AETNA - Get It Right - Chance 1

OR - My Own "Sicko" Episode

At this time, I am going to stop short of calling AETNA Insurance a scam. However, if you go to any of the major complaint sites on the Internet (like RipOffReport.com) and do a search on AETNA, you might wonder about my decision to "bite my tongue."

Here is our situation. My wife is the subscriber to our health insurance through her employer (whom I will not name). Her employer uses a company called Gevity to coordinate the company's benefits. I am still not certain how much of our current dilemma with AETNA is the fault of Gevity's handling of the contract with AETNA, but for now, all I know is that AETNA is not paying claims.

Until July of 2006, my wife and I were paying directly for our own health insurance. At that time, my wife's employer decided to begin providing health insurance as a benefit. We looked at the plan, asked lots of questions, and decided that the national PPO plan that was being offered would be worth making the switch, instead of continuing to pay for our own insurance. We are beginning to seriously question that decision.

Apparently, when my wife and her colleagues were entered into the AETNA system, they were put under an "indemnity plan" instead of the national PPO to which they were to have been subscribed. For those of you who do not know, an indemnity plan basically reimburses the subscriber for a portion of the medical bills which the subscriber must first pay "out of pocket." Needless to say, when we found this out, we began complaining rather loudly to my wife's employer, to Gevity and to AETNA. In November of 2006, Gevity and/or AETNA issued the correct policy telling us that the bills from the previous 4 months would need to be resubmitted, and they would be paid under the PPO. After almost a year of complaining, questioning, proposed solutions, etc., we are no closer to having these claims paid than when this fiasco began.

We have jumped through every hoop that has been placed before us by AETNA and Gevity. We have remained very patient, giving both companies ample time to sort this out. We have exercised restraint and have not filed complaints with the Insurance Commissions of Pennsylvania (our home state), California (the headquarters of my wife's employer), Florida (the headquarters of Gevity) nor Kentucky (the headquarters of AETNA). That is about to change. We have contacted Gevity and AETNA and notified them that they have until this Friday, June 15, 2007 to have this resolved to our satisfaction, or we will be filing formal complaints in all of the aforementioned states with both their insurance regulating bodies and their Attorneys General. After reading many of the complaints on RipOffReport.com, I am beginning to believe that this is the only way that action ever takes place at AETNA. They have a terrible record of creating mountains of red tape to avoid paying claims in a timely manner, if at all.

By the way, this is "chance number 1" for AETNA to get it right. Chance number 2 will be when the Insurance Commissions and Attorneys General come after them. Chance number 3 will be when take them to court.