Feedback on Aetna USHealthcare Coverage

[Guest rmshrier]

As an insurance broker, I am looking for feedback on peoples experience with Aetna USHealthcare HMO.

[Guest ScottN]

My experience with Aetna HMO and even the PPO over the past 3 years has been very poor. They have been a nightmare to deal with in administration and claims. The PPO and HMO act like two separate companies which can lead to a lot of confusion for Aetna in processing claims and performing relatively simple administrative tasks.

Unfortunately, they are priced agressively in the Denver area currently but are beginning to raise their rates.

Some brokers in this area ask employers to sign liability waivers if the employer chooses Aetna. That should give you an indication.

[Guest jreddi]

We use Aetna/USHealthcare nationally for close to 7000 ees. I inherited the plan and doubt that I will renew with them next year.

When Aetna and USHealthcare merged several years ago, I personally set a 3 year moratorium on shopping them for coverage. Then, they laid off thousands of employees a couple of years later and that set another 3-year moratorium, out of which they are just coming in my mind.

I don't like their business practices and their claims payment history is dismal.

They aren't the only game in town though. I would shop CIGNA this year instead of Aetna.

[Guest nac]

We use AUSHC HMO in NY, NJ, PA and CA. Very small population with small participation - about 100 total between all 4 states.

We've had similar problems, though - last week their collections people informed us that a recent audit indicates that we owe them $93,000 in unpaid back premiums and we would need to overnight them a check to avoid having our account cancelled! (As a side note, we do in fact pay them each month.) After some extensive, expensive research, we've uncovered that all but about $6,000 is related to enrollment/disenrollment issues going as far back as 1996.

Needless to say, they're not real high on my hit parade right now.

That's the administrative standpoint. From a consumer standpoint, I've had relatively few complaints from participants - they seem to be no better or worse than most other HMOs out there.

[This message has been edited by nac (edited 01-27-2000).]

[Guest REverly]

As a previous employee of Aetna US Healthcare, I can tell you that we had received a number of calls while I was at Aetna about the poor administration since the merger. I'm currently on the other side of the table dealing with Aetna US Healthcare. We currently have HMO,QPOS & PPO coverage for our members. As mentioned earlier, there are only a small handfull of complaints that I receive from our members. From an administrative standpoint, they could improve. Getting something simple done is like pulling teeth (especially since I know how easy it should be from working there). I usually have to fax things several times or speak to our main rep several times before there's any resolution to our simplist of problems. We are a self-insured plan, so Aetna's standard guidelines don't apply. My best recommendation is shop around! If you do choose Aetna USHC, you may want to recommend that your clients include performance guarantees in their contracts (Ask that it include response / resolution from their administrative side as well).

If it's any help, we will be actively looking for another carrier with better rates and service shortly.

[Guest [Pat M]]

Between 95 and 98 (during merger), I administered a self-insured plan (multi-carrier/HMO,PP0,Traditional)of approx 3,000 lives, most on Aetna/USHC...the plus side was that in NE US, most areas had adequate provider networks, with the exception of a few towns. Our MA office had a couple of folks from RI that had trouble getting PCPs..Burrillville/Warwick area. The old USHC claims side did an admirable job for us out of their PA office (considering I actually had to call them and go over many individual claims) on a very complicated plan. The account rep side provide less than acceptable service... turnover, new reps, and new systems caused numerous issues at open enrollment. The reports/reporting process was an issue relative to our other self-insurance requirements. Also, currently in NJ, some hospitals are terminating their acceptance of A/USHC because they don't pay what the hospitals want. One other idea if you end up having to go with A/USHC- you might have an opportunity, depending on your payroll provider, to take advantage of a new JV project they have going to provide unified enrollment automated thru payroll. Let me know if you need a contact. As someone else mentioned...try CIGNA, too.

[Guest rmshrier]

Thank you all for your feedback on this topic.

[Guest Frank Miller]

:mad: :confused:

Aetna has raised our RX's and costs to specialists and they question everything that OUR DOCTOR (WHO KNOWS US AND TAKES CARE OF US, ETC...) asks them to provide, and we are in most cases paying $1.16 per pill on RX's. It isn't our fault that only certain drugs will work in our body metabolism. Also they have raised our Doctor co-pay?

I wish someone on Mr. Tom Gallagher's Investigative Task Force for the State of Florida could do something to help us being that our municipalities have sold us out to aetna and the like and also the large drug companies!!!!!!!????????? Most of the time I pay for the drug completely so the hmo gets off scott-free!!!!!!!!!????????

Can you HELP us Mr. Gallagher????

Sincerely

F. Miller