Aetna, Inc.

Review: Aetna is refusing to cover my medication and when I have called I get one representative and they tell me that my medication will be covered then they talk to the people in the Pharmacy part of Aetna im guessing and they state that My Employer is not paying for my medication my employer has noting to do with me getting my medicationDesired Settlement: I need and want my medication at the price I was told that it was going to cost me that’s what I would like the outcome to be

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on January 23, 2015.

Review: We are a small medical practice with less than 10 employees. For over 5 years we offered our employees group health benefits after successfully completing a 90 day probation period. When adding one of our employees on Nov 20, 2014 for enrollment on December 1, 2014 to our group plan with Aetna online, the system automatically reverted the day back to November 1, 2014 and now Aetna has sent us to collection for a month of health benefits when 1) THere are no outstanding claims 2) Our internal employee policy is a 90 day probation period. We were Aetna's customer for many years and do not understand how a reputable company like this would use such low tactics to increase their revenue. Doctors are already struggling with declined reimbursements and we certainly do not appreciate this lack of professionalism and poor business ethics. Both my insurance broker and I have tried to communicate with Aetna, but there appears to be no one willing to help us on this matter. The amount oustanding is $590. There collection agent [redacted] keeps calling and sending emails. All over $590!Desired Settlement: We paid our premiums punctually in the past for over 5 years. We honestly do not believe we owe Aetna any monies. They imposed a 60 day waiting period in the system to benefit for an additional montly premium when our policy is a 90 day probation period to become eligible for health benefits. As a small medical practice, we are appalled and the behaviour of this insurance giant. Grateful for your assistance with this matter,

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 member and emailed her for more information on November 04, 2015, so we could investigate the complaint. Unfortunately, at this time we have yet to hear back from Ms. [redacted]. If she wishes to pursue this complaint further please have her email us the following information to the email below. We need the employee’s full name, DOB, as well as the medical office/group name this is related to.

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:

Dear Ashley S.Re: Complaint [redacted]Please note I have not received any messages from Aetna direcly to solve this situation. All the calls I have received have been from the collection agency. However, here is the information requested:Employee Name: [redacted]Date of Birth: [redacted]Employer: [redacted] Aetna Account Number [redacted]Thanks for your prompt response. [redacted]cc: Revdex.com

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].

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: Aetna states I owe them reimbursement for LTD benefits after awarded SSDI. All paid-now 2 years later they say I owe additional.

Aetna provided LTD payments through my employer, UPS, from March 2010 through February 2011. Aetna contracted with [redacted] to help with awarding of SSDI and then to collect over-payments after I was paid back SSDI payments. This was collected by Allsup and this sum is not in dispute.

My disabled son received an increase in his SSI payment (now collecting under my benefits). [redacted] collected $5,373 on 3/22/11 via credit card for payment of child's increased award. On 4/16/2013, I received a letter from Aetna stating that the total owed was $5, 623.50 and that my current outstanding balance is $3,774.25. I sent proof of payment and asked for additional documentation. None provided. Now sent to collection agency [redacted] and is reported on my credit report. Documentation of payment was also sent to collection agent [redacted]) on June 24th, along with written notification of disupute. I had been told this would not be reported to credit agencies while it was in dispute. Also note that this request came over 2 years from actual payment.

My accountant has also reviewed-this involved complex tax returns for affected years, and he believes Aetna is in error.

Desired Settlement: I am requesting that Aetna review their records and provide sufficient documentation of the the charges it seeks to collect. I have paid everything through [redacted] as requested and have documentation of all correspondence and payment. [redacted] believes there should be no problem and they paid Aetna. If Aetna believes it was not reimbursed appropriately, [redacted] or Aetna itself is responsible for the error. Collection activities must cease.This incorrect information must be removed from my credit file.

Aetna disability claim case #: XXXXXXX.

I

Business

Response:

Business Response /* (1000, 5, 2013/08/06) */

Thank you for your inquiry received on July 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 Disability department for assistance with the member's concerns. They advised the member's file was overpaid on two separate times:

1. December 10, 2010 for Primary Social Security, $20,054.50 gross/$16,280.25 net (if paid in 2010).

2. For Family Social Security, $5,623.50 gross/$5,373.30 net (if paid in 2011).

For the Primary SSD, since the overpayment wasn't paid in full in 2010, the full gross amount was due $20,054.50. [redacted], our Social Security vendor, recovered $16,149.00 on

January 21, 2011 and $131.25 on February 7, 2011, leaving a balance of $3,774.25 on the Primary SSD overpayment.

The Family SSD, [redacted] recovered $5,373.30 on April 5, 2011, recovering the overpayment due to Family SSD in full. Since the overpayment occurred in 2011 and was reimbursed in 2011 the net overpayment was due.

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, 2013/08/12) */

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

I had a long-term disability policy through my then employer [redacted]. It provided a defined monthly benefit. When I was approved for Social Security disability payments, I received a lump sum from Social Security retroactive from the date of coverage. I repaid Aetna every penny of the amount I received from Social Security. I have provided documentation of this payment. I do not understand why I have to repay more money than I was reimbursed by Social Security. Isn't that the purpose of the disability plan?

Business Response /* (4000, 9, 2013/08/28) */

Thank you for your inquiry received on August 14, 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 Disability department for assistance with the member's concerns. We were advised that [redacted], Senior Technical Specialist at Aetna called and spoke with the member on August 20, 2013 and tried to address his concerns. She advised the member needed to review his lump sum payment from SSD and verify whether or not taxes or any other deductions were taken out as Aetna has to calculate the overpayment based on the gross monthly award. The member understood and stated he would review his SSD payments to verify if taxes or any other deductions were taken out.

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

Review: My complaint does not involve a health issue directly but rather nonpayment of insurance by Aetna. I am covered under a group Aetna policy through the [redacted] Aetna is my secondary insurer. I submitted a group of pharmacy bills back in April for payment under the Co-ordination of Benefits portion of my policy. Aetna has made a partial payment, applying the payment as if they were primary insurer. I have called them 3 times, been assured someone will call me back, and there have been no call backs. I resorted to emails - 2 of those without marking on their site that my complaint was "formal" and the last time stating it was a formal action. It didn't make any difference whether it was formal or not formal - all I get is a form letter saying they are investigating. I've run out of patience.What I want is a copy of the COB portion of my contract along with an explanation of how they arrived at the amount of their payment. Neither request should be difficult for them.Desired Settlement: What I want is a copy of the COB portion of my contract along with an explanation of how they arrived at the amount of their payment. Neither request should be difficult for them. Alternatively, they can adjust the payment amount to what it should be and send me a copy of the COB for future reference.

Business

Response:

Thank you for your inquiry received on September 17, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Shortly after the 2nd of January I started looking for immunization clinics because I am starting on a world wide journey tomorrow (February 2nd). I proceeded to call my insurance company (Aetna) and ask them if this would be okay and what was covered. I talked to a lady, but did not get her name (I just thought it was a routine question). I explained the clinic and what I was doing at the clinic. She proceeded to tell me that "Yes, you are covered. For out of network clinics, you pay 20% and we will pay 80%." I thought wow, okay that is awesome! I proceed to get all of the shots for [redacted], and [redacted]. My first visit cost me $1075.00 out of pocket. My Second visit cost me $80.00. The third visit cost me $325.00. So coming to a total of $1,480.00. I was expecting to get a check for 80% of the cost, which would have been $1,184.00. I submitted all of the claims and waited to hear back. I didn't hear anything back from them so a few days ago I called to confirm all the information. When I asked the guy I was talking to, he told me my claim had been denied. When I asked him why, he said the clinic wasn't covered. I proceeded to tell him that I had called before I even went to the clinic to make sure that it was covered and I had been told it was. I stayed calm, but I was very worried. I am a 22 year old girl who has a limited budget. For me it was eating and not eating. Having a place to sleep. It wasn't just $1,200.00..it was my livelihood. I know the people on the phone can't always do much, so I asked if I could speak to a manager. He proceeded to tell me she wouldn't tell say anything else. When the manager got on the phone, she has such a cold, callous voice. You could tell she showed no ounce of sympathy. She continued to tell me there was nothing I could do, but she could file an appeal. I said couldn't you listen to the call? I know it was recorded. She said they would listen to the call and I had to wait 30 days.Desired Settlement: If there is anything you can do, I would be so very grateful. I will be leaving the country tomorrow morning at 6am. All this is happening at the worst time, which makes it all so much harder for me to deal with. I will have access to the internet sporadically. My email is [redacted]. My global phone number is [redacted]. I also have a blog you can check out if you are interested. [redacted].

Business

Response:

Thank you for your inquiry received on 02/01/2014 regarding compaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Revdex.com info braces

I need help here, or I am stuck for life in these braces that they Aetna are responsible for the care and treatment for full completion.

finish the job

Complete resolution care and satisfaction to complete the care and services and obtain the initial desired goal and treatment that was assessed and diagnosed upon services. My desire is to fully complete the services for braces and obtain the goal set out to that was explained to me by dentist that rendered me care. Their expertise expressed to me that this is what they recommended to me. Aetna gave me all of the contacts to call for services within the network, and their rep gave the ** permission to treat via phone prior to their services.Desired Settlement: Complete the work and fully refund me for my monthly and out of my pocket fees and full reimburstment to me and with Aetna paying for the full completion of my braces in full without charges to me at all, due to the companies inability to resolve this matter with many attempts from me to many of their staff via calls. I need help here.

Business

Response:

Thank you for your inquiry received on November 17, 2014, regarding complaint # [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Since December 2014 I have had to make numerous calls and inquiries to Aetna to get my benefits paid correctly. I went through their precertification process and received written approval to have my health services covered as in-network at the highest rate. I have had to make more than 20 calls and sent several emails and I still am unable to get them to process my latest claim from 1/26/15 correctly. I have an email from them telling me that they made mistakes and are reprocessing and today when I checked it is still not correct. It is completely unacceptable that they run their business this way, every claim form I submitted has my case number for pre-approval and the letter they provided me with and they still processed wrong. After many calls I was told my account was marked for 'manual processing' to ensure it would be correct for the future and it is still wrong. There is absolutely no excuse for them to process these correctly when I did all the pre-work to ensure it was correct beforehand. I have hours of my time trying to get them to do their job.Desired Settlement: I want them to do the job I am paying them to do and process my claims correctly.

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 Claims department to have the date of service January 26, 2015 reviewed. We were advised that it was originally processed incorrectly and we had the claim reprocessed correctly under the member's plan. The member's policy was set up for manual processing on February 21, 2015 so that future claims will drop to a processor for handling.

Please accept my apology for the delay in processing the claim correctly, and that it required multiple attempts on your part to resolve your issue. Unfortunately, in some instances, procedural errors do occur. When they do, we take them very seriously and do our best to understand how and why the errors occurred and determine what we can do to prevent a recurrence. We continually use feedback like yours to improve our service and prevent issues from reoccurring.

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

Thank you,

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

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: On May 11,2015 I received a check for $1,950.00 from Aetna Life Insurance Company via a company named [redacted] Card Services Inc. I deposited it into my bank and was contacted a week later by my bank stating the check was counterfeit! This was after I paid my rent and other bills. I have contacted Aetna MANY times to be told "we are looking into it". Meanwhile my good standing with my bank of 3 yrs is gone, and I cannot get another bank account.I need help getting this resolved asap pleaseDesired Settlement: I would like Aetna to put the monies into my account electronically (do not trust checks anymore)to include fees Also no derogatory affect with my bank Thank you

Business

Response:

Hello,

Review: received a letter in the mail stating that Aetna had dropped my health insurance as per my request. I never requested. After 2 days of phone calls with 4 hours of wait time via the phone a service representative stated that the letter was a mistake and I could dispose of it ??? It was because the Affordable Care Act was forcing me into a new plan and I was no longer grandfathered in. She continues to state that it will be $1004.00 per month with $6,000 for each person deduct. with 100% pay until reach of deductable. I stated that this was UNACCEPTABLE . She stated that I would have to speak with someone in sales and that the last day to change from this New plan was the 15th! She then transferred me to the "sales" department and dropped my call ! I phoned again spending 2.5 hours on hold with no answer. I phoned again 3 hours on hold no anwer. Over the next three days I called and called and called on hold NO ANSWER!! I searched the Internet looking for every number for Aetna , I called them all , either disconnected or on hold with no answer !! This evening one of the numbers yielded a switchboard operator , she was extremely rude with no regard for my situation , provided no customer service said she would transfer me to "sales" and she promptly hung up ! After 6 days and 14 hours of hold NO RESULT!! they will automatically enroll me into that expensive no coverage plan with NO OPTIONS !!!! This feels like to communism/socialism .Desired Settlement: To be able to speak with someone to place me into the appropriate Health Insurance plan for my family !! We've had great health insurance for 30 years , why is AETNA trying to force us into a plan that is OVER THE TOP EXPENSIVE INSURANCE PLAN WITH NO BENEFITS !!!!!!!

Business

Response:

During our review, we reached out to our Enrollment department to address [redacted]’* concerns. However, [redacted]’s information was not found in our system which required [redacted] to be contacted.An outbound call was placed to [redacted] by our Enrollment department so we could address [redacted] concerns. However, there was no answer from [redacted], so a detailed voicemail was left including the nature of the call and a direct call back number ###-###-####. This way [redacted] may call our Enrollment department directly so her concerns may be addressed.I apologize for any difficulties or confusion this may have caused [redacted]. 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 there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]Regards,Julian C[redacted]Executive Resolution Team

Review: In April 2012, the company I worked for went out of business and my coverage was switched to COBRA. I was covered under COBRA until 8/31/2012. However, Aetna made a clerical error and failed to enter the COBRA information. Because of this, they refused to pay my pharmacy bill of $400. I called & spent an hour on the phone being shuffled around until finally someone took the time to help me and paid the claim. Next, I got a letter saying they paid in error and wanted their money back. I have now spent over 6 months of frustration, including many hours on the phone, trying to resolve this. I've been told by three different people at three different times that the problem was solved. Now, I've received a collections letter.Today, my mom spent 2 hours on the phone with Aetna (we timed it). She, like me, was shuffled around in a circle ending up back where she started. She asked for a supervisor (a Ms [redacted]) three different times and was denied access to her. There seems to be no way to remedy this situation.My credit is now affected by Aetna's error and we have spent hours and hours in extreme frustration trying to fix this problem. What more can we do????

Product_Or_Service: Aetna Insurance

Account_Number: WXXXXXXXXX

Desired Settlement: Fix your error, and clean up my credit. Pay me for the hours I've spent dealing with this. (I know, I'm dreaming).

Business

Response:

Business Response /* (1000, 5, 2013/04/08) */

Thank you for your inquiry received on March 29, 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 Strategic Resource Company (SRC) for assistance with the member's issue. They advised the system was not reflecting the correct termination date for the Cobra coverage as August 31, 2012. They manually corrected the information and Aetna Pharmacy Management (APM) was contacted by SRC to have the credit file number XXXXXXXXXX reviewed. [redacted], Senior Customer Service Representative, with SRC, advised he spoke with the member's mother by phone on April 4, 2013 and explained the situation. We apologize for the delay and inconvenience.

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]com.

Consumer Response /* (2110, 7, 2013/04/16) */

(The consumer indicated he/she ACCEPTED the partial settlement response from the business.)

The only fear we have is that we've been told that this issue has been fixed three different times by three different people (this is the 4th time). We are afraid to hope that this time it really is fixed. We have received no paperwork from Aetna providing us with verifiable proof that this issue is repaired once and for all. For all we know, we will get sent to collections next month as well and we'll start this horribly frustrating phone circle all over again.

Review: The main issue is, now all of a sudden after covering a medication they refuse to cover it any longer and provide no explanation. I have had aetna insurance since 2010 on this plan and not once have they required a pre certification for my medication. All of a sudden I went to get my script filled and they wouldn't cover it, they said precert was required. So I paid cash. Then they approved the precert for only 3 months, and I was told by their customer service that precertifications are usually good for a year?When my doctor submitted the info to get the precert reissued they denied it.AN appeal was sent to Aetna from my Dr's office and they have not sent any response. Account_Number: wXXXXXXXXX

Desired Settlement: For them to continue the medication that I have been taking for years. My Dr and I have tried other therapies and this dosage works the best for me.

Business

Response:

Business Response /* (1000, 5, 2013/05/17) */

Thank you for your inquiry received on May 3, 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 department for assistance with the member's concerns. An appeal, Case number[redacted].com, was completed and a resolution letter was sent to the member on March 22, 2013. An authorization was backdated, allowing the drug that was filled on November 9, 2012. The authorization is now good for an indefinite timeframe since we have previously approved. The authorization number is XX-XXXXXXXXX, the drug was only approved up until February 26, 2013, however since we have covered this drug before for the member as 4 per day, they have extended it out indefinitely.

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.

Consumer Response /* (2110, 7, 2013/05/22) */

(The consumer indicated he/she ACCEPTED the partial settlement response from the business.)

I WOULD LIKE THIS IN WRITING FROM AETNA

Review: Was told by 3 different representatives that services would be covered and the failed to inform us that we must pre-authorize in order to get coverage

On May 13th 20013 I spoke w/ [redacted] at Aetna and was told for patient [redacted] that [redacted] were a covered benefit at 80%. On 07/22/2013 I spoke w/ [redacted] at Aetna and was told that [redacted] were a covered benefit at 80%.On 06/14/2013 I spoke with [redacted] at Aetna and was told that [redacted] were a covered benefit at 80%. All of these patients have Aetna coverage through their employer [redacted]. I submitted a claim for Mr. [redacted] for [redacted] placed on 05/20/2013 and the claim was denied because Aetna says that [redacted] are only covered when a pre-authorization is first submitted. I have exhausted my appeals with Aetna and am now turning to the Revdex.com for help. I was told the same thing by 3 separate Aetna employees and believe they should stand by their word. The patient cannot afford to pay for their employees gross misinformation.Desired Settlement: I want them to cover what they said they would cover.

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: I have Aetna Medicare Advantage Select Health Insurance (HMO) which provides for a Welcome to Medicare wellness visit with no co-pay or co-insurance under it's preventive benefits. There are several test, vaccines and other proceedures that the doctor may include under this visit. These test are clearly listed under Aetna's "Benefit #21 - Preventive Services" and stated to be at $0 copay. The very first test listed is an "Abdominal Aortic Aneurysm Screening". I went to my doctor for an initial wellness visit on May 7, 2014. His visit and lab test were properly paid by Aetna under the "Preventive Services" benefit, with NO co-pay. However, I was also sent downstairs to an in-network Imaging Lab ([redacted]) on the same day for the Abdominal Aortic Aneurysm Screening. Their bill was processed with a $35 co-pay deducted. I have spoken to 8-10 Customer "Service" Reps/Supv and have been given several different excuses. The most common being that the provider didn't code the claim properly to be paid as part of the preventive care benefit. However, none of them will tell me what needs to be changed to get it coded properly. I have also requested them to contact the provider and explain it to them which they also refuse to do. I have filed a Grievance/Appeal and was told that would take up to 30 get done. Last week, I was called by someone to followup on the Appeal. She looked at the claim and said it was processed by computer and the computer did not catch that it was part of the "wellness visit". I assumed she could fix the problem, but no she said I had to file another form, a "Request to Reconsider Denial" which could take another 30-60 days. I have mailed that form. No one at Aetna has said the claim should not be paid in full, but I can't find anyone with the ability and authority to get it done. How high does a $35 Aetna error have to go to find someone with the authority to fix it.Desired Settlement: I would like for Aetna to act in good faith and correct their error in processing the claim from their network provider. This is NOT a million dollar claim! It should not require a quorum of the Board of Directors to fix your $35 processing error. Your network provider has been calling me almost daily and threatening to turn me over to a collection agency. Waiting another 30-60 days for Aetna to fix their mistake is not acceptable.

Business

Response:

Thank you for your inquiry received on 07/14/14 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I was injured in a motorcycle accident on the 25th of April. I have [redacted] which I still am experiencing symptoms from.\par I have short term disability through work.\par I have seen one check from them that was for the complete amount for the total amount that I was owed for. I should be receiving individual checks, which should have started from the 25th of April. On May 30, 2013, they deposited $1231.32 into my account and there was no breakdown provided of what they are supposed to be paying me.\par I had to see my Doctor on May 28th for the same issues from the accident. According to my doctor, I will eventually have to have another surgery. Myself and the doctors office went through all the proper channels and sent in the requested paperwork to keep my payments coming, because I am still too weak for surgery at this time. \par I called the company this morning, because I didn't receive a check. I found out from the representative that they closed my case. No one called me, no letters received, no notification was given informing me that they were going to close my case. My case should remain open as I am still under doctors care.\par I feel this company is not professional and not providing me with quality customer service or assistance. This company lacks professional business ethics in customer careDesired Settlement: I would like the company to reopen my case. I want them to be more professional and communicate with me as to what is going on with my case. They just make decisions without consulting with anyone to see what the status is on their situation. I also want them to send me a breakdown of my individual payments that I never received

Business

Response:

Business Response /* (1000, 5, 2013/07/08) */

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

We reached out to the Disability department for assistance with the member's concerns. The disability claim was called in on April 30, 2013. They did not get medical information to support the disability claim until May 16, 2013. The disability claim was approved on May 21, 2013 at which time we called the employee to advise of the approval and what was needed to extend the disability. An approval letter was sent out to the employee. During the approval call, we do not normally discuss the payments unless the employee asks the amounts he will get. With direct deposit an Explanation of Benefit (EOB) is not sent to the employee. Our letters do advise the claim will close and on what date if we do not have updated medical. The employee called upset and had asked for a call back from the benefits manager not understanding why his claim was closed. The benefits manager did call the employee back to walk through when the medical came in and what was received. She did advise it was minimal information. The employee did say he followed up with his doctor's office after he spoke with the customer service representative that morning and the office did share the information it was on doctor's desk and had not been sent over to Aetna and he apologized to the benefits manager as it was not our fault. The Disability department did get updated medical and the member's disability is currently approved to July 16, 2013. Also, Aetna does not issue benefits; they are issued from member's employer.

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 claim issues with Aetna Health Insurance.I filed a complaint through NCDOI.I had sent in claims with no acknowledgement(TWICE).I did everything I could to do to make it SIMPLE for them to process my claim.(mailed claims for dependents seperatle y)NCDOI forwarded my complaint and my claims (FOR THE THIRD TIME!)They acknowledged receipt (they had to at this point).They said they were processing the claims (oh yea,we have to now.....right).This company will do anything it can to ignore claims.Their response to my complaint to NCDOI completly ignored my complaint that they do not process claims unless there is proof of receipt.They said "we regret this has come to this point and we do everything to ensure that this does not happen" I am paraphrasing. BS!When I called to ask about their receipt of claims was "Do you have a fax machine"?It was like if you faxed them this would be a non issue.My response was "NO".I beleive they were trying to say unless you are faxing claims you have no proof that you mailed them to us.This happened twice.Ironicly,they sent some EOB responses that I had sent to them way earlier that they had not responded to.This company has received my claims and have tried to deny them.This is not the first time.Charles Jarvis

Product_Or_Service: Health Insurance Claims

Account_Number: ID [redacted]Desired Settlement: Acknowledgement of wrongdoing.No more ignoring claims.They know that this has happened and think they can pacify me with their response to the NCDOI.Not gonna happen.

Business

Response:

Thank you for your inquiry received on September 6, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I have not been able to get allergy shots now for over two months due to Aetna confusing my account with my son account. We go to different doctors and each doctor is filing correctly. Now I cannot get allergy shots due to all of the claims being filed under my name and I am over the limit due to Aetna's mistake. I called three weeks ago and the issue was brought to Aetna's attention and I was told the matter would be cleared up in two weeks. I just got off the phone with my doctor office and it still has not been cleared up. I need this matter resolved so that I can get the medical attention that I need!Desired Settlement: I needs Aetna's records to be corrected so that I can get allergy shots as needed.

Business

Response:

Thank you for your inquiry received on September 18, 2*13. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: A few years ago I purchased Aetna's prescription insurance. About eight months ago I realized that Aetna was charging me a premium of about $40 per month and providing me almost no service. Rarely, when I would need any prescribed medication, some time the medication would not be in the coverage package or the discount was minimal.I decided to cancel the insurance. About eight months ago, with one month's advance notice, I informed Aetna to cancel my prescription insurance. I did not hear back. For last eight months, every month I am receiving the monthly statement every month. The statement shows the balance from the previous month + late penalty fee + the premium for the next month. The latest unpaid total is shown as $361.20. In last eight months I have neither attempted or received any benefit from the insurance.

Product_Or_Service: Aetna Prescription Insurance

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

1. Aetna should stop sending me the statements.2. Cancel the balance of $361.20.3. If any information was sent to the credit rating companies, that information should be corrected so that there is no impact on my credit rating.

Business

Response:

Thank you for your inquiry received on 05/30/2014 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.