Insurance Scams, which are fraud and thievery, are common these days. Seniors and those in financial straits are often the target. How are those targets discovered by these criminals? It is a direct result of identity theft and also one of the direct fallouts from security breaches. A security breach is where your personal information is lost, stolen or purchased by criminal groups.
So - what to do? A word of caution to seniors and others.
Below is some background information gathered as a result of a recent attempt at telephone fraud involving medical insurance. In this case - Aetna.
Legitimate health insurance companies like Aetna do make outbound calls to members for specific purposes, such as obtaining consent for releasing pharmacy records or scheduling Medicare Advantage home visits (which are often handled by third-party vendors like Signify Health). However, they do not initiate contact to "offer new services" and immediately demand sensitive account details like your member ID without prior verification.
Aetna's official fraud prevention guidance explicitly warns against providing personal or account information to unsolicited callers claiming to represent them. Instead, they advise you to hang up and contact them directly using the number on your ID card to verify any claims. Medicare-related rules (which apply to many Aetna plans) also state that official representatives won't cold-call asking for bank, Social Security, or health plan ID details.
Scammers frequently impersonate Aetna (or other insurers like CVS, Blue Cross, etc.) via phone, spoofing caller ID to make it look official. They use vague pitches about "new services" or "updates" to build urgency and extract info for identity theft, fraudulent claims, or phishing.
Suggesting you call the official 800 number on your card and "enter in your account ID" is a way for scammers to appear credible without directly taking the info themselves. It mimics legitimate advice (which Aetna does promote), but in an unsolicited context, it's designed to either confirm they have the right person or trick you into revealing details indirectly (e.g., if they stay on the line or follow up). Real Aetna reps wouldn't jump to this after being nonspecific about the call's purpose.
Being evasive when you asked for details about the call is another hallmark of fraud—legit callers can clearly explain their reason and provide a reference number.
Aetna's customer service lines (including the multiple toll-free numbers on ID cards) are heavily automated with interactive voice response (IVR) systems, making it notoriously hard to speak to a live person. Many members report long hold times, language barriers, or getting looped in menus without resolution, especially for general inquiries. This doesn't indicate anything wrong with your account or the legitimacy of Aetna itself—it's a common complaint across their plans.
Do not provide any information to unknown callers, even if they seem polite or knowledgeable. Block the number and report it to the FTC at ftc.gov/complaint or your state's attorney general.
If you're concerned about your account security, log in to Aetna's official member portal (aetna.com) or app using a trusted device, or call the number on your ID card during business hours (e.g., 8 AM–8 PM ET) and navigate the menu to "fraud reporting" or "account verification." Aetna's fraud hotline is 1-800-338-6361.
Monitor your account for unusual activity and consider enabling two-factor authentication if available.
For peace of mind, you can also report the incident directly to Aetna via their fraud/abuse reporting form online.