Victoria B.
Aetna Medicare Advantage
Extra Benefits: Aetna Medicare Advantage draws in consumers by offering extra benefits beyond what regular Medicare offers. Vision, dental and hearing are the biggest with some plans offering generous benefits for dental, vision and hearing. The main catch is that you must use their “in-network, 3rd party providers” to access some of those benefits. Contracts between these 3rd party providers, such as Nations Hearing offer up to $4,000 for a pair of hearing aids, but no out of network choice for consumers and lucrative profits for selling low end products at a premium price. Recent reports show consumers not utilizing these extra benefits, but reasons for this are more about the convoluted process of access and the potential denial of reimbursement claims. Claims Processing: provider claims are processed quickly (within 30 day) but member reimbursement claims take up to 3 months to receive a check and often are arbitrarily denied, requiring appeals. Reasons for denial are poorly written and often in conflict with their own EOC. Many seniors who struggle with the insurance bureaucracy simply give up and eat the cost. Customer Service: CSR’s are poorly trained and have difficulty deciphering and interpreting the language in their EOC and policy directives. Working with them often requires escalating complaints to higher levels, which results in constant delays in service and payments. It often takes months for a complaint or appeal to get resolved. If you’re lucky enough to have a complaint resolved in your favor, you receive written documentation of the complaint and a resolution that barely resembles the original complaint, almost as though written by AI, though they insist that’s not the case. Rewards: Advertised rewards for basic health screenings is another draw to consumers. However, when it comes to redemption you are limited to 5 merchants (2 are fast food), 1 is CVS (owned by Aetna) and 2 others are retail home and home building supplies. Previously, Walmart and Albertsons were options that helped people stretch their food budget, but these have been removed. Unless you own your own home or need new clothing, then the options of unhealthy fast food are all that’s left. Website: Very general, basic information can be found at the website, which is frequently down or gets stuck processing requests. It doesn’t allow for submission of certain reimbursement requests and those that are allowed, don’t show submission confirmation or status updates. Other than the messaging section, all submissions fall into a black hole until you hear whether they’ve approved or denied your request. Communication: Aetna has an active marketing presence and frequently sends out notifications about products and services they want to sell or support. Contact them about how to access these things is always a challenge. As previously noted, CSR’s have difficulty communicating with consumers and don’t seem to have very basic knowledge of healthcare terminology or their own products and services. I don’t know who is in charge at this company or whether they have a board of directors that includes consumers. Companies that include a consumer or community-based consumer group on their boards often find their customers have higher satisfaction with their services. I don’t believe this company has the insight or motivation to improve their product and I’ve noted over the past 4 years of coverage with them, that their product has declined in value. Having said that, they are by no means the worst, but it’s a pretty low bar. Sadly, it doesn’t need to be that way; it just is, and in my view it’s because the customer is the lowest on their priority list. It begs the question, who is this company’s true customer? It’s clearly not the lonely consumer of their product, but the investors.