I have been screwed by Aetna four different ways:
#1 Several claims were reimbursed at a rate of only 50% instead of 80% as specified in the policy. No explanation was given and Aetna refused to reimburse the proper amount.
#2 Aetna routinely delayed the claims they actually payed by three to nine months.
#3 Aetna refused to provide data allowing me to determine which claims were paid and which were not and routinely LIED about not having the information (I will explain further below).
#4 I suspect Aetna screwed me on the exchange rate of claims but I can't tell for sure due to #3 - it conveniently covers their tracks as I'll explain below.
I believe points 1 and 2 are self-explanatory. As for point 3, which in a way I find most egregious due to the blatant incompetence and lying, I believe further explanation is necessary. I had international health coverage from Aetna while working outside of the United States. During this time I suffered an accident which resulted in over $5,000 in medical bills distributed across 10's of different invoices.
In order to be reimbursed a series of redundant and cumbersome forms must be filled out for each invoice and then sent to Aetna Global Benefits for payment which they claim should occur in 2-4 weeks. I NEVER received payment in less than 2 1/2 months or so. Often claims were delayed by 3, 6 even 9 months and no explanation was given other than the excuse that they need time to translate the invoices.
It is important to note here that all bills were paid and submitted in foreign currency.
When I finally started to receive the claims the claims were paid either as a check in US dollars (something I specifically requested they NOT do because it cost me $15 to deposit a check abroad) or as a direct deposit to my foreign bank account in US dollars. NO detail whatsoever was provided on the payments other than the following: the supposed date of the claim (which was often wrong) and the amount being reimbursed in US dollars.
The other details that should have been provided like the name of the healthcare provider, the type of service on the original invoice, original invoice number, etc. were all listed as "unknown" or "NA." Note that ALL of these details were painstakingly provided in English by me on each of the claim forms. Furthermore often times claims were bundled together into one large deposit or check. This left me in a position in which it was impossible to determine which claims Aetna paid and which they didnt as well as if they paid the proper amount.
To reiterate: Aetna received the bill in foreign currency, they reimbursed a unknown percentage of the bill (which should be 80%) at a unknown exchange rate converted to US dollars. Given simply the dollar amount they decided to reimburse at an unknown exchange rate of their choice it was impossible to tie payments back to the original invoices.
I contacted Aetna and made the exceedingly simple request that they take original claim forms 1 by 1 and indicate for each claim individually: if it was paid, when it was paid, and the full amount reimbursed toward the claim. They refused. They claimed they didn't have this information for foreign claims. This is not only an exceptional demonstration of spectacular incompetence but a downright lie. Anyone that has ever worked in the finance department of a publicly traded company would know that it would be absolutely impossible for them to pass an audit if this were true.
Think about this to really understand how absurd this is: I have submitted detailed medical bills in a foreign currency with numerous forms detailing the bills in English. Aetna claims the ONLY data they have retained regarding these claims once paid is the DATE OF THE CLAIM and the AMOUNT PAID CONVERTED TO US DOLLARS (which is only a percentage of the original bill). I honestly find it difficult to believe that anyone could be stupid enough to even make that claim yet this is the case. This is coming down from a senior executive account manager handling multi-million dollar corporate accounts.