pros and cons of Aetna Medicare?

[InsuranceGuy29]

Work with them a lot in the Chicago area region of Illinois. Never had any issues with them personally and my clients are all happy. Tons of different plans to personalize needs for my clients. They're also VERY aggressive about getting as many doctors and hospitals in-network. Which, in my opinion, is the most important part of this whole Medicare thing. The closer coverage gets to a supplement, the better. If I search for 100 doctors or hospitals, usually 95 are in-network. They have 100% of hospitals in-network here, as well, in this region. Their area managers are definitely very thorough and "on it."

 

[LostDollar]

LD - I am trying to follow but I have no idea what you are talking about. Your stories almost completely contradict each other lately. Pre Medicare plans have zero correlation to Medicare plans.

You said if you were to become an agent you said you would contract with Aetna but not sell their MA or med supps? Makes zero sense.

Caveat, I am not an agent.

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I was responding in relation to this carrier's customer service. You and another agent, the first two responders to the thread, cited customer service as a problem area for this carrier.

Unsatisfactory customer service for Medigap and MA plans matches exactly with my experience with this carrier for EGH plans. In Kansas, this carrier bought another insurance company. The other company had concern for its consumers and provided wonderful customer service. The year the health care management started happening under this carrier name, customer service turned into a nightmare from hell.

As best as I can understand, this carrier attempted, on my claims, to apply small employer EGH plan COB rules to a large employer EGH plan situation. The carrier reversed prior payment decisions, issued revised EOB's and clawed the payments back from providers. The providers came after me for the money.

I was finally able to get the name of an area manager who was willing to listen to me. He could do nothing with the original claims, he had to file duplicates to get new EOB's and new payments sent to providers.

The process the area manager had to use to get my claims situation straightened out resulted in both providers being paid small amounts under the original claims and the proper EGH Plan liabilities under the second set of claims. I mentioned that to the area manager. He said that could not happen because they had procedures in place to prevent that from happening. Well ................. I told him thank you for his help and dropped it.

Then when I was looking for Medigap plans a couple of months later, I mentioned this to a national Medigap phone sales agent who wanted to sell me Aetna coverage. He thought my story was B/S and told me Aetna was a wonderful company. I did not do business with that agent.

That situation was one of the most emotionally frightening experiences I have ever experienced because it demonstrated the absolute, raw power that insurance carriers hold over the healthcare and healthcare finances of American citizens.

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MA coverage problems

Some time in the last four years there has been a thread here about from someone asking about claims denials or partial claims denials by this carrier for a financially significant MA situation.

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Commissions

There are agents who have posted here that they have stopped sales of this carriers products because of this carrier's approach to agent commissions. OP can verify that, or not, with other agents.

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The selling question

The responding poster after you probably sells in a combination of KS and MO.

If I were a new agent, I would have to be very concerned about getting new business. This agent's post suggests that currently in KS, regardless of my personal feelings about the carrier, I would likely have to contract with them in order to compete well with other agents.

@somarco's post about E&O insurance was very informative. With that information, my personal experience with the carrier, and the post cited above, I know I would not sell any of this carrier's MA plans without having occurrence based E&O in place. I did not say I would not sell them, I said I would not sell them without proper insurance for me in place. It would only take one large MAPD service denial suit to financially destroy a new agent.

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I don't know what other stories you might be talking about, I would have to address those in other threads.

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Regards
LD

 

[steve3752]

During last AEP I had five referrals that were on Aetna and all were complaining about pre authorization for simple services like MRI's. The first went to an orthopedic surgeon who wanted to MRI his shoulder. Denied it until he did six weeks of PT. Others were similar. All switched to UHC - FL

 

[DonP]

During last AEP I had five referrals that were on Aetna and all were complaining about pre authorization for simple services like MRI's. The first went to an orthopedic surgeon who wanted to MRI his shoulder. Denied it until he did six weeks of PT. Others were similar. All switched to UHC - FL

United is the king of all mapd . In all the apps I’ve written the last few yrs I’ve yet to have one client call with a medical gripe . My highest loyalty mapd carrier by far

 

[vic120]

During last AEP I had five referrals that were on Aetna and all were complaining about pre authorization for simple services like MRI's. The first went to an orthopedic surgeon who wanted to MRI his shoulder. Denied it until he did six weeks of PT. Others were similar. All switched to UHC - FL

United is the king of all mapd . In all the apps I’ve written the last few yrs I’ve yet to have one client call with a medical gripe . My highest loyalty mapd carrier by far

Yes super high loyalty but I have had a good bunch who have complained about Preauth and other like things with them

Just as I have had with other carriers

and I have the same in Love with other carriers claiming best CS and preauth ease with Humana and Aetna

Probably less complaints with UHC then Aetna and Aetna less then Humana

But still you always get those who love em and claim they will always approve anything,. and others who say they deny everything and don't cover Nuffin

Heck I have even had a couple over the years complain plan G doesn't cover Nuffin

 

[Jim Wright]

I'm sure this is happening other places as well but people in the Carolinas are getting scared away from UHC. They have had some MAJOR network fights. Lost the biggest provider network in SC on all lines (MA, ACA, Group) and had some long fights with some others in Raleigh. People are worried they are going to lose their Dr. mid plan year.

 

[vic120]

Pro = Some people think they are the bestest

Some think their approval is far easer and better then others they have worked with
Some love the way their dental works
some love their network
some love their CS

Con = Some people think they are the worstest

Some think their approval is far harder and worse then others they have worked with
Some hate the way their dental works
some hate their network
some hate their CS verse others

really no different then any other carrier

 

[MedicareAgent]

I'm in SW Florida and Aetna came in STRONG a few years back but the customer service they offer is non existent, I have customer complaints regarding dental claims not being paid, waiting on a claim from Dec. I resubmitted it 3 times and still not being done. The network is shrinking and customers are not being told when their dr's leave network, had one last week, moving her to UHC.
UHC has it's share of problems too, they fired the agent managers and receiving an answer from the help desk takes an act of congress, seems no one is leading. The hospital network game was a disaster last year, hospitals not signing contracts until Dec 31st.
There is no perfect company anymore, they all suck it seems.

 

[DonP]

I'm in SW Florida and Aetna came in STRONG a few years back but the customer service they offer is non existent, I have customer complaints regarding dental claims not being paid, waiting on a claim from Dec. I resubmitted it 3 times and still not being done. The network is shrinking and customers are not being told when their dr's leave network, had one last week, moving her to UHC.
UHC has it's share of problems too, they fired the agent managers and receiving an answer from the help desk takes an act of congress, seems no one is leading. The hospital network game was a disaster last year, hospitals not signing contracts until Dec 31st.
There is no perfect company anymore, they all suck it seems.

I’ll agree with that . We can expect network fights to explode in next few yrs as non agreement over reimbursement fees . What I’m noticing which is concerning . When a carrier goes out of network many hospitals and Dr’s are no longer taking and billing ppo’s . They tell the patient we don’t accept this insurance . Also the old days an agent would say “don’t worry even if it goes a few weeks past the expiration of oon date they always come to agreement . No more I’m seeing some out of network fights at over a yr now.

 

[Chazm]

It’s comical how every thread turns into a doomsday debacle. I thought that’s why we made a “doomsday” thread.
People need to take a step back from the ledge.