Complaint Review: Aetna Health Insurance - Aetna Open Access plan - Lexington Kentucky
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- Aetna Health Insurance - Aetna Open Access plan www.aetna.com Lexington, Kentucky United States of America
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- Category: Health Insurance
Aetna Health Insurance - Aetna Open Access plan, Aetna makes up reasons not to pay claims!!! Lexington, Kentucky
*Consumer Comment: Urgent suggestions about Aetna
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If you have Aetna, don't bother going to the doctor! They will look for an excuse to NOT pay your claims...
Earlier, I had to deal with Aetna refusing to pay my claims because, just out of thin air, they tried to say I have Medicare. They would reject my claims saying "we need member's MEDICARE statement of benefits."
Once I got THIS resolved, they then tried to deny my claims by claiming that the four office visits I am allocated before my deductible kicked in, had been made. Problem is - THEY HADN'T. They denied all claims from my FIRST doctor visit when I went for a bladder infection.
Guess how they justified this? By counting visits I made to a therapist/relationship counselor towards the 4 office visits, even though my plan SPECIFICALLY states that mental health benefits are separate.
I've been dealing with this since March. I have spoken to more Aetna reps than I care to count. Some of them have fought and argued with me on the point of whether the therapy visits counted, others of them contradicted the PREVIOUS reps and agreed with my reading of the plan, that mental health benefits are SEPARATE.
On 8/25, I thought I had this resolved. I spoke with an Aetna supervisor named Katrina who said the problem was caused by a technical glitch, and that she was going to escalate the problem. She gave me a tech support ticket number and told me to tell my drs office to re-submit the bill, and that Aetna would pay it.
On 9/4, my drs office resubmitted the bill at my request. IT NEVER GOT PAID.
On 9/22 I got a letter from a collection agency. The CFO at my drs office got tired of waiting and sent it to collections against me!!
Today I ONCE AGAIN had to argue with an Aetna rep about whether the mental health visits apply towards the 4 office visits. When I called back later, I got a DIFFERENT rep who agreed with me yet again and agreed to call the collections agency on my behalf. I am not holding my breath that this is going to happen.
In the meantime, I disputed the charge in a certified letter against the collection agency. I'm seriously considering pressing my case against Aetna with an attorney. Any attorneys in the L.A. area, I am more than open to being contacted through this site! I AM FED UP!!!
This report was posted on Ripoff Report on 10/08/2009 01:31 PM and is a permanent record located here: https://www.ripoffreport.com/reports/aetna-health-insurance-aetna-open-access-plan/lexington-kentucky-/aetna-health-insurance-aetna-open-access-plan-aetna-makes-up-reasons-not-to-pay-claims-506396. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year. Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report. READ: Foreign websites steal our content
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#1 Consumer Comment
Urgent suggestions about Aetna
AUTHOR: V - (U.S.A.)
SUBMITTED: Friday, November 06, 2009
I too have been ripped off by Aetna, mine was LTD, see Report: #167002. I do have some suggestions for people who have spent the time writing to Rip off report---NOW is the time to also write your elected representitives in Washington DC! Whether you agree with the health care plan or not, I think we all agree that health insurance companies have abused way too many patients and need some regulation. At the very least the ERISA law needs to be changed to favor the patient rather than the insurance companies! So, write, email, or call your elected representitive and tell them your story, maybe refer them to Rip Off Reports to read all the abuses by Aetna.
Also, contact some of the Senators/US Reps who are not in your state, specifically, Speaker of the House Pelosi (you have to go to her Speaker page), Senators Dodd and Lieberman (as they represent the state Aetna is HQ'd in), Senator Shumar, as he has called for anti-trust legislation against the Health Insurance companies, and especially Representitive Waxman in Calif, as he is gathering info to have House hearings on the abuse of health insurance companies as I type!!! Anyone else you see standing in front of the cameras demanding health insurance company reform--contact them with your story! It is IMPORTANT they all hear these stories! Not only should you write or call or email them, your families should too if they were adversely affected by what happened to you, the more the merrier!
Unfortunately, in some of the above cases, you will have to just look up and use a zip code from their represented areas, because most won't look at anything from someone outside their district, which I feel is wrong, as someone like Rep Waxman is on a committee that represents all in the USA not just those in his district and therefore needs to hear from people all over about the abuse they have sufferd from these health insurance companies. I use my actual city, and their zip code, and at the bottom of the email I tell them my actual zip code. You also might want to suggest to your own Senators and Reps that they give a copy of your email to anyone they know working on any health insurance committees for reference.
Write well, write often, I do it once a week!
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