InsuranceComplaintCheck

AETNA HEALTH INC. — health Insurance Complaints

Analysis of 1,145 health insurance complaints filed against AETNA HEALTH INC., based on public NAIC and state DOI data.

Key Statistics

  • health Complaints: 1,145
  • Total Complaints (All Types): 1,245
  • health Share: 92.0%
  • NAIC Complaint Ratio: 2.48
  • AI Risk Score: 92/100

health Complaint Issues

Issue TypeComplaints% of Total
Claim denial44038.4%
Delayed payment27123.7%
Premium or billing dispute615.3%
Provider or network dispute292.5%
Unsatisfactory Settle/Offer | No Jurisdiction272.4%
Unsatisfactory Settle/Offer | Information Furnished151.3%
Policy cancellation141.2%
Unfair settlement121.0%
Unsatisfactory Settle/Offer | Contract Language/Legal Issue100.9%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue90.8%
Usual And Customary | Contract Language/Legal Issue90.8%
Other80.7%
Unsatisfactory Settle/Offer | Information Furnished; Contract Language/Legal Issue70.6%
Prompt Pay | Contract Language/Legal Issue70.6%
Claim Procedure | Claim Handling50.4%
Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Information Furnished40.3%
Unsatisfactory Settle/Offer | Claim Settled; Corrective Action Taken; Additional Monies Received40.3%
Recoupment Of Claims Payment | Contract Language/Legal Issue; Information Furnished40.3%
Coverage dispute40.3%
Prompt Pay; SB418 Rule Violation | Contract Language/Legal Issue40.3%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | No Jurisdiction40.3%
Misleading sales30.3%
Other | Information Furnished30.3%
Unsatisfactory Settle/Offer | Information Furnished; Additional Monies Received30.3%
Unsatisfactory Settle/Offer30.3%
Unsatisfactory Settle/Offer | Corrective Action Taken; Additional Monies Received; Claim Settled20.2%
Unsatisfactory Settle/Offer | Information Furnished; Corrective Action Taken20.2%
Unauthorized Acts | Information Furnished20.2%
Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Company Position Upheld; Information Furnished20.2%
Recoupment Of Claims Payment | Information Furnished20.2%
Access to Care | Information Furnished; Contract Language/Legal Issue20.2%
External Review | Claim Handling20.2%
Usual And Customary | No Jurisdiction20.2%
Prompt Pay; Unsatisfactory Settle/Offer | Contract Language/Legal Issue20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Information Furnished; Contract Language/Legal Issue20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Company Position Upheld20.2%
Prompt Pay; SB418 Rule Violation | No Jurisdiction20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Information Furnished20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Company Position Upheld; Contract Language/Legal Issue20.2%
Unsatisfactory Settle/Offer; Usual And Customary | Referred To; No Jurisdiction20.2%
Unsatisfactory Settle/Offer | No Jurisdiction; Information Furnished20.2%
Unsatisfactory Settle/Offer | Additional Monies Received20.2%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Corrective Action Taken; Additional Payment Expected; Contrac10.1%
Fraud | Contract Language/Legal Issue; Company Position Upheld; Information Furnished10.1%
Cust Srvc Policy Holder Srvcs | Contract Language/Legal Issue; Company Position Upheld; Information Furnished10.1%
Claim Recoding/Bundling; Prompt Pay | Clean Claims Violation; Claim Settled; Corrective Action Taken10.1%
Authorization Dispute | Information Furnished; Corrective Action Taken10.1%
Health Privacy; Unauthorized Acts | Referred To; Company Position Upheld; Information Furnished10.1%
Cust Service Claim Handling; Maximum Out of Pocket; Pediatric Care | Corrective Action Taken; Additional Payment Expecte10.1%
Authorization Dispute; Unsatisfactory Settle/Offer | Corrective Action Taken; Additional Monies Received; Claim Settled10.1%
Recoupment Of Claims Payment | Corrective Action Taken; Contract Language/Legal Issue; Policy Not In Force10.1%
Ambulatory Patient Services; Maximum Out of Pocket | Information Furnished; Contract Language/Legal Issue10.1%
Enrllmt/Canc/Rnwl Of Enrollee | Additional Payment Expected; Corrective Action Taken; Information Furnished10.1%
Unsatisfactory Settle/Offer | Claim Settled; Additional Monies Received; Corrective Action Taken10.1%
Unsatisfactory Settle/Offer | Information Furnished; Corrective Action Taken; Additional Monies Received10.1%
Unsatisfactory Settle/Offer | Claim Settled; Information Furnished; Corrective Action Taken10.1%
Unsatisfactory Settle/Offer | Information Furnished; Company Position Upheld10.1%
Unsatisfactory Settle/Offer | Claim Settled; Corrective Action Taken10.1%
Prior Authorization | Information Furnished; Contract Language/Legal Issue; Company Position Upheld10.1%
Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Information Furnished; Company Position Upheld10.1%
Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Additional Payment Expected; Information Furnished10.1%
Unsatisfactory Settle/Offer | Information Furnished; Additional Monies Received; Corrective Action Taken10.1%
Maximum Out of Pocket | Referred To; Corrective Action Taken; Information Furnished10.1%
Access to Care; Prior Authorization | Information Furnished; Company Position Upheld; Contract Language/Legal Issue10.1%
Authorization Dispute; Cust Service Claim Handling; Unsatisfactory Settle/Offer | Additional Monies Received; Stat Pen P10.1%
Cust Srvc Policy Holder Srvcs; Enrllmt/Canc/Rnwl Of Enrollee | Corrective Action Taken; Policy Issued/Restored10.1%
Enrllmt/Canc/Rnwl Of Enrollee; Maternity and Newborn Care; Pediatric Care | Contract Language/Legal Issue; Corrective Ac10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Company Position Upheld; Contract Language/Legal Issue; Infor10.1%
Prior Authorization | Contract Language/Legal Issue; Information Furnished10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Information Furnished; Company10.1%
Enrllmt/Canc/Rnwl Of Enrollee; Recoupment Of Claims Payment | Referred To; Contract Language/Legal Issue; Company Positi10.1%
Cust Service Claim Handling | Contract Language/Legal Issue; Information Furnished10.1%
Unsatisfactory Settle/Offer | Corrective Action Taken; Additional Monies Received; Stat Pen Pd-Over 90 Dys Late10.1%
Unsatisfactory Settle/Offer | Stat Pen Pd-Over 90 Dys Late; Additional Monies Received; Corrective Action Taken10.1%
Cust Srvc Policy Holder Srvcs | Information Furnished10.1%
Unsatisfactory Settle/Offer | Stat Pen Pd-46 To 90 Dys Late; Corrective Action Taken; Claim Settled10.1%
Recoupment Of Claims Payment | Information Furnished; Company Position Upheld; Contract Language/Legal Issue10.1%
Recoupment Of Claims Payment | Company Position Upheld; Information Furnished; Contract Language/Legal Issue10.1%
Coordination of Benefits | Claim Handling10.1%
Unsatisfactory Settle/Offer | Claim Settled; Corrective Action Taken; Information Furnished10.1%
Cust Service Claim Handling; Recoupment Of Claims Payment | Information Furnished10.1%
Unsatisfactory Settle/Offer | Information Furnished; Corrective Action Taken; Claim Settled10.1%
Maximum Out of Pocket; Unsatisfactory Settle/Offer | Information Furnished; Corrective Action Taken; Additional Payment 10.1%
Maximum Out of Pocket; Unsatisfactory Settle/Offer | Corrective Action Taken; Additional Payment Expected; Information F10.1%
Maximum Out of Pocket; Unsatisfactory Settle/Offer | Information Furnished; Additional Payment Expected; Corrective Acti10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Claim Settled; Corrective Action Taken; Information Furnished10.1%
Prior Authorization | Company Position Upheld; Information Furnished10.1%
Cust Service Claim Handling; Recoupment Of Claims Payment | Claim Settled; Information Furnished10.1%
Cust Service Claim Handling; Recoupment Of Claims Payment | Contract Language/Legal Issue; Information Furnished10.1%
Maximum Out of Pocket | Contract Language/Legal Issue; Information Furnished; Additional Payment Expected10.1%
Other | Contract Language/Legal Issue; Company Position Upheld; Information Furnished10.1%
Usual, Customary, Reasonable (UCR) Charges | Claim Handling | Claim Settled10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Corrective Action Taken; Information Furnished; Additional Pa10.1%
Unsatisfactory Settle/Offer | Claim Settled; Information Furnished; Stat Pen Pd-Over 90 Dys Late10.1%
Cust Service Claim Handling; Unsatisfactory Settle/Offer | Information Furnished; Contract Language/Legal Issue10.1%
Access to Care | Corrective Action Taken; Information Furnished10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Company Position Upheld; Corrective Action Taken; Information Furnish10.1%
Timely Filing Deficiency | Information Furnished; Company Position Upheld; Contract Language/Legal Issue10.1%
Cust Service Claim Handling; Maximum Out of Pocket; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Correct10.1%
Cust Service Claim Handling; Maximum Out of Pocket | Contract Language/Legal Issue; Company Position Upheld; Information10.1%
Unsatisfactory Settle/Offer | Corrective Action Taken; Additional Monies Received; Information Furnished10.1%
Misrepresentation; Unsatisfactory Settle/Offer | Information Furnished; Contract Language/Legal Issue10.1%
Maximum Out of Pocket; Unsatisfactory Settle/Offer | Additional Payment Expected; Corrective Action Taken; Information F10.1%
Unauthorized Acts | Referred To; Information Furnished10.1%
Refusal to Insure | Underwriting10.1%
Cust Service Claim Handling; Essential Health Benefit | Claim Settled; Information Furnished; Contract Language/Legal Is10.1%
Emergency Services | Claim Handling | Company Position Substantiated10.1%
Access to Care | Contract Language/Legal Issue; Information Furnished10.1%
Assignment of Benefits; Unsatisfactory Settle/Offer | No Jurisdiction10.1%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | Contract Language/Legal Issue10.1%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; No Juris10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue; No Jurisdiction10.1%
Prompt Pay | Contract Language/Legal Issue; Stat Pen Pd-Over 90 Dys Late10.1%
PPACA-Out-Of-Ntwk Emerg Care; Unsatisfactory Settle/Offer; Usual And Customary | Information Furnished; Company Position10.1%
SB418 Rule Violation | No Jurisdiction; Contract Language/Legal Issue10.1%
Claims Reimb/Bal Bill Problems; Cust Service Claim Handling; Overcharges | No Jurisdiction10.1%
Prompt Pay; Unsatisfactory Settle/Offer | Corrective Action Taken; Contract Language/Legal Issue; Additional Monies Rece10.1%
Unsatisfactory Settle/Offer | Claim Settled10.1%
Prompt Pay; Unsatisfactory Settle/Offer | No Jurisdiction; Contract Language/Legal Issue10.1%
Prompt Pay; SB418 Rule Violation | Contract Language/Legal Issue; Corrective Action Taken10.1%
Access to Care | Record Only; No Jurisdiction10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Information Furnished; Contract Language/Legal Issue; Company Positio10.1%
Prompt Pay; SB418 Rule Violation | Stat Pen Pd-46 To 90 Dys Late; Clean Claims Violation; Corrective Action Taken10.1%
Prompt Pay; SB418 Rule Violation | Corrective Action Taken; Stat Pen Pd-46 To 90 Dys Late; Contract Language/Legal Issue10.1%
Prompt Pay; SB418 Rule Violation | Clean Claims Violation; Corrective Action Taken; Stat Pen Pd-46 To 90 Dys Late10.1%
Prompt Pay; Unsatisfactory Settle/Offer | Company Position Upheld; Information Furnished; No Jurisdiction10.1%
Prompt Pay | Corrective Action Taken; Additional Monies Received; Claim Settled10.1%
Prompt Pay; SB418 Rule Violation | Corrective Action Taken; Stat Pen Pd-46 To 90 Dys Late10.1%
Prompt Pay; SB418 Rule Violation | Information Furnished; Contract Language/Legal Issue10.1%
Prompt Pay; SB418 Rule Violation | Clean Claims Violation; Stat Pen Pd-Over 90 Dys Late10.1%
Prompt Pay; SB418 Rule Violation | Stat Pen Pd-46 To 90 Dys Late; Additional Monies Received; Corrective Action Taken10.1%
Prompt Pay; SB418 Rule Violation | Corrective Action Taken; Stat Pen Pd-Up To 45 Dys Late10.1%
Prompt Pay | Additional Monies Received; Stat Pen Pd-Up To 45 Dys Late10.1%
Prompt Pay | Information Furnished; Contract Language/Legal Issue; Stat Pen Pd-46 To 90 Dys Late10.1%
Prompt Pay | No Jurisdiction10.1%
Prompt Pay | Corrective Action Taken; Stat Pen Pd-46 To 90 Dys Late10.1%
Unsatisfactory Settle/Offer | Other; No Jurisdiction; Record Only10.1%
Prompt Pay; SB418 Rule Violation | Contract Language/Legal Issue; Information Furnished10.1%
Not Within TDI Jurisdiction; Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | No Jurisdiction; Contract Langu10.1%
Prompt Pay | Contract Language/Legal Issue; Corrective Action Taken10.1%
Prompt Pay | Additional Monies Received; Stat Pen Pd-46 To 90 Dys Late; Corrective Action Taken10.1%
Not Within TDI Jurisdiction; Unsatisfactory Settle/Offer | No Jurisdiction; Additional Monies Received10.1%
Prompt Pay; Unsatisfactory Settle/Offer | Information Furnished; Stat Pen Pd-46 To 90 Dys Late10.1%
Unsatisfactory Settle/Offer; Usual And Customary | Information Furnished; Contract Language/Legal Issue; No Jurisdiction10.1%
Insurer Fraud; Unsatisfactory Settle/Offer | Contract Language/Legal Issue10.1%
Prompt Pay; SB418 Rule Violation; Unsatisfactory Settle/Offer | Additional Payment Expected; Stat Pen Pd-Over 90 Dys Lat10.1%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer; Usual And Customary | Contract Language/Legal Issue10.1%
Unsatisfactory Settle/Offer | Corrective Action Taken; Claim Settled; Additional Monies Received10.1%
Fraud; Unsatisfactory Settle/Offer | No Jurisdiction10.1%
Unsatisfactory Settle/Offer; Usual And Customary | No Jurisdiction; Referred To10.1%
Prompt Pay; SB418 Rule Violation; Unsatisfactory Settle/Offer | Clean Claims Violation; Stat Pen Pd-46 To 90 Dys Late; A10.1%
Recoupment Of Claims Payment | Overpaid Claim Recouped; Contract Language/Legal Issue10.1%
Agent Handling | No Jurisdiction10.1%
Not Within TDI Jurisdiction; Other | No Jurisdiction10.1%
Cust Service Claim Handling; Not Within TDI Jurisdiction | No Jurisdiction10.1%
Unsatisfactory Settle/Offer | Claim Not Clean10.1%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Company Position Upheld10.1%
Claims Reimb/Bal Bill Problems | Contract Language/Legal Issue; No Jurisdiction10.1%
Recoupment Of Claims Payment; Unsatisfactory Settle/Offer | Overpaid Claim Recouped; Company Position Upheld; No Jurisdi10.1%
Access to Care; Continuity Of Treatment; Continuity of Treatment; Disclosure Of Benefits | No Jurisdiction10.1%
Prompt Pay; Unsatisfactory Settle/Offer | Information Furnished; Claim Not Clean10.1%
Access to Care; Continuity of Treatment; Not Within TDI Jurisdiction; Other | No Jurisdiction10.1%
Unsatisfactory Settle/Offer; Usual And Customary | No Jurisdiction10.1%
Prompt Pay; SB418 Rule Violation | Information Furnished; Additional Payment Expected10.1%
Unsatisfactory Settle/Offer | Contract Language/Legal Issue; No Jurisdiction10.1%
Recoupment Of Claims Payment | No Jurisdiction10.1%
Unsatisfactory Settle/Offer | Claim Settled; Additional Monies Received10.1%
Unsatisfactory Settle/Offer | Clean Claims Violation; Additional Monies Received; Stat Pen Pd-Over 90 Dys Late10.1%
Prompt Pay; SB418 Rule Violation; Unsatisfactory Settle/Offer | Claim Settled; Additional Monies Received10.1%
Timely Filing Deficiency; Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Additional Monies Received10.1%
Recoupment Of Claims Payment10.1%
Agent Handling; Improper Inducements; Misrepresentation | No Jurisdiction10.1%
SB418 Rule Violation; Unsatisfactory Settle/Offer | No Jurisdiction10.1%
Misrepresentation | No Jurisdiction10.1%
Recoupment Of Claims Payment | Contract Language/Legal Issue10.1%
SB418 Rule Violation; Unsatisfactory Settle/Offer | Claim Not Clean; Information Furnished10.1%
Unsatisfactory Settle/Offer | Claim Not Clean; Information Furnished10.1%
Access to Care; Out Of Ntwk Referral | Contract Language/Legal Issue; Information Furnished10.1%
Unsatisfactory Settle/Offer | Insufficient Information10.1%
Access to Care | Contract Language/Legal Issue10.1%
Material Change To Contract | No Jurisdiction10.1%
Prompt Pay; Unsatisfactory Settle/Offer | Claim Not Clean10.1%
Unsatisfactory Settle/Offer | Additional Monies Received; Claim Settled10.1%
Cust Service Claim Handling | Information Furnished10.1%
Unsatisfactory Settle/Offer | Information Furnished; No Jurisdiction10.1%
Other | Referred To10.1%
Den/N-Pymt MD Nec Trmt N-Emrg | No Jurisdiction10.1%
Recoupment Of Claims Payment; SB418 Rule Violation | Clean Claims Violation; Additional Monies Received10.1%
Coordination of Benefits; Unsatisfactory Settle/Offer | Information Furnished10.1%
Unsatisfactory Settle/Offer | Information Furnished; Additional Payment Expected10.1%
Unsatisfactory Settle/Offer | No Jurisdiction; Information Furnished; Additional Payment Expected10.1%
Unsatisfactory Settle/Offer | Contract Language/Legal Issue; Company Position Upheld10.1%
Misrepresentation | No Jurisdiction; Information Furnished10.1%

health Complaints by State

StateComplaints
Texas1,071
Connecticut74

Recent health Complaints Against AETNA HEALTH INC.

Frequently Asked Questions

How many health complaints does AETNA HEALTH INC. have?

AETNA HEALTH INC. has 1145 health insurance complaints on file, according to NAIC and state DOI data.

What are the most common health complaint issues with AETNA HEALTH INC.?

The most common health complaint issues for AETNA HEALTH INC. are: Claim denial (440), Delayed payment (271), Premium or billing dispute (61), Provider or network dispute (29), Unsatisfactory Settle/Offer | No Jurisdiction (27).

Which states have the most health complaints against AETNA HEALTH INC.?

The states with the most health complaints against AETNA HEALTH INC. are: Texas (1071), Connecticut (74).

health Complaints by State

AETNA HEALTH INC. Complaints by State

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