Complaint Review: Aetna Life Insurance Company - Internet
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- Author Confirmed
- Aetna Life Insurance Company .aetna.com/ Internet U.S.A.
- Phone: 888-802-3862
- Web:
- Category: Health Insurance
Aetna Life Insurance Company Ceased payment of claims without warning Internet
*UPDATE Employee: Assume Part B...
*Consumer Suggestion: Odd
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My wife has been disabled since 1988. She receives a monthly disability check and is enrolled in Part A only. We opted not to enroll in Part B since she is covered by my health plan at work. We reasoned why pay out the additional monthly cost. My wife and I are both in our 50's.
I have had no problems all these years until a few months ago. I noticed Aetna was holding all claims with the reason being additional information was required.
After many many calls and emails to Aetna Customer Service (or lack thereof) I found out that they showed my wife was in both Part A & Part B. The represtentive was told that in no uncertain terms that my wife has never been enrolled in Part B. She then confirmed this with the local SS office. She told me the claims would be resent to processing.
Now the bad news.
All of my claims going back to May 7, 2007 were then re done as if my wife had been enrolled in Part B. So far (it keeps changing ever time I visit their web site) I have gone from about $700 out of my pocket to over $20,000.
The new EOB (Explaination of Benefits) now states and I quote "Your plan reduces covered expenses by Medicare benefits for which you are eligible, whether or not you are actually enrolled in Medicare." My question is what are my options, is this legal?
I am concerned too, that next they may say my wife was eligible for Part D and they will quit paying for her prescriptions. Which run over $1500 per month.
Any insight is greatly appreciated.
Guy
Maumee, Ohio
U.S.A.
This report was posted on Ripoff Report on 01/23/2008 11:23 AM and is a permanent record located here: https://www.ripoffreport.com/reports/aetna-life-insurance-company/internet/aetna-life-insurance-company-ceased-payment-of-claims-without-warning-internet-302631. 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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#2 UPDATE Employee
Assume Part B...
AUTHOR: Aetna-1 - (U.S.A.)
SUBMITTED: Tuesday, August 05, 2008
Here's the dirty little secret,
The company YOU work for wrote in their contract with the insurance company that since you're eligeable for Part B you should have it. And, if you do not or opt out of it that amount will then become YOUR responsibility. Their take on it is "why should we pay the bulk of claims when Medicare could take that brunt".
In turn the insurance company will always process your claims as if you have Part B Medicare, and whatever Medicare would pay YOU are now responsible for! See that? You thought you were saving some cash every month when in fact you just screwed yourself by not keeping Part B!
If you want more clarification you should ask your employer about this part of their contract with the insurance company.
#1 Consumer Suggestion
Odd
AUTHOR: Jim - (U.S.A.)
SUBMITTED: Friday, January 25, 2008
The general rule is that groups of 20 or more employees (recognized by the federal government) have a coordination of benefits with the group carrier is primary payor and Medicare as secondary payor.
Groups below 20 (and this may depend on state) are not recognized as groups by the federal government (by state they are) and as such Medicare is primary and the group plan is secondary.
Since you are in Ohio, it is a bit different in that Ohio only recognizes groups of 10-19 as small group, not 2-9.
Check this again and contact Medicare to see what they have to say.
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