Aetna Customer Service

I have experienced nothing short of a nightmare with medical claim reimbursement for a family member with a policy from Aetna. Through much time and effort, I have found contact information of Aetna employees capable of addressing ongoing issues. In my experience, contacting each person with continued follow-up was the best way to resolve Aetna's missteps and the only way to be reimbursed for clean claims after Aetna repeatedly violated the 40-day timely reimbursement requirement by the state:

Michelle Peluso, Chief Customer Officer: [email protected]
Teresa Grothe, Executive Director Service Operations: 701-221-7333; Cell: 701-471-2788 Email: [email protected]
Federico Preuss, Legal: 860-305-2822; Email: [email protected]
Zuri, Complaint Response: 904-351-4358

Please share this information with others in need of assistance as I know how difficult it can be getting properly reimbursed by Aetna.

They don't speak good English that is very up setting for seniors

I want to cancel plan

Just try to get healthcare services priced or arranged will take 10 years off your life. Maybe that is their plan - kill people off earlier.
I have never been hung up on more in my life. Nearly every call ends with the foreign representative putting me on hold and 'losing' the call, or they promise to call back and never do. Shameful.
As for trying to find costs, they do everything in their power to never give you a cost.

Just like their customer service reps, their in-network dentists barely speak English and are bottom-of-the-barrel education-wise. No wonder their dentists have very low "star" ratings on various rating sites. If you want substandard treatment by sub-standard dentists, then Aetna is your plan.

Denied claims for medical implant device as experimental when 3 years ago they paid for the same surgery. (Device malfunction required a replacement). Refused replacement and related claims as experimental despite a review PRIOR to surgery and stating in writing that preauthorization wasn't necessary. Denied the surgeons, anesthesia, the implant device itself and other related hospital expenses. Second appeal process resulted in FOUR different people with Indian names reviewing claims for the same surgery. ONE person reversed the first decision denying the surgeon's claim, stating it was medically necessary after all. The other three upheld the denials as experimental. So, they will pay the surgeon to implant the necessary medical device but not pay for the device itself or anesthesia? Idiocy! One denial letter listed the wrong claim amount for the provider! Spent hours on the phone being transferred around only to be told by multiple people they can't help me. I have to get a third party who I have to release my personal medical information to plus pay a filing fee. This was AFTER I pointed out the discrepancies! Common sense, critical thinking, and logic do not exist. Blanket deny to avoid doing actual work and paying claims. Meanwhile, I am having to pay over $19,000.00 to creditors after fighting this for over 6 months! Total incompetence.

If only you knew what type of systems they give them poor employees and the amount outdated unrealiable support/training they receive. I guarantee if you seen what they go through you would be mad at the person who is the ceo of this company. How could you allow so much disfunction within a company? Poor employees all I can say

I have Aetna accident and hospital indemnity plan. They are awful. They provide no communication for requesting information, they say 3 to 5 days to process claims, then when that fails and you call, agent tells you it's 7 to 10 days from when they receive your documents. Only they have not asked for any. Then they promise to escalate and call you back with follow-up in 3 days. Guess what nothing changed. Or no call back. It has been over 20 business days and still and nothing. Talk to supervisor, guess what,another 24 to72 hrs.

Unable to get question answered

I have been trying to work with Aetna for 2 months on claims and payments. There is no provider relations. Everyone, including their EFT reps, are in Asia. No one can answer my questions or problem solve and they just keep transferring me around. I would not recommend any provider take Aetna when there are so many insurance companies that are a pleasure to work with.

Horrible company

Every six months I need a health coverage verification letter for my car insurance and every six months it is the same battle. Nobody knows what to do and every time, they send me the wrong letter at first. The customer service is horrible. I have gotten snipped at by a couple of people stating they are not familiar with car insurance laws. Every time, I tell them that I am not asking them to be familiar, I just need a verification letter. One time, the representative told me that they dont do that (after 2 years of actually doing it) and argued with me about it. I even sent an attachment of previous documents and they still didnt get it. Its a battle for at least 2 weeks every 6 months untill I actually get someone that knows what they are doing.

My family pays over $1500 a month in insurance to #aetna and these mofos denied a simple ct scan. Why am i paying insurance for #aetna. You guys suck. How is it you can say what that what my doctor ordered is not necessary?

Aetna won't cover doctors prescribed FDA approved medication even in generic form. Filed appeal with urologist intervention. Won appeal against Aetna but they still won't pay. I can buy with coupon for $25 for ninety days but that's not the point, I'm paying for coverage. What would happen to somebody if the prescription was hugely expensive, as in Alzheimer's or cancer instead of prostate BPH

I am trying to find out what in the heck my Medicare Advantage plan will help with for 2023. Yes I approved this plan but, I have been on the phone with people that don't speak very good English for 1.5 hours so far with No answers to my questions. I tried to sign on to the website which says my ID is not valid. Now I will have to find another vendor due to this obscured company.

Need MRI to plan treatment for back pain. X-Ray found problems and doctor needed MRI to determine on hoe to proceed. Aetna refused MRI submitted second request and Aetna canceled it. submitted third request and Aetna canceled it. Been in pain and unable to stand up straight and Aetna refused MRI. call people responsible for approval and left name member number and phone number 9 different days and no call back

Hi, my name is Alida and I work for a provider, I was on the call today with a representative who was completely unprofessional. I seemed not to know what he was doing, he submitted a wrong claim for reconsidered with the wrong DOS. When I asked him to transfer me for a survey he did not.

Theire automatic service is the worst 30 minutes couldn't get someone

Had to resolve something very straightforward. I started the process in March. I've been on hold, cumulatively for more than 14 hours (multiple calls). I get different information on each call and misdirected. I recite numbers and they are entered incorrectly. I have reference numbers for calls that customer service people can't find. I have screen shots and other reference numbers that the staff also can't find. If you try to call corporate or bump it up a few levels you're placed on hold or directed to venues you've already tried. If you are told someone will call you back forget it. This is a nightmare.

I have Aetna for health insurance. I needed heart surgery and Aetna turned my surgery down ! My Doctor had to get involved and call Aetna and asked why ! After a couple of days it was approved. My question is, how do you think I felt after being told you can't have it ! This is why Aetna's ratings are low !!! Will change insurance company this November . Beware ! Check out the insurance company ratings and make sure they will cover you, it very well could cost you your life !!!

I have had to call Aetna several times over the past week and speak with Provider Services. Each time has reinforced how completely horrible their customer service is. The do not speak English clearly and they bounce you around so much you have no idea what department you are talking to. You get a different answer every time you call and you can count on at least a 20 minute hold time. This is the worst company I have had to try and work with. You are awful Aetna!!!! Get it together!

My son is going through chemo and Aetna dropped him right in the middle with no notification. Their customer service is the worst of any company I have ever dealt with. I can barely understand a word the service people say and the connection is like a walky-talky. I've been on hold for 1:45 hours right now.

These people speak no english. They outsourced their company reps to India for cheaper costs and literally every single time I have an extremely frustrating time, lasting hours more than it should, trying to resolve issues. It's infuriating. I need an important life or death medical issue resolved and these people don't understand a word of what I'm saying.

Absolutely the WORST customer service!!!! When you finally get through to a human being they don't understand your questions, they hardly speak the language and there are innumerable long pauses (I mean up to 5 minutes) while they apparently struggle to comprehend the previous notes. This must be part of Aetna's business model--make the provider struggle to obtain remittance until they finally give up. SHAME ON YOU AETNA!!!!

Aetna has no customer service! Their website does not work so you have to call. I got transferred and put on hold 3 times just to pay a bill. Not sure I trust them to pay. The reps don't even know how to pronounce the medication names and barely speak English.

5/25/2016: I called Aetna with a question regarding pre-natal services. I was helped by a representative called DEJOUR. I have never been so pleased with a call before. It was the best call ever; he literally walked an extra mile to help me and show me that I am appreciated as a customer. He walked me through the various links online that I could use during my pregnancy and postpartum. He was very helpful, courteous and very efficient. I wish there were more aetna representatives like him. I really hope this comment reaches and helps him get appreciated as a very good employee. Thanks.

I have dealt with Aetna customer service for many years. I just talked with makeeda. What a wonderful experience. Was very helpful and followed my question as i am changing from an hmo to a ppo for service. I was very impressed with her.

We have had aetna open select for 4 or 5 years now and have never had a problem with the customer service reps or them paying for any dr, emergency, ect.. We changed to them through my husbands company when bcbs went way high on their premiums. I feel so bad that all of ya'll are having such a hard time. Good luck

I read all of your comments and researched the credentialing dept. myself for the provider I work for. It took me less then 10 mins to get a hold of a live representative and was given a correct phone and fax #.

here's the direct line to Aetna's credentialing department: (800)-999-5698

And next time,doctors, do a little research before you start complaining.

I am trying to figure out numerous hospital and medical bills for my mother, who has dementia. She was under hospice services for a short time last year, but was discharged in November 2011, and somehow all claims were still being denied. Several phone calls have been made, speaking to various representatives. The hospice involved notified CMS when they discharged, and numerous letters,( of which I have copies) from the hospice involved, have been sent to Aetna. We have continued to receive EOB's stating she is under hospice care. I have made numerous calls, speaking to your representatives. Many told me they " couldn't fix it until I contacte CMS...no one ever so much as tried to look up the information.
Today I was finally able to speak with Patty at Aetna..This employee deserves to be recognized for her patiece and dilligence in finding and correcting the problem! Please have her teach some of your other "phone problem solvers" how to speak to customers, and how to handle the situation. "Patty" not only found the problem by contacting CMS,but assurred me that everything will be resolved. That is REAL customer sevice! I wish some of the numerous other employees I spoke with could learn from her. She deserves the "customer service award"!

My Cobra is Up August 31, 2010. I called several numbers for Aetna trying to get the same coverage. I was able to reach a customer service rep each time I called. I finally did get a policy to cover me until I go on Medicare in April 2011. I didn't like the monthly figure quoted, but what can you do. All I can say is that I had a pleasant experience with customer service. even though I had to call about five numbers.

wow..Aetna happens to be one of the easiest companies to navigate thru. As soon as you get a rep on the line ask that your call be recorded. That usually changes the tone of the phone call, also ask for a call reference number...they do keep track of all calls.

Horrible customer service! I had to call a few times just to get an issue looked into. They gave me a different number to call and ask for someone by name. When I did, that person didn’t exist. Then after a few more calls, the person that was able to answer was not pleasant at all.

I actually have had Aetna for the past 6 years and never have a problem getting through to someone, and you can mail your payment in or pay over the phone.

I had the pleasure of speaking with Ruby from your customer service dept for providers.She was very knowledgeable and nice. I hope I don't have to collect from Aetna, but if I do, I hope I get Ruby on the phone. :)

As a former aetna employee just for the record. We are horribly understaffed in call centers, high turn over rate, and the training is not enough for those who have no insurance experience or working in insurance. It really is a horrible place to work. They do not care about employees at all. They have managers there with no back ground in the medical field only on a high school education. Honestly one needs formal training to work in insurance so they give the proper customer service info. Believe me there are those of us who really do care about our members and will bust our humps to try to help. But when an employed does not have a working computer or phone its hard to service the members. Horrible company to work for as I said they do not care about employees I the mean management. I'm so sorry to hear all these bad experiences but know there are good people at Aetna that really do care and do know what they are doing, also that have a formal education in heathcare. It is until I was in the customer side I really found out just how bad some experiences can be with this company. It's no fun I totally understand the frustration.

I work for the bloody company and am forced to have Aetna insurance. They pre planned their OE 2015 to end before the marketplace is open. So in short I have to elect Aetna or chance the marketplace! Real nice Mr. Bertolini!
I have paid out $1600 just for insulin and test strips alone for my type 1 child. That doesn't include pump supplies which topped another $2000 this year! (And I have 3 other kids with broken arms, cuts, check ups ect.)The coverage is RAPE plain and simple! My premiums are $500 monthly and for what!!!!???

ok...for the people that just talk their crap about this company. the company YOU work for is the one that CHANGES (MAKES CHANGES) to your plan...everyone in the US and other countries DOES NOT HAVE THE SAME PLAN...every company has their OWN PLAN...SO THEY MAKE THE DECISION in what they want to have their plan cover. everybody always blames Aetna..."They changed this and didn't notify me....I was not told about this..." GO AFTER THE COMPANY THAT YOU WORK FOR....THEY MAKE THE CHANGES...AETNA JUST PUTS IN THE SYSTEM WHAT YOUR COMPANY WANTS TO PAY FOR YOU. STUPID!!! every medication is not covered on most plans. just because a doctor writes a prescription for you doesn't mean that the insurance will pay for it. for example....suboxone must be pre-authorized by a department within the company by a phone call or fax that your doctor must call. that being said...that will not always 'APPROVE' that medication. there are certain criteria and reasons why medications will be approved by the precert dept. if they are not met -- then it will be denied. plan and simple. AND FOR THE person that says they paid $1400 for 1 year for BCBS insurance....that's a FAT LIE...you paid more than that honey, whether you knew it or not...and did you know...EVEN IF YOU SKIP AROUND TO DIFFERENT DOCTORS to get those controlled medications like for pain, anxiety (hydrocodone, Xanax) -- and go to 3 or 4 different pharmacies....that the insurance company can see all that when they pull up your file....YES they can tell when they are talking to a drug addict on the other end of the phone. STOP BLAMING others for a mistake that most of you made -- YOU DIDN'T READ THE PAPER YOU SIGNED THAT YOUR EMPLOYER GAVE YOU.

I am a rep. Believe me, we don't like the problems anymore than you do! We are only the voice of the computer, and it mostly says, "no." Those of us who answer the phones are moms just trying to pay our bills and put food on the table. That's not to make you feel sorry for us, just to let you know that we are not pharmacists, we are only on the other end of the phone to serve you (at least I know I am). I could go into a whole list of issues we reps are having to deal with, but the last thing I want to do is add fuel to this obvious fire.

To save you frustration on your next experience 1) call us right away at 1-866-612-3862, the computer and automated service DO NOT work right now, 2) PLEASE have your Aetna ID ready for the rep, 3) realize we are not machines, please read your ID numbers off in a human speed, and 4) have some patience. Those will make your experience at the very least tolerable.

If all else fails, by all means, call your Member Services listed on your Aetna card to file complaints.

It is true. Being aprovider for this company sucks. They are rude, never helpful....and i have been trying to sign up to use their online service. Its been about three months now and no one will help me. We should drop them.

You think this company sucks for members? Try being a provider. You cannot reach anyone in provider services. You get the ivr and then when you request to speak to a real human being it "pretends" to transfer you then hangs up on you. Great Provider Relations right there! Ha! I wish my company would cancel our contract with them. This company is almost as bad as Anthem. At least they give the run around and don't hang up on you.

Let me start by saying that Aetna employees have the same crappy coverage that the average joe has. There are no "better" plans for us, no matter how long we have worked for this company!
Second, Aetna has sent a very very large portion of work to India which I believe will result in me losing my job eventually. This includes claim processing, appeals, claims rework, overpayment requests, and probably alot of other things I am not aware of. The people in India have no clue what they are doing, 1) because Aetna thinks a few weeks of training actually prepares someone to do things correctly, and 2) because their country has no companies offering insurance and the like, they have no mental concept of how it works in the first place. EVERYTHING in this company has gone downhill since they outsourced everything, all in the name of higher profits!!
And please don't think our pay and benefits are better than those for someone in another line of work because, believe me, they aren't. Every employee at Aetna is expendable, because we can always be replaced at a much cheaper rate by someone in India.

At Aetna, what it all comes down to is training, or lack thereof. When someone mistakenly denies your claim, or your coverage is wrongly cancelled, etc, it's all because no one trained to do their job properly! No one listens to the complaints of the employees when we say we need more training, and we have such high quality and production rates that we have to make in order to even keep our jobs, many end up with the attitude that "it's a paycheck, and no one cares, so I won't either".

One of Aetna's sayings is "Do the right thing for the right reason." What a joke. More like, "Do whatever will make us more money, but don't give a damn about the people that actually work their butts off trying to do a good job and help people." The upper mgmt does not care about you OR me, only their stock options and bonuses. If you have the choice, go somewhere else. (And fyi, what the other employees have commented on here is all true-I can vouch for that.)

All of you people complaining about how "Horrible your coverage" is have to realize one thing. Aetna does not determine your benefits packaged and what is covered and not covered. YOUR EMPLOYER DOES! Your employer builds his insurance compensation package with Aetna and the determining factor is HOW MUCH HE WANTS TO PAY. The more he pays the better YOUR coverage. If you are only allowed 25 Chiro visits a year it is because that is all your employer wants to pay for. Aetna will only give you as good of an insurance policy as what your cheap ass employer will pay for. So before you bellyache about how poor your coverage is have a talk with your employer.....hes the one calling the shots!

As a former employee of Aetna Pharmacy Management precrtification depeartment I can tell you this is a horrible company. Thankfully their pharmacy benefits were sold to Caremark starting 1/1/2011.

The call center reps there really do want to help you but there are a few issues.
1) The staff (front line) is given incomplete or incorrect information. This is due to management not allowing information to flow to all staff members. Speak with a supervisor if you question the response.

2) DO NOT TRUST THEM WITH MEDICARE PART D.
Aetna does not understand how to make a "situational" determination on drugs that can be covered under part B or Part D of Medicare. They rely on a system called Code Correct, which is for medical procedures not pharmacy. If you have a relative in LTC often times these medications will be processed incorrectly.

3) Before submitting a prior authorization request review the criteria online. Almost every brand drug with Aetna will require authorization. Its easier to have your md submit the request with the information or to try the drugs they are asking. Appeals can be a mess and get lost in their system.

4) DO ALL MEDICAL AUTHORIZATION OVER THE PHONE!
Their faxes to the medical side as well as the mail is handled in India. These people do not speak English very well and do not know where to route the requests. I would see requests get thrown from department to department for a year or more.

5) AETNA STUDENT HEALTH
Although many of your medications are covered without authorization if you are on a contraceptive make sure your dr tells them its for a medical reason and not contraception. Read their PCB- at aetna.com because your diagnosis must be on the list.

6) TRANSPLANT PATIENTS BEWARE
The staff does not understand how to process your requests. Ask to speak to a supervisor if in doubt.

Beware of any supervisor you speak to as well. You may get Deb Moy- if she is still there. Beware of anything she says. I am not certain who is still there as a supervisor but be wary and ask to speak to Rebecca (Becky)Potts if she is still there.

As for a rep not giving out their first and last name, Aetna does not allow reps to give out their last names. Which as a customer, I am sure that you do not care, but either way, we are not allowed to give out or last names and do not have to. That is why they give id numbers.

They also encourage us to not get superviors because usually, no supervisor can do what a regular csr cannnot. Now when it comes to knowlegde, that is different, but trying to over ride your plan, such as trying to get 90 days at retail when you plan only allows 30, asking to speak to a supervisor is only going to waste everyones time because we cannot go beyong what the plan allows. A lot of plans are sponsored by the memebrs employers who set the standards of what can be allowed and what cannot, such as, a common complaint is mandatory mail order, that is something put in by your EMPLOYER, not aetna and they provide the exceptions to the plan, not aetna.

Contact numbers are provided on the back of your card. We are not being rude when we tell you to look on the back of your card. There are different divisions within aetna, such as Small Business Accounts, self sponsored accounts, national accounts and there is not just one member services phone number so it would be highly impossible to provide you with the correct mm svs number, we are provided with a general mm svs number, which we can connect you to, but they will probably give you another number to call which will just upset customers more. So it is best to locate the number on the back of your card and call.

If you are complaining that aetna has not updated your cobra coverage, that is because aetna does not updated the cobra coverage. Your EMPLOYER provides effective and term dates. Same goes for over payment or member termination letters, if you receive a bill from aetna stating that you owe them money for a rx that the pharmacy filled after your coverage termed, it is because your employer as not timely in sending in paper work, so aetna continued to pay for your medications because according to aetna, you were active, then when your emloyer turns in paper work and it is processed, aetna will go back and terminate you and the computer generated letter will be sent seeking payment for medications that were paid.

If you are going out of the country and want to contact Aetna, unless you have out of country or out of network coverage, you are wasting your time because it won't be covered anyway. If you are contacting aetna and you do have out of country/network coverage, you will simply need international code and call the same number you would in the states.

As for customer service only being open mon-friday, I am not sure which line you are calling but we do have reps that work weekends and late nights. However, it is healthcare call center... not a 24 hour emergency room. If you need emergency care, seek care first and worry about the cost later. You shouldn't be going to the emergency room unless its an emergency anyway, it if is an emergency, than you won't care about the costs, because you will have to pay them either way.

As for member services, if you want to speak to a live person, keep pressing 0 and it will go ahead and connect you. The only reason that the voicemail prompts you to put your information in, is so that the rep that takes your call doesnt have to waste your time asking for it, if this is an inconvience to you, push 0 and then you can give the information to the rep. If you have questions about your pharmacy benefits call 800-238-6279. Medical member services is tricky, as stated above because there is not just 1 number.

For DMR (direct member reimbursement): the estimated turn around time is 6-8 weeks for dmr processing, as long as all information is submitted in full (detailed phcy receipts with ndc#'s (your pharm can provide them to you) along with quantity and drug name included in this).