Why Is Aetna Insurance So Bad and What to Expect

Aetna insurance has a reputation for being one of the worst in the industry. One reason is that it has a history of denying claims, with 22% of claims being denied in 2020.

Aetna's denial rate is significantly higher than the national average. This can be a huge financial burden for policyholders who are already struggling with medical expenses.

Aetna's customer service is also notoriously bad, with many customers reporting long wait times and unhelpful representatives. In fact, Aetna's customer satisfaction rating is 2.5 out of 5 stars, which is one of the lowest in the industry.

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Aetna insurance has several drawbacks that may make it a less desirable option for some individuals. Aetna will no longer offer individual or family ACA-compliant plans as of January 1, 2026, affecting roughly 1 million members across 17 states. This move is due to sustained financial losses in that segment.

Aetna's limited focus on short-term, student, and supplemental non-Medicare markets is another concern. The company's above-average complaint index, especially in past ACA and individual coverage, is also a red flag. Mixed consumer reviews about billing transparency and claims communication further erode trust in the company.

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Aetna's higher-than-average premiums compared to competitors are a significant drawback. The company's limited availability in only 17 states is another limitation. Not working with independent agents also limits accessibility for some individuals.

Aetna has faced thousands of complaints regarding customer service, billing, and claims. The company's limited transparency on available discounts is also a concern. These issues suggest that Aetna may not be the best option for those seeking affordable and accessible health insurance.

Here are some key cons of Aetna insurance:

Insurance companies like Aetna have a tendency to deny valid claims, and it's often in bad faith. They collect billions of dollars in premium revenues, but still find ways to delay and deny coverage.

Aetna has been known to reject benefits for medically necessary treatment, even when the patient's doctor deems it necessary. This can lead to serious consequences, including hospitalization, worsening conditions, and pain and suffering.

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Aetna's practices have come under fire for being improper, with some cases involving physicians who never actually read the medical records or made personal investigations into the requested treatment. Instead, they relied on second-hand information from Aetna's nurses.

Delays in claims can also be a problem, with Aetna generating profits from holding onto your coverage. Each day the amount of money you're entitled to sits in their bank account is another day they collect interest on the money.

Aetna's complaint index remains above average, primarily due to ACA claim disputes and communication issues. This is a significant issue, as health insurance companies like Aetna should be working to resolve claims in a timely and fair manner.

It's not uncommon for Aetna to deny claims and then ask you to settle for less than it's really worth. This can be frustrating and unfair, especially when you need the coverage to pay for medical treatment.

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Aetna insurance companies collect over 30 billion dollars in premium revenues each year, but still find ways to delay and deny valid claims.

This can be frustrating for policyholders who thought they were protected. Aetna knows that giving the insured an eternal runaround or outright denying claims can often increase their profits.

In some cases, Aetna's physicians who make decisions on claims never actually review the evidence, relying on second-hand information instead. This can lead to benefits being denied in bad faith or negligently.

Aetna generates profits from delaying, denying, and underpaying claims, which can add up over time. For every day a claim sits in Aetna's bank account, they collect interest on the money.

If your claim is denied, it's not the end of the road. An experienced Aetna insurance delay attorney can help ensure that Aetna or any other health insurance company doesn't delay your claims unreasonably.

Aetna's practice of delaying claims can be a significant burden for policyholders who need medical treatment. By delaying valid claims, Aetna can hold onto your coverage and generate more profits.

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If you've exhausted your internal appeals and Aetna still denies your claim, you have the option of requesting an external review with an independent physician.

Aetna allows members to request an external review for coverage denial based on the experimental or investigational nature and lack of medical necessity of the supply or service at issue. You can also file your complaint for benefits with ERISA, a federal statute that applies to employees whose Aetna insurance plans are provided by labor unions and private employers.

Typically, a denial for a group disability coverage by Aetna will fall under ERISA, which was enacted to protect workers but can be used by insurance companies to hurt disabled employees by denying legitimate disability claims.

If Aetna wrongfully denies your claim, you may be entitled to compensation for the pain and suffering, financial losses, and other expenses. You could also be entitled to substantial compensation if Aetna's decision to deny your claim or cancel your benefits was unreasonable.

In extreme cases, denial of health insurance claims may lead to the demise of the claimant, and you may be entitled to receive compensation if the wrongful denial led to the death of a loved one.

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If Aetna still denies your claim after exhausting all appeals, you have a few options to consider.

You can request an external review with an independent physician, which is allowed by Aetna for coverage denials based on experimental or investigational nature and lack of medical necessity.

This option is only available if you've exhausted the applicable plan appeal process and the coverage is one that you'd be financially responsible for more than $500 of the medical costs.

Keep in mind that an external review is not a precondition for seeking the court's intervention if Aetna has wrongfully denied your claim.

You may also file a complaint for benefits with ERISA, which is a federal statute that applies to employees whose Aetna insurance plans are provided by labor unions and private employers.

ERISA is a law that protects workers, but insurance companies often use it to deny legitimate disability claims.

Typically, a denial for a group disability coverage by Aetna will fall under ERISA.

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Suing for Denied Necessary Treatment can be a viable option if your insurance company denies coverage without a medical basis. Aetna's internal review process may not always yield a favorable outcome, so it's essential to explore external review options.

If Aetna denies your claim, you may be entitled to compensation for pain and suffering, financial losses, and other expenses. This is especially true if the wrongful denial led to the deterioration of your condition or even death.

Aetna's medical director may not always conduct thorough research or review medical records before making a decision. In one case, a former Aetna medical director confessed to not researching a patient's condition or knowing what drugs were effective in treating rare conditions.

If your insurance company denies coverage without a medical basis, you can sue for wrongful denial of coverage, breach of contract, and bad faith. This is because insurance companies have a duty to inform you about your policy provisions and make decisions based on medical necessity.

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Aetna may be considered to have acted in bad faith if the claim was denied without any real research, medical opinion, or investigation. This can lead to significant financial losses and emotional distress.

You may be entitled to substantial compensation if Aetna's decision to deny your claim or cancel your benefits was unreasonable. Additionally, if Aetna's review of your claim was handled with negligence or in bad faith, you may be entitled to receive punitive damages for the denied benefits.