end of the phone says again that there was no referral. “I faxed it to you myself,” I said, and gave him the name of the person I had last spoken to. I fax the referral to them AGAIN. The man assures me that he is paying the claim as we speak.

I get another bill soon thereafter, and a curt letter from a collection agency. Now I’m pissed. I call Aetna again, and ask to speak to a supervisor. “We don’t have
supervisors,” the woman tells me.

“What?” I say. “Everyone has a supervisor. Even the President answers to someone!”

“No, ma’am, we don’t have supervisors.”

She tells me I had no referral, and I fax it off to her once more, along with the transmission slips proving I had faxed it to them several times before. “I’ll get this taken care of right away,” she says.

Two letters from the collection agency, and two angry phone calls later, they finally pay the claim.

This is not an isolated incident. Aetna has NEVER, not ONCE, paid a claim without this long, drawn-out battle. What the hell is their problem? Why must every single claim be a three or four month struggle? I’m embarrassed when I get the collection agency letters, and the most frustrating thing is that Aetna apparently doesn’t give a good goddam about their customers. Complaints get no response. As soon as we’re allowed to, we’re dropping them and going to another company, even if it means more out-of-pocket when we need a doctor.

Lissa -

Aetna has ALWAYS been like that. When my parents and I had the misfortune to be on that policy, it was HELL getting anything paid. Prescriptions were almost never covered. There was always a 6 month long fight over the eye exams I needed every 6 months to make sure I wasn’t going blind from a medication I’m required to take. IIRC, we had the same problem with specialists getting paid as you did.

I’ve been on…over 6 insurance plans, and Aetna is quite possibly the worst of them ALL. (With the possible exception of MDIPA here in Maryland. Same damn thing happened.)

Aetna in California seems to be treating me fine. I’ve been seeing my specialists, and they’ve had no trouble billing/collecting yet.

Sorry you’re having so much trouble!

-Sam

aetna in California blows!!! I was with them for 6 months. I couldn’t just choose a doctor, I had to choose a hospital and THEN choose a doctor affiliated with that group. I choose a hospital close to me thinking the doctors would also be close to me. What a fool I was.
The doctors were scattered to the four winds, some were 2 counties away. I went to see some of them. Let’s just say they were not the ‘best and brightest’.

Many Aetna problems:
[ul]
[li]Aetna has been sending us statement about claims. At the bottom are two notes: one that says that we owe nothing, the other that we owe for going out-of-network.[/li][li]Also, our PCP changed associations, but he’s the same doctor in the same place with the same phone number and still is covered by Aetna. Every time they get a claim from him, they bill us the remainder because their computer records aren’t up-to-date.[/li][li]When I first signed up with them, they put me in group GA-01, not VA-01. So when I picked a neighborhood doctor, he wasn’t assigned since I had to pick one in Georgia, not Virginia. However, my wife was assigned him because dependents can pick PCPs anywhere. When I argued with her, I pointed out that my office was in Virginia, my home address was in Virginia, my desired PCP was in Virginia (in the same ZIP code as my house). No avail. I had to have my office HR department call them and straighten it out.[/li]
Thing was, my whole enrollment was done via automatic telephone menus. But it must’ve gotten transcribed by hand at some point, where someone typed “G” instead of “V”.
[/ul]

I almost miss Kaiser-Permanente.

I should clarify: the “her” I was arguing with in my 3rd example was the Aetna rep, not my wife. :D:D