Aetna's Incompetence: or, Does Health Insurance Pay?

Back in June 2014, I submitted a claim to Aetna for services from health care providers. The providers in question are among the increasing number who bill their patients for services, then have their patients submit receipts to their health insurance provider.(This is in the USA, by the way. You can tell that it doesn’t involve a single-payer system.)

The expectation is that the insurers reimburse the insured. At least, that was my expectation. I think that it is also Aetna’s expectation and intention. But, seven months and many phone calls and electronic messages later, I have yet to receive the bulk of the reimbursement. I did receive one check, but that was for less than 10% of the amount due.

I think that this is due to incompetence on the part of Aetna. The many employees I talked with on the phone seemed sincere in their wish to help me. They also seemed to be having difficulty getting the relevant information from their information systems. That’s why I suspect that it is organizational, rather than individual, incompetence.

Could it be an attempt by Aetna to avoid paying? I don’t think so. Aetna has not argued that it is not liable to pay for the particular services for which I sent the receipts. I think that Hanlon’s razor is applicable here: “Never attribute to malice that which is adequately explained by stupidity.”

Aetna claim that a check was sent to a previous address, even though a new and accurate address was on file. I believe that. I requested a stop of that check, and the issue and sending of a new check. Aetna said yes.

We now seem to be in a cycle.

  • I ask Aetna where the check is, since I should have received it by now.
  • Aetna tells me that the previous check wasn’t stopped, and that a new check wasn’t cut.
  • Aetna tells me that the previous check will be stopped, and that a new check will be cut.
  • Time passes.
  • Back to start of cycle.

I decided to try to find a senior Aetna executive whose part of the organization deals with paying claims. I think that person is Meg McCarthy, Exec VP, Operations & Technology. I tried to find her email address. I did not succeed, although I did find out about many awards and media appearances, and that her annual compensation exceeds $4M (that’s four million US dollars).

Any ideas on how to get Aetna to actually cut and send the check? I’m getting so desperate, I may resort to writing a letter on paper and sending it to Ms McCarthy, in the hope that she or someone who can actually get something done in Aetna sees it. Thank you for reading, anyway.

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