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Complaint 0 of 0 in "Errors in Claim Payments"

Insurance Carrier: Aetna
State: Pennsylvania

Consumer Complaint:

My son's medical coverage should have been effective July 26, one month after birth. Also due to clerical error on their part -- wrong doctors, name, wrong diagnosis-- they didn't correct mistakes until March 09. They are now requiring me to pay the wrong amount approximately $600 from January forward. Also they are not back tracking my son's doctor's visits (normal checkups). I have been working with my son's doctor and can show the amount of times the doctor's office and myself had to correct this problem due to their error.


Insurance Expert Answer:

Aetna is not on top of the list of bad insurance companies and undoubtedly this is all part of a bureaucratic foul up which someone in authority could address and resolve.

The best way to explain that and get action is in a polite and reasonably detailed letter to the VP for Claims of Aetna, setting out the name of the employer (I assume this is an employer sponsored plan) through which you were covered, the policy and certificate number, asking for his or her help to straighten things out. Attach a few relevant documents (birth certificate, insurance card, and an explanation of benefits that was rejected) to make the case. Don't waste time with clerks in call centers answering 800 number calls. The employer's benefits office might also help.