Complaint / review text:
I am appalled at Aetna! My 18-month old son had a cold for a week. One Saturday night, he broke out in a horrible painful cry for almost an hour. My son has never had colic or have cried for that long. Something was visibly wrong (frankly, I should have taken him in much sooner). I put him in the car and rushed him to the emergency room after an hour of crying. There are no urgent care facilities open on a Saturday night nor would I have the time to stop and look if there was, when my son was in such agony. The ER doctor only diagnosed him with upper respiratory infection. I was sure there was something else wrong, so I took him to his pediatrician first thing on Monday morning and sure enough, she diagnosed him with two ear infections.
Aetna is denying my coverage of the emergency room as they state it was a non-emergency. Crying does not constitute an emergency in their book. I can't even believe that I have to even appeal this; nevertheless for a second time! To make matters worse, no one at Aetna or the appeal department has ever asked me why I took my son to the ER. They only looked at his chart. How can you have a full investigation if you don't ask your client directly?! Now I have to spend more time appealing this further and now having to go through a third party Arbitration Association. Ridiculous! Never again will I recommend Aetna. I am changing to Blue Shield tomorrow.