Aetna, Inc.

Review: I had a surgery done to remove an infection in my body. The insurance company has my claim coded incorrectly as a cosmetic procedure. I contacted them multiple times to resolve the issue. They advised that they did not have the right to contact my Dr. regarding the issue. They wanted 3rd party authorization. After I gave my consent, it took more than 30 days for them to review my dispute of the bill. No follow up calls were made that I requested to keep me updated during the process. I finally called to follow up on the dispute, and was told I was flat out denied. I asked what I would have to pay out of pocket for this so called "cosmetic" procedure to remove an infection from my body. The woman advised that she doesn't know and its up to the hospital to determine what they feel I should pay. This is a poor representation of the company. They do not have my procedure coded correctly. There is another portion of this bill that I am currently paying on. Yet they are cover that bill and not this one as well? They are not consistent with their business practices.Desired Settlement: *I wish that someone would contact my Dr. Directly. Get the correct information. Update my insurance claim. I do not intend to pay the mystery balance that I "might" be getting from the hospital, at any time or date. I will only pay for the procedure that was actually completed. Or I will not pay at at. Contacting me directly is a good start to this resolution, and getting the facts straight.

Business

Response:

Thank you for your inquiry received on 09/08/14 regarding complaint #[redacted] for [redacted]. Our [redacted] Team researched your concerns, and I would like to share the results of the review with you.

Review: Aetna Insurance Providing Misinformation and Mishandling a Routine Claim

On July 16, 2014, I had a routine prenatal panal test completed at [redacted]. I had previously experienced 2 [redacted] and my doctor ordered this panel to investigate the reasons why.

I later received a bill from [redacted] for the services and found that Aetna had denied coverage for the claim. I contacted Aetna and was told I needed a letter from my doctor indicating the necessity for these tests. My doctor provided such letter on October 30, 2014. I faxed this letter to the [redacted] for Aetna. During a follow up call, I was told Aetna did not receive that letter. I asked for the fax number once again and faxed it on November 18, 2014. The first attempt to fax the letter did not work as I was provided another incorrect fax number. I called Aetna yet again at that moment and was provided another number. I then had a successful connection and the fax was complete.

I followed up by phone and was told the paperwork was received and that the claim was being processed once again. In early December, I then again followed up with a phone call and was told that it was being paid and that a new bill should arrive but it would only be for a smaller amount, if anything at all as I had met my deductible for the year.

I was satisfied that the payment was being made.

I then received another bill from [redacted] on January 26th for $1080.62.

I contacted Aetna and was told by the representative, [redacted], that my letter was never received and that the claim had not been reprocessed and that I would need to again file an appeal. I explained that I was three months into the issue and that I needed to know why the appeal was not processed. [redacted] could not provide this information and said my only action was to again file the appeal. She said to send the letter again. I requested an address to send by certified mail and she gave me the address from the back of my insurance card, an address in **. I insisted a transfer to anyone else who could help me. Yes, I lost my temper at this point in the call.

I was transferred to another man who then told me that what [redacted] had said was not the case. The appeal was processed and the original letter was received but that they claim was still being denied and that I should have gotten a letter explaining why. I have not gotten that letter. He tells me it will be mailed soon and that it was processed on January 20th. He told me to send another letter from my doctor and file another appeal. He then gave me a [redacted] to send the letter to. A completely different state that [redacted] had given me just moments before, following yet another completely different scenario!

My complaint is that I am chasing my tail. Every single time I call and follow up with Aetna I am told a different story. I am asked yet again to file an appeal and am receiving conflicting information from the company as to what my next steps are and where to even send the information!

I am getting a bill that will soon be sent to collections and once again find myself reliving my [redacted] every time I need to call these agencies for information. I feel this is now harassment because it is an emotional and terrible situation that I need to retell every single time I call to get this settled.Desired Settlement: I want straight answers as to why this is being denied and a clear path to getting this settled. I was told, time and again, these tests are routine and should be covered, yet I cannot get anyone on the phone to tell me what to do from here. I want someone from claims to contact me and to stay in contact to ensure this situation is resolved.

I will get another letter from my doctor to ensure that all questions Aetna has regarding the tests are answered, but need someone to make sure the

Business

Response:

Thank you for your inquiry received on 01/28/2015 regarding complaint [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: My problem is that I called AETNA in December 2012 and explained that I would use funds accrued in 2012 to purchase reimbursable eligible items. I spoke with three different reps and explained to each one that I was using 2012 funds. I spoke with one representative and told them that I was using 2012 and would purchase the items in January 2013. When I submitted the claim, a representative later told me that the items should have been purchased in December 2012; I was specific when I spoke with the representative in December and January and explained that I would be using 2012 funds. AETNA refuses to acknowledge that their reps made a mistake and is sitting on my $160 (approximate) in their treasure chest. Not a good experience; in the past I have been extremely satisfied with AETNA services and representatives. This would not be an issue if I had not called AETNA multiple times not once but three times.Desired Settlement: My desired outcome would be for AETNA to reimburse the funds. This would not be an issue if I had not called AETNA; not once but multiple times before I made any purchase.

Business

Response:

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

Based on our review, we have found that our previous decision was correct. Unfortunately, we cannot make an exception to pay for services incurred in 2013 with [redacted] 2012 Flexible Spending Account (FSA). Expenses must be incurred during the eligibility period. In this case, the member’s 2012 FSA was effective October 01, 2012, and ended on December 31, 2012. Therefore, no exceptions can be made.

Under the plan, Aetna will perform a level one and level two appeal review. Once this has been exhausted, [redacted] has the option to submit a voluntary appeal to her employer, The [redacted], for further review. If [redacted] has not already filed an appeal with Aetna, she may do so by submitting a written request to the following address:

We take customer complaints very seriously. If you or the member have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Review: I am an employee of the federal government and can only change or add insurance plans once a year during open season. I researched and added Eatna [redacted] Effective 01/01/2015) for this year after confirming that my eye doctor was a preferred in network provider for exams and materials. When I went to make an appt. for an eye exam (yesterday, 3/4/15 at the [redacted] in [redacted]) the Dr. told me this was mistake, it is not in network, that AETNA had to correct this mistake, that other customers had the same problem and there are actually no in network providers here in [redacted]. I called AETNA and explained at noon today (3/4/15) and they told me they could do nothing and that I had to call [redacted] because I purchased the plan through [redacted]. I called [redacted], they said that the carrier, AETNA, was responsible. The [redacted] counselor ([redacted]) called AETNA and we had a 3-way teleconference for an hour, during which AETNA called my eye doctor and confirmed he was not in network but that there was nothing I could do, they could not cancel my plan, I could only go for an exam, fill out an out of network claim form and submit that for up to $40 possible reimbursement. The plan I enrolled in covers 100% and 85% of contact lenses. I asked them to cancel my plan since they can't provide what they sold me. They told me this is impossible. This means I am forced to continue paying for the insurance plan that I cannot use for the remainder of the year and I am inelligible to switch to or even add another plan until the next open season. They kept trying to transfer me to a [redacted] counselor, she was already on the line. I asked to speak to a manager, he was extremely rude to both of us and told me the only thing I could do was write a letter to AETNA's Quality Assurance Department. I tried to get contact information for that and he hung up on both of us (myself and the [redacted] counselor). [redacted] is doing a "Carrier Escalation" about AETNA but can do nothing to help me: in these cases, customers are directed to providers and the provider is supposed to work with the customer to provide service. The call was recorded, it began at 12:48 [redacted] time on 3/4/2015.Desired Settlement: I desire AETNA to cancel my vision plan because unless they do I cannot, through [redacted], add a vision plan that I can use for the remainder of the year and I will be forced to pay for the AETNA plan that does not provide what AETNA confirmed for me that it did when I added it.

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 [redacted] and we were advised an exception was already made for the member. We agreed to reimburse the member at the in-network level of benefits. [redacted] has emailed the member and asked her to submit a receipt, and we have also mailed a letter to Ms. [redacted] to verify that she can submit a receipt and be reimbursed at the in-network level on the eye exam.

The provider is only in-network for materials but not for eye exams. We are working internally to make a distinction between providers that only are participating for the exam and/or materials to prevent further issues such as this one from arising. We advised the member in the future she will need to utilize an in-network provider for the eye exams since there is one in-network in her area.

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

Thank you,

Complaint and Appeal Consultant

Executive Resolution Team

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: On 1/12/2015 an incorrect claim was submitted by my doctor to aetna resulting in $91.02 being charged to my Aetna [redacted]. I discovered the error and after 10-15 calls to both my doctor and aetna I finally got the claim corrected several months ago. The issue is that even though the claim was corrected the funds were never returned to my Aetna [redacted]. I called Aetna several times to correct and rather than correcting they have made the issue worse by taking an additional $91.02 from my Aetna [redacted]. Now a total of $182.04 is missing from my Aetna [redacted]. Aetna will not correct the issue and responds with "We will put in a request check back in a week" This has been going on for months now and I need Revdex.com's help in getting this issue resolved. I have made several attempts to work with Aetna and it is not working.Desired Settlement: An adjustment resulting in $182.04 being returned to my Aetna HealthFund HRA. $91.02 from the 1/12/2015 original claim that included the error and the additional $91.02 that was taken from my account in Aetna's failed attempt to correct the error.

Business

Response:

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

Review: Aetna denied me my [redacted] medicine on 5-29-15.Desired Settlement: I am a [redacted] and need my medicine. I called Aetna and talked to [redacted]. and he denied my coverage.

Business

Response:

Thank you for your inquiry received on 06/01/2015 regarding complaint # [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I have two pending claims from [redacted] and [redacted] dated 6/11/2014 and Aetna refused to process them. Aetna said that they did not receive the bills on time but the provider did bill the insurance company at the time of the visit.Desired Settlement: Process Claims & Remit Payment to the Hospital & Collection Agency

Business

Response:

Thank you for your rejection notice received on 07/21/15 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.

AETNA outsources their eyecare to [redacted]. Long story short, I had to file an out-of-network claim. I never saw the payment. I heard from an ex-employee that AETNA actually TRAINS their employees to outright DENY claims or make the process to get paid extremely difficult, if not impossible. My experience certainly would vouch for that.

Injured on the job at [redacted]. Received 5% disability rating and can no longer repair cars for a living. Aetna is refusing to pay long term disability I have carried for 4 years with [redacted].

Review: On another topic, please advise how much money I need to pay out of pocket for tests like X-rays, MRI. I may need some additional testing and I have already been stuck with $850 in lab fees. I would like to know what else I have to pay before Aetna will actually pay for any lab type work.

I would like an official complaint placed on record. I expect Aetna to work with [redacted] before our associates begin to seek alternate health care providers. Even under the best options, the coverage is terrible in comparison to other providers.

-[redacted]

cc: Congressman [redacted]

Revdex.com

From: [redacted]

Sent: Jun 15, 2015 2:56:46 PM EDT

To: [redacted]

Subject: [SEND SECURE] RE: [redacted]

Hi [redacted],

I have information regarding your concerns. We are sorry to hear that

you are unhappy about your out of pocket costs. The plan that you

have has a $1250 in network deductible, of which you have a remainder

of $637.50 to meet, as of today. Physical therapy applies to this

deductible first and, after meeting your deductible, your

responsibility will be 30% coinsurance. I hope this helps. Please let

us know if you have any questions or concerns.

Thank you,

[redacted]

Social Media Resolution Team (SMRT)

[redacted]

-----Original Message-----

From: [redacted].[redacted]

[mailto:[redacted].[redacted]]

Sent: Monday, June 15, 2015 11:46 AM

To: Social Media Customer Service

Subject: [redacted]

Hello:

As per our Twitter contact:

-[redacted]

-10/XX/19XX

-W19423XXXX

I am very unhappy that I arrived to my physical therapist to learn

that I have to pay $90 out of pocket until I meet a different type of

deductible. I recently had to pay for my entire MRI and I would have

hoped that cost would have met a majority of my deductible. I am not

rich and at this point I would rather suffer than be covered with

"better coverage," which really benefits me very little in exchange

for a hefty premium. If Aetna does something to actually help me I

would be blown away.

-[redacted]

Business

Response:

Thank you for your inquiry received on 06/16/15 regarding complaint #[redacted] for member: [redacted].

Review: Aetna issued a check no. [redacted] on [redacted] that was a reimbursement of my flexible spending account in the amount of 20.00 twenty dollars. I have never received this check. My company Flexible Spending Account with Aetna was eventually changed to a different provider but Aetna never sent me the check. After innumerous calls with Customer Service of Aetna and promises that the 20 dollars would be reissued and/or refuned to me, I have still not received the money due to me.Desired Settlement: Aetna should refund my 20.00 dollars, which is due to me.

Business

Response:

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

Review: I have been in a Aetna Consumer Driven Health Plan (CDHP) with the same ID number since 2008. Aetna refers to my fund in their brochure as a CDHP. Every January I have an employer contribution deposited into my account for medical expenses. According to the contract, as long as "I remain in the CDHP any unused remaining balance in the medical fund is rolled over" up to $5,000. In the eight years I have been with Aetna they have changed the codes of the fund (originally was 221) and names but I have always stayed with a CDHP funds and have never had issues with the rollover. I contacted a representative a few weeks ago on another issues and the representative went and wiped out the entire rollover amount on my account. I completed a survey and requested to be contacted and so far have been ignored with my rollover still gone.Desired Settlement: I am requesting my rollover be added back into my account. I have honored the terms of the contract remaining in a CDHP fund for the last eight years and I feel you should honor the terms of your contract by allowing my rollover to remain in the fund. I can only go with the wording you use in the contract. If you write something and mean something else that is something that you should clarify in the future contract. I should not be penalized because you misrepresent yourself.

Business

Response:

Hello,

Thank you for your inquiry, regarding complaint [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 our Enrollment and Eligibility department to have the member’s concerns addressed. We were advised that this member changed plan options in 2016. The member changed from the CDHP plan, enrollment code EP1, to the Aetna Direct plan, enrollment code [redacted]

The FEHBP brochure states in section 5: “If you terminate your participation in this Plan, any remaining Medical Fund balance will be forfeited.” If the member would have stayed in the same plan, the funds would rollover from year to year, but due to the plan change the member forfeited the funds in the 2015 account.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Freedman’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

Business

Response:

Hello,

Thank

you for your inquiry, regarding complaint [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 Enrollment department to review the

member’s concerns. We were advised that this member changed plan options for

2016. The member changed from the CDHP plan, enrollment code EP1, to the Aetna

Direct plan, enrollment code [redacted]

The

FEHBP brochure states in section 5: “If you terminate your participation in

this Plan, any remaining Medical Fund balance will be forfeited.” If the member

would have stayed in the same plan, the funds would rollover from year to year,

but due to the plan change the member forfeited the funds in the 2015 account.

Aetna cannot allow an exception for a plan change. The member would need to

speak to their Health Benefits Officer.

We

take customer complaints very seriously and appreciate you taking the time to

contact us and giving us the opportunity to address Mr. Freedman’s concerns. If

you have any additional questions regarding this particular matter, please

contact the Executive Resolution Team at [redacted].

Thank

you,

LaShonda

C.

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 will accept the decision even though I do not agree with it.

Review: We were initially told that as soon as we delivered our paper work, my insurance policy would go into play immediately. We turned in the paperwork on February 18 and my insurance card was delivered the first week of March with 3 errors on entered on Aetna's part-- the spelling of my first name, last name and birthday month and day. When the card arrived in march it said it would not activate until June 1, 2013. When I called to have all of my information changed, the first person I spoke with said it should activate in 30 - 60 days. When I pointed out that the start date was not until over 3 months from when I turned in my paperwork, she said my employer would have to call a particular department to have it clarified. When she called they said it can take up to 90 days to activate. However, June 1 is over 90 days from when we delivered the paperwork by about a week. It does not seem right to me that this health insurance company is making me wait uninsured for over 3 months before I can get coverage. Meanwhile I have health concerns I would like to be taking care of such as prescription medication and vaccinations for international travel. We do not intend to use Aetna again because of all the hassle we have dealt with.

Product_Or_Service: Health Insurance

Account_Number: Account # XXXXXXXX

Desired Settlement: I would ideally like my health insurance to activate by at least April 17, which is 60 days from when we turned in the paper work. But if that is not possible, it is only fair that they deliver no more than 90 days from when we turned in our paperwork which is May 17.

Business

Response:

Business Response /* (1000, 5, 2013/07/03) */

Thank you for your inquiry received on June 19, 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 Enrollment department for assistance. They advised the member's plan sponsor group has a contracted 90 day Benefit Waiting Period and the employee would be effective the 1st month after the waiting period. In this case, the employee was hired February 18, 2013, the 90 days brings it to May 18, 2013, and the 1st of the month would be effective date June 1, 2013 for this member. Unfortunately, the Enrollment was processed correctly for an effective date of June 1, 2013, based on the Employee's Date of Hire and the Group's contracted Benefit Waiting Period.

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 been in contact with Aetna every day for the past two weeks in regards for the termination and cancellation of my aetna insurance plan without notice of this and before the date in which I was said to be 'terminated' from my plan, I spoke to Aetna over the phone, getting lied to and the run around by customer service that has fed me false information since I have been concerned about my plan.There was also a claim on my account which was never resolved or no information was ever given to me in the false doctors visit that someone claimed to be me, [redacted] and I was being charged $471.00 for that particular doctor who I never saw.Along with that, I was told from the beginning that my general practitioner was supposed to be covered by my plan along with my medication and the first month or two they covered my doctors visit and medicine however; decided to stop, leaving me with a large bill.The issue is that I have been on the phone every day redirected to representatives that tell me one thing and then put me on hold, and tell me something completely different. I asked on 5 separate occasions for the manager in which was either never in the office, or in meeting and still have yet, 8 phone calls later, have had no response in regards to the piles of issues I have had with this company. I have never seen such a company so ignorant and disrespectful in my life in which has lied to me, will not call me back, and now, seems to hang up when I call their number. I still don't know the total in which I still have outstanding however; I feel at this point in time, I should be paid for my time and waste of life over the phone. I am currently looking for work and have been unable to do so due to the ongoing phone calls I have had to make to get down to the bottom of the situation.Desired Settlement: I would like to find out what the overall issue has been and the paperwork not matching what I have been told over the phone with Aetna. I feel I don't owe Aetna money and I want an answer why I have been getting the run around

Business

Response:

Thank you for your inquiry received on 07/09/14 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: did not follow with the process of transition of care as they instructed and they did not have a clear answer as to what happen to the form that submi Eatna is the new insurance that my husband was assigned through work, in their forms indicates there is a program called transition of care that will be honor for three months if completed before or the first week of eligibility. this done and they have not been able to process as of today. I'm under pain management care and depression medication.Desired Settlement: terminate the insurance so I can pay out packet to continue care with [redacted]. To continue the care I was receiving

Business

Response:

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

Based on our review, we were informed that one of our care managers contacted [redacted] on February 12, 2015, and was able to refer her to a participation provider. An appointment was made for [redacted] on February 19, 2015; therefore, a transition of care is no longer needed at this time. In addition, our files do not show any requests or denials regarding prescriptions for [redacted]

If [redacted] would still like to cancel her Aetna policy through her spouse’s employer[redacted]., her spouse would need to contact his Human Resources department for information on how to cancel the policy.

We take customer complaints very seriously. If you or the member have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Review: In the beginning of the month (March 2015), when I was about to have my teeth cleaned I found out that for some reason my Aetna DMO was not active despite my paying the premium monthly through [redacted] and I had to cancel the appointment. The first time I called it was my dental insurance was inactive as of 7/1/2014 and now it is inactive as of 1/1/2015. Every 2-3 days I call Aetna and [redacted] and get their customer service representatives who blame the other. At the AETNA customer service number, [redacted],they say [redacted] is not sending them the information to update the policy. When I call [redacted] at [redacted] they inform me they have sent the information to AETNA and will send again. Another problem is that neither have a person that you can go to for quick service, they just make you call back to see if it went through. The bottom line is that due to this stupid system I am paying for a service (e.g. the dental insurance) and unable to get that service (e.g. dental check up and cleaning). I am not sure it makes sense to go ahead with dental appointments without documented coverage since then AETNA could just go ahead and deny coverage due to that glitch.Desired Settlement: Reinstatement of active coverage.

Business

Response:

Thank you for your inquiry received on 03/30/2015 regarding complaint # [redacted] for [redacted] Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I have been a customer with [redacted], which is owned by Aetna for the past 18 months. At the beginning of the year, I renewed my plan with the [redacted] marketplace and resumed the receipt of my subsidy. However, Aetna charged me the full, unsubsidized price for the month of January. Fortunatley, the system issued me a refund for the subsidy. In February, once again, I was charged the full $200 but this time the system did not issue a refund. Noticing this on my bill, I called Aetna in March to resolve the issue and was told that it was being processed and I should see the refund in the next few days. A month later, after looking at my bank statements, I noticed that I never received the refund. I called Aetna once again and had to explain the issue once more. I was told that it would be processed in a few days. In July, after still not seeing any refund, I called again and once again I was told it would be processed in a few days. Just last week, I noticed that I still had not received a refund so I called again and mentioned how many times I have had to call in over this issue, and was told that it would be processed in a few days. Frankly, I am fed up with having to call in over this issue. It should have been resolved along time ago. In addition, Aetna's payment system is filled with glitches. Most of the time I am unable to access my bill online without encountering some sort of error. Please fix your payment system. When someone entrusts you their payment information, they should not have withdrawals for erroneous amounts.Desired Settlement: I want to be refunded my subsidy for February, which was approximately $200 (I don't know the exact amount because I cannot presently access my bill online and have not been able to access for the past several weeks due to Aetna's awful payment system).

Business

Response:

Thank you for your inquiry received on 09/15/15 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to the Individual Plan’s department, and the member is not due a refund. According to the member’s record, the Marketplace stated he was not eligible for a tax credit for the month of January 2015, so he was billed the full premium of $239.83. Aetna does not control or determine eligibility of tax credits for Marketplace members, and cannot make any changes without permission from the Marketplace. A refund of $216.00 was processed in error on 01/23/2015, and sent back to the member’s credit card. A plan change and premium change was received from the Marketplace on 01/12/2015, and was made effective 02/01/2015. The February bill then produced the charge back of the $216.00 that was refunded in error and the new rate of $23.83. If the member is disputing that he should have a tax credit for the month of January, then he needs to contact the Marketplace at ###-###-####.

Furthermore, the ebilling system was down previously, but the issue is now resolved and the member should now be able to access his account. We apologize for any inconvenience this may have caused the member.

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

Consumer

Response:

Review: [redacted]

I should get a full refund. It's obvious your online billing system is filled with glitches. It's not my fault that your system was unable to process my request. It is downright criminal that you would erroneously bill me with your inefficient system and have the audacity to refuse to give me a refund.

Sincerely,

If you ever had a choice of medical insurance, and aetna is one of them - RUN the other way, as if you life depended on it.
My company switched it's insurance from [redacted] to Aetna in July 2014. They promised to roll over the previous deductible from [redacted] into Aetna. My rollover didn't take place until Oct, after a consistent weekly, drawn-out calls with reps and finally supervisor.
During the period of July-Oct, medications were prescribed, which I paid 100% for, but should have only been billed at 50%. When the rollover FINALLY applied in October, I was sent to the "pharmacy" section to work with them on getting the overpayment of medication sent back to me. Again, after daily drawn-out "conversations" with the pharmacy department, a "resolution specialist" (not quite a revolutionist, neither a specialist) told me that it was finally resolved, and a check would be sent out to me on Oct. 22, 2014.
The last week of October rolled by. No check in sight. I called. They told me I have to be patient and wait. It's ONLY been a week.
Fine. First week of November came. No check in sight. I called. They told me I have to be patient and wait. The excuse now: It's being processed.
How did it go from it's sent, to wait, to now being processed? So the check never existed, and never left the building.
It is now the second week of November. Twenty-two days have passed. I called to enquire the whereabouts of this VERY elusive check. After being passed from a rep, to a resolution specialist, and then a supervisor, they finally tell me, that a check was NEVER issued. NEVER processed. The amount due back to me was never reinstated BACK to me. Meanwhile, that said amount has been removed from my total out-of-pocket amount.
THIS IS WHAT YOU CALL DAYLIGHT ROBBERY!

Review: Aetna is refusing to pay a medical bill because they did not my doctor listed as my primary doctor in their system. Although it is the only doctor I go to, and the doctor has also said they are my primary doctor. As an [redacted] sufferer, I see the doctor on a regular basis, and communicate with them even more frequently to have prescriptions filled, so it is quite easy for me to provide proof this is my primary care provider. Because of this, I have a $1,400 bill that they will not pay for regular medical care and tests that are done by my primary physician. I have filed an appeal, but it fell outside the 180 day window. I was told by both my doctor and Aetna, that this doctor would be fine to go to as my primary physician, so I was under the impression they were taking care of it, and I had no reason to believe this wouldn't be handled properly. All I'm asking is for Aetna to treat this doctor as my primary physician, and pay the bill as they normally would.

Product_Or_Service: Health Insurance

Account_Number:[redacted]Desired Settlement: I would like them to work with [redacted] group and treat my primary physician as the primary physician that he is. My bill is $1,482.00. My insurance should cover the vast majority of this.My doctor is [redacted] my No with [redacted] is XXXXXXXXXXXX.

Business

Response:

Business Response /* (1000, 5, 2013/07/03) */

Thank you for your inquiry received on June 21, 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. The claims for October 4, 2012 and October 17, 2012 were denied for no Primary Care Physician (PCP) selected. According to Aetna systems, member contacted Aetna concerning this issue, insisting this doctor was requested to be assigned as the PCP; however, there was no record that this PCP was assigned. We will allow the claims to be reprocessed as a one-time exception and will have the services reprocessed.

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 company canceled our Aetna dental insurance on 12/31/2012. Aetna continued to bill us after that date and our accounts payable department accidentally paid two month's of premiums before the error was caught. I called Aetna on June 21, 2013 to complain. Spoke with a woman who assured me all future billing would cease and that our biller would contact me about our refund within 5 business days. She never called and I got another bill. On July 10, 2013 I called back and spoke to a different woman who also assured me we would receive no further billing and that our biller would call me in 5 business days. She never did. I received another bill so I called again and was told the matter was only sent to billing on July 18, 2013 for manual adjustment and that it takes 5 - 10 days for processing. I am very disappointed in the way this has been handled by Aetna; I would not be inclined to use them for business or personal insurance in the future nor would I recommend them to anyone asking my opinion.

Product_Or_Service: Dental Insurance

Order_Number: n/a

Account_Number: Account # XXXXXXXX

Desired Settlement: Aetna owes my company $850.60 and I would like that money refunded promptly. I would also like them to stop billing me for additional premiums since we no longer have their dental coverage.

Business

Response:

Business Response /* (1000, 5, 2013/08/13) */

Thank you for your inquiry received on July 30, 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 Aetna Small Group Sales Support Team for assistance with the member's concerns. They advised that a manual credit adjustment of $1275.90 was requested for the group since the system did not generate credits upon termination effective December 31, 2012 that reflected in April 2013. Also, an immediate request for a refund of $850.60 was submitted and once approved will be sent as urgent. We apologize for any delay and inconvenience this has caused.

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].