Aetna, Inc.

Review: I first called Aetna at [redacted] on Feb 20th 2014. I requested proof of my medical premium payments during 2013...for my taxes. They said they would mail it. When I hadn't received it by feb 28th...I called again. They told me that it was mailed to me and it just takes awhile to get there. I called again on March 3rd and the switchboard person said that she saw no record of me in the computer and that they didn't mail things like that out. I had my second appointment for my taxes on Wed March 5th. This was why I needed to schedule a second appointment for my taxes...I was suppose to bring in proof of my Aetna medical premium payments. I called again this afternoon...March 7th after the mail came and it still hadn't arrived. I asked for a supervisor but the switchboard operator said that one wasn't available....so she put me thru to a voice mail and I left a msg.Desired Settlement: I want a copy of my medical premium payments for 2013 mailed to me. I want to have to stop calling them to follow up

Business

Response:

Thank you for your inquiry received on March 10, 2014. 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 Billing and Enrollment department for assistance with the member’s concerns. They advised the requested letter was prepared and sent to the member on March 3, 2014. We apologize for the delay and inconvenience this has caused the member.

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Why don't you just mail me another one then.... Because I never received it and I check my mail every day. Also, I requested the letter on February 20th or 21st and when I called the last week in February I was told that it had already been mailed......your saying it was mailed on March 3rd. I don't want to argue with you about who is telling the truth. I just want the letter so I can prove my payments if the IRS asks for it.

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 trying to call the member on March 13, 2014 and left a message. They again advised the requested letter was sent on March 3, 2014 to the member’s address. We again apologize for the confusion and delay.

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

I NEVER RECEIVED THE INFORMATION IN THE MAIL. WHY CAN'T THEY JUST REMAIL IT? PERHAPS IT WAS LOST IN THE MAIL BUT I NEVER GOT IT

I DID RECEIVE A PH MSG FROM THEM BUT I DIDN'T RETURN IT BECAUSE I WAS TIRED OF BEING PLACED ON HOLD AND I WAS COMMUNICATING TO THEM THRU THIS Revdex.com.

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. We again apologize for the delay and they advised e-mailing a copy of the letter to the member on April 2, 2014 to the e-mail address on file.

Review: Aetna sent me a form explaining that they had assigned a company with the name [redacted] to collect information from me concerning a health insurance claim.

AETNA would not answer questions I asked them on their web site, instead referring all questions to The [redacted]. The [redacted], meanwhile, did not respond to my letter, and continues to harass me for detailed information that I consider private.

Specifically, neither company will tell me which questions on their form I am obligated to answer by law or previous agreement, and specifically which laws or agreements. I answered the questions on their form that felt I had a duty or an obligation to answer.

AETNAs agent [redacted] continues to harass me for information and will not respond to my letters.Desired Settlement: AETNA, and their agent The [redacted], will answer my questions, or stop harassing me for information.

Business

Response:

Hello,

Review: Aetna is a leader in the health industry and I hope that my problem is not a common occurrence. I am a provider, credentialed and participating in network with Aetna. I followed the requests and guidelines to update my demographic profile to add a new location and tax ID. I submitted my request and all supporting documents in June. I was told that the process should take a month to update my profile. We are now 5 months later and this still has not been done.

I have remained in contact with Aetna since June 2015. Each time I call, I was told something different. I was told that I am in network by one representative in the provider relations dept. I have called the same dept

back 20 minutes later just to confirm that I received correct information, and was told by a different representative that I am not participating in network. This uncertainty has been going on since June. I have opened 9 tickets since then and 8/9 are still open. On one occasion, I was told that Aetna's representative sent my documents to the wrong department but they would correct that. I was told on several occasions that form letters were sent. I was told that I would receive a call back with in 72 hours (on more than one occasion). It never happened. I was told that I would receive an email to resolve the issue. That did not happen. I only received an email notice that I am not participating in network yet. Provider relations directed to me to the credentialing dept and when I did, the credentialing dept redirected me back to the provider relations dept. This happened repeatedly on various days. I have spoken to several representatives since June. I have made requests to speak to the supervisor and most of the time, I was told that a supervisor was not available. On the one or two occasions that I was connected to a supervisor, I was told that they were working on the issue. I was told to go on [redacted] or Aetna's website to resolve the issue myself. I have done this... still nothing yet.

Since June, it has been the same thing, being told that I am "in network", "out of network", "working on it." Different responses in the same day. Some representatives did say that this should have been completed seamlessly, long before now. I was told that they communicate via email and not via phone. Perhaps, this has caused a break in the communication. I have successfully completed this process with other insurance companies all within a month or two at the most. I have been working on this with Aetna for 5 months now.

I requested to file a complaint internally but did not receive much support to do so and was advised not to. I understand that I may never become in network after submitting to the Revdex.com, but I hope that at the very least, someone will review staff training and procedures so that improvements can be made so that no one else has to share my experience. Ultimately, the patients are the ones who suffer. I have started turning Aetna patients away because they can't afford out-of-network services.

I will end by saying that the staff overall have remained professional and pleasant. I have complimented one recently, but the problem remains as there are major deficits within their system.Desired Settlement: I would like to become participating in network under my new location with products included or simply be told that I will remain out of network. I would like a definitive answer, whether participating or not. Thank you.

Business

Response:

Hello,

Thank you for your inquiry, 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.

Upon receipt of the complaint we immediately reached out to the provider and emailed her requesting more information to investigate the complaint. We sent an email on November 06, 2015, to the email listed in the complaint. If the provider wishes to have us resolve the complaint we would please need the following information: the Tax Identification Number (TIN) or Provider Identification Number (PIN) so that we may locate the correct contract for this provider. Once we receive this information we would be more than happy to investigate and resolve this issue for the provider.

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

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Consumer

Response:

Review: [redacted]

I am rejecting this response because: Aetna has not made any attempt to contact me as indicated in their response. I have not received any emails from them dated Nov. 6th or otherwise. I even checked my spam folder. They already have my tax ID on file. It has been submitted to them with each call that I made to them. Also, a W-9 has been sent more than once. This is just a small example of what I have been experiencing over the past 5 months. No resolution.

Sincerely,

Business

Response:

Hello,

Thank you for your inquiry, 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.

Upon receipt of the compliant we requested that our Network Director reach out to the provider directly on Friday to have her concerns addressed. We were advised that Ms. [redacted] was able to speak with our Director and they discussed her concerns regarding her contracts with Aetna. Our Director left the provider with her direct contact information for any issues that may arise in the future.

Please accept my apology that we did not provide the level of service that you rightfully expect and deserve, and my assurance that your concerns are getting the highest level of attention at Aetna. I would also like to thank you for sharing your experience with us. It is feedback like yours that helps us address issues and prevent them from reoccurring.

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

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

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: My daughter is insured through the California [redacted] program but for the last years the [redacted], An Aetna company has been appearing on her file as her private insurance medical provider, so her [redacted] won't cover her visits and get's denied medical attentionI have contacted the company on several occasions and they have informed me she's not covered through them and that they will remove her from their system and until this day, she still hasn't been removedI need this company to resolve this issue so my daughter can have medical attention neededThe company had told me they would mail me a letter saying my daughter wasn't insured by them so the state could remove it from her file and until this day I still haven't received anythingI hope this can be resolved since the company seems to think a person's health is not seriousMy daughter is and hasn't been able to see her Doctor because of this issue
Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)
I just want this to be resolved since the company seems to think getting me off the phone is the number priorityMy daughter needs medical attention so this is urgentI would also like for them to take responsibility for all these years of giving me the run around
Business
Response:
Thank you for your inquiry received on 10/15/regarding dependent coverage through Aetna [redacted] for [redacted]Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you

Review: My name is [redacted]. I retired from [redacted] in February 2012 and started Cobra coverage through Aetna in March 1,2012. By federal law I have Cobra until August 31, 2013 which is 18 months. Aetna has cancelled my medical coverage as of March 31, 2013 and made the cancellation retroactive back to March 1, 2012. To date I have paid Aetna every month since March 1, 2012. I have paid $7658 for coverage, including $547 for April which they have processed. My first phone call to Aetna was on April 8, 2013 when my perscriptions were denied. I have talked to Aetna every day except Saturday and Sunday (they are closed) for a minimum of 1 hour. Today I talked to a [redacted] M ID#AXXXXXX at Aetna and was told again my benefits were in place but they still might be working on some issues. I then called my pharmacy and was told again there are NO benefits. I have spoken with the employer, at the advice of Aetna, as Aetna said the employer cancelled the plan. The employer states there has been no change in the plan. This is creating a medical emergency due to my being denied benefits/perscriptions I have paid for. I am on a fixed income and do not have the hundreds of dollars needed to pay full price for my medicine. Plus I have already paid for my medical coverage with Aetna. I also received a bill from Aetna for all retroactive perscriptions for $3,237. I have paid over $7600 for my Cobra and now am being denied a Federal program. This is an internal Aetna problem and needs to be resolved by Aetna but they seem incapable of resolving the problem. Please help!!! [redacted]

Product_Or_Service: Cobra medical/pharmacy through Aetna

Account_Number: [redacted]

Desired Settlement: I want Aetna to resolve my Cobra coverage and honor my contract with them. I want them to send a letter absolving me of any past charges for medicine while I was covered under Cobra. I want a check paid for all days I have been denied my Aetna benefits through the federal Cobra program.

Business

Response:

Business Response /* (1000, 5, 2013/04/30) */

Thank you for your inquiry received on April 23, 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 Pharmacy and Eligibility department for assistance with the member's concerns. They reviewed the coverage for the member and they advised the member should not owe on claims, as she had coverage from her old plan until March 31, 2013. Currently, the member is active under Identification (ID) number WXXXXXXXXX, effective April 1, 2013. There are paid claims on file under this ID from April 7, 2013 and April 12, 2013 for this 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].com.

Review: My name is [redacted] and I am filing this on behalf of my father [redacted]. My father purchased hearing aids from [redacted] at the end of December to take advantage of the fact that his medical insurance would refund $1000 for hearing aids according to his plan. I called the insurance company on 12/27/12 while we were in the office getting ready to purchase them just to ensure that if he got them that they would infact refund him the $1000. I spoke with a male who confirmed that as long as we got this done prior to the year ending that my father would be able to take advantage of this. I called to confirmed this because I had read that his plan was changing the following year 2013 from $1000 to $500 and I wanted to ensure we would have no issues. Before we left the office I sent the copy of the receipt to the claims department via fax. Several weeks letter we received a denial letter stating that we needed to wait 30 days and we also needed a statement of satisfaction (SOS) form filled out by the company we bought it from and us. I faxed this in Feb 2013. Several weeks later we received another denial letter stating that they still didn't receive the SOS form. I refaxed in March and again we got the same denial letter so I refaxed it two more times. Each time I call they tell me they don't have it and when I ask to have it escalatd the supervisor always seems to find it. I've spoken with 3 supervisor in March I can't remember her name on 4/15/13 with [redacted],and on 5/13/13 with [redacted]. This last time when I spoke with [redacted], she told me she would call me back with an update by either 5/15 or 5/16 and I never heard anything. Today I received another letter that it was denied because this was not a covered service according to the plan. D48. I was told on several occasions that it was covered and that he would get $1000 back. If they would have told me this wasn't covered I would have NEVER had my father spend money he doesn't have. Please help.

Product_Or_Service: Hearing aids

Account_Number: [redacted]

Desired Settlement: I would like for someone to care and please review his file completely. I was told on several occasions that he would qualify for the $1000 refund and I have done everything as your office has directed me to. When I spoke with [redacted] this week I pleaded with her and pretty much begged her to get this resolved and to call me back with a resolution and I got NOTHING but a letter of explanation. I need for someone to please contact me wih a resolution and a overnight tracking # for $1K.

Business

Response:

Business Response /* (1000, 5, 2013/06/05) */

Thank you for your inquiry received on May 22, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reviewed the member's plan and claim history. According to hearing reimbursement guidelines, the service was allowed and member reimbursement in the amount of $1000.00 was processed on May 23, 2013. We apologize for the delay and confusion concerning the member's issues.

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].com.

Review: I purchased an AETNA student health plan through my university and it was a disaster from the get-go. There was almost no information about how to go about filing a claim and when I did file a claim though a doctor's office, extensive paperwork was apparently sent to me, but I never received it. After calling in to find out why a claim was denied, I was told I did not fill out the required paperwork. This paperwork, which I completed over the phone, asked a variety of invasive questions including information about preexisting conditions that did not have anything to do with the claim that was being filed. They again claimed they sent this paperwork to me so I gave them an updated address. Then, I went to the doctor again and was, again, told that my claim would not be covered. This was apparently because my coverage had been terminated. I had no idea my coverage was terminated and again, was apparently send information about this in the mail, but I never received it. I have now purchased a different kind of insurance because of the endless piles of paperwork and frivolous claim denial that comes with AETNA health insurance. I spoke with them on the phone in an effort to resolve this matter but was told my termination date was my termination date and they could do nothing about the claim and again told me they had sent out letters. They refused to check if the letters had been going to a different address and essentially told me the claim denial was my fault. Even when I did manage to get previous claims paid, the coverage was lacking to say the least - they didn't even cover the cost of a cast for a broken arm. AETNA is a colossal waste of time and money.Desired Settlement: I would like the denied claims to be paid.

Business

Response:

Thank you for your inquiry received on December 3, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: My doctor renewed a prescription and I had this filled. I was not informed that the health insurance provider through my school had just changed, as had the procedures for being reimbursed. Prior policy required paying up front for medicine, then submitting a reimbursement form. I submitted to the new company when I was told of it, for reimbursement ($184.55). The reason code for it not being reimbursed was 75: Prior authorization required.After several calls to Aetna and my doctor, each saying the other was responsible, I talked to a manager at Aetna. The manager said I could seek prior authorization. When I did, Aetna told me this could only be backdated one month. I explained they had not informed me that the provider and policy for reimbursement had changed. I asked for another manager, explained the situation, and I was given a number for the precertification department. I called there, and they said they could look into getting it preauthorized. They did get it preauthorized (after the doctor contacted them), but for a future prescription, not the past one. I called back to the original number and talked to a manager I had spoken with before; she said to talk with a manager in the preauthorization department, and that she felt like, should they not back date it, I should appeal it since Aetna did not inform me that my school insurance company had changed with policies for reimbursement.I called a manager in the preauthorization department. She said she would be able to take care of it, getting preauthorization backdated more than a month for reimbursement). Reassured everything was finally taken care of, I let the issue rest for two months while I left the country. When I returned, no message was left. I called member services, who forwarded me to preauthorization services, who forwarded me to student services. No resolution--I felt misled now. I filed two appeals, but in their reply, the board twice ignored my core contention of not being properly notified.Desired Settlement: Request reimbursement for the medication: $184.55.

Business

Response:

Thank you for your inquiry received on December 31, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Since April 2014, I have been submitting OUT OF NETWORK claims for myself as a result of services that I have paid for through my therapist. My therapist is an OUT OF NETWORK doctor who happens to be associated with a provider that has an IN NETWORK doctor. However, my therapist is not in network and I pay for ALL services out of pocket. My first three claims submitted were processed properly as OUT OF NETWORK, and I received the 70% disbursement back according to my plan. My deductible was met a long time ago, and so I should continue to receive 70% back of my total out of pocket expenses. Since that time, I have submitted three claims using the exact same format and method, and they have been processed incorrectly. These claims start on 6/29/14, 7/26/14, and 8/2/14. For some reason Aetna's inept claims department decided to start processing these claims as IN NETWORK even though I am paying for all services 100% out of pocket. Therefore, I have received only 30% of the amount. I have received 3 checks so far for each claim equal to 30%. Aetna owes me the remaining 40%, which at this point equals $650.Desired Settlement: Aetna owes me the remaining 40%, which at this point equals $650. There is no question of this being owed to me, as it has been documented on my account through several customer service reps who have completely agreed with me. There is no other acceptable resolution.

Business

Response:

Thank you for your inquiry received on 10/06/2014 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.

The member’s issue is being reviewed as an appeal under case number [redacted], and we will respond directly to the member with a determination.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted] 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 am writing because my daughter ([redacted]), had an occlusal orthotic appliance made by her dentist ([redacted]) to treat [redacted]. Although I was told repeatedly by Aetna representatives that the appliance was covered, the claim was repeatedly denied. I appealed the claim and was told that the appliance was not covered. I was told that the appliance was covered BEFORE my daughter was fitted for the appliance. I was told two other times that the appliance was covered. I NEVER would have allowed my daughter to be fitted for the appliance if I had known it was NOT covered. I have received repeated MISINFORMATION and CONTRADICTIONS from Aetna, which I have documented below.

FIRST INSTANCE OF MISINFORMATION: On August 14, 2014, I spoke with [redacted] BEFORE my daughter was fitted for the appliance. I explained that our dental insurance ([redacted]) would not cover the entire cost. [redacted] told me that the appliance would be covered because it qualified as “Durable Medical Equipment.”

My daughter, then proceeded to have the appliance fitted and ordered. The dentist submitted claims to both [redacted] Dental as well as Aetna. [redacted] Dental paid a portion of the cost ($300 out of $750), however, Aetna denied the claim.

SECOND INSTANCE OF MISINFORMATION: I then called Aetna on September 24, 2014 and spoke to [redacted]. After speaking with an oral surgeon, he assured me that the appliance would be covered, and he sent the claim in to be reprocessed. Again, the claim was denied.

THIRD INSTANCE OF MISINFORMATION: On September 30, 2014 I called Aetna and spoke with [redacted] who told me the appliance was covered and that she would resubmit the claim with attention to the supervisor. Again, the claim was denied.

UNSATISFACTORY CUSTOMER SERVICE: On October 9, 2014, I was finally assigned a supervisor, [redacted] (x[redacted]) to investigate the problem since I had been told THREE times that the appliance would be covered. After repeated phone calls, [redacted] stopped returning my phone calls and never resolved the matter.

On October 23, 2014, I called Aetna and spoke with [redacted] who told me that [redacted] is not covered by my plan, thus the appliance would not be covered. She sent me a link to the Clinical Policy Bulletin: [redacted] Disorders (a 30+ page document) stating that Aetna does not cover the appliance.

After filling out a customer service survey expressing my dissatisfaction from receiving misinformation three separate times, [redacted] (###-###-####) called to follow up. She was the only one to explain to me that I have a right to appeal this decision.

I was told that the appliance was covered BEFORE my daughter was fitted for the appliance. I was told two other times that the appliance was covered. I now learn that the appliance is NOT covered. I NEVER would have allowed my daughter to be fitted for the appliance if I had known it was NOT covered. I have received repeated MISINFORMATION and CONTRADICTIONS from Aetna, which I have documented above. I have been working on this issue for over two months. I am extremely DISSATISFIED with the service that Aetna has provided—in particular with Ms. [redacted]—the supervisor, who stopped returning my phone calls.

Finally, Aetna’s response to my appeal was that the appliance was not covered and that it is “the member’s responsibility to be familiar with their health plan.” By “their health plan,” Aetna is referencing the [redacted] Corporation Summary Plan Description (SPD). This is a 143 page document! It is very reasonable that a patient would call Aetna to clarify information in a 143 page document! Aetna takes no responsibility for the fact that they provided me with repeated instances of misinformation—they state that the “information provided by Member Services is general plan information only…not a guarantee of coverage or reimbursement.” Again, as a reasonable consumer, I called Aetna repeatedly for clarification of the 143 page document. Repeatedly, I was told the appliance was covered.

In addition, I attempted to request an independent medical review from the Federal Department of Labor External Review process, however, Aetna sent me a letter saying my case was not eligible for review because "Denials must be based on medical necessity or the experimental investigational exclusion."

Basically, I was given repeat misinformation from Aetna and have no recourse according to them.

This situation is UNACCEPTABLE. I would like Aetna to cover the remaining portion of the bill.Desired Settlement: Aetna owes me $450.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on December 18, 2014.

Review: This is the second time your company has provided poor customer service to me. The first time was because your paperwork does not provide space for a 'Mailing Address' so Aetna/[redacted]sent mail to the incorrect address for months (instead of to my post office box), so the policy lapsed. In October of this year, I allowed myself to be convinced to go against my principles and let Aetna/[redacted] debit the premiums on the FOURTH day of each month. However, this was not done and I am now building up a nice chain of overdraft charges, which you will reimburse.Desired Settlement: I immediately and completely withdraw my permission for Aetna/[redacted] to directly debit my checking account. Cash refund of all overdraft fees and premiums paid to date.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on December 30, 2014.

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,

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 have on numerous occasions requested Aetna to correct my name on my medical cards to reflect my legal name. They have failed to do so. It has been extremely difficult to try and make any progress with this company. They finally did resend the cards, but again had my name listed incorrectly. The most recent time that I called the company, after speaking with a representative, she disconnected the phone. I am at end meeting nothing but resistance. Apparently my name is correct in their system, but it is not correct on my card. Which means it does not match my drivers license, passport, SS card or any other identification that I have. This ultimately affects me at the doctors office, pharmacies, and other associated places where I might use this card. If my legal name can not be addressed, I will have to cancel the accountDesired Settlement: I want my legal name on my cards. If not, than I want to cancel the account and I no longer want Aetna to be my insurance provider.

Business

Response:

Hello,

Thank you for your inquiry, 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.

Upon receipt of the complaint we immediately had our files reviewed to verify that we had the member’s name correct in our system. Our records indicate we have the member’s name in our system just as it shows in the Revdex.com complaint. Our records also indicate that we do not carry this employer’s medical benefits, only dental benefits. The employer’s medical benefits are with any of the following carriers: [redacted] and [redacted]. Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those records. Please contact your medical carrier to request a corrected medical ID card.

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].

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Consumer

Response:

Review: [redacted]

I am rejecting this response because:Dear Revdex.com,As you can clearly see from the response from Aetna, they can not even get my name correct in the correspondence about correcting my name!!! Please see the red areas below for my comments.While I will agree that the term "medical" may have been a poor choice for a description, what I was referring too in my complaint is my Aetna Vision cards. Ashley is correct that Aetna carries my Dental coverage, but she is incorrect when she states that is all. Aetna carries my vision as well. Please see the attached pictures. On my dental information, my name is listed correctly, on my vision information, it is listed two different ways on the same piece of paper, and both are incorrect. And as far as contacting my employer for corrected cards, they do not issue the cards, they only provide information to the carriers who distribute the cards to the members. When I signed up for the insurance, I filled out the paperwork correctly and with my full legal name.Bottom line is that I need my legal name reflected on my vision cards and other pertinent information related to insurance coverage.And to the Revdex.com, your system doesn't have my name listed correctly either. If I have a complaint about the Revdex.com, who do I send that too.I have attached some pictures for your viewing pleasure. I look forward to a response and mitigation of this matter[redacted]

Thank you for your inquiry, 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. Upon receipt of the complaint we immediately had our files reviewed to verify that we had the member’s name correct in our system. Our records indicate we have the member’s name in our system just as it shows in the Revdex.com complain** Our records also indicate that we do not carry this employer’s medical benefits, only dental benefits. The employer’s medical benefits are with any of the following carriers: [redacted] and [redacted]. Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those records. Please contact your medical carrier to request a corrected medical ID card. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [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 $20,599.50 from [redacted] for services performed on May 12, 2015. I billed [redacted] as my primary insurer, who paid the majority of the balance, and Aetna as the secondary insurance.

Aetna is refusing to pay for the remainder, even though I pay for their insurance policy.Desired Settlement: I would like Aetna to pay the $1514 balance on the bill, as they are my secondary provider.

Business

Response:

Hello,

Thank you for your inquiry, 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.

Upon receipt of this complaint our office had already received a letter from the member regarding the same complaint. The consultant reached out to speak with the member to let him know we would research the issue. The member was advised that his claim was processed correctly according to his coordination of benefits. There will be no additional payments made on the claim.

I understand your concerns and recognize this is not the outcome you desired. Our actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants.

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].

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Review: I lost my dentist sometime after November, 2012. He abandoned his business and his office in

[redacted], **. - 75 miles away from my home in [redacted], **. I did not become aware of this fact

since there were no pressing concerns to my dental care. Since I was not informed by Aetna Dental

Access of my renewal date as they had done in the past, and of the increase in renewal fee to $179.00

per year, I as waiting for them to contact me by phone asking me to renew. They did not contact me

by phone. Recently, my husband found letter on his email stating that there would be an automatic

withdrawal of $179.00 per year from my bank account. Neither my husband nor I had actually seen this

letter until just recently when my husband, Lee, had searched for something on his past emails.

Since I had no dentist between Nov.2012 and Oct. 2015, Aetna Dental Access Discount Plan was taking

money out of my bank without my knowledge or authorization. Since this company is not an insurance

company, it does not operate as one, therefore, in lieu of my not having made use of their discount

plan for almost 3 years, I must have at least $360.00 back compensation for my inactivity from

Nov., 2012 to October, 2015. If I do not receive compensation, I am cancelling my membership w/them.Desired Settlement: I feel that requesting Aetna Dental Access to refund at least 2 years of renewal fees which

were taken out of my bank account at $179.00 per year is only a reasonable and justifiable

compensation; since, I did not use their discount services for more than 2 years. and was not given

privilege of being informed personally by phone of their withdrawels from my bank account.

I believe these withdrawels are tantamount to stealing money from me. I only ask that they

compensate me by a refund.

Business

Response:

Hello,

Thank you for your inquiry, 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.

Upon receipt of the complaint we immediately reviewed the member’s records to see what type of dental discount policy the member is enrolled in. We found that the member is enrolled in a Vital Savings plan purchased through http://www.[redacted].com. Aetna is strictly an administrator of this plan; Aetna does not control the enrollment or the billing.

All enrollments are handled through a Third Party Administrator ([redacted]) and the Billing is handled by the [redacted], not by Aetna. The participant makes the payments directly to the [redacted]; there is no pay roll deduction. Anyone requesting a refund of premiums or a cancellation of the plan must contact the [redacted] directly. You can call ###-###-#### or go online to the website listed above.

Please be aware that this plan is strictly a discount plan and is not insurance. There are no claim submissions of any kind and the member is responsible for paying the discounted price directly to the dentist. Aetna would have no way of verifying if the plan was not used by the member. Also any renewal information would come from the [redacted] directly to the member; Aetna is not responsible for any communications to the member.

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

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Review: Aetna has failed to refund a deductible that was erroneously charged twice. 7 months has passed [redacted] they promised to refund the amount.

In early November of 2012, I was charged a deductible ($50) for a prescription that had been previously paid in August of 2012. I called Aetna immediately after to inquire about the double payment. The sales rep, a woman, said that she saw that they had overcharged and notified me that I would receive a refund check for $50 in the mail within 4 to 6 weeks. By January, I had not received the check so I called back. This time I spoke to [redacted]. She advised me that they had no record of my call from November and that whomever I had spoken with did not have the authority to issue a check. She gave me a ticket # (XXXXXXXXXXXXXX) and told me to call back in 24 hours after the complaint was sent up. I called back a couple days later, spoke to [redacted] (I believe) and was told that the ticket # I was provided was wrong because it had too many numbers. She then issued me a different "task" number (XXXXXXXX) and told me to call back within 24-48 hours. I asked to talk to a manager and was on hold for about an hour and eventually hung up. I called back about a week later and spoke with [redacted]. She advised me that there was no word back on the claim and that they were still processing it. I asked to speak to a manager about this issue, but that I didn't want to be put on hold forever and asked if a manager could call me back. She said that "they don't really call people back." Eventually, on another date sometime in early March, I finally talked to someone who told me that I needed to send in a receipt of some kind showing the overcharge. I faxed bank statements from August and November showing where I had been charged twice. On March 15, I reached out to [redacted] who is the Student Insurance Coordinator at [redacted]. She forwarded the above information to a Aetna representative that deals with student insurance at [redacted]. On April 22, [redacted] notified me that Aetna was sending me a reimbursement check and asked if I had received it yet. I had not. In May, [redacted] notified me that she had sent an email to the Director of Accounts and that he was informed of the situation. I asked if she could find out someone who I could contact directly about this matter because I am very close to contacting the Revdex.com. She said that the Aetna pharmacy dept. would like to call me, so I confirmed by telephone number with her on May 24. No one from Aetna has ever called me. Today, June 3, [redacted] emailed me to ask if anyone had called or if I had received my check yet. Again, NO ONE from Aetna has ever called me. The reimbursement check was promised to me in November and I have not received any money. There has been absolutely no communication from Aetna to me regarding this matter. Aetna is capable, however, of sending me a questionnaire about a claim unrelated.

Desired Settlement: I would like my $50 refund to which I am entitled, plus interest and/or a late fee.

Business

Response:

Business Response /* (1000, 6, 2013/06/19) */

Thank you for your inquiry received on June 5, 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 Aetna Student Health (ASH) and the Pharmacy department for assistance with the member's concerns. They advised a check was submitted for processing on May 31, 2013 and the reimbursement would be for $50. 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].com.

Review: I was terminated from my health insurance plan without proper notification or threat of termination. I received a final termination notice only. No email, no phone call, and no mail except for regular monthly bills. The last bill I received I went to make a payment online and Aetna online pay center was offline and I was not allowed to make the payment. I then forgot about the bill because I always pay my bills when I get them and it slipped my mind with a busy work schedule. When I get a termination notice without any prior warning, not even a warning on my last bill I was astonished. How could this be? To make things worse they sent the mail on Wednesday 11/27 and I recieved it on Friday 11/29. The significance of this is Thanksgiving was Thursday 11/28 and they were closed til Monday 12/2. How was I supposed to get in contact with them. They found a way to get rid of me like they will with everyone so that they can start charging the higher premiums that The Affordable Care Act will allow them so that they make more money off of me. I have paid my past due balance since and while on the Aetna site it still shows my termination. Please correct this! This is a blatant abuse of power.Desired Settlement: I want reinstatement of my plan benefits and a solution for their archaic bill pay system.

Business

Response:

Thank you for your inquiry received on December 3, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: In November of 2013 I tentatively signed up for aetna insurance to start in January 2014. It was tentative because I really wanted to check out Obamacare but was having trouble accessing the website. The Aetna service rep told me that I could call to cancel at any time.I cancelled in November. On December 5th Aetna took $263 out of my checking account for this insurance which I had cancelled.I called member services and spoke with someone who told me I would be getting a refund of the $263 in the mail. I explained to her that I had incurred a $35 overdraft fee because I didn't anticipate this deduction. It was paid to Aetna because I have od protection, but I still had to pay the $35 fee. The rep told me that to get the $35 back I needed to mail a copy of the bank statement and a letter to aetna....which I did.I still have not received a check from them. I did receive a statement noting a $263 credit, but no check. I haven't heard back about the od fee at all. I called member services again on December 27th and spoke with an "[redacted]". She said there is no record of such payment from me and that I should call another number which she gave me. After being on hold for 30 minutes and never speaking with anyone...I hung up. I also had 5/3 bank fax a copy of the od statement to them because [redacted] told me to do that. The fax cost me $5. I tried calling again today but got the recording, "We are experiencing a large call volume." I held for 15 minutes and then hung up. So, now I am writing to you.Desired Settlement: I want a check for $303. $263 for the premium refund, $35 for the overdraft fee and $5 for the fax. And I want it asap. This has gone on too long.

Consumer

Response:

From: [redacted]

Sent: Thursday, January 02, 2014 2:33 PM

To: [redacted]

Subject: Re: You have a New Message from Revdex.com Serving Connecticut Regarding Complaint #[redacted]

Aetna did deposit $263 into my checking account this morning, but they have not paid the $35 fee caused by their incorrect deduction or the $5 fax required by their customer service rep.

Business

Response:

Thank you for your inquiry received on December 30, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: After January 20, 2014. I received every single week at least 7 or 8 letters from AETNA with ID cards, most of these ID cards have my name, with the ID , health plan, place of employment and type of insurance of other person. Also ID cards with mixed information (my ID information and health plan with the name of other person); in other cases the ID cards of other people with their personal information. in envelopes that have my wifes name and our address, and in other cases the envelopes have somebodys else name with my address, and inside I found my information or other people's insurance information. Just a few of these letter have our name on the envelope and our correct ID cards. I ignore most of the letters, however the frequency and all the mistakes made me concern about my personal information being delivered to somebody else. I called AETNA on February 24, 2014, and inform the costumer service representative about all these issues, she inform me that she will get this resolved and just to disregard any other letter received during the next week.After that I still receive 8 letters weekly with the same issues, I called AETNA on 3.7.14, the costumer service rep that took my call told me that she did not found any previous report about my id cards, and that she will take care of it.She did call me on 3.11.14 to ask me about the information in the ID cards, and told me that she will take care of it, in these 11 days I received more than 16 letters, all showing the same issues that I described before and until now I have no idea how many people receive my personal information in their mail, and I'm still getting other people's information in envelopes that have my wife's name and our address.Desired Settlement: I want an answer from AETNA, stating if my personal information was delivered to somebody else or not, I dont want to receive more mail with other peoples information, an apologize and a possible economic compensation for all the time that I spent and stress that these issues caused to me and my wife.

Business

Response:

Thank you for your inquiry received on March 24, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. We reached out to Aetna Student Health (ASH) department for assistance with the member’s concerns. They advised an error in their system caused the issue with the ID cards. They advised correcting the issue and the member should not receive further incorrect information. They have also advised the Privacy Compliance department to investigate the privacy concerns. We apologize for the issues and inconvenience this has caused the member.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is partially satisfactory to me. I wan´t to receive answers about the security of my personal information from AETNA

Sincerely,