Review Time
My physician submitted a prior authorization for a procedure she has been recommending for over a year. Aetna denied it twice, both times with a generic letter citing lack of medical necessity, directly contradicting the written recommendation of the doctor who has been treating me for three years. The appeals process is designed to exhaust you into giving up and I genuinely believe that is intentional. Paid premiums faithfully for four years and the one time I needed real coverage they found every reason not to provide it.
Aetna is literally the worst insurance I have ever had. I am trying to find a new job solely so I can avoid having Aetna. They deny everything, don't abide by the pricing in your benefits, have no clue what they are doing and are a pain to deal with. Last time I called I asked for where I could find a list of what's considered a "specialty visit," and the girl said, "umm, I don't really know." That was it, no offer to help, no offer to ask, nothing. My Rx has tripled and cannot be filled at the same pharmacy it was last year (Walgreens, not like a mom and pop place). Just AWFUL.
I have an Aetna part d prescription plan. In 48 months, my premium has gone up 840%! And in the 48 months I've had it, I've never used it once. Given that I was unaware of this insane increase, I missed the open enrollment. Now I'm trapped at $94 a month for the entire year of 2026 for a plan I will never use, as I have no prescriptions.
Three years ago, I permitted a company to deduct payments from my social security check. I have been struggling ever since to stop these deductions, even though they no longer provide me with insurance and haven't for two years. They continue to withdraw money from my check. This feels like total fraud, and I feel powerless except for sharing my experience in hopes it helps others.
The company seems primarily focused on maximizing charges, which I have found to be consistently inflated. I address this issue with them every time it occurs. There appears to be a significant lack of integrity. Additionally, the support team often struggles with communication due to their poor English, making it challenging to resolve issues.
For those of you who also use Aetna or may plan to. I wanted to share a story regarding my horroble experience. I emailed my claim forms Friday Nov 7th for reimbursement, nothing major just $350 for a fixed benefit plan. How it's advertised is if I see a doctor throughout the year they pay $50 for a visit for copays. Since I had already paid my copays that is supposed to be paid to me. I called on the following Monday or Tuesfay just to confirm my emails had been receieved. I was told 10 business days to have an answer. I waited. The Tuesday before Thanksgiving, I call again. It has now been 10 business days. My emails were not turned into claims. I was assured that all of them had been received and someone would assign claim numbers to have them reviewed ASAP. I wait. I call the following Monday Dec 1st. I have a two claims created and one is a claim for a date I didnt even submit. My other claims are lost apparently. An escalation specialist found my emails. Assured me they would get claim #s assigned and have the review expedited. I was told I needed itemized bills not medical records, but someone would call my doctors cuz you have a waiver as part of my claims form package to get what they needed. I didnt believe that for one second, so I called every one of my doctors and asked them to re-run my paid invoices with this secondary insurance. I wait. It is now Dec 16th. One of my claims has been approved. 6 have not been paid. And of those 6, 4 of the emails I sent have still not had a claim generated. I was assured again someone would get it resolved. It is now closer to 2 months than 10 business days and my emails are still "lost". No claim numbers. No examiner. No outreach to my doctors. No benefits paid. They still owe me $300. This timeframe is unacceptable and shows signs of incompetence of fraud. I have lodged formal complaints with the BBB and the department of insurance. I wil be contacring my HR team tomorrow. Be warned.
I feel that this service no longer values Medicare clients. I've consistently been dissatisfied with the customer support team, as they are quite frustrating to deal with. Communication is difficult, and they often apologize instead of addressing my questions directly. Battling over a small claim of $64 isn't worth my time. Submitting an appeal seems pointless since they claim no such claim was ever filed, despite me spending over an hour on it.
Aetna has ceased accepting Medicare clients. I have consistently been dissatisfied with their customer service, which is quite bothersome. Communication is challenging, and they tend to apologize instead of addressing direct questions. Fighting for a claim of just $64 is not worth my effort. Submitting an appeal feels futile since they insist that no claim was ever filed, despite my spending over an hour on it.
I’ve been with this provider for nearly a decade through my employment, contributing over $15K of my income. Initially, I didn’t utilize my insurance much, but when I finally needed it, I was consistently let down. To get reimbursed for vision costs, you must mail in your claim form, a rule that remains unchanged even in 2025. This seems designed to discourage benefit usage, revealing the company's priorities. Additionally, there are limited quality providers within their network, forcing you to settle for average doctors. The final straw was the severe breach of security regarding my personal data, as my information was shared without consent. This resulted in my twin brother's claims being billed against my insurance. Despite the chaos, they did eventually correct the situation, but only after countless hours on the phone. Their website is also poorly designed, making navigation difficult. I've decided to switch insurance providers this year.
Steer clear of this insurance company. They failed my family during a critical moment. My son needed an ambulance after breaking his arm, and for nine months, the company refused to handle their part of the bill, a mere $340.88. I received misleading information, lost my appeal, and was pushed into new appeals despite their acknowledgment of the debt. I've made multiple calls and followed up endlessly, yet they still haven't paid. Paying over $1,200 monthly for this insurance seems absurd given their inability to manage basic claims. I would recommend finding another insurer.
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