my daugter's health is jepordized because her aetna policy won't cover anymoremental health benefits

I have so-called health insurance with Aetna. Several weeks ago I had to see my ophthalmologist for certain symptoms which she diagnosed as punctate keratitis, conjuncitivitis, and severe dry eye syndrome in both eyes. As part of the treatment she inserted plugs in the lower tear ducts of both eyes to help with the dryness and help retain the prescribed steroid drops in the eyes. Aetna refused to pay for the procedures, saying that they violated the ban on multiple surgical procedures in one visit. Instead, Aetna paid a much lower amount towards the cost of the plug for one eye. Now I'm stuck with $250 to pay for the plug on one eye.

Oh, was I supposed to choose WHICH eye to treat that day and forego treatment on the other until another day? Was I supposed to incur charges for an additional office visit? Aetna must be one of the worst insurance companies in the U.S.

I worked for an Insurance broker for just over a year and dealt with claims and complaints on a regular basis. Now I know that certain things are not covered, however with Aetna there are a few things I would like to share. Out of all the companies I worked with they were hard to deal with and when I say that I mean: Rude customer service people and no accountability.
This insurance was provided through Group Insurance at work so I figured I was getting a great deal. The providers on the list in my area would not see new patients for a waiting period of 4-6 months. And given the state of the economy I wasn't sure how long I would be able to afford it. Anyway after I got through the entire list of providers with just one doctor willing to see me that month. I called Aetna and asked to change my provider, they said, "No problem." After 10 minutes of waiting I was informed that there was an issue with that provider and they couldn't make it my primary at the time. The Representative went on to say as long as they are an Aetna provider I can see that Doctor. I went to a simple standard check up with urine analysis, blood work, reflects, and check for hernia. Now About 7 months after my visit I get a letter from a billing company stating I owe them 150.00. Aetna refused to pay even though I called to verify and had given them up to 1600.00 without going to the Doctor once. They made the process drag out for the next 3 months with promises it would be resolved, but it never happened. The Claim was denied on three different occasions. Two times due to an invalid tax id that the doctor uses and Aetna requires. I am now in the midst of filing an appeal and it's almost been a year since the visit and I am still slugging it out with this insurance company that enjoys collecting money. But, refuses to pay for one Doctor visit in a year. I had not been to the Doctor in 2 years because of tough times and this is what I had to deal with.
I understand their are regulations on policy on what’s cover and what’s not. But, to mis-inform customers and then say well their are no notes on the call so must pay the full amount. This is a prime example of Insurance company abusing the fact this country has one of the worst providers of Medical assistance. I make too much for Medicare and not enough for regular insurance. Their are millions of Americans like me that get the shaft from companies like this on a monthly basis. This company I would recommend you stay away from if possible. However, until they fix the system in this country they will profit from us when we are sick and when we are healthy. They refuse to provide basic checkups and increase our rates because we fail to go to the Doctor due to fact it's such a Dam hassle. I am sure some will say stop complaining or just pay the bill. For 1600.00 a year I think I deserve a doctor visit with simple co-pay that was explained to me when I joined. I highly advise you go with Humana if you can qualify or is worth it in your individual situation. Will write back with the outcome; however I have a feeling it will take a year from the date I went to the doctor. wtf

My employer ( One of the big banks taking gobs of taxpayer money to clean up their bad business practices) switched my health insurance coverage to Aetna and I have had nothing but problems since. Aetna seems to cover very little compared to my former provider and they demonstrate a "Couldn't care less" attitude when I call to get their reasons for dening claims that the old provider covered with no questions. Since I pay just as much for my current Aetna policy as I did for the old one, ( a bit more in fact) the difference in coverage is nothing short of a complete rip-off. I have no choice in the matter as my employer offers no other option ( I wonder how much Aetna is paying for that) I strongly advise anyone with an opportunity to choose their healt care insurance provider to avoid Aetna like the Plauge! (they don't cover that either, I'm sure)

I was told over the telephone when i called customer svc about a claim that although i work, my husband's medical ins (which was aetna) would be primary due to him being older than I. Although I was always told in the past that your employer is always primary and anything else is secondary, i thought she knew the law better than i did and besides she worked for an ins company so she should know(at least that's what i thought). I told her that true what she wa telling me to put it in our computer file about what she told me. She also adv me to let all of my Dr.'s offices know to change it as aetna being primary. So I did. 6 mths later i get a letter from my human resources dept saying they were primary and we had a long conversation about it and i explained what aetna had told me. I then called aetna about it and spoke w/another operator whom advised me that what i was previously told was incorrect information. i asked her to look in my file at the notation of my initial call and the remarks were there about the conversation i had w/the operator telling me that aetna was primary because of my husband being older. well to make a long story short, they asked for all of the money back from the DR's offices that ws paid and i had to file w/my own insurance. Of course my own ins didn't pay because of a "timely filing limit" and aetna refused to take responsibility of their error and pay the bills. They are not professional and their staff isn't knowledgeable. They gave my the wrong info which in turn caused me to have medic al bills out of this world that my ins company and theirs especially don't want to pay.