Aetna Mistakenly Tells Members Their Doctors Are Out of Network


Recently, Aetna mistakenly sent letters to more than 8,000 policyholders across California saying that their health care providers are no longer covered in the insurer's network, the Sacramento Bee reports.

Letter Details

The letter -- dated March 21 -- said policyholders' physicians were considered out-of-network, effective March 1. It stated that policyholders' benefits could be reduced or denied if they continue receiving treatment from the physicians after that date.

Aetna Response

Anjie Coplin -- director of communication for Aetna -- said, "The letters were sent in error," adding, "We have rectified the problem and are in the process of mailing out retraction letters." She also said the insurer is sending notification letters to providers who mistakenly were removed from the network.

According to Coplin, affected policyholders should call customer service numbers listed on their Aetna identification cards if they require more information (Garza, Sacramento Bee, 4/5).

Petra Taylor
Interestingly enough similar thing happened last year just about the same time. There is fundamental problems in Aetna's Provider Enrollment system. Even when Aetna had made an error, it was (as always) made the Physician's job to fix it. Meanwhile claims were bouncing as OON and patients understandably put the brakes on seeing their Doctor.

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