Talk to me about Aetna medical insurance

[klmama]

It's time to sign up for health insurance again, and I'm exploring our options.  Please share your experiences with Aetna medical insurance.  Good and bad, please.  Have they ever said something would be covered "for medical necessity" and then not covered it, despite the doctor's Rx for a standard treatment?  Have they ever refused to cover a visit with an in-network provider because they didn't like the diagnosis codes the doctor used?  If you do go to an out-of-network provider, do they apply all of the charges toward your deductible, or do they apply just the amount they'd normally pay an in-network provider?  Thanks for any Aetna stories you can share to help us with this decision.

 

 

[Ellie]

We had Aetna for awhile, and it was ok, although we didn't have any major health issues, so there's that. However, we had to find a new primary care physician because our "old" one quit accepting Aetna patients.

[kbutton]

Providers don't particularly like working with Aetna. I am not sure why, but I think they are fussy about billing codes. We've had it for a short while, so I can't speak to any of your specific questions.

[Lady Florida.]

We had Aetna for many years until a few years ago when dh's work no longer offered it as a choice. I also had them in the 90s when ds was born and I was still teaching. They were the company that covered my pregnancy and his birth. Despite the many complaints I've seen online, we never had a problem. They covered more for less than Cigna, which we had for the last few years. We no longer have Cigna and are happier with our current choice, but if Aetna was still offered we'd probably choose them. Of course it depends on what kind of deal the employer makes with Aetna or any other insurance company. I think we were lucky, first with the local school board when I was teaching, then with dh's employer who is a government contractor.

[TAFKAPastry]

We had them a few years back, and the coverage was good overall. Narrower network though, at least in that state. These days I really think there isn’t huge variability, every insurance has drawbacks of some kind.

It also depends on the plan too, if you’re on a higher tier plan with lots of options and add ins, you’re going to have a better experience than some of their more stripped down options. That erases a lot of the inconvenience and disparity in network, even if it doesn’t fix the billing hassles. But we are on UHC now and experiencing as much drama with that so.....

Edited October 22, 2020 by TAFKAPastry

[SereneHome]

I am very superstitious and don't want to jinx it but it's been fine with Aetna. I thank G-d daily that they are covering my DH's  very expensive MS meds.

Our rates have been going up, but I don't know if its them or my DH's company. We have high premiums and high deductibles.

I don't think we ever went out of network, but I can't imagine who is not taking Aetna so I can't imagine a lot of drs being out of network...

 

[historically accurate]

We have Aetna, which DH's employer switched to about 3 years ago. It's not my favorite.

Bad points: I had problems this year since DD's therapists had been covered as in network despite being out of network (special case agreements with Aetna) and our co-pay changed on Jan 2020. They paid everyone wrong, and it took months and many calls from me as well as DH's employer to figure it out. They never paid the case agreements as in network until I called/emailed 1-5 times every single time. I was feeling like an unpaid clerk for a while there.

Good points: fairly large network. We've never had a problem finding someone in network. (We've chosen some out of network, but there were options for in network). Willing to do some legwork on mental health issues (IE: find available therapists and programs). Willing to do the case agreements in order to keep doctors consistent. All tele-health is free this year due to the pandemic. 

This year, DH's employer went to a "concierge" level, which just means as far as I can tell that you talk to a representive in America rather than India when you call. Mental health is not covered under the concierge level, so I have to go through the outsourced call center anyway. 

 

Have they ever said something would be covered "for medical necessity" and then not covered it, despite the doctor's Rx for a standard treatment?  Have they ever refused to cover a visit with an in-network provider because they didn't like the diagnosis codes the doctor used? They did not cover my updated genetic testing. According to Aetna, I should owe several thousand. However, the genetic counselor said since I did not receive a call from the lab prior to running my sample, I do not owe. That is a law that they had to have informed me insurance didn't/wouldn't cover before running the test, so I never saw the bill. We've never had any other problems with them as far as covering procedures; we've had a couple doctors who had to resend things a few times to get them approved.

If you do go to an out-of-network provider, do they apply all of the charges toward your deductible, or do they apply just the amount they'd normally pay an in-network provider? Yes, the whole charge is applied to the deductible. 

[QueenCat]

So much with any insurer depends on the actual plan. Many large employers have self-created plans with insurance companies. 

[Terabith]

We've had and once again have Aetna, and we haven't had any problems (knock on wood), but my husband took a huge pay cut to get a job with the hospital and hospital insurance.  Because he works for the hospital, it's very good insurance.  

[cintinative]

I am not a fan, but part of that is that I am not a fan of the plans we have available to us.  We have a very high premium and a high deductible.

My big beef with Aetna is that they require your physical to be at least 12 months from your last one, or they refuse to pay for it. One year I was two weeks early. They refused payment. I fought it and they finally paid, but it was truly ridiculous. My husband ended up getting his physical on December 15th or something like that one year. He actually can't get one later than that in the year. They aren't open!  We are required to get a physical every year for my husband's job, so it's an annual annoyance.

Other than that, we have had some billing issues, mostly where the provider didn't code things to Aetna's liking. Nothing major that I can think of, but most of our major health things happened pre-Aetna. 

[gardenmom5]

It will vary according to what plan you have, and what state you live in.  Dh is an agent, and Aetna is one of the companies he sells.  They are better than many, not as good as others.  But it depends on your state, and your plan.

[sweet2ndchance]

We've had two different plans from different employers in different states from Aetna. They were wonderful but as the others have said, it really depends on your plan and your specific health issues you are dealing with. They always covered exactly what they said they would cover with us. Our plans were fairly decent though with reasonable deductibles and premiums considering our income at the time. I never had an issue finding doctors or with offices not accepting Aetna while we had it.