Aetna, Inc.

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: 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 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: 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: 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: 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: 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: 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: 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 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: 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: 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: Aetna has ignored my attempts to cancel an application for health insurance that they deemed "incomplete", and placed a pending charge on my credit card, disregarding my numerous cancellation requests. The application was processed through [redacted].com, where my credit card information was required up front. The application stated that my card would only be charged if the application was approved. I received an email from [redacted] stating that Aetna deemed my application "incomplete". I attempted to reach customer service multiple times for assistance with how to complete the application. After receiving no response, I emailed [redacted] at [redacted].com to cancel my incomplete application. Meanwhile, I took out health insurance with another company. Several days later, I receive an email from both [redacted] and Aetna that my incomplete application is suddenly "approved" and that my credit card will be charged. I phoned [redacted] at ###-###-#### to repeat my wish to cancel the incomplete application. The lady hung up on me. I then emailed both [redacted] and Aetna repeating my cancellation request. I called Aetna billing at ###-###-#### and repeated my cancellation request. The lady told me that they have already placed a pending charge on my credit card. I asked to cancel, and she said they "usually go through with a pending charge". I insisted that I NOT be charged. I called my credit card company, and they said until the charge actually goes through, they cannot be of assistance. Both Aetna and [redacted].com have displayed terrible customer service by ignoring my requests 1st for assistance, and then to cancel the application. They have threatened unauthorized charges to my credit card by refusing to honor my request to cancel a health insurance application that they initially deemed incomplete. Ignoring repeated cancellation requests is an unacceptable business practice.Desired Settlement: Refund if the unauthorized charge appears on my credit card as Aetna has threatened. I would also like an acknowledgement of my cancellation by Aetna and [redacted] in writing so that I can be assured of no future charges.

Consumer

Response:

From: [redacted]

Sent: Wednesday, December 04, 2013 10:51 AM

To: Revdex.com

Subject: #[redacted]

Resolved. I received an email of cancelation from Aetna.

Thank you for your help.

Review: For 6 months I have been unable to use my health insurance at my [redacted] Aetna requested paper work from [redacted] Clinic to continue my care. Dr. [redacted] says the paperwork has been submitted and Aetna continues to deny having received it. I have not been able to get relief from my pain, even though I am paying for health insurance. I have pain [redacted]. I should not have to wait six months to clear this up. I am asking for your help to fix this matter, since Aetna does not seem to care about the issue.

Account_Number: wXXXXXXXXX

Desired Settlement: For Aetna to resolve the issue so I can continue to use my benefits that I have worked hard for. My pain causes me to not enjoy life as I should. I want to be able to use my health benefits as they are stated in my contract.

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 Claims department for review of the member's issues. They advised looking at claims for this member, the last date of service for the provider, Dr.[redacted], was January 3, 2013. All claims billed from this provider have been processed and paid. No claims were ever pended nor do they have claims requesting more information from the provider. Also, they have not received any information from the provider about this member.

They also reached out to the Clinical Care Review (CCR) department, to see what information they have on this member and her claims (if they have been reviewed for medical necessity or if they have received medical records). They were also not able to locate anything on this member nor have they done any reviews.

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 /* (3000, 7, 2013/08/05) */

(The consumer indicated he/she DID NOT ACCEPT the response from the business.)

This response does not address my concern.

Aetna response says all my claims are paid, but that is not the problem. As I previously stated, Aetna has told me over the phone twice, that if I go to the [redacted], my visit will not be covered. I am paying for health insurance, but unable to use it to address my back issues. Aetna is telling me I have no unpaid claims, no kidding! Why would I go to the [redacted] and pay out of pocket, when you have already told me it will not be covered?

I will accept Aetna settlement when they allow me to use the health care I am paying for. I want to be able to go back to the [redacted] and ease my back pain.

Business Response /* (4000, 9, 2013/08/21) */

Thank you for your inquiry received on August 7, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We again reached out to the Claims department for review of the member's issues. They advised nothing showing in our systems where the member was told they could not move forward with having [redacted] services rendered. The plan benefits for [redacted] are up to a maximum of 60 visits per year and at the 25th visit claims will hold for review (we will request medical records from the provider performing the services and the Clinical Claim Review (CCR) department will determine the medical necessity of the services going forward. This is the same with Short Term Rehabilitation. Massage and Acupuncture are not covered on the member's plan.

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: 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: 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: 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: Aetna refuses to pay the entirety of a $20.00 medical billing balance as a secondary insurance carrier. Through some convoluted formula, Aetna determined their responsibility is $9.69 leaving a balance of $10.31. Please Note: As a primary carrier, Aetna would have paid a total of 109.84. Aetna's payment of $9.69 falls way short of this figure.

Product_Or_Service: Medical Dental Insurance

Order_Number: Claim# [redacted]

Account_Number: XXXXXXXXX

Desired Settlement: Pay the $10.31 balance due.

Business

Response:

Business Response /* (1000, 5, 2013/06/28) */

Thank you for your inquiry received on June 14, 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. Unfortunately, the claim was received and was correctly processed in accordance with the plan. In accordance with the Associate Handbook, page 33, the plan coordinates with other plans using Maintenance of Benefits (MOB) or non-duplication. Under this method, Aetna compares its normal benefit to the other plan's benefit (handling). An Explanation of Benefit (EOB) was sent to the member on February 7, 2013, outlining the correct handling of the claim.

Allowable amount: $134.84

Copay: $25

Aetna's normal payment: $109.84

Primary plan's payment: $100.15

Aetna's payment as secondary: $9.69

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 /* (3000, 7, 2013/07/01) */

(The consumer indicated he/she DID NOT ACCEPT the response from the business.)

Aetna still needs to pay $10.31

Business Response /* (4000, 9, 2013/07/16) */

Thank you for your inquiry received on July 2, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We again reached out to the Claims department for assistance with the member's concerns. We thoroughly reviewed the claim again and unfortunately, the claim was processed correctly, Aetna's payment as secondary insurance was $9.69 and no more payment is due.

Allowable amount: $134.84

Copay: $25

Aetna's normal payment: $109.84

Primary plan's payment: $100.15

Aetna's payment as secondary: $9.69

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 /* (4200, 11, 2013/07/17) */

(The consumer indicated he/she DID NOT accept the response from the business.)

Will refer issue to Massachusetts Attorney General Consumer Protection Division for complaint and resolution.

Review: Dear Revdex.com:

I am very frustrated with Aetna, my health insurance. I have Aetna Open Access HMO, and I live in [redacted]. Every time I go have a health appointment, whether it's this optometrist appointment or a health appointment, I spend almost two months trying to fix Aetna's overcharges by hundreds of dollars. This has happened repeatedly recently.

This particular time, I had an optometrist (eye doctor) appointment on April 23, 2015. I paid my bill at the eye doctor's office. Aetna overcharged me at least $142.00. Aetna was supposed to pay for all my eye exams benefits under my Aetna medical plan's stated benefits of paying 100% of my exam costs, but Aetna did not apply the full benefits to cover my bill. I have contacted Aetna over 10 times by email/messages and phone calls. Aetna has admitted their mistake, but still has not resolved the claim/overcharge. Today Aetna said they have heard my many complaints and have asked their claims center a second time to review and take away the charges. Many, many Aetna reps have told me it is Aetna's fault and I should owe $0. But their claims department is dragging is not responding and I don't know why.

Aetna states on their materials that they will resolve claims within 10 business days. It has been over 10 business days and I still have no resolution. I have requested that they send me written documentation that I do not owe anything anymore and that they made a mistake--again.

Aetna has made repeated mistakes. They have delayed almost two months clearing my name and my bill--it's completely unacceptable.

I look forward to your investigation's response. Thank you.

Sincerely,

[redacted]Desired Settlement: Biling adjustment AND written confirmation that I do not owe anything anymore, and that they overcharged me and that the overcharge is now withdrawn

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 contacted our Claims department regarding the claim from April 23, 2015 from [redacted] Vision Care. We confirmed that the plan does allow one routine vision exam every 12 months. Based on the plan benefits, the copay applies to a routine vision exam. The total billed charge of $142.00 has been allowed at 100 percent. The claim has been reprocessed to allow the all charges after a copay of $35.00. An explanation of benefits was mailed on June 15, 2015 which indicated the member responsibility. We apologize for the inconvenience this has caused.

Review: We were quoted a 50% charge plus $25.00 deductible on our son's partial denture prior to making the appointment and having the procedures completed to allow him a tooth replacement. [redacted] (our dentist's admin) was quoted this price when she spoke to your customer service agent on February 12. In that conversation, the agent did not mention the claim would be denied if there was not a medical purpose for the tooth. Please pull this call to see the agent is at fault for not reciting the proper disclaimers to [redacted] relayed the information to us and that was the ONLY reason we had continued the procedure for our son's partial denture. Because of poor customer service and misinformation from the insurance company, we are at the risk of being charged double the amount we budgeted. This is unacceptable and has been appealed with the Dental Insurance Board and Revdex.com. Please submit the proper invoice for $111.00 that we should only be paying.

Product_Or_Service: Dental insurance coverage

Desired Settlement: Updated bill to member/patient in the amount of $111.00 as opposed to $222.00.

Business

Response:

Business Response /* (1000, 5, 2013/04/11) */

Thank you for your inquiry received on March 28, 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 Dental and Customer Service department for review of the member's concerns. They advised there was no record of a call received to Aetna on February 12, 2013 from a [redacted]. They did locate a call from February 20, 2013, which they reviewed the call. The office requested the coverage information for pediatric partial denture (CDT-D6985) and if the deductible had been satisfied. The general benefit information was provided correctly and no further details or review of medical necessity were requested. The dental office submitted a preauthorization for the services several times, on February 19, 2013, February 25, 2013 and March 11, 2013. The first and second times it was received x-rays were requested to review the service. The member completed the service before x-rays were received by Aetna and a decision was reached. The dental office sent back the requested information on March 11, 2013 and it was reviewed and the service was determined to be cosmetic. The member has also filed an appeal under Case number [redacted], which is still under review.

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].