Is Aetna PPO a good insurance?
Asked by: Breanne Herman PhD | Last update: May 30, 2025Score: 4.2/5 (5 votes)
What is downside to a PPO plan?
In general, PPO plans tend to be more expensive than an HMO plan. Your monthly premium will be higher and you will have to meet your deductible before your health insurer starts paying. You will also have to pay more out-of-pocket if you visit a provider who is not part of your PPO network.
What does Aetna PPO mean?
PPO: The plan with the most freedom
A Preferred Provider Organization (PPO) has higher premiums than an HMO or POS. But this plan lets you see specialists and out-of-network doctors without a referral.
Are people happy with Aetna insurance?
Aetna has an average rating of 1.2 from 90 reviews. The rating indicates that most customers are generally dissatisfied. The official website is aetna.com. Aetna is popular for Insurance, Financial Services. Aetna has 109 locations on Yelp across the US.
Does Aetna deny a lot of claims?
In the same year, Medicare denied 6.85% of its claims. One year later, AMA reported that all the surveyed insurers were denying fewer claims: Aetna's denial rate was down to 1.81%, Anthem BCBS reduced its rate to 4.34%, and private insurers overall were down to 2.79%, while Medicare denied only 4% of claims.
Aetna Unboxed! Learn more about Aetna's insurance plans with Mark
Which health insurance denies the most claims?
According to the analysis, AvMed and UnitedHealthcare tied for the highest denial rate, with both companies denying about a third of in-network claims for plans sold on the Marketplace in 2023, respectively.
Does Aetna cover surgery?
If you successfully meet the requirements, then your insurance provider will cover the costs of the surgery or treatment plan recommended by your doctor. Elective or cosmetic plastic surgery procedures are typically not covered by Aetna insurance policies.
Why is Aetna so expensive?
Factors influencing Aetna insurance monthly costs
Plans with broader coverage and extensive benefits, such as lower deductibles, co-pays, and comprehensive services like dental and vision care, often come with higher monthly costs.
What is the best healthcare insurance?
Investopedia's analysis ranks Kaiser Permanente as the best health insurance company for 2025 because of its blend of affordability and low customer complaints. UnitedHealthcare and Aetna also earned top marks. We evaluated nine insurers using dozens of criteria, such as customer satisfaction, plan types, and costs.
Why is Aetna struggling?
Aetna majorly miscalculated utilization trends in pricing Medicare Advantage plans for this year, causing hundreds of thousands of seniors to flock to its generous coverage and saddling the insurer with an unexpectedly steep price tag for their care.
Do doctors prefer HMO or PPO?
HMO plans might involve more bureaucracy and can limit doctors' ability to practice medicine as they see fit due to stricter guidelines on treatment protocols. So just as with patients, providers who prefer a greater degree of flexibility tend to prefer PPO plans.
Do you need referrals with Aetna PPO?
With the Aetna Open Choice ® PPO plan, members can visit any provider, in network or out, without a referral. But when they stay in network, we'll handle the claims and offer lower, contracted rates.
Is it worth getting PPO?
PPO plans give you more choices when picking health care providers than other types of insurance. In a PPO plan, you have a network of “preferred” providers. These include doctors and specialists who can offer care at the lowest out-of-pocket cost, compared to out-of-network providers.
Does PPO have a deductible?
Deductibles: PPO plans usually come with a deductible. This means you pay for care and services until the deductible is met. Then your plan starts sharing costs.
Why is my PPO so expensive?
Because PPOs offer access to a larger provider network, your monthly costs may be higher. You'll likely need to meet an annual deductible, which is the minimum amount you'll need to spend on medical care before your insurance coverage kicks in.
Is $200 a month good for health insurance?
Health insurance that costs $200 per month is a good deal in California. Silver plans typically cost $513 per month for a 21-year-old or $656 per month for a 40-year-old. The best way to get cheap rates is to use health insurance subsidies, which lower the cost of an insurance plan based on your income.
Is Aetna good insurance for seniors?
Aetna is an established health insurance company with a long history of providing coverage and support to millions of seniors across the country. Their Medigap plans offer a variety of benefits and options to make sure that older adults have the quality care they need and deserve.
Is Aetna considered good insurance?
It also offers benefits like access to 24/7 virtual care at no or low costs, depending on your plan, and mental health coverage. Aetna is regarded as a good health insurance provider overall.
Why is Aetna not paying claims?
If you've had a health treatment or disability claim denied by Aetna, it could be because: The procedure is considered cosmetic (not medically necessary) Your doctor is out of network or doesn't participate in the plan. Your plan doesn't cover your medical condition.
Does Aetna have copays?
The plan requires only copays for medical services and prescription drugs up to the plan member's out-of-pocket maximum, with no deductibles or coinsurance costs.
Does Aetna cover MRI?
Aetna considers magnetic resonance imaging (MRI) medically necessary for appropriate indications without regard to the field strength or configuration of the MRI unit. Aetna considers intermediate and low field strength MRI units to be an acceptable alternative to standard full strength MRI units.
How long does it take Aetna to approve surgery?
Once your doctor sends a request for prior authorization, Aetna reviews the request. During our review, we look at the most recent and highest quality medical research and guidelines. We update your care provider throughout the review process to keep them informed on the status, and come to a decision within 14 days.
What surgeries are not covered by insurance?
Cosmetic procedures such as plastic surgery or vein removal are nearly always considered elective and so are not covered. Fertility treatments are only covered in certain states, and even then, there are loopholes that allow insurers to deny coverage.