What You Need to Know
When it comes to customer service satisfaction, Aetna may have room for improvement.
Who Is Aetna?
Aetna is one of the most trustworthy health insurers. With more than 160 years of experience, Aetna offers health plans to fit a variety of needs and situations.
Basics on Aetna
Since 1853, Hartford, Connecticut-based Aetna has offered healthcare benefits and services to individuals, employers, and healthcare professionals.5 In 2018, Aetna began to offer those services as a subsidiary of CVS Health.6 As of then, Aetna provided medical services to approximately 22.1 million policyholders and dental services to approximately 12.7 policyholders. In addition, 13.1 million policyholders received pharmacy benefits from Aetna.7 The health insurance giant offers plans across all 50 states and the District of Columbia.8 It also offers international policies for individuals who are living or working abroad.9 Approximately 39 million people received healthcare services through Aetna as of September 2018.10
Aetna also has a large provider network. The company’s global network encompasses approximately 1.2 million healthcare professionals, more than 700,000 specialists and primary care doctors, and more than 5,700 hospitals.11
What Types of Health Insurance Plans Does Aetna Offer?
Aetna offers a variety of different types of health coverage, including:
- Individual plans to cover your own medical needs.12
- Family plans to cover your medical needs as well as those of a partner or dependents.13
- Group plans for employers to offer insurance as a benefit to their workers.14
- Medicare plans and Aetna Medical Advantage Plans15 for individuals 65 and older or those who have a disability.16
- Medicaid plans for individuals with limited assets, a disability, or special needs.17
- Student health insurance plans for those in college in the United States or studying abroad.18
- Supplemental plans that cover gaps in your primary health insurance to pay for costs associated with such events as critical illness, accidents, and hospital stays,19
What Are Member Benefits for Aetna?
In addition to offering medical services, Aetna provides a number of other preventive care benefits designed to help you stay healthy. For example, some plans come with a gym membership, yoga and massage sessions, and health coaching to help you reach certain fitness goals.20 Other benefits include discounts on diet and weight management programs and a 24-hour hotline.21
How Do You Enroll in Coverage with Aetna?
If you decide Aetna is the insurance carrier for you, there are a number of ways to sign up for coverage.
You can start by clicking on “Shop for a Plan” from the upper left-hand corner of the company’s website, Aetna.com.22 You can also contact the company by calling 1-800-872-3862 to speak with someone who can help you. If you prefer interacting via social media, Aetna offers two Twitter handles: @Aetna and @AetnaHelp.23 Aetna also works with agents and brokers so you can sign up for coverage by having a professional walk you through the options.24 As you explore what is available to you, make sure you check to see if you qualify for a current-year subsidy under the Affordable Care Act.
How Do You File Claims with Aetna?
If a time comes when you need to file a claim, Aetna has a variety of ways to do so. According to the company, the most efficient way to file a claim is online.25 However, you can also file a claim via fax, email, or traditional mail, preferably within 180 days of the services you are filing a claim for.26
There is certain information you want to make sure you have on hand before filing your claim:
- Your member identification number and contact information27
- A description of the medical service and the date it was completed28
- Copies of bills and receipts29
- Information on the method you’d like to be reimbursed30
- Bank account information if you choose to be reimbursed via Electronic Fund Transfer31
For certain procedures, such as chiropractic or homeopathic treatment, you may need to get a referral from a doctor or specialist before submitting a claim.32
How is Aetna Rated?
When it comes to choosing an insurance company, it’s a good idea to make sure your insurer is financially stable. Checking the insurer’s financial ratings by third-party companies can offer peace of mind.
When it comes to customer satisfaction with Aetna, there may be some room for improvement. The National Association of Insurance Commissioners tracks complaints about insurance companies, and Aetna has a complaint index that is more than three times higher than expected in the market.35 The most common complaint was for the denial of a claim, followed by delays in the handling of the claims process.36
Several websites give consumers the opportunity to share their experiences with different companies. Consumer Affairs features 1,601 ratings for Aetna in the past year, and of those ratings the average score was 4 out of 5.37
However, the website Trustpilot featured 13 reviews of Aetna, with 77% of them giving the company a “bad” rating and 15% describing the service as “poor.”38
The Better Business Bureau reported that 618 complaints about Aetna closed in the last three years and 230 complaints closed in the last 12 months. Out of 72 customer reviews on the website, the average score was 1.04 out of 5.39
What Are Strengths of Aetna?
Aetna has been around for 168 years, so it has longevity in the insurance market. It’s also financially strong, as exemplified by high ratings from A.M. Best and Fitch Ratings. It’s array of products make it likely that you will find a policy that suits you whether you’re looking for a family plan, a student policy, or a Medicare supplement plan.
What Are Weaknesses of Aetna?
Customer service may not be Aetna’s strong point, as evidenced by some of the complaints that can be found about the insurer. While the most common complaint is related to denied claims, Aetna clearly lays out the best way to submit a claim in order to yield the best results.
Choosing the best health insurance company is a subjective process that depends on your individual needs and priorities.
If you’re thinking about buying health care coverage through Aetna, make sure the policy fits your personal needs and your pocketbook. For example, would you prefer an HMO or a PPO? Not only should you be able to afford your premium, but you need to be able to afford out-of-pocket expenses, too. That means making sure your copayments, coinsurance, prescription drugs, and any deductible fits within your budget. Finally, pay attention to the customer service you receive while signing up for your policy.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.