• Report:  #3530

Complaint Review: Aetna Insurnace - California

Reported By:
- Tempe, Arizona,
Wed, October 04, 2000

Aetna Insurnace
California, U.S.A.
Insurance Companies
Tell us has your experience with this business or person been good? What's this?
My story has been ongoing since February. To make a long story short, Aetna approved some dental work, then didn't pay the bill. I've been stiffed with a $2800 dental bill for work I would not have had completed without Aetna's prior approval. Second, Aetna continually refers me to providers that don't accept Aetna patients because "Aetna doesn't pay its bills", or providers outside of the local area, or provider phone-numbers that are not correct.

My file is 6 inches thick with correspondence and notes from phone conversations. It is clear, to me, that Aetna is hoping I will give up so they won't have to pay for office visits.

4 Updates & Rebuttals


Beverly Hills,
Small Claims Court: a viable solution

#2Consumer Suggestion

Wed, September 07, 2005

For $50 ($20 filing fee and $30 service by a Sheriff) you can have your case finished in 30 days. Small claims court is absolutely the way to go. I've done it twice with unscrupulous health insurance companies and have never been disappointed. If you have all the records and have documented all phone conversations, they will likely settle with you before going to court, but if it does go to court, a judge will likely be sympathetic. End your misery in 30 days and if you win (which sounds likely) Aetna will also have to pay your court costs (the $50). Good luck.



#3Consumer Suggestion

Wed, April 27, 2005

I am not on the dental end, but I can tell you as a Nurse Practitioner, Aetna US Healthcare is a pain to deal with and they do not want to pay the contracted rate to the providers..in fact, they will try to pay 20-30% of the already discounted contracted rate and it is like pulling teeth to collect anything from them. We stopped taking Aetna back in 2000. They rip off their policyholders and the providers.


Response to rip off of Aetna Insurance

#4UPDATE EX-employee responds

Wed, April 27, 2005

As a prior employee and claims processor of Aetna Insurance, I can assure you of the following possible reasons for your coverage problems. 1. The doctor's do not use the correct codes in which would allow payments to be made. 2. The paperwork the doctor's send in is not legible. 3. The policy you have does not cover the specific procedure you had. 4. The amount allowed in your policy has exceeded the max limit. Claims Processors do not make the rules or the policies. They can only pay claims that are coded correctly, legible, and are within the allowable amounts. If they try to exceed the limits, the computers won't allow it. You also have to realize that Claims Processors have to process a minimum of 200 claims per day. That may not seem like alot to you, but, with investigation of each claim, it can become very trying. Many of the problems arise from the initial policy purchase and what it covers. Please be sure to double check your policy and all the extra features or non features. If you still have questions, call the customer hot line. There are representatives there who can help you. I hope this helps. By the way, the reason I quit Aetna was because of a personal nature, not because of the company.


Doctors say they no longer accept Aetna because they raise rates for customers and then refuse to pay claims

#5Consumer Comment

Mon, March 29, 2004

I agree with your claim. I have had Aetna my entire life but recently changed out of it because of thier poor practices. A lot of doctors are telling me that they no longer accept Aetna because they raise rates for customers and then refuse to pay claims. It is a shame that they take your hard earned money every month and say they are going to provide a service but never do! They have definitely gone downhill in the past few years. It seems all they care about is profits. I wish you all of the best of luck in dealing with them.

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