Customer Review - Aetna

Aetna drags out appeals process with denials

My teenage daughter needed inpatient mental health care and I kept calling to get her pre-certified at an inpatient facility that was recommended by her counselor. Aetna said we should try two other places. One of the places they recommended was for adults only. The other didn't treat my daughter's condition. We told Aetna this and that we wanted them to pre-certify. They kept giving us the run around. Lots of phone calls with no commitment or definitive answer. Finally one of their phone agents said we could send our daughter to the place that was recommended, pay directly, and then submit the claim. however, it has been six months since we submitted the claim, and they have been denying it repeatedly, and tell us to keep going through their appeals process. They just keep denying that the treatment was pre-certified and are also starting to question the medical necessity. It feels like they keep putting up hurdles to wear you down. One thing we found out is that one can file a complaint with the National Committee for Quality Assurance - ncqa.org - that accredits healthcare organizations. They track complaints in their database and investigate.