Aetna
Allergy Shot Claims Misprocessed Repeatedly Despite Department of Insurance Ruling

My company switched to Aetna for health insurance one year ago and since then I've had to file twice with the Calif. Department of insurance and one small claims suit. I eventually get my money but getting any claims paid is like pulling teeth. There is much "red tape" and run around and those with little endurance likely give up before getting their claims paid.

One situation which is ripe for a class action is their habitual denial of a benefit clearly listed on the benefit summary they use to sell policies. When getting allergy shots, if you don't see the doctor, you should not pay anything (no co-pay), however, Aetna has misprocessed my claim each and every month even AFTER I filed with the Calif. Department of insurance and WON that case. Aetna sent a letter saying a "computer error" was to blame and they supposedly fixed it. Yet for 6 months after that they still misprocessed the claim. Aetna's attorney finally got involved and promised my computer file would get "flagged" so the claim would never get misprocessed again. And still to this day, they still misprocess the claim after their attorney promised the error would not happen again.

I am just ONE person. How many people are they doing this to? How many people are charged a co-pay due to a supposed "computer error" that they can't fix even after TWO interventions with "the law". If they don't realize my policy calls for no co-pay (they treat my situation like it's a rare case and I have some "special" deal) how many other people are treated the same way even though their policy is the same as mine?

This is just one of 3 examples of poorly processed claims in the last year that I finally prevailed in (of course all "mistakes" favored Aetna).

Just as in the film "The Rainmaker" I believe they mishandle claims the first several times and only those with tenacity and endurance get their benefits.

Company: Aetna
Country: USA
State: California
City: Los Angeles

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