I have never had a problem before but now find myself very upset with Aetna and believing the other chatter that they must look for loopholes as to not pay. We own a mid sized emplyment company in New York. We started utilizing Aetna as our provider for our family as well as our employees.

My son has been having problem with his feet while doing sports. He is very active and kept complaining that his heel hurt. Our pediatrician referred us to a foot doctor. Upon reading the x-ray he said that he was flat footed and that he was having growth plate issues in his heel. He recommended orthotics be made and put in his shoes and cleats. I was told this would be costly (several hundred a foot). We agreed that we should get approval from Aetna prior to making them. The office did that for me and was told verbally by two different reps (all documented) that we had a zero co-pay and were totally covered. After I picked up the orthotics the office and I were told we were not covered for any of it. They said they have it documented also from the reps that we were covered however, they do not stand by any verbal assurances. We should have read the manual as it says they are not covererd in the fine print.

We are on our second appeal however, I cannot believe that these reps are authorized or even utilized to speak with the insured, give erroneous approval and then rescind upon their discretion. How many businesses do you know that practice this kind of false advice and do not stand behind their word.

I am extremely surprised and suggested to them that they tell people upon calling not to believe what they are told. Had i been told to refer to my manual I sure would not be in this mess. How many of you run your businesses this way? I'm sure not many for if you did you would certainly be out of business. Something is just not right with this practice...any advice???

I cannot give Aetna even one star, but I had to before this service would allow me to post. Negative stars would be more suitable. My experience with Aetna...I've found that Aetna searches out and locates every loophole to avoid paying what they are contracted to pay and because I care about the doc and my credit rating, I am required to pay the doctor bills instead.

We are generally a healthy family and go to the doc once a year for a general good health check up (for school) but remarkably, even this is not covered as promised. I've had to pay the better part of two well-child checkups this year out of my own pocket.

And when we are ill enough to visit the doctor--also a rare event, about once a year or once every two years--these visits are also not covered! I cannot get a straight answer as to why the bill is not covered as promised; there seems to be a different reason each time. I've spent dozens of hours on the phone with Aetna troubleshooting billing codes to try to find out why basic, normal health services like this are never covered as promised.

I am at the point now where I call the doctor's billing assistant when we need an appointment with a doctor and get the specific billing codes, then call Aetna, attempt to get the codes all approved ahead of time...but even this preventative measure does not work. There is always some new, surprise reason that Aetna won't cover the bill. (The doctor is covered and contracted with Aetna, but the office where the doctor works and where the visit was performed was not covered by Aetna, something they conveniently forgot to mention when recommending the doctor...)

I am pregnant, and the pregnancy is normal. But in addition to the whopping $40 per visit copay I'm required to cough up (because an OBGYN is a 'specialist' rather than a general practitioner...but where else would I go for prenatal checkups but to an OBGYN that they approved? A dentist?) Aetna has also rejected over $400 dollars worth of doctor charges, and I have only seen the doctor twice (three times, but that third bill hasn't arrived in the mail yet. I'm sure we're well over $500 by now...). I can no longer afford to go to the doctor for prenatal care, and I'm tempted to just have this baby in the car, since I'm certain that the hospital bill for delivery will be a whopper of rejected payments.

This denial of payment is robbery considering the fact that I pay Aetna hundreds of dollars monthly and our employer pays an additional hundreds of dollars monthly for what Aetna calls 'insurance.'

As a matter of routine or policy, Aetna invents some reason to wiggle out of paying EVERY SINGLE BILL that our family doctors have ever presented to them, no matter how mundane. Most recently, Aetna decided to not cover basic pregnancy test, blood test, maternal glucose test, and one other common test for pregnant women because these tests were given "at the doctor's office" instead of at a "lab," where, apparently, I was supposed to go for this service...yet this was information that Aetna had not given me. A lab!?! Since when do I need to visit a laboratory for prenatal blood work and urine sample?

Deceptive tricks like this are what Aetna uses to get out of paying their bills. These inconvenient, out-of-the way requirements aren't spelled out ahead of time, but are like a slap in the face after you receive the rejected bill and read the big number on the "patient responsibility" line.

I had phoned Aetna ahead of time because I anticipated some loophole would turn up before visiting a doctor for this pregnancy, but although they selected my "contracted doctor" they never told me that the doctor was not allowed to do what doctors do in her own office...blood tests. Instead, now I have to go find some lab technician to cover this stuff, but I'll be darned if I can find one that Aetna will approve of and cover.

I have paid over $1,000 this year out of my own pocket to cover costs that Aetna was supposed to cover but rejected for a colorful variety of reasons. And it just occurred to me that Aetna has not counted one cent of this toward my deductible yet, and I'm sure they have a remarkable, 'red tape' reason why. I believe that this company is managed by dishonest people who specialize in making money off of honest people, and I'd advise you to avoid it at any cost if you want to keep your sanity and your wallet intact.

Even while pregnant, we are considering dropping our skimpy, wimpy Aetna 'coverage' altogether, because it would be less expensive to pay the doctor bills ourselves than to pay Aetna and then in addition pay the doctor bills ourselves. What a horrible experience we've had attempting to work with them to get them to pay even a small bit on basic, routine health care. I hope you never have to go through what we've been through.

J. Carol

I have insurance administered by Aetna through my employer. They do some things I really like. They will send paper or electronic EOB's "explanation of benefits" detailing exactly what my doctor has billed them and exactly what should be paid, and what I'm not responsible for. They also will send statements directly to the people who administer my Health Care Reimbursemnt account, so I'll get reimbursed without even submitting a form. That rpogram is great!