Aetna, Inc.

Review: I authorized [redacted] to send me a breastpump and I paid $150. Insurance is suppose to cover the rest for $250. Instead Aetna authorized a payment to [redacted] healthcare for the amount of $250. Now I am stuck with a $400 bill that should have been covered by Aetna in the amount of $250. Aetna doesn't care to correct this or review this. They will not retract a payment and said the services are satisfactory. How is this right when I am out paying for something I never wanted? [redacted] HealthCare will not acknowledge their mistake and will not accept the breast pump back which is unused and unopened in its original packaging.Desired Settlement: Aetna needs to submit payment in the amount of $250 to [redacted].

Business

Response:

Thank you for your inquiry received on February 06, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to Aetna’s Plan Sponsor Service Consultant for assistance with the member’s concerns. Under the member’s plan, only one breast pump is covered per pregnancy. Our records show that we received a claim from [redacted] Healthcare Service for a breast pump on October 25, 2013. We later received a claim from [redacted] Systems for date of service October 28, 2013, for a breast pump which we denied as the allowable limit had already been met.

Review: Aetna is not processing claims from the [redacted] correctly. I went to the [redacted] Emergency room in August 2012. At that time I was employed by [redacted] and under their health plan policy. [redacted] decided that I needed to be admitted, but due to the [redacted] not being in Network I was transferred to [redacted]. All of my deductibles were met and I paid the $250 co pay required for the emergency room visit. However they are stating that I still owe nearly $800. Due to the lack of communication on Aetna and [redacted]s part, this situation has not been taken care of. I have made multiple attempts at getting the situation settled with both, spending countless hours doing three-way calls between Aetna and [redacted] and the situation is still un-resolved. I now have a collection agency threatening to report to the credit bureaus and I am at a loss of whom to contact or what to do to get this taken care of. Please help!Desired Settlement: I would like Aetna to contact [redacted], get the billing codes corrected and resolve this balance due before it negatively affects my credit. I feel that because I was admitted to the hospital, Aetna should be responsible for any balances due after all deductibles and copays were met. Which they all were.

Business

Response:

Thank you for your inquiry received on September 19, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I have been overcharged on my health insurance premiums for 2 months now. Every time I call member services the wait time to speak with a representative is no less than 45 minutes. During my last call they told me my premium was supposed to be $100 less than what they charged and they would reimburse me for it the following month. The following month I was charged $60 more than the previous month so I have now been charged a total of $260 more than I am required to pay in the last two months. I am still trying to contact someone to resolve this issue to no avail. I am beyond frustrated and not sure what else to do other than canceling my insurance.Desired Settlement: I would like the overcharge of $260 refunded as well as some restitution for all the time I have spent calling Aetna about this issue.

Business

Response:

Thank you for your inquiry received on 01/07/2014 regarding the assigned complaint #[redacted] by [redacted] regarding being overcharged on her health insurance premiums.

Aetna's case number [redacted] and due date 01/20/14.

Sincerely,

Executive Response Team

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Sincerely,

Review: My cell phone number is a on a no-call list and Aetna keeps contacting me on the phone almost everyday. They have voice mail system and it seems automatic for what I can tell. When I go through and actually talk with one of their representatives, I request them to stop calling, and the person I'm speaking to hangs up the phone on me.

Desired Settlement: I just want them to stop calling me.

Business

Response:

Business Response /* (1000, 5, 2013/09/03) */

Thank you for your inquiry received on August 20, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We have placed the complainant on the Do Not Call List. This will exclude them from receiving outbound calls regarding current and future campaigns and solicitations for the marketing of new products, services and materials. Thank you.

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: The vision rider on our Aetna health insurance includes a portion whereby lenses/frames claims are processed through our medical rider. There is an [redacted] vision rider that is merely a "discount" program and not an actual insurance. Providers are contracted to participate in [redacted] but there are no claims for the me to submit. Once I have the [redacted] discounted price, I am then able to submit my vision expenses to the medical portion of my Aetna insurance. At this point, my expenses are paid (after deductibles have been met), at 80% of WHAT I HAVE PAID, NOT what is usual and customary or the contracted price. For dependents under 18, there is no cap on the amount I am reimbursed. For dependents over 19 as well as my husband and I, it is still 80% of what is submitted but there is a $200 cap. I am still trying to get claims processed at the correct amount for claims dating from 3/31/14 for my daughter and 4/4/14 for my son and 5/6/14 for me, so that I can submit them to my FSA. I have contacted Aetna on 9 occasions and the claims are still being processed incorrectly. on 6/3/14 the customer service representative was sending the claims to the claims review dept. and I was told there would be followup calls to me. 2 follow up calls merely said they were still working on them. At no point can I call the claims review dept or anyone directly, and as of today, 7/7/14, the claims are still not processed correctly. I have also received "bills" from Aetna for $28.77 and $111.20 because they "overpaid" on the claims, and just this week, I received another check from Aetna for $71.18 as reimbursement on the claims. These claims have been processed at least 6 times by Aetna. At one point, my son's claim was processed correctly, but someone at Aetna resubmitted it and it then was incorrect. The only means I have of speaking with someone is through the general customer service number and unfortunately, the extent of these claims are beyond their ability to provide help.Desired Settlement: I would like to be able to submit correct EOB claims to my FSA so that I may be reimbursed what I have already paid out of pocket for services. At this point any EOB provided by Aetna would be incorrect and I would be submitting a fraudelent claim to my FSA.

Business

Response:

Thank you for your inquiry received on 07/07/14 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: Unethical Claim/Reimbursement Practices - Overpayment of two orthodontic treatments to Dr. [redacted] - one for myself (complainant) and the other for my son ([redacted]), in which both treatments have been completed and payments, including partial coverage that should have been covered by Aetna Dental insurance, have been paid in full via my Health Spending Account (HSA) over the years as the aforementioned orthodontist and office staff failed to properly bill my insurance. I hereby report that Aetna has been contacted numerous times starting in April 2014 regarding this issue (request for full reimbursement directly to me and not to the orthodontist), which has been denied; hence, has been escalated to management, Corporate Office/Executive Resolutions Team (ERT), including Aetna [redacted], and General Counsel ([redacted]), [redacted], to no avail. The last Aetna representative I have spoken to by the name of "[redacted]" in the Executive Resolutions Team failed to provide any resolution nor a simple follow-up. I have contacted the Corporate switchboard operator again for a status update, but was instead placed on long holds, then ultimately and deliberately transferred to a voice mailbox, which appears to be unmonitored, as I still have yet to receive a requested callback - 2..3 weeks later. It appears that Aetna's Claims Department strictly adheres to the company process of reimbursing filed claims only in small amounts, which can take up to 1.5 to 2 years to receive in full, regardless if the treatments have already been completed, there is no owing balance to the provider, and the paying plan member is requesting it. This subjects me and any members in a similar situation to unnecessary delay and forced effort in attempts to obtain the entitled funds from a provider; wherein, services may no longer be in use or patient-doctor relationship no longer exists. Members are also subjected to the strong possibility of funds mismanagement (deliberate or accidental) by the provider and/or staff in disbursement of the full claim amount.Desired Settlement: I hereby request to amend Aetna's Claim policy to protect its members and not subject them to victimization or possible theft along with my request to directly reimburse me on the overpayment in one lump sum. Further actions, which are not limited to litigation and/or class action suit, will be taken if the above requests are not honored in a timely manner. Countless hours, which have caused monetary loss, along with wasted efforts have been exerted due to this situation.

Business

Response:

Thank you for your inquiry received on 09/17/14 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 pre-certified by Aetna, I still have the approval letters, to receive [redacted] for migraines. I had the injections January 23, 2013. Aetna refuses to pay my claim, saying that they are not my primary insurance. I have Worker's Compensation insurance for an injury to my wrist a year ago. When my doctor's office told me that Aetna wouldn't pay, I called them. I spoke to a representative, explained the Worker's Compensation insurance and what it was for, and told them that it had nothing to do with my [redacted] which would fall under my Aetna coverage. They sent my claim back to the underwriters saying that it was a mistake and it would be taken care of. I started receiving bills from my doctor's office, and I had to call Aetna again. I explained my situation with the Worker's Comp insurance again, and the representative again said that it was simply a mistake, they entered more information into their system, and sent it back to the underwriters. I am still receiving bills from my doctor's office, indicating that Aetna is not paying. They make small payments as if they were my secondary insurance, which is what they are claiming to be. I have called them about 5 times to try and correct this, and every time I am told that it is a mistake, they will send it back to the underwriters for payment. I just received another bill telling me that my payment is now 60 days overdue, I'm worried that this is going to affect my credit, and I just want Aetna to pay what they pre-approved me for.

Desired Settlement: I simply want Aetna to pay my physician's office like they are supposed to do. They are my primary insurance, I have informed them of this fact multiple times, and they are supposed to pay for this medical service because they pre-approved my getting it. I am tired of being harassed by the doctor's office, I'm worried about my credit, and I'm tired of making apparently useless phone calls to Aetna customer service and getting nowhere. I want Aetna to pay this claim.

Business

Response:

Business Response /* (1000, 5, 2013/06/18) */

Thank you for your inquiry received on June 4, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reviewed the claim history for this issue. The claim was already processed on June 3, 2013; claim was paid to provider on June 4, 2013 with a $20.00 copayment member responsibility

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].

Called Aetna trying to find a gastro doctor covered under my plan. The website has a list of Doctors but called all with in a reasonable distance and they all said they did not accept my plan. The rep gave me names of the list I already tried calling and we went round and round. Finally escalated to a supervisor and I asked if they would approve and out of network Dr. She said no and started on the "list" again. She found me a Dr. near me and I booked an appointment.
Well now I am being billed for an out of network visit. Called Aetna and they tell me the notes on my call about this only state I was told out of network would be my responsibility NOT that I was told this Dr. was in network and would be covered.
Also asked why I am being billed $40 co pays on Specialty not $15 as my card states and was told my card was not correct and my plan name was not correct yet they sent me the card at the beginning of the year stating it was my new card.
Hopeless trying to deal with them. They seem to bill services as they see fit, not applying correct totals to the deductible, and not paying for things that are supposed to be covered. No accountability. Anxious to change insurers and will never recommend or use Aetna again.
Can't wait to change to another plan!

Review: They deny nearly every FSA claim at least twice despite the fact that the expenses are approved (by the [redacted]) as legitimate.I eventually get my money but only after spending my time and money on stamps and envelopes. When I call for help the phone tree loops into nothingness - operators are never available when I call and the website is minimally helpful.This is my money - and I want it back.It is frustrating that I can't get my money back when the [redacted] says I am entitled to it but Aetna won't give it back despite following their instructions. It's no wonder health insurance cost so much - to much paperworkDesired Settlement: Reimburse me for my [redacted] qualified expenses and stop giving me the runaround with paperworkThank you

Business

Response:

Thank you for your inquiry received on August 06, 2014 regarding complaint #[redacted] for [redacted] Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I had Aetna Health Insurance and [redacted] Part A (Hospital Only). Aenta has denied multiple claims stating I have [redacted] and need to submit through them. I have made numerous calls to Aenta explaining that my [redacted] is Hospitalization ONLY. They have told me that there is an error and I am correct. I have been told multiple times this will be fixed but they have so far failed to do so.

I fear that my credit will be affected due to Aetna not processing the claims correctly. I need help fixing this as all my calls have been useless in solving this problem.Desired Settlement: I do NOT have [redacted] Part B. The claims need to be processed correctly under the plan I had with Aetna. I only have [redacted] Part A which only covers hospitalization and is the reason I was paying over $500 dollars a month for Aetna insurance as well.

Business

Response:

Thank you for your inquiry received on 05/28/15 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 our Claims department, and had the member’s claims reviewed. The member’s claims have now been reprocessed and corrected with [redacted] Part A only. 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 Ms. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Business

Response:

Thank you for your inquiry received on 05/28/15 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 our Claims department, and had the member’s claims reviewed. The member’s claims have now been reprocessed and corrected with [redacted] Part A only. 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 Ms. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Business

Response:

Thank you for your inquiry received on 05/28/15 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 our Claims department, and had the member’s claims reviewed. The member’s claims have now been reprocessed and corrected with [redacted] Part A only. 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 Ms. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Business

Response:

Thank you for your inquiry received on 05/28/15 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 our Claims department, and had the member’s claims reviewed. The member’s claims have now been reprocessed and corrected with [redacted] Part A only. 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 Ms. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: I signed up with Aetna via the [redacted] in December. Because of multiple cc processing errors (their system, not my card), I missed the January 10 deadline for coverage. Fine. I viewed this as a blessing in disguise. If a company has this much trouble processing payments, surely they can't be very good at processing medical claims. I decided to forego health insurance with Aetna and pursue other options. I called Aetna to formally cancel my plan. Then February rolls around and I have a bill from Aetna for two months worth of insurance. I called Aetna again to make sure I was really cancelled. After bouncing around on their very slow phone system and speaking with several people, I was assured that I was indeed cancelled and that I would not receive any more invoices in the mail from them. How foolish of me to believe them. March: same routine. April: same routine. May: same routine. June: same routine. The latest invoice claims that I owe them six months worth of insurance. The person I spoke with on the phone today assured me that I am indeed cancelled and it is just a problem with their system. I've had enough. It has been six months. I don't normally leave bad reviews but this is ridiculous. How much money does this company have to make before it can fix its software system? If anybody is reading this, do NOT sign up with this company. The people running it are not fit to stand on a street corner and beg, let alone run a multibillion dollar company that is in charge of other people's well being.Desired Settlement: I would like to stop receiving invoices in the mail from Aetna claiming that I owe them money. I would also like a statement from Aetna stating that I have a $0 balance.

Business

Response:

Thank you for your inquiry received on 06/25/2014 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: Paid my health insurance premium thru [redacted] on 12/30/15 and am not updated in the Aetna system as of today 1/20/15. Have placed calls for over a week to Aetna with no resolution. I am still uninsured as of today and have had to stop important medications and was unable to get a monthly IV medication because they have not made me eligible in their system.Desired Settlement: To be made eligible in the Aetna system ASAP

Business

Response:

Hello,

Thank you for your inquiry, regarding complaint #[redacted]or [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 Eligibility department to verify if the member should have active [redacted] coverage with Aetna. We confirmed that the member’s employer switch to a new health insurance carrier in the middle of 2015 and the member is no longer covered by Aetna. We were advised that a representative from the member’s Human Resources (HR) will be reaching out directly to the member to confirm that her coverage is with United Health Care. The member will need to contact either her HR or United Health Care with any benefit or eligibility questions. I apologize for any inconvenience this may have caused for the member.

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

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

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 Eligibility department to verify if

the member should have [redacted] coverage with Aetna. We confirmed that the

member’s employer changed health insurance carriers to [redacted] in

2015. We have no record of receiving any [redacted] information for medical coverage. However

for 2016, this member has medical coverage with another employer: [redacted]

Her member ID is [redacted]. The member ID card has been mailed. Please

allow 7-10 business days. She can register for Aetna Navigator with the new ID number to get

a temporary ID card.

We

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

contact us and giving us the opportunity to address [redacted] concerns. If you

have any additional questions regarding this particular matter, please contact

the Executive Resolution Team at [redacted] Thank you[redacted] Complaint and Appeal Consultant Executive Resolution Team

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution is satisfactory to me.

Sincerely,

Review: Last year my wife had [redacted]® ([redacted]) injections dispensed from Aetna Specialty Pharmacy. Even with our Aetna insurance, the injections were more than $1,700 a month in out-of-pocket expenses. As such, we were approved for copay assistance from the [redacted]. However, due to the strict timing of the injection schedule we were required to pay the copay on the first month of injections before all the paperwork could be processed for the copay assistance. Aetna Specialty Pharmacy assured me that once they received payment from the copay assistance, they would reimburse the copay. I have called the billing department every few months for the last year to ask what the status of the reimbursement is, and every time I am told that [redacted] has still not payed them. However, Aetna Specialty Pharmacy never sent the dispense information or bill to [redacted]. Two months ago I arranged a conference call between Aetna Specialty Pharmacy billing department and [redacted]. With all parties on the phone, Aetna agreed to send the needed dispensing information for [redacted] to process the copay assistance. As of today, that has still not been taken care of.Desired Settlement: 1. Aetna Specialty Pharmacy properly submit dispensing information and bill to the [redacted].

2. Process the reimbursement to me for the original copay

Business

Response:

Thank you for your inquiry received on 04/20/2015 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 states they cover 60 consecutive day of physical therapy on the day you start. If you have further surgery related to the same issue, they grant you an additional 60 days of physical therapy. I expected to have received 120 days of physical therapy covered by the insurance company, but they only offered the 60 days and a little overlap (approx. 2 weeks). I received a bill to cover the physical therapy charges, then immediately disputed the charges. I filed an appeal with a doctor's note, explaining the need & prescription to have extensive physical therapy. They denied my appeal, only to tell me it was too late to appeal but then also reviewed the case and gave me a reason and to refer to the handbook. It makes no sense, why won't you deny my appeal based on date then give me a reason? Well they never mentioned a time frame for an appeal, secondly, they never provided any documentation to prove what they are saying is valid. No handbook, nor copies of handbook were given stating their physical therapy coverage policy.Desired Settlement: I would prefer to not only have a full refund, but also an apology admitting their fault.

Business

Response:

Thank you for your inquiry received on 04/09/2015 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: On October 19, 2013 I went and got [redacted] at an urgent care facility and was told at the facility that my insurance company would reimburse me for the charges, as I did not have my insurance card with me. I called my insurance company immediately after, Aetna Student Health, and they verified this information, as long as I could provide them with the services received. I faxed them my receipts totaling $28.00. Aetna mailed me a check for $57. I immediately called them to notify them of the mistake and Aetna informed me they would mail me an envelope to send them back the incorrect check and then I could wait for a new one. I waited several weeks and I was never mailed an envelope. I called back in November, December, and January inquiring about this issue and every time I was assured that they would resolve it immediately, which they never did. On March 29, 2014 I received a letter from Payment Resolution Services, a debt collector, stating they had been contacted by Aetna Student Services to recover $35.68 that I allegedly owed. I do not owe Aetna a penny, I had reached out to Aetna to be honest about a mistake they made and rather than communicate with me they contacted a debt collector. I do not understand what kind of business they are running.Desired Settlement: I would like Aetna to contact the debt collector and have that issue resolved, because I do not owe Aetna $35.68.

Business

Response:

Thank you for your inquiry received on March 31, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. We reached out to Aetna Student Health (ASH) department for assistance with the member’s concern. They advised the member cashed the check on March 31, 2014. The claim was reprocessed issuing the correct benefit of $28.00 plus .27 cent Prompt Pay Interest (PPI). Originally paid employee $57.93 and less the corrected benefit of $28.27, there is an overpayment of $29.66. ASH updated the employee’s file and have sent a corrected overpayment letter requesting refund of $29.66.

Review: [redacted] by mistake billed [redacted] for a medication on January 8th 2014, [redacted] paid for the medication when they should have declined it. A year later they sent me a bill for this medication, unfortunately my new insurance does not cover this medication, should they declined as they were obligated to, I would have gotten a new medication that is covered. Now because of both [redacted] and [redacted] mistakes, [redacted] is attempting to charge me a year later for a medication I wouldn’t get should they do their jobs.

I asked you to assist me with this dispute, as I believe it should have to be worked between [redacted] and [redacted]Desired Settlement: I do not belevie I should be held responsible for a mistake made by [redacted] and [redacted], I ask you to ask [redacted] to work with [redacted] and release me of responsibility for their mistakes.

Business

Response:

Thank you for your inquiry received on 04/07/2015 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 doctor suggested me to do [redacted]. I called Aetna member services in December 2014 to find out if [redacted] is covered as preventive care because on Aetna navigator it is mentioned that [redacted] can be done under preventive care. Aetna member told me if my doctor submits bill under preventive care then It is 100% covered and I don't have to pay anything. I received a bill from Doctor and when I check claimed on Aetan navigator, it says I have to pay deductible.

1. I called Aetna 03/12/2015 to find out why do I have to pay deductible. First answer from Aetna doctor submitted bill as diagnosis procedure. I said no. It is not true. Then they changed story saying that it is not consider as preventive care because I am under 50. When I called in December no one mentioned me about this. I also checked in benefits book and it is not mentioned in it. I also checked on Aetna navigator and it is not there either. There is not a single place it is mentioned about age limit 50 or above for [redacted]. I asked representative that I want to talk to Manager. Response I got that I cannot talk to manager directly. Manager will call me within 24 to 48 hours.

2. I talked to Aetna coordinator at work and explained him what happen to me. Aetna responded with email saying that I talked to aetna representative in December but I did not asked anything about [redacted] (Another lie)

3. I called again Aetna 03/19/2015 because I did not hear anything from Aetna, now they came with another excuse that during preventive care procedure if they find anything wrong then preventive care procedure becomes diagnosis care.(Another lie). I insist that I want to talk to manger they finally got manager on call. She said she will check with claim and call me back by end of day. She did not call me on same day, she called me on 03/20/2015 and gave me same answer.

They don't to pay for my [redacted] so they are playing game with me. Every single time I talked to Aetna they came up with different answer.Desired Settlement: I want them to pay my [redacted] bill as it was discussed in December under preventive care

Business

Response:

Thank you for your inquiry received on 03/23/2015 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: Hello I have two separate problems in one in a sense, My insurance company refused my cancellation request, I had requested for them to cancel my insurance and they said they could only cancel it if my previous employer authorized it and my previous employer refused to cancel my insurance because they were disgruntled that I was quitting after being there for 5 months and also my previous employer kept my last pay check because they said I owed more for my insurance bill then my pay check was, as far as I know that is illegal but I don't know that. My previous employers name is, [redacted] , located at [redacted] the owners name is [redacted]. I also worked a lot of unpaid over time but I know I have to contact the board of labor to handle that. Aetna would not respond to me when I had asked them for the balance was that I supposedly owed.Desired Settlement: I want my paycheck that I lost due to this matter and I want the insurance cancelled because I have insurance available from my current employer.

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 our Eligibility department to verify when the member was active with the insurance. We confirmed that he was active from February 01, 2015 through February 28, 2015. The member will be responsible for that month’s premium to the employer.

Premium payments are made by the employer to Aetna and the member pays their portion to the employer. The member would have to work with the employer regarding the premium payments, as this is considered payroll information. Aetna would not be able to verify the amount owed by the employee for a month’s premium or refund the member this amount.

I apologize for any difficulties and inconvenience this situation has caused. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address your concerns.

If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at[redacted]

Thank you,

[redacted] %

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Sincerely, [redacted]

Review: Received a bill from Aetna erroneously. I do not have an Aetna policy and received a bill for pharmacy at local [redacted]. I tried to call to clear up bill, spoke with[redacted]. She told me to just pay it. This is not right.Desired Settlement: I want this bill resolved.

Business

Response:

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

Review: I went to doctor for the annual physical checkup around July 2nd, which should be 100% covered under the insurance policy. However, the medical bill showed only partial coverage with about $414.42 amount that I need to pay out of my pocket. I contacted aetna trying to resolve this issue but they claimed my previous visit to my [redacted] already used this benefit. The visit to my [redacted] was in January and that should be covered by the Maternity Care for postnatal visit and/or by the well-woman exam. That visit was not annual physical checkup at all, then why does Aetna claim so? The insurance policy clearly states that "Routine physical exam" is 100% covered. Well-woman exam (include [redacted]) is 100% covered. My member ID number is [redacted]. Case number is [redacted].Desired Settlement: Aetna should provide the 100% for the routine physical examination as stated in the insurance policy and pay all the charges for the routine examination.

Business

Response:

Dear Ms. [redacted],

Thank you for your inquiry dated 01/08/14 reference #[redacted], regarding the complaint received by member [redacted]

about the routine exam rendered on 07/02/13. Our Executive Resolution Team is reviewing the complaint and will respond to you by 01/21/14. Reference Aetna case #[redacted].

Sincerely,

Executive Response Team

Business

Response:

Thank you for your inquiry received on January 7, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.