I would like to alert readers regarding Aetna PPO denial of claims and reimbursement decrease practices. In 2010, Aetna PPO Health Insurance tried the following to eliminate/ reduce claims from my husband's providers:-

1) Arbitrarily decided that he had other primary insurance and denied all claims after a date chosen by them.

2) Arbitrarily applied a 75% discount to bills previously paid in full. It seems that a discount program was erroneously applied to the provider. The reduction came to light when the provider billed us for the difference.

Both of these were eventually resolved but only after hours and weeks of phone calls.

My fiance has had Aetna for over 10 years. He has a brain tumor that is controlled with Brand name meds only (there are no generics yet, these meds are new) These injectable meds cost $170, 000 a year. Aetna has paid for them for over 2 years but now as of Oct 1st they gave him a maximun limit of $2, 500 per year for brand name prescriptions. So they are basically dropping him after 10 years of being a member because of this cost. They will not budge. Without the meds his tumor will grow so large that it will invade his brain and he will die. We are scared to death now thanks to Aetna.

Aetna has continued to deny paying bills for both my husband and myself, claiming the procedures were not precertified. I have contacted all doctors who called for the procedures and they are certain everything was PRECERTIFIED AND PREAUTHORIZED. I continue to get the run around from everyone at Aetna, as well as their third party Med Solutions. This is now going to the California State Board of Insurance, initiated by both my providing hospital Hoag, my prescribing doctor and myself.
In the last year, my premiums have DOUBLED and the service from Aetna is terrible. I am discussed.

Aetna has prohibited Houston members from receiving Airrosti therapy (rapid recovery therapy) on a self-pay basis for the past two months.

Airrosti was an Aetna participating provider. Airrosti physicians perform their services within primary care physician’s offices here in Houston. The problem began when Aetna and Airrosti entered in contract

negotiations two months ago. Aetna threatened their PCP'S with contract violation and possible contract termination if their Houston members

received Airrosti therapy on site. As such, Houston Aetna patients couldn't receive Airrosti therapy on a cash or out-of-network basis.

Aetna's legal department recently ruled that members could receive Airrosti services on a self-pay or out-of network basis. Such services

would be process under Airrosti separate tax ID. Aetna's recent communication

to their PCP's reiterated the risk of contract violation and termination if PCP's violate their fiduciary responsibilities to Aetna by referring

to out-of-network providers.

It is illegal for a health care provider to limit access to medical services for their members on a self-pay basis. Aetna commands approximately 30% of the Houston patient population.