Aetna, Inc.

Review: I changed employers and my health insurance was discontinued on 12/31/13. Aetna Pharmacy placed 2 claims after this date in which they are now charging me the full price. I reached out to my employer immediately to avoid a situation like this and they said there was nothing Aetna would do except they would bill me for the full cost (without insurance)for the medication. This was their mistake. I wanted to do the RIGHT THING and bring this to light to avoid having to pay full price in the future. The prescriptions are still in their original packaging and have not even been opened from the package they arrived in and Aetna will not accept the medication back to avoid the full charges. This was a mistake on aetnas part for processing these medications after the inactive date. These prescriptions were in fact on auto refill but I NEVER asked them to fill these medications after 12/31/13 nor would I. I can't afford to pay full price for multiple prescriptions because of an error on their processing part. There were three prescriptions - prescription order numbers were [redacted], and [redacted]. All order dates were in January.Desired Settlement: I would like to return the three prescriptions and be refunded the cost that they already taken out of my bank account and NOT receive a future bill for the full cost of the medications.

Business

Response:

Thank you for your inquiry received on January 30, 2014 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I have had Aetna health insurance coverage for 14 years. This includes 4 years with an employer and 10 years as a retiree (albeit I continued working with other organizations). Thus I have been paying the monthly premiums faithfully, and because my health is good, have not had many healthcare claims submitted to Aetna. Around July last year, my current GP's office called to say that Aetna was rescinding payments made to them for my healthcare services and were pulling monies from other accounts to cover my charges. I had received no notice from Aetna that this was going to happen or why it was going to happen. But I suddenly had several healthcare providers dunning me for unpaid bills. Given that I am on fixed income, this was a heavy impact to my budget. I had to submit complaints and appeals to Aetna over several months to find out why they were taking my money but not paying for healthcare services. Aetna said it was because of my age. They did not immediately provide this in writing; a customer service rep rudely told me this on the phone. "I hadn't enrolled in [redacted]" he said and at my age I should be. So the charges they were taking back from healthcare providers were to cover what [redacted] would have covered. So now, thanks to Aetna, my credit report is in shambles and there exists the probably that some healthcare providers will sue me, thanks to Aetna's own administrative error in overlooking non-enrollment in [redacted]. Ultimately, I was paying premiums to Aetna for 14 years, which loosely amounts to some $15,000, of which probably less than half of that amount actually went to healthcare providers over that time period. So it appears to me that Aetna is punishing me for having good health--making me pay for it basically.Desired Settlement: Aetna to repay all the healthcare providers who have provided services for me and from whom they have rescinded funds.

Business

Response:

Thank you for your inquiry received on 02/05/2015 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

The member’s concerns were reviewed under appeal numbers [redacted] and [redacted]. Based on review of the information submitted, the appeals were upheld per the plan guidelines. Under the terms of the member’s plan through [redacted], Aetna estimates [redacted] benefits in accordance to the provisions of the plan. [redacted] pays before [redacted] coverage for a person who is over age 65 and retired, or who is under age 65 and has received Social Security disability benefits for 24 months. [redacted] benefits will be taken into account for any person while he or she is eligible for [redacted]. This will be done whether or not he or she is entitled to [redacted] benefits.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Review: My husband, [redacted], died April 30, 2013. He had insurance with Aetna. During the first part of October 2013, I sent info, including [redacted]'s death certificate, to Aetna in response to a letter from Aetna telling me that there was a settlement due me from them from [redacted]. The amount is an estimated $13,000. I have since been told on 3 separate occasions that the check was in the mail. The first time, the check SHOULD have arrived by Thanksgiving. I was then told that the check didn't get sent, but would be issued immediately. I waited to no avail. I continued to call Aetna and was next told that it must have been delayed by Christmas mail. Still no check. After another call to Aetna, I was told that it was 2 separate checks and that they must have gotten lost in the mail and that Aetna would reissue the checks and send them 2 day delivery. This was on Jan 3rd. After many more calls and working my way to a [redacted], I learned that Aetna had not sent a single check to me at all-ever-in the past when I was told "the check was in the mail". I was told that it was all "miscommunication"...I call it being lied to. On Jan 14th, [redacted] assured me that the checks would be sent overnight delivery on Wednesday, Jan 15th. That would mean that the checks should have arrived yesterday. Yet again, NO CHECKS arrived. I do not understand, nor accept, Aetna not paying me, a widow, the money my husband paid into them for 30 years. This has been going on 3 months and I am facing eviction, which I told [redacted] when we spoke. How is it possible for such a large corporation to get away with treating clients in this manner???Desired Settlement: I want the estimated $13,000 that [redacted] intended for me to receive. This is money [redacted] paid into Aetna all those years and it is his money Aetna owes me.

Business

Response:

Thank you for your inquiry received on January 17, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I switched from Aetna to [redacted] 12/1/13 with regards to health, dental, and pharmacy. My pharmacy,[redacted], was given the new information for [redacted] but accidently billed Aetna for two prescriptions, one on 12/14/13 and another on 12/29/13. Aetna in error paid both of them and then I received a bill in the amount of $230.05 in a letter dated 10/28/14, 11 months later!!! The billing ID is [redacted] and my member ID is[redacted]. When I called to ask why they were not dealing with this problem themselves they said[redacted] will not make changes after a week and they could not contact [redacted]. I contacted both and spent hours on the phone trying to get this fixed to no avail, both said too much time has passed. This should not be my problem, it should be Aetnas, especially since they waited almost a year to contact me!!!!!!! I even went as far as to call Aetna to pay the bill jus so I would never have to deal with them again and they bounced me around to 5 different locations until I finally asked for a supervisor repeatedly and they sent me to a so called "resolution specialist" who couldn't resolve anything nor could they take my payment over the phone. The letter has threatened me with collections on a bill I should not owe and I am sending in a check to Aetna today because I am moving in a few months and will need a mortgage so I do not want any hits to my credit. This should be there problem and not mine.Desired Settlement: I am paying the bill but I FULLY expect them to refund the $230.05 regardless of whether they get reimbursed by[redacted] or [redacted]. They made the error and won't fix it, I have insurance and shouldn't have to pay this.

Business

Response:

Thank you for your inquiry received on December 16, 2014, regarding complaint # [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to our Aetna Pharmacy Management department for assistance. They reviewed the member’s claim(s) and unfortunately, we are unable to waive the member's liability. Since the claim was paid and the medication was filled when the member was no longer covered by Aetna, the member is responsible for the cost of medication. The member may submit the claim to the correct insurance carrier for the date of service involved.

Review: I was terminated from a previous employer and chose to continue my health coverage under [redacted]. I promptly filled the forms for the [redacted] Administrator ([redacted]) and paid my first months premium. Now, over a month later, Aetna has not reinstated my health coverage. They have not responded to my inquiries, and they have not responded to [redacted]'s direct contacts. Because of their poor reponse I have had to make considerable out-of-pocket payments for medications, and I have delayed essential lab tests. There is absolutely no reason either for this very long delay to reinstate me, or for their failure to resolve the problem.Desired Settlement: I either want an immediate reinstatement of my health coverage or I want a refund of the 2 months of premiums that I have now paid. I also want assurance of prompt reimbursement of the expenses that I have incurred because of their lack of action.

Business

Response:

Thank you for your inquiry received on 04/07/2014 regarding complaint#[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

According to our records, his [redacted] plan is active under ID # [redacted]. The system completed processing of his [redacted] information as of today 04/08/2014.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]'s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Sincerely,

Review: I was pre-approved for a surgery and was told exactly what I was going to be required to pay and how much Aetna would pay. After the surgery, Aetna's website said that they would pay the hospital bill and the anesthesiologists bill, but they wouldn't pay for the surgeon's bill. I appealed the doctor's bill and mentioned that they had paid the hospital and other bills, so how could they deny the surgeon for the same procedure. After they received my appeal, they also now say that they won't pay the hospital and anesthesiologist, even though it was all pre-approved.Again, I was pre-approved for this surgery and now they say they won't pay.Desired Settlement: I have gone ahead and paid for most of this (the surgeon and anesthesiologist - the hospital is still appealing their bill). I would like Aetna to pay for what they said they would pay toward my surgeon and anesthesiologist). And pay for the hospital bill, too - since they said they would with their pre-approval.

Business

Response:

Thank you for your inquiry received on October 24, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to the Claims department for assistance with the member’s concerns. They advised the member submitted a second level appeal under Case number [redacted] and service denials were overturned. The claims for date of service April 16, 2013 were reworked for payment. The facility, [redacted], paid on October 31, 2013. The claim for the surgeon, Dr. [redacted], processed on October 30, 2013. The check has not been issued yet but will be within 2 weeks. The claim for the anesthesiologist, Dr. [redacted], processed on October 30, 2013. This check will also be issued within 2 weeks. We apologize for the delay and inconvenience this has caused the member.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the chance to address these concerns. If you have any more questions about this particular matter, please contact the Executive Resolution Team at [redacted].

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: Aetna did not cover entire claim. Employee misled me and stated (before I purchased the medication) that I would be reimbursed the difference between what I normal co pay ($1.20) and full amount Rx cost (74.99).

Aetna paid -

49.68.

I paid -

25.31

My co-pay for medication is $1.20. Atena owes me $24.11.

If company does not comply with the Revdex.com mediated service, I will be releasing the phone conversation I had with their representative, on public forums, via 4 television news affiliates. The representative clearly stated that I will only be paying 1.20 for co pay and will be getting the difference between the co pay and full price of 74.99 back.

Other requests - Aetna employees do not know how to do their jobs. I requested to be opted out of selling my information to other companies/businesses and not one person knew how to carry the action out, which Aetna needs to do.

Created online profile and I need to change my username and your system does not have an option to do it.

Selected paperless statements, but when I log back onto account, your unstable system states that I am still enrolled in paper statements. Aetna is not an eco-friendly company and is killing millions of trees for the sake of sending paper statements customers don't want. Change my account to paperless statements immediately.Desired Settlement: Aetna did not cover entire claim. Employee misled me and stated (before I purchased the medication) that I would be reimbursed the difference between what I normal co pay ($1.20) and full amount Rx cost (74.99).

Aetna paid -

49.68.

I paid -

25.31

My co-pay for medication is $1.20. Atena owes me $24.11.

If company does not comply with the Revdex.com mediated service, I will be releasing the phone conversation I had with their representative, on public forums, via 4 television news affiliates. The representative clearly stated that I will only be paying 1.20 for co pay and will be getting the difference between the co pay and full price of 74.99 back.

Other requests - Aetna employees do not know how to do their jobs. I requested to be opted out of selling my information to other companies/businesses and not one person knew how to carry the action out, which Aetna needs to do.

Created online profile and I need to change my username and your system does not have an option to do it.

Selected paperless statements, but when I log back onto account, your unstable system states that I am still enrolled in paper statements. Aetna is not an eco-friendly company and is killing millions of trees for the sake of sending paper statements customers don't want. Change my account to paperless statements immediately.

Business

Response:

Can you please request either the member’s ID number or Date of Birth to be able to start an investigation for this complaint? We are not able to locate him with just his name and zip code search. Thank you,Ashley

Review: AETNA has failed to process a bill from [redacted] Hospital. Despite being provided with the proper documentation and multiple phone calls from myself.Desired Settlement: Please pay this bill as I am covered.

Business

Response:

Thank you for your inquiry received on December 08, 2014, regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. We are currently reviewing the member’s issue under case number [redacted], which was received on December 08, 2014 by our Executive Resolution Team. The member will receive a determination once the review has been completed under separate cover. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]. Have a good New Year! [redacted] Complaints and Appeals Consultant Executive Response Team

Review: company has not send me refund as of today, I Have left several messages for [redacted] the agent in charge of the insurance for the company I used to work for [redacted](he's phone number , I have send him emls asking him to call me back at [redacted], the company I worked for at the time [redacted] used yto take 156 every paid period . when they did the cancellation I spoke with mr [redacted] and he said will figure how much they will refund me and call me back , I left the company on January and never heard from him again ,,,,

Desired Settlement: I want to received the money I paid , I had cancel my heath insurance and was promised a refund for the difference

Business

Response:

Business Response /* (1000, 5, 2013/08/26) */

Thank you for your inquiry received on August 12, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to the Customer Service and Plan Sponsor department for assistance with the member's concerns. They advised that the member's group, [redacted], was sent a check for the member's refund of premiums on January 2013, in the amount of $1010.00. [redacted] would need to reimburse the member.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address these concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Review: On July 3, 2013 I filed an application online for health insurance with Aetna. Received a response notifying me that the application was received. Only july 5, 2013 received a phone call from Aetna were additional cuestions were asked regarding my health. After responding to all question. I was told that in order to submit my application for review I needed to take a lab work [redacted] and needed to be submitted. I asked the girl how long because I needed to call my physician and get a referral for the lab work. According to Aetna I had 30 days to submit the information. This was July 5, 2013. I called my doctor and set-up the earliest appointment they had, July 12, 2013 @3:00Pm. The lab was performed which the results were good [redacted]. Them I received a letter, the next day, from Aetna dated july 5, 2013 indicating that my application was decline. They did not wait for me to send the results to make a decision, they already had made their decision, when they spoke to me on July 5, 2013, and asked that I do the lab work and submit to them. I wasted my time and money paying for the gas and lab work when in turn they had already rejected my application. I am asking that Aetna reimburse any expense incurred $40.00 for gas and $25.00 for lab work. Their lack of professionalism and consideration to people seeking health insurance has to be desired.

Desired Settlement: I asked that my application for health insurance be reconsidered; and refund of expenses incurred.

Business

Response:

Business Response /* (1000, 5, 2013/07/30) */

Thank you for your inquiry received on July 16, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to the Individual Underwriting department to review the member's issues. Unfortunately, after reviewing the member's complaint and the member's medical history, the original decision is correct. A [redacted]. Per medical guidelines for [redacted], the applicant must be well controlled and showing improvement with [redacted] levels and weight loss to be considered for individual insurance. The member also requested Aetna to reimburse $40.00 for gas and $25.00 for lab work. It is not Aetna's practice to reimburse for pre enrollment requirements.

If the applicant disagrees with the decision, they have the right to appeal within 180 business days from the date of the June 5, 2013, denial letter. They need to send:

* A letter asking for an appeal and the reason why

* A copy of the June 5, 2013 denial letter

* Medical records that support the appeal

Send all information to:

[redacted] - [redacted]

[redacted]

[redacted] XXXXX-XXXX

They can also fax this information to: X-XXX-XXX-XXXX.

They do not accept an appeal request by phone or a request from a broker or doctor.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the chance to address these concerns. If you have any more questions about this particular matter, please contact the Executive Resolution Team at [redacted].

Review: My wife ([redacted]) on numerous occasions contacted your organization to request that you list [redacted] be listed as her PCP. Over several MONTHS, your organization repeatedly sent her an insurance card with an unknown doctor listed as her PCP. Your response to my wife each and every time she requested that you updated it, was to send her the exact same insurance card with the unknown doctor listed as her PCP. To make matters worse, when she went and had a doctors appointment with her PCP ([redacted]) she paid the required $20.00 co pay. Your organization decided that it was best to charge her as a specialist visit and bill her $30.00, creating a balance of $10.00. We then attempted to dispute the additional $10.00 on numerous occasions. The final attempt was in January where I spoke with [redacted]) who ensured me that this situation was resolved.Here we are nearly a year after the appointment and I still have a bill stating that I owe you money.Correct this issue and compensate us for the time invested.Desired Settlement: $10.00 removed off of the bill from 7/29/13 and compensation for your companies complete ineptitude.

Business

Response:

Thank you for your inquiry received on 06/01/2014 regarding complaint# [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We were unable to locate Mr. and Mrs. [redacted] in our system with the information provided. In order for us to review, we require the member’s Aetna identification number the claim was billed under. Once this information is received, we can then review for the member.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: I received a letter from Aetna in early May this year stating that, due to the ACA, between May and December of 2014, that if I paid out of pocket for smoking cessation medicine that I was due a refund. Before I even went to my Dr. for smoking cessation counseling, I questioned Aetna through secure messaging in May if it was covered by my plan and the person who responded stated that both the couseling and the medication were covered 100%. When I filled the Rx the first time and I had to pay for it, I called in to Aetna to find out why and they stated that medicine wasn't covered.

Fast forward to present day, I filed the reimbursement claims as directed to do by Aetna and they have denied it stating that, the first time filling the medicine, wasn't covered by the plan (which the letter I received stated that I am due a refund if I paid out of pocket) and the following refills were denied using the reason of being refilled too soon. I have the written proof from Aetna, letters and secure messages, stating that everything is covered 100%, at no cost to me yet I've had to pay out of pocket. And I am unable to be reimbursed because they have a different reason every time I speak to them as to why it won't be accepted.Desired Settlement: The business should reimburse me as they have stated I am entitled to.

Business

Response:

Hello,

Review: I had applied for health insurance in Nov. 2013 for effective date 1/1/14. I was approved and Aetna collected the first months premium. After reviewing the coverage I chose to cancel and select a new policy with a lower deductible. I sent a cancellation on Nov 13. I was charged for another premium in Feb. 2014. When I called the representative stated the policy had not been canceled. She stated she would cancel the policy effective 1/1/14 (voiding my policy). I have made repeated calls to receive my refund for premiums. I have been told the refund has been processed and should be in my account. I have not received my refund and I have waited more than 2 weeks since the process date.Desired Settlement: Full refund of the $744 premium payments on a voided policy.

Business

Response:

Thank you for your inquiry received on February 26, 2014. Our [redacted] Team researched your concerns, and I would like to share the results of the review with you. We reached out to the Individual Billing and Enrollment department for assistance with the member’s concerns. They advised a refund of $744 was placed back into the member’s account on February 13, 2014.

Consumer

Response:

Review: [redacted]

I am rejecting this response because: I have been reviewing the account the premiums were taken from and no credits have been made to my account. I have patiently waited for my premium refunds. I have been in contact with Aetna customer service for a month and still have not received the refund I was told would be coming. I have attached two files from current activity on my account (the same account the Aetna premiums were debited from). These prove the refund has not been credited. I printed the entire activity from 2/10/2014 to current. I have taped paper over the balances and transaction amounts for my privacy.

Sincerely,

Business

Response:

Thank you for your inquiry. We again reached out to the Individual Billing and Enrollment department for assistance with the member’s concerns. They advised a refund of $744 was placed back into the member’s account on February 13, 2014. They advised the account on file is [redacted] with an account number ending in [redacted].

Review: I pay for insurance, through my employer, and the cost is over $300/month.

The insurance I pay for has been active since 1/1/2015.

However, we did NOT get our policy numbers until 1/12/2015 and we had to forgo medications and medical care during this time UNLESS we wished to pay out of pocket. Some people cannot pay out of pocket for these services and I am one of those people.

Currently, I cannot get prescriptions filled because Aetna reps keep telling me there is a coding error. On 1/26/2015 I was told that the error would be resolved within 72 hours.

I waited past that time to contact them again and called back on 1/30/2015

STILL, my policy, which includes medications, CANNOT BE USED for medications! I cannot fill prescriptions at the pharmacy even though my plan shows I have coverage! NO ONE can help me. All they keep saying is that I need to pay, out of pocket, for my medications. I cannot afford that.

I pay for insurance so that I do NOT have to pay out of pocket for medications.

The answers I am getting from Aetna are unacceptable and not helpful.

I need my medications now and I cannot continue to wait. Their service is shoddy and they are not providing what I pay for.Desired Settlement: I want to be able to GET my medications, at the pharmacy, the way I am supposed to.

I want them to fix it IMMEDIATELY and not continue to make me wait.

They have screwed up from the set up of this policy and their incompetence should not be my headache, but it is.

I want them to issue an apology and fix the plan so that my medications can be obtained.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on February 13, 2015.

Review: Was notified several months ago that my insurance coverage would be cancelled with Aenta due to the Affordable Care Act(ACA) and that unless I selected another plan that I would no longer be covered. Having received unsatisfactory service and effort from Aetna previously I found coverage else where. I saw on January 9-10th of 2015 that Aetna had debited about $227 from my checking account. At no time had a contact Aetna to continue coverage or to select a new plan. At no time did I authorize them to debit any new amount from my account. I contacted Aetna through their online complaint form and have not received any communication from them.Desired Settlement: I would like the debited amount, that was never authorized, refunded in full, and any coverage, that I never agreed to or signed for or that was ever explained to me, to be cancelled retro active to 1/1/2015.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on January 21, 2015.

Review: This situation involves [redacted] Pharmacy as well as Aetna Insurance. From January 2013-September 2013, I had Aetna insurance through a previous employer. I had told [redacted] that as of October 2013, I no longer had Aetna insurance and not to process my medication through them. They were aware that I would be paying out of pocket till my new insurance kicked in.The medication was filled on 11/15/13 and picked up by me 11/16/13. Fast forward to October 2014, I received a bill in the mail from Aetna to pay $179.78 for a medication that was filled a year ago. I called Aetna to inquire further about this issue since I no longer had/have health insurance through them. They stated " we are doing audits and you must pay this bill because [redacted] submitted a claim to us when you were not an active member." I questioned them why they approved the claim since I was not an active member. They are blaming not only [redacted] but also my previous employer's health insurance representative for the mistake. I made Aetna aware that I had already paid for the medication and besides that it has been almost a year and I am only now hearing about this. I then took it to [redacted] who is placing blame on Aetna for processing the claim. Neither company wants to accept the blame therefore, I have to pay for their mistake. I have the receipt from [redacted] that says the amount I paid for it and also that the claim was rejected. [redacted] will not assist me with this issue because it has been over 6 months. I spoke with 2 different customer care representatives from Aetna who were very rude and unfriendly. There was only one representative that actually attempted to help me and listening to my situation without interrupting me.

Product_Or_Service: Medicaton_[redacted] Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

1. For Aetna, [redacted] or both take responsibility for the mistake2. Since it has been over a year since issue has occurred that I do not have to pay for their mistake3. An apology from both companies for the headaches they have caused due to this situation particularly Aetna for their poor customer service

Business

Response:

Thank you for your inquiry received on November 25, 2014, regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: We live in CA and were in MN during the summer when my husband came down with pneumonia. I called Aetna and they said since there were no in-network facilities we would have to go to another facility and be sure it was during urgent care hours. We did that and then for the last 2 1/2 years I have spent 20 hours on the phone with Aetna trying to resolve this and get the bill paid. Every time they are polite and claim that the issue is resolved. And then a month or two later we get a letter stating that the bill is still due. This has happened 5 or 6 times.Desired Settlement: We would like Aetna to pay the bill from [redacted], MN. regarding the July 14, 2012 visit.

We would also like them to get organized so they don't waste years/hours of people's lives and cause undue anxiety. We would also like them to stop telling people that issues are resolved when they are clearly not resolved.

Business

Response:

Thank you for your inquiry received on December 12, 2014, regarding complaint #[redacted] from [redacted] concerning the claim for her husband, [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I am a provider and I billing aenta better health of [redacted] for one of my patients. I submitted my claim and was told it would take up to 30 days to process. I called every other day in fear they were not even working on any of my claims. Well I was right. Not only did they start my claims on the 29th day (Dec. 9, 2014), they underpaid 45 of my claims. This is uncalled for, for a company of this size. Things like this shouldn't happen. Also every time I ask to speak to a supervisor, one is never around to take calls. They take my information and state a supervisor will call me with in 24-48 hours. The thing is I never get a phone call from a supervisor. I will also file a complaint with the [redacted] as well as the [redacted] dept of [redacted].Desired Settlement: I would like to get paid my correct amount as well as whoever worked my claim fired.

Consumer

Response:

Review: I work part time for [redacted]. They offer Insurance through Aetna Voluntary and is done by payroll deductions. I enrolled with Aetna for: Enhanced Hospital with RX, Life, Vision, and Dental. I was never able to use this insurance, so I cancelled it. My cancellation number is [redacted]. This was given to me on 7/2/2015. After cancelling this policy, Payroll deductions were made again out of my paycheck dated July 10, 2015. I have all of my check stubs with the deductions broken down which come to a total of $109.62. I spoke to member services again today and they can not tell me when or how I will get my refund. I think part of the problem is that these member services representatives are in the [redacted] and the corporate office is in [redacted].Desired Settlement: I would like the $109.62 that was deducted from my paychecks back ASAP.

Business

Response:

Hello,

Please see our response regarding complaint #[redacted] for [redacted] that was received by us on July 15, 2015.

Upon receipt of your complaint, we contacted our Eligibility department and confirmed that the cancelation has taken effect within the normal timeframe. This member’s coverage is in arrears and she requested the cancellation on June 30, 2015. The member has to allow time for the request to transmit to CVS Health which occurred July 1, 2015. The deduction taken July 10, 2015, paid for coverage through July 4, 2015, which is one pay cycle beyond the cancellation date and falls within the normal time frame.

We apologize for any inconvenience this has caused the member. However, a refund is not due based on the coverage guidelines.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Complaint and Appeal Consultant Executive Resolution Team

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: I called Aetna and discovered that they dropped my health insurance. The health insurance was through my employer. Since I no longer work for my previous employer, my previous employer informed Aetna that I no longer work . A portion of the money for the health insurance was taken directly from my check. My health insurance was dropped on 6/15/15. The problem is that Aetna electronically took money from my checks even though I no longer have health insurance with them. I shouldn't be paying for a health insurance that I don't have.

Additional Information will be furnished upon request.Desired Settlement: I am requesting that Aetna Immediately refund me $ 358.5O in addition to any other monies that are owed to me.

Business

Response:

Hello,