Finding Strength and Support: A Resource for Aetna Employees Coping with Illness

Healthcare Provider Update: Healthcare Provider Information for Aetna Aetna, part of the CVS Health family, has been a key player in the Affordable Care Act (ACA) marketplace, providing health insurance plans to individuals and families. However, significant changes are on the horizon for 2026, as Aetna will exit the ACA marketplace in 17 states, impacting approximately 1 million members. This withdrawal is attributed to the company's challenges in maintaining competitiveness and providing value in a rapidly evolving healthcare landscape. Potential Healthcare Cost Increases in 2026 As the healthcare landscape shifts, substantial premium hikes are anticipated for those enrolled in ACA marketplace plans, with projections of up to 75% increases in out-of-pocket costs due to the potential loss of enhanced federal subsidies. In some states, insurers have filed for rate increases exceeding 60%, driven by surging medical costs and the expiration of premium tax credits established under the American Rescue Plan. For Aetna's former members, this change further complicates their healthcare landscape as they seek new insurance options amid heightened financial pressures. Click here to learn more

What Is Coping With Illness?

Illness is unpredictable because it usually strikes without much warning and it's difficult to predict how long a disabling illness will last. As used here, illness refers to both a disabling illness and injury that leaves you unable to work at Aetna and earn income, thus putting you in a precarious financial position. Coping with illness means figuring out a way to survive physically, emotionally, and financially.

Taking Leave from Work

You may feel guilty or reluctant to take time off from Aetna when you're sick, particularly if you aren't entitled to paid sick leave or if Aetna discourages employees from taking time off. You may worry about getting fired because you are unable to perform your job. This is a valid concern. If you lose your job at Aetna, not only will you lose your income but you may lose your health benefits.

Fortunately, the federal government and many states have laws protecting your rights if you have to take leave for medical reasons. And Aetna probably has a medical leave policy that is more liberal than you might imagine.

Aetna's Policy

When you get sick, contact Aetna as soon as possible to discuss your company's medical leave policy. You should determine how many days of paid sick leave you are entitled to and whether you can use any accrued vacation days toward your medical leave. Some employers also carry disability insurance on their employees--ask the director of human resources if you are entitled to any disability benefits through Aetna. Some employers also have a policy allowing employees to donate their unused sick days to other employees. Find out if Aetna has such a policy. If you expect to be out of work for any length of time, you can also ask to take leave under the Family and Medical Leave Act of 1993.

Your Rights Under The Family and Medical Leave Act

The Family and Medical Leave Act (FMLA) of 1993 protects workers from losing their jobs because they have to take time off as a result of illness or to take care of family obligations. Under the FMLA, if you have worked for your employer for at least 12 months, you may be entitled to take up to 12 weeks of unpaid leave either if you (or an immediate family member) have a serious health condition, for the birth and care of your child, and in certain other situations (you may be entitled to extra weeks of leave if you're caring for a family member who is a servicemember with a serious illness or injury).

When you return from leave, your employer must restore you to your former position or to an equivalent job. While you are on leave, your employer must continue paying your health insurance premiums (if he or she normally pays them), and your health insurance won't be canceled. The catch? The FMLA covers all public agencies and only private companies that have employed 50 or more people during at least 20 calendar weeks in the current or preceding calendar year, so small employers are exempt from the law. Even if you aren't covered by the FMLA, check your state's laws. Some states have rules regarding leave time that are more generous than federal rules.

Find Support

When you're sick, you may need emotional support, medical advice, in-home care, child care, financial advice, and help managing your medical care and health insurance benefits. But where do you find the help you need? For the Aetna employees who are able, try to organize an informal support network, a group of individuals and organizations that can give you emotional support, information, and practical advice while you concentrate on getting well. You can look for support from your friends and family, support groups, your doctor or local social service agency, or even over the Internet.

Survive Financially

One of your biggest worries when you get sick is how you'll support yourself and your family. The keys to surviving an illness financially are: 

•  Applying for any benefits to which you are entitled
•  Managing your money wisely.

Apply for Benefits

If you are covered by a disability income insurance policy, you're lucky. You may have purchased a private disability policy or you may be covered by a group disability policy through Aetna. If you are covered, it's likely that you are covered by short-term disability insurance. Most short-term policies begin paying benefits after an elimination period (called a waiting period) and pay benefits for up to 24 months. If you are covered by a long-term policy, you may receive benefits longer, as much as a lifetime, depending upon the policy's benefit period.

Even if you don't have a private or group disability income policy, you may be eligible to receive disability benefits from Social Security if your disability is expected to last at least 12 months or result in your death. If your illness or injury is work-related, you may be eligible for benefits under your state's workers' compensation laws. However, if you aren't covered by any disability income policy, you'll have to pay particular attention to wise money management and consider applying for public assistance if you need it.

Manage Your Money

In general, managing your money means cutting back on your expenses. There are several ways to do this. First, you'll have to review your income and your expenditures. Next, you should make out a basic budget, taking into account any increased expenditures you may have, such as child care or medical expenses. Hopefully, you can balance your outflow with your income. If not, you may need to borrow money from your savings, your retirement plan, or other sources.

Review Your Health Insurance Coverage

Read Your Benefits Handbook

You probably have a basic understanding of your health benefits, but when you get sick, you'll need to know the specific details of your insurance coverage. These Aetna employees should start by reading their benefits handbook from cover to cover. You'll need to know what your health plan will pay for, what your deductibles are, and how to file your claims. If you belong to a managed care plan, you'll save money if you make sure your doctor is a participating provider. If not, make sure you know how much more using a non-network provider will cost you. Because filing claims can be very confusing, ask your doctor's office or hospital to file your claim for you. 

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Check With Your Insurance Company Regarding Claims Filing Procedures

You'll save yourself a lot of time and avoid stressful confrontations with bill collectors if you thoroughly understand the procedures you must follow when filing a claim and how your insurance company pays claims. Although this is outlined in your benefits handbook, it's a good idea to call your insurance company and talk to a claims representative rather than rely solely on printed information. Your claims representative can tell you, for instance, what to do when you receive a bill from a physician or hospital, what to do when you receive a letter or statement from the insurance company asking for information, who should submit claims, and how long you should wait before checking on an unpaid claim. Such specific information is often not covered in the benefits handbook.

Example(s):  After Achilles fell and tore a tendon, he received a bill from the hospital demanding payment from him and saying that his insurance company had not yet paid his claim. He immediately called his insurance company to find out whether he should pay the claim. The claims representative told him, however, that they had no record of receiving the claim from the hospital. She added that since the hospital had a contract with the insurance company and his medical procedure was covered by the contract, Achilles should not pay the bill directly but instead ask the hospital to resubmit it to the insurance company.

Keep Good Records

Because you'll receive numerous bills or benefit statements while you're sick, set up a file specifically for insurance claims' information. Every time you receive a bill or a notification from your insurance company, read it to find out whether it has been paid or it's asking for payment. Although many hospitals and doctors' offices have lenient policies regarding payment, don't assume that your insurance company will handle everything swiftly and correctly. Next, go over the bill carefully to make sure that you are not being over- or double-charged; medical billing errors are common.

Don't pay any bills that you think your insurance company should pay. If you receive a bill from your physician or hospital--particularly if it is marked 'second notice' or 'overdue' or it comes from a collection agency--call your insurance company immediately. Never ignore bills or letters. Unpaid bills (whether or not it's your responsibility to pay them) can jeopardize your good credit. In addition, keep a detailed log of any conversations that you have with claims representatives or collectors. Make sure that you write down the person's name and the date and time of your conversation and follow up with a letter detailing any action you want to be taken.

Consider Hiring a Claims-Assistance Professional

If you are filing complex health insurance claims or need help challenging a denied claim, you may want to contact the National Association of Claims Assistance Professionals for a referral to a claims assistance professional. Claims assistance professionals charge hourly fees (sometimes quite steep) for their services, so this may be an option only if you have adequate income. You may also be able to get advice and assistance from your physician's office, insurance provider, or Aetna. Your state also has a department of insurance that you can contact for basic advice and to file a complaint after you have tried to resolve the matter with your insurance company.

Know Your Rights

It's important that Aetna employees know their rights regarding their health care. If you receive a claim denial, find out from your insurance company how you can appeal the decision.

Plan for The Future

Living with a serious illness makes you confront your own mortality and forces you to face issues that many people like to avoid, like estate planning and planning for incapacity. Now is a good time for these Aetna employees to talk to their lawyer, insurance agent, or financial advisor about what they can do to plan for the future. If you are terminally ill (or if your illness is potentially life-threatening), this is vital.