Aetna Refuses to pay claims on false pre-existing conditions clause Ripoff El Passo Texas

Aetna uses this trick constantly.  Case in point.  I had health insurance up until 04/30/09 when I was laid off.  Covered through Cobra for 05/01/09-07/31/09. Started with Aetna on 08/01/09 with my new employers group insurance.  Should be covered through ERISA right? 

On 10/13 took the kids to a doctor for what I thought was sinus infections.  Turns out not to be he sends us to an allergy doctor for tests. Allergy doctor is in the same office so we go on 10/22.  

Aetna pays the initial visit but not the allergy visit.  Due to allergies being pre-existing condition as I have not been insured from 05/01-07/31 even though I have sent proof twice.  So question for those of you who are defending the pre-existing clause how can they not cover the allergy test under pre-existing excuse?  I am covered under ERISA and they don't have allergies which proves no condition. 

Oh and by the way, I am still paying into my deductible so they aren't going to have to pay a dime anyway they are only on the hook for the agreed upon price for that doctor.

Second case, they accept a claim for an xray on my son's foot after an accident. They refuse to accept the claim for the xray technician who took the xray due to pre-existing condition.   

Still want to defend them? 

Most of us know by now, that the little plastic card is worthless, unless you get into an accident or develop a serious condition after giving up a chunk of your salary to managed care.

Those with "pre-existing" conditions get no coverage.

I totally disagree with the above post, especially with: "The surplus from their premiums is then used to cover the much larger claims that will inevitably be made by the seriously ill or injured."

BS- The "surplus" is actually a gigantic pile of money which is slurped up by a bunch of greedy Wall St. investors. It does not cover "seriously ill individuals". It does not cover claims. These corporations are in business NOT to pay, regardless of the condition. That is how it makes money. Otherwise, it would take its game elsewhere.

Lets just say we accept this crap- sure, it is legal, and we signed a "document", but it is a major league ripoff- to the tune of hundreds of billions of dollars. Healthcare is not the objective, as the healthcare statistics in the USA make glaringly obvious. As our economy worsens, we will see the healthcare statistics worsen as well, because the healthcare dollar is now a huge commodity on our floundering NYSE. Managed care will be forced to make even more ludicrous claims about our "pre-existing" conditions.

I am just awaiting the day that managed care determines that since my relative had high blood pressure, that is genetic, and since I am predisposed, it is now "pre-existing"

Your situation is exactly what pre-existing medical condition clauses are intended to deal with.

The way any insurance works is that each person enrolled is paying premium into the system, and the proceeds from the premiums are used to pay for claims made by enrolled members. The idea behind Group Health Care Insurance is that most members will remain healthy, with annual costs significantly lower than claims paid on their behalf. The surplus from their premiums is then used to cover the much larger claims that will inevitably be made by the seriously ill or injured.

You have to bear in mind that nearly every one of us will at some point need some very expensive medical care. The only way you can avoid this is if you are killed in such a way that there is clearly no possibility of resuscitation. To deal with this, we should all expect to be paying into Health Care Insurance for years in anticipation of the day when we will be able to get some return on what we have paid.

In your situation, you spent two years without paying into Health Care Insurance, and then you expected to be able enroll in Group Insurance and suddenly be treated for the condition that has plagued you during that time. If Insurance Agencies allowed you to do this, then _nobody_ would pay for insurance until they had a condition where the cost of medical expenses exceeded the cost of the insurance premiums. In such a system, where would you expect the money to cover the medical claims to come from?

In your case, I believe the reason you were uninsured is that you could not afford the insurance payments. Pre-existing medical condition clauses are not really designed to single you out, but it's simply not possible to tell the difference between your case and someone who was irresponsible and chose to try to save money by not purchasing insurance. You should also be aware that there _are_ low-cost Health Insurance policies that don't provide very good coverage or reimbursement, but would have at least served to prevent you from encountering the pitfalls of the pre-existing medical condition clause. Of course if you have to choose between eating and Health Insurance, you really don't have much of a choice.

The fortunate thing is that Group Health Insurance generally cannot simply deny you coverage due to a pre-existing medical condition. This means that Aetna should pay for anything not related to your pre-existing condition, although it may take them some time to decide what is and is not related. Furthermore, I believe Aetna only applies the pre-existing condition clause for a period of twelve months. That means you should expect to be covered for expenses related to your condition in a year or so. However, you should check with your employer on the specifics of your plan. I would avoid involving Aetna directly if you can -- your explanation is just going to announce that you were aware of your pre-existing condition and solidify their position. Based on the original date of the complaint, I'm hoping you are already happily covered.

If you seek private insurance with a pre-existing condition, you can expect to have your application denied. This is beyond unfortunate for people in your situation.

The current legislation for changes to Health Care in the US seeks to remove the pre-existing condition clause. There are only two ways this can be done without destroying the Health Care system:

1. Make Health Insurance compulsory for everybody. Nobody should expect this to save them any money. We will all pay for this in taxes, one way or the other. Is it the right thing to do? I'm not sure. By buying into the plan, you are depending on the government to decide whether you make enough money to afford your own insurance, or if you are eligible for assistance. I'm not sure I would trust the same government that decides on what constitutes "poverty" and what "minimum wage" should be to make such decisions.

2. Allow Group Insurance to charge higher rates for people with a pre-existing medical condition. Without some sort of control, this could allow Group Insurance to effectively deny enrollment from someone with such a condition by setting the price higher than anyone could reasonably afford.

I believe the first option is the one we are likely to end up with. Until that time, you should seek to maintain some form of recognized coverage. It can be difficult to find a reasonably-priced policy, but there are many more options than most people are aware of. If anybody is in need of an insurance policy, I would recommend that you seek the assistance of a private insurance broker, as they will not steer you towards one particular Insurance Agency and are more likely to work with you to find the best policy for you. I would also recommend shopping around. You'll be surprised at how different the answers can be from one broker to the next.

Your situation is exactly what pre-existing medical condition clauses are intended to deal with.

The way any insurance works is that each person enrolled is paying premium into the system, and the proceeds from the premiums are used to pay for claims made by enrolled members. The idea behind Group Health Care Insurance is that most members will remain healthy, with annual costs significantly lower than claims paid on their behalf. The surplus from their premiums is then used to cover the much larger claims that will inevitably be made by the seriously ill or injured.

You have to bear in mind that nearly every one of us will at some point need some very expensive medical care. The only way you can avoid this is if you are killed in such a way that there is clearly no possibility of resuscitation. To deal with this, we should all expect to be paying into Health Care Insurance for years in anticipation of the day when we will be able to get some return on what we have paid.

In your situation, you spent two years without paying into Health Care Insurance, and then you expected to be able enroll in Group Insurance and suddenly be treated for the condition that has plagued you during that time. If Insurance Agencies allowed you to do this, then _nobody_ would pay for insurance until they had a condition where the cost of medical expenses exceeded the cost of the insurance premiums. In such a system, where would you expect the money to cover the medical claims to come from?

In your case, I believe the reason you were uninsured is that you could not afford the insurance payments. Pre-existing medical condition clauses are not really designed to single you out, but it's simply not possible to tell the difference between your case and someone who was irresponsible and chose to try to save money by not purchasing insurance. You should also be aware that there _are_ low-cost Health Insurance policies that don't provide very good coverage or reimbursement, but would have at least served to prevent you from encountering the pitfalls of the pre-existing medical condition clause. Of course if you have to choose between eating and Health Insurance, you really don't have much of a choice.

The fortunate thing is that Group Health Insurance generally cannot simply deny you coverage due to a pre-existing medical condition. This means that Aetna should pay for anything not related to your pre-existing condition, although it may take them some time to decide what is and is not related. Furthermore, I believe Aetna only applies the pre-existing condition clause for a period of twelve months. That means you should expect to be covered for expenses related to your condition in a year or so. However, you should check with your employer on the specifics of your plan. I would avoid involving Aetna directly if you can -- your explanation is just going to announce that you were aware of your pre-existing condition and solidify their position. Based on the original date of the complaint, I'm hoping you are already happily covered.

If you seek private insurance with a pre-existing condition, you can expect to have your application denied. This is beyond unfortunate for people in your situation.

The current legislation for changes to Health Care in the US seeks to remove the pre-existing condition clause. There are only two ways this can be done without destroying the Health Care system:

1. Make Health Insurance compulsory for everybody. Nobody should expect this to save them any money. We will all pay for this in taxes, one way or the other. Is it the right thing to do? I'm not sure. By buying into the plan, you are depending on the government to decide whether you make enough money to afford your own insurance, or if you are eligible for assistance. I'm not sure I would trust the same government that decides on what constitutes "poverty" and what "minimum wage" should be to make such decisions.

2. Allow Group Insurance to charge higher rates for people with a pre-existing medical condition. Without some sort of control, this could allow Group Insurance to effectively deny enrollment from someone with such a condition by setting the price higher than anyone could reasonably afford.

I believe the first option is the one we are likely to end up with. Until that time, you should seek to maintain some form of recognized coverage. It can be difficult to find a reasonably-priced policy, but there are many more options than most people are aware of. If anybody is in need of an insurance policy, I would recommend that you seek the assistance of a private insurance broker, as they will not steer you towards one particular Insurance Agency and are more likely to work with you to find the best policy for you. I would also recommend shopping around. You'll be surprised at how different the answers can be from one broker to the next.

Your situation is exactly what pre-existing medical condition clauses are intended to deal with.

The way any insurance works is that each person enrolled is paying premium into the system, and the proceeds from the premiums are used to pay for claims made by enrolled members. The idea behind Group Health Care Insurance is that most members will remain healthy, with annual costs significantly lower than claims paid on their behalf. The surplus from their premiums is then used to cover the much larger claims that will inevitably be made by the seriously ill or injured.

You have to bear in mind that nearly every one of us will at some point need some very expensive medical care. The only way you can avoid this is if you are killed in such a way that there is clearly no possibility of resuscitation. To deal with this, we should all expect to be paying into Health Care Insurance for years in anticipation of the day when we will be able to get some return on what we have paid.

In your situation, you spent two years without paying into Health Care Insurance, and then you expected to be able enroll in Group Insurance and suddenly be treated for the condition that has plagued you during that time. If Insurance Agencies allowed you to do this, then _nobody_ would pay for insurance until they had a condition where the cost of medical expenses exceeded the cost of the insurance premiums. In such a system, where would you expect the money to cover the medical claims to come from?

In your case, I believe the reason you were uninsured is that you could not afford the insurance payments. Pre-existing medical condition clauses are not really designed to single you out, but it's simply not possible to tell the difference between your case and someone who was irresponsible and chose to try to save money by not purchasing insurance. You should also be aware that there _are_ low-cost Health Insurance policies that don't provide very good coverage or reimbursement, but would have at least served to prevent you from encountering the pitfalls of the pre-existing medical condition clause. Of course if you have to choose between eating and Health Insurance, you really don't have much of a choice.

The fortunate thing is that Group Health Insurance generally cannot simply deny you coverage due to a pre-existing medical condition. This means that Aetna should pay for anything not related to your pre-existing condition, although it may take them some time to decide what is and is not related. Furthermore, I believe Aetna only applies the pre-existing condition clause for a period of twelve months. That means you should expect to be covered for expenses related to your condition in a year or so. However, you should check with your employer on the specifics of your plan. I would avoid involving Aetna directly if you can -- your explanation is just going to announce that you were aware of your pre-existing condition and solidify their position. Based on the original date of the complaint, I'm hoping you are already happily covered.

If you seek private insurance with a pre-existing condition, you can expect to have your application denied. This is beyond unfortunate for people in your situation.

The current legislation for changes to Health Care in the US seeks to remove the pre-existing condition clause. There are only two ways this can be done without destroying the Health Care system:

1. Make Health Insurance compulsory for everybody. Nobody should expect this to save them any money. We will all pay for this in taxes, one way or the other. Is it the right thing to do? I'm not sure. By buying into the plan, you are depending on the government to decide whether you make enough money to afford your own insurance, or if you are eligible for assistance. I'm not sure I would trust the same government that decides on what constitutes "poverty" and what "minimum wage" should be to make such decisions.

2. Allow Group Insurance to charge higher rates for people with a pre-existing medical condition. Without some sort of control, this could allow Group Insurance to effectively deny enrollment from someone with such a condition by setting the price higher than anyone could reasonably afford.

I believe the first option is the one we are likely to end up with. Until that time, you should seek to maintain some form of recognized coverage. It can be difficult to find a reasonably-priced policy, but there are many more options than most people are aware of. If anybody is in need of an insurance policy, I would recommend that you seek the assistance of a private insurance broker, as they will not steer you towards one particular Insurance Agency and are more likely to work with you to find the best policy for you. I would also recommend shopping around. You'll be surprised at how different the answers can be from one broker to the next.

Your situation is exactly what pre-existing medical condition clauses are intended to deal with.

The way any insurance works is that each person enrolled is paying premium into the system, and the proceeds from the premiums are used to pay for claims made by enrolled members. The idea behind Group Health Care Insurance is that most members will remain healthy, with annual costs significantly lower than claims paid on their behalf. The surplus from their premiums is then used to cover the much larger claims that will inevitably be made by the seriously ill or injured.

You have to bear in mind that nearly every one of us will at some point need some very expensive medical care. The only way you can avoid this is if you are killed in such a way that there is clearly no possibility of resuscitation. To deal with this, we should all expect to be paying into Health Care Insurance for years in anticipation of the day when we will be able to get some return on what we have paid.

In your situation, you spent two years without paying into Health Care Insurance, and then you expected to be able enroll in Group Insurance and suddenly be treated for the condition that has plagued you during that time. If Insurance Agencies allowed you to do this, then _nobody_ would pay for insurance until they had a condition where the cost of medical expenses exceeded the cost of the insurance premiums. In such a system, where would you expect the money to cover the medical claims to come from?

In your case, I believe the reason you were uninsured is that you could not afford the insurance payments. Pre-existing medical condition clauses are not really designed to single you out, but it's simply not possible to tell the difference between your case and someone who was irresponsible and chose to try to save money by not purchasing insurance. You should also be aware that there _are_ low-cost Health Insurance policies that don't provide very good coverage or reimbursement, but would have at least served to prevent you from encountering the pitfalls of the pre-existing medical condition clause. Of course if you have to choose between eating and Health Insurance, you really don't have much of a choice.

The fortunate thing is that Group Health Insurance generally cannot simply deny you coverage due to a pre-existing medical condition. This means that Aetna should pay for anything not related to your pre-existing condition, although it may take them some time to decide what is and is not related. Furthermore, I believe Aetna only applies the pre-existing condition clause for a period of twelve months. That means you should expect to be covered for expenses related to your condition in a year or so. However, you should check with your employer on the specifics of your plan. I would avoid involving Aetna directly if you can -- your explanation is just going to announce that you were aware of your pre-existing condition and solidify their position. Based on the original date of the complaint, I'm hoping you are already happily covered.

If you seek private insurance with a pre-existing condition, you can expect to have your application denied. This is beyond unfortunate for people in your situation.

The current legislation for changes to Health Care in the US seeks to remove the pre-existing condition clause. There are only two ways this can be done without destroying the Health Care system:

1. Make Health Insurance compulsory for everybody. Nobody should expect this to save them any money. We will all pay for this in taxes, one way or the other. Is it the right thing to do? I'm not sure. By buying into the plan, you are depending on the government to decide whether you make enough money to afford your own insurance, or if you are eligible for assistance. I'm not sure I would trust the same government that decides on what constitutes "poverty" and what "minimum wage" should be to make such decisions.

2. Allow Group Insurance to charge higher rates for people with a pre-existing medical condition. Without some sort of control, this could allow Group Insurance to effectively deny enrollment from someone with such a condition by setting the price higher than anyone could reasonably afford.

I believe the first option is the one we are likely to end up with. Until that time, you should seek to maintain some form of recognized coverage. It can be difficult to find a reasonably-priced policy, but there are many more options than most people are aware of. If anybody is in need of an insurance policy, I would recommend that you seek the assistance of a private insurance broker, as they will not steer you towards one particular Insurance Agency and are more likely to work with you to find the best policy for you. I would also recommend shopping around. You'll be surprised at how different the answers can be from one broker to the next.

Your situation is exactly what pre-existing medical condition clauses are intended to deal with.

The way any insurance works is that each person enrolled is paying premium into the system, and the proceeds from the premiums are used to pay for claims made by enrolled members. The idea behind Group Health Care Insurance is that most members will remain healthy, with annual costs significantly lower than claims paid on their behalf. The surplus from their premiums is then used to cover the much larger claims that will inevitably be made by the seriously ill or injured.

You have to bear in mind that nearly every one of us will at some point need some very expensive medical care. The only way you can avoid this is if you are killed in such a way that there is clearly no possibility of resuscitation. To deal with this, we should all expect to be paying into Health Care Insurance for years in anticipation of the day when we will be able to get some return on what we have paid.

In your situation, you spent two years without paying into Health Care Insurance, and then you expected to be able enroll in Group Insurance and suddenly be treated for the condition that has plagued you during that time. If Insurance Agencies allowed you to do this, then _nobody_ would pay for insurance until they had a condition where the cost of medical expenses exceeded the cost of the insurance premiums. In such a system, where would you expect the money to cover the medical claims to come from?

In your case, I believe the reason you were uninsured is that you could not afford the insurance payments. Pre-existing medical condition clauses are not really designed to single you out, but it's simply not possible to tell the difference between your case and someone who was irresponsible and chose to try to save money by not purchasing insurance. You should also be aware that there _are_ low-cost Health Insurance policies that don't provide very good coverage or reimbursement, but would have at least served to prevent you from encountering the pitfalls of the pre-existing medical condition clause. Of course if you have to choose between eating and Health Insurance, you really don't have much of a choice.

The fortunate thing is that Group Health Insurance generally cannot simply deny you coverage due to a pre-existing medical condition. This means that Aetna should pay for anything not related to your pre-existing condition, although it may take them some time to decide what is and is not related. Furthermore, I believe Aetna only applies the pre-existing condition clause for a period of twelve months. That means you should expect to be covered for expenses related to your condition in a year or so. However, you should check with your employer on the specifics of your plan. I would avoid involving Aetna directly if you can -- your explanation is just going to announce that you were aware of your pre-existing condition and solidify their position. Based on the original date of the complaint, I'm hoping you are already happily covered.

If you seek private insurance with a pre-existing condition, you can expect to have your application denied. This is beyond unfortunate for people in your situation.

The current legislation for changes to Health Care in the US seeks to remove the pre-existing condition clause. There are only two ways this can be done without destroying the Health Care system:

1. Make Health Insurance compulsory for everybody. Nobody should expect this to save them any money. We will all pay for this in taxes, one way or the other. Is it the right thing to do? I'm not sure. By buying into the plan, you are depending on the government to decide whether you make enough money to afford your own insurance, or if you are eligible for assistance. I'm not sure I would trust the same government that decides on what constitutes "poverty" and what "minimum wage" should be to make such decisions.

2. Allow Group Insurance to charge higher rates for people with a pre-existing medical condition. Without some sort of control, this could allow Group Insurance to effectively deny enrollment from someone with such a condition by setting the price higher than anyone could reasonably afford.

I believe the first option is the one we are likely to end up with. Until that time, you should seek to maintain some form of recognized coverage. It can be difficult to find a reasonably-priced policy, but there are many more options than most people are aware of. If anybody is in need of an insurance policy, I would recommend that you seek the assistance of a private insurance broker, as they will not steer you towards one particular Insurance Agency and are more likely to work with you to find the best policy for you. I would also recommend shopping around. You'll be surprised at how different the answers can be from one broker to the next.

I have also been denied by Aetna after paying $72.30 a WEEK from my pay check! From October 2007 to June 2008 when I got laid off. I received a phone call from my doctor that none of the bills are being paid. I called Aetna numerous times only to be told it is pending. In July 2008 we were informed (after I no longer was paying each week) it was pre existing. This after 8 months of paying $72.30 a week. My husband did not know he had high blood presure till he went to the doctor. Like I said I paid 72.30 a WEEK till June 2008. I contacted a laywer who said we had a good case. Our doctor is owed $900.00 Aetna will not pay and we received a phone call from our laywer in March 2009 saying they cannot pursue this claim as AETNA took it to Federal Court under the ERISA LAW. The ERISA LAW states they donot have to pay. My laywer states they can not win under this law. Please look up the ERISA LAW at Google www.erisalaw.com. My husband was never asked or signed anything concerning pre-existing. They just took the money each week.
If you are also in this situation with AETNA please contact me at ras_2002@yahoo.com
Perhapes there is something we can do as I can not be the only one they have done this to.
I look forward to hearing from you
Betty
Tampa, FL

We all need to act. Fight this madness as often as you can. Get others involved. Do not get complacent.

The managed care business model is a big disaster. It is not just Aetna. Managed care's game is to increase market share. It has powerful lobbyists, and is difficult to oppose.

It sounds like Yvonne has a "pre-existing" condition. So what? How does Aetna know it was "pre-existing" anyway?

It is shocking to me as well that pregnancy is also a "pre-existing" condition according to managed care.

We are spending $640 billion a year (plus $25 billion from 2009 bailout package) to these bozos. We still have many uninsured individuals as a result of managed care's incompetence. Managed care will always defend itself by trying to claim that "abuse and fraud" is the reason for its twisted policies.

I doubt Yvonne was planning on dumping Aetna after her pre-existing condition was treated. I think Aetna is denying care to save a buck.

Read your policies carefully. It claims to cover, but in another clause, will deny coverage.

This is a disaster. Real fight for your rights not popular in this country but we need to ACT!!!

This is ridiculous! The whole Health Care System is not a Health Care but a ROBING System!!! Watch the movie "Sicko" I'm sick of health care BS in this country. This is the only "civilized" country where ambulance and emergency room are paid. Not just paid, but they use the fact that you have no choice and give you the biggest possible bill! For something that is free in Europe.

Now Aetna??!! Is Aetna the only company that does this?? I'm currently going through the same issue. I had insurance with UHC before this company one through Aetna. The gap between the two insurances was 56 days. And my case is pending and no one is explaining me why!? No one is explaining me also what exactly is considered "Preexisting conditions" I called Aetna and the person I spoke, was just repeating - "We need to investigate you for preexisting conditions" I asked her 6-7 times - "What does this mean?" She was just repeating the same thing as she was instructed not to explain what exactly this trap....is Ridiculous! The only thing she told me was that I need to call UHC for a letter stating when my insurance with UHC expired, and then to fax it to Aetna... What!?!? If I hadn't called - I would never get insurance service, and would just be paying monthly payments. I don't know if I will get service after I fax them the letter from UHC because Aetna doesn't tell you how long is the gap allowed to be... I guess their lowers and higher management have figured out ways to rob and kill and manipulate quite securely. Especially because this insurance is through the company I work for, and I cannot change or cancel it - they just got me. Is this Health Care? - No this is pure crime and robbing. And someone needs to go to prison for being too smart! Enron, Medow, some others Aetna executives should be next! The whole system needs to be changed!!!

If we were living in countries where people react and fight for their rights - it would be different. Here we are so busy with the economic slavery (work to pay loans, mortgages, monthly payments, bills) that we don't see how abused we are! Or just don't want to see it... Or even when we see it, don't have time to do anything. Slavery is not an easy life for sure...

Insurance companies are not on your side, they work for the company shareholders. Most claims adjusters are trained to find reasons to deny your claim, rather than pay it without question. They will second guess your doctor, the hospital and experienced medical professionals. In short, the burden of proof is on you.

Not unlike a credit card agreement most insurance policies are written intentionally to be unreadable by the average consumer. There are generally as many exclusions as there are covered items.

You, by your own admission, had a pre-existing condition. Their policy of considering those uninsured to have pre-existing conditions aside, in all honesty your condition existed prior to coverage, and for an extended time.

You feel your policy is useless, however, if you get into a major accident tommorrow and find an extended hospital stay/recovery in your future you will think differently.

Many of us are paying for health insurance and are totally healthy. Many of us pay for auto insurance and have NEVER had an accident. You pay for peace of mind against future unforeseen occurrences.

Basically our health care system sucks. But you won't see a change in our lifetime.

Insurance companies are not on your side, they work for the company shareholders. Most claims adjusters are trained to find reasons to deny your claim, rather than pay it without question. They will second guess your doctor, the hospital and experienced medical professionals. In short, the burden of proof is on you.

Not unlike a credit card agreement most insurance policies are written intentionally to be unreadable by the average consumer. There are generally as many exclusions as there are covered items.

You, by your own admission, had a pre-existing condition. Their policy of considering those uninsured to have pre-existing conditions aside, in all honesty your condition existed prior to coverage, and for an extended time.

You feel your policy is useless, however, if you get into a major accident tommorrow and find an extended hospital stay/recovery in your future you will think differently.

Many of us are paying for health insurance and are totally healthy. Many of us pay for auto insurance and have NEVER had an accident. You pay for peace of mind against future unforeseen occurrences.

Basically our health care system sucks. But you won't see a change in our lifetime.

Insurance companies are not on your side, they work for the company shareholders. Most claims adjusters are trained to find reasons to deny your claim, rather than pay it without question. They will second guess your doctor, the hospital and experienced medical professionals. In short, the burden of proof is on you.

Not unlike a credit card agreement most insurance policies are written intentionally to be unreadable by the average consumer. There are generally as many exclusions as there are covered items.

You, by your own admission, had a pre-existing condition. Their policy of considering those uninsured to have pre-existing conditions aside, in all honesty your condition existed prior to coverage, and for an extended time.

You feel your policy is useless, however, if you get into a major accident tommorrow and find an extended hospital stay/recovery in your future you will think differently.

Many of us are paying for health insurance and are totally healthy. Many of us pay for auto insurance and have NEVER had an accident. You pay for peace of mind against future unforeseen occurrences.

Basically our health care system sucks. But you won't see a change in our lifetime.

Insurance companies are not on your side, they work for the company shareholders. Most claims adjusters are trained to find reasons to deny your claim, rather than pay it without question. They will second guess your doctor, the hospital and experienced medical professionals. In short, the burden of proof is on you.

Not unlike a credit card agreement most insurance policies are written intentionally to be unreadable by the average consumer. There are generally as many exclusions as there are covered items.

You, by your own admission, had a pre-existing condition. Their policy of considering those uninsured to have pre-existing conditions aside, in all honesty your condition existed prior to coverage, and for an extended time.

You feel your policy is useless, however, if you get into a major accident tommorrow and find an extended hospital stay/recovery in your future you will think differently.

Many of us are paying for health insurance and are totally healthy. Many of us pay for auto insurance and have NEVER had an accident. You pay for peace of mind against future unforeseen occurrences.

Basically our health care system sucks. But you won't see a change in our lifetime.

The problem is that if the insurer did cover pre-existing conditions, people would only purchase health insurance to cover specific claims, then dump it again. You yourself said you had no health insurance the previous two years. Had you had coverage, you would not be experiencing pre-ex problems now.

Also, check your policy and see if pre-ex are permanently excluded. Most group plans only exclude major services for certain periods of time without prior creditable coverage, 6-months or 12-months are the most common.

Another thing I don't understand is how health insurance companies are even able to refuse coverage for a pre-existing condition to begin with.

I am not a vehicle. I am a human being. Insurance was supposed to help cover the costs of health maintenance.

If someone has a heart condition, high blood pressure, diabetes, or in my case, thyroid problems. This person needs to have their conditions monitored by a health professional pretty much for life. Without medical care, anyone with any of these conditions, or a numerous amount of other conditions, could possibly die.

Lack of good medical care could cause my death. Let's make that clear.

This is not plastic surgery here, this is a real and important health issue.

We pay premiums for this service. It is not free to me, or anyone else that I am aware of. The insurance companies and politicians have us so brain-washed to believe that this is some sort of an elective service, but it is not. They are playing with our lives.

Any health condition could be considered pre-existing, just simply because it wasn't diagnosed until recently. How many people have had cancer, and weren't diagnosed until after many tests, that they've had it for quite a while. Could your insurance company be the next one who denies you service because of these silly clauses?

As far as what would I be paying if I didn't have insurance? Well considering the fact that Aetna is NOT paying the claims...I am paying full price anyway, now aren't I?

If health maintenance was a priority in this country, we would all be able to seek medical attention without concern to cost or pre-existing conditions. This is just another way to build insurance companies profits......which are in the BILLIONS by the way, at the cost of human lives.

The issue with the insurance company not paying for pre-existing conditions is not the complaint here. Like I quoted in my original complaint, Aetna clearly stated that a condition is considered to be pre-existing if the member did not have prior insurance or did not have health insurance within the 90 days prior to enrolling in this plan.

That is not a medical health condition...that is your insured status. NOT a condition.

While it does stink, Aetna has a right to not pay pre-existing claims. Your idea that you are paying for a plastic card that is worthless is silly. You are paying for coverage on all claims for medical treatment occurring AFTER your coverage began. I can understand why you're upset, but is it fair to ask the insurer to cover an illness for something outside their coverage period? Would you ask a car insurer to cover an accident that occured BEFORE you got covered? A fire policy to pay you that you got AFTER your house burned down?

As for you saying "it's bad enough I have to pay $40 for a specialist", you should think about how much that would e WITHOUT Aetna.