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Aetna, Inc.

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Reviews Aetna, Inc.

Aetna, Inc. Reviews (441)

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: 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 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: 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: 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: 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: 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.

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].

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.

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: 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: 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: 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: 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: 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: 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,

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: 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: Twice now my wife and I have been using birth control and picking it up at our local pharmacy. The first time the pharmacist told us it was no longer free and we had to pay $50 that we should have gotten reimbursed for. Our reimbursement got denied because they said we were forced to switch over to having it mailed to us instead of completed in the pharmacy.We switched to a different pill and yesterday was told the same thing. We refused to pay and the pharmacy suggested we call Aetna to work it out. We don't have a secure mailbox, and Aetna told us that it doesn't matter, they refuse to continue using the pharmacy to allow us to pick it up.

Product_Or_Service: Birth control pills

Desired Settlement: I want two things: I want my $50 reimbused, and more importantly I want the ability to pick up my prescription from the pharmacy instead of being forced to have it mailed to us.

Business

Response:

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

Thank you for your inquiry received on May 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 department for resolution of the member's concerns. The member's plan has mandatory mail order and the member will need to use mail order after 3 retail fills.

Also, the member has a $50.00 copayment responsibility for the drug according to the member's plan and no reimbursement is allowed. We recognize that this is not the resolution you sought, and we apologize for the frustrations and difficulties you experienced.

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, 2013/06/07) */

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

We paid a total of $121.49, so according to our co-pay we were supposed to get reimbursed 71.49. I now understand the mail order part, but we ought to have that money reimbursed.

Business Response /* (4000, 9, 2013/06/24) */

Thank you for your inquiry received on June 10, 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 Pharmacy department for review of the member's concerns. Unfortunately, the resolution remains unchanged. They reviewed the claims again and again it shows that we have always charged the member $50 copay for the medication. We do not see that we charged them any less or a $0 co-pay. At this time we will not reimburse as the claim is being processed with the correct plan benefit. We recognize that this is not the resolution you sought, and we apologize for the frustrations and difficulties you experienced.

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: Aetna continually voids my spouse's insurance coverage. It takes them 3 weeks to fix the issue, then--at the beginning of every month--her coverage is terminated back to June 1st. This means that we continually pay out of pocket despite the fact that I pay for her coverage through my employer without interruption. I've called every month since June to get it fixed. There is obviously a problem with the eligibility file being loaded. However, I cannot get anyone (Aetna or [redacted]) to get to the root cause and implement an permanent fix. It usually takes weeks for them to fix the issue and they have not followed up with me once since July. I've gone through the [redacted] customer service department who in turn is in contact with Aetna. They assure me that the coverage is valid and that they will fix the issue. Although I've requested it, they will not tell me who fixed it and how it was fixed. --so there is no one accountable for the issue when it comes up EACH time. I've also had my employer contact the [redacted] Account Rep, so that they could use their influence to correct the issue. It has not worked. The account rep only responded once to tell me it was fixed. --it was not. We are still paying out-of-pocket as of September.Desired Settlement: Stop voiding my wife's eligibility without cause. Find the root cause and implement a permanent fix.

Business

Response:

Thank you for your inquiry received on 09/09/2014 regarding complaint #[redacted] for [redacted]. Our [redacted] Team researched your concerns, and I would like to share the results of the review with you.

We reached out to plan sponsor liaison for assistance, and the employer-[redacted] Services corrected [redacted] wife’s account and are contacting the member to advise him of this information. [redacted] account is now showing active with effective date 06/01/2014.

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

Consumer

Response:

Review: [redacted]

I am rejecting this response because: I cannot confirm that the issue has been resolved until after October 1st. Although, we were able to fill a Rx this week, our problems have been temporarily resolved before. However, at the beginning of each month, my wife's eligibility is voided back to June 1st. Because of this and the need to have medical and Rx claims resubmitted for payment, I cannot confirm that this issue has been resolved. If the (1) medical and Rx claims do not get rejected for 'no eligibility' (2) my wife's eligibility is not erroneously voided on October 1st and (3) someone from Aetna or [redacted] actually call me to confirm items (1 and 2) are no longer a problem, I will accept the response to Revdex.com. It should be noted that no one has contacted me from Aetna or [redacted] to let me know that any of the issues that I have logged with them have been resolved or that we could attempt a Rx transaction. We found out by requesting our pharmacy to check every other day.

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Description: Insurance Companies, Insurance - Accident & Health

Address: 3150 Lenox Park Blvd #110, Memphis, Tennessee, United States, 38115

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