Aetna, Inc.

Review: In 2014 I had Part D Rx coverage with [redacted] and change effective Jan 1, 2015 to Atena Insurance[redacted]. I take several different medicati

and now both Part B Health Plans are stating I have no insurance coverage for my medications and on 1/3/2015 I paid my co payment to[redacted] and no one received the co payment of $116.00. I cannot be without my heart and diabetic medications and[redacted] saids I have Atena and Atena saids I have [redacted]. Now, [redacted] said I have no insurance coverage. I will die without medications and I have called all day these two health plans and gotten no where. Can you please help me find out who is my Part D health plan.Desired Settlement: Coverage by one of these health plans.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on January 12, 2015.

Review: I filed a previous claim with the Revdex.com #[redacted] which is now closed. Here is the response from Aetna: MESSAGE FROM BUSINESS: Please see our response to the complaint # [redacted] for [redacted] received on December 18, 2014. Based on our review; we have found that our previous decision was correct. Unfortunately, we cannot make an exception to pay the claim, the member was advised that the [redacted] appliance would be considered as a medical expense, however, [redacted] treatment can be covered under her medical plan only if medical necessity is proven; otherwise [redacted] appliances are excluded from coverage. We take customer complaints very seriously. If you or the member has any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]. However, when I emailed the Executive Resolution Team at the above email address--they never responded. I emailed them with additional documentation on January 23, 2015 and I have not received a reply after 7 days. I would like them to respond to my email with the additional information!Desired Settlement: I would like Aetna Executive Resolution Team to respond by email to my email sent on January 23, 2015. My email address is [redacted]

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on February 03, 2015.

Based on our review, we have found that our previous decision cannot be changed. Unfortunately, we cannot make an exception to pay the claim. We must administer the plan as written in the plan document. Please refer to an excerpt from the Associate Handbook, in the chart on page 21, which states:

“Services for the disorder of the [redacted]

In network

Plan pays 100% of covered services after applicable office visit copayment if performed in physician’s office; otherwise, Plan pays 80% of covered services after deductible when medically necessary; excluding crowns, inlays, bridgework and appliances

Out of network

Plan pays 60% of covered services after deductible when medically necessary; excluding crowns, inlays, bridgework and appliances”

We are also showing a final appeal on file, under case #[redacted], that was upheld explaining the same determination. This plan does not cover crowns, inlays, bridgework and appliances related to TMJ. In the final appeal decision letter, we outlined that if [redacted] did not agree with the decision to contact the Employee Benefits Security Administration at[redacted]

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]

&n

Review: Aetna paid my obgyn bill from last year. Then decided to take the money back a year later claiming that I did not have coverage.

Aetna took money back from my obgyn [redacted] a year later. I got a bill in the mail from my doctors office saying that I owed $88.00. So I called and that when the billing lady [redacted] ###-###-####.. said that Aetna took their money back a year later claiming that I had no coverage. Well I called then and they are saying that it doesnt show in their system that they took the money back. Please help me! They did this to me one another claim recently. But praying that the other claim gets paid.Desired Settlement: I want them to pay what they owe my Obgyn $ 88.00.

Review: Date of service 3/25/15 Dr [redacted] I was billed as OUT OF NETWORK. HE IS IN NETWORK.

I have contacted both [redacted] and the person in charge of physician contracts and Aetna and ONLY THE FORMER has informed me that there is no way that they could submit a tax ID number from [redacted]. Aetna has never resolved the issue. They allege that Dr. [redacted] is not an in network provider which contradicts the signed contracts and Aetna's own records. This is what they wrote me on 7/10/15:

"We received your inquiry

The claim we received was billed under the [redacted] tax

identification number (TIN). Our records indicate that John [redacted] is

not contracted under this TIN."Desired Settlement: Aetna MUST adjust the OUT OF NETWORK CHARGES DEDUCTIBLE($285.80)already made and place them into the IN NETWORK CHARGES DEDUCTIBLE AND REFUND MONIES I HAVE PAID NEEDLESSLY, something like $41.12 AND cancel the balance they reported to Eisenhower that they say I owe [redacted], $46.93.

Business

Response:

Dear Ms. [redacted],

Please see our response to complaint #[redacted] for [redacted] that was received by us on July 15, 2015.

We contacted our Medicare department and asked them to review Mr. [redacted] concerns. They advised that the claim submitted by Dr. [redacted] for March 25, 2015, was processed correctly. Dr. [redacted] billed the claim with a nonparticipating tax identification number (TIN), which does not accept the Aetna Medicare PPO plan. Dr. [redacted] is participating under a different TIN than the one used on the claim. However, we cannot tell providers how to bill their claims. The Medicare department sent Mr. [redacted] a letter on August 04, 2015, which includes a detailed explanation of their review and his next steps.

I apologize for any difficulties this situation has caused Mr. [redacted]. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted] concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Regards,

Executive Resolution Team

Consumer

Response:

Review: [redacted]

I am rejecting this response because: I contacted [redacted] Billing today 3 times, was put on hold each time and then an automated message asked that I leave my name and number. I have already, months ago, contacted the person in charge of physician contracts and TIN numbers and she assured me that the matter would be resolved. Her name is [redacted] and her number is [redacted]. I spoke to her and her office at least twice beginning in April. She assured me that Dr. [redacted] has ONLY ONE TIN.Aetna on both occasions was cited as having made the error since Eisenhower does not even have the TIN Aetna claims to have used.

Sincerely,

[redacted] NAME CORRECTION PLEASE NOTE

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: Aetna is the provider of health insurance offered to students at [redacted] University. Health insurance is required of undergraduate students, but is optional for graduate students. There is a provision in the policy that charges students (consumers) a $100 penalty for seeing their primary care doctor without first obtaining permission (via a referral) from the university. This provision is a deviation from the terms of most health insurance plans. Because it is a deviation from standard health insurance terms, this requirement should have been clearly disclaimed in both the health insurance brochure and full policy provided to students. The Aetna brochure and policy do not indicate that this referral requirement is applicable to primary care doctors. No reasonable person would be on notice that such a requirement was part of the policy. In most (if not all) other insurance plans, the primary care doctor is the one that writes a referral. For this policy to be valid, Aetna was required to explicitly disclaim it, so as to adequately put students on notice of the possible penalty charge.

Product_Or_Service: Medical Insurance

Order_Number: Member No WXXXXXXXXX

Account_Number: Plan XXXXX XXXXXXXXX

Desired Settlement: I would like my $100 refunded. I would also like the policy and brochure to be revised so that the referral requirement is explicitly disclaimed to other students (consumers). It should be specifically stated that a referral from [redacted] University is required to see any doctor, even a primary care doctor, to avoid the $100 penalty. It is recommended the text be larger, in all caps, and red to be legally valid.

Business

Response:

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

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

We reached out to Aetna Student Health (ASH) for assistance with the member's concerns. According to the member's plan brochure, under referral requirements, a referral from the Student Health Center (SHC) is not a requirement; however, the deductible amount will be waived when services are provided at the Health Center or when a referral is made by a Health Center Doctor. The office visit for March 11, 2013, was not a routine visit. She did not have a SHC referral, so the deductible is not waived when there is not a referral. Unfortunately, the deductible requirement stands according to the plan provisions.

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: Have to call every month and fight to get my infant's medication approved, even though there is a letter on file stating it has been approved for a year. This letter is dated January 8, 2013. Yet, I have to call and spend hours on hold fighting for approval.

Desired Settlement: Approve the medication so I don't have to fight each month!!!!

Business

Response:

Business Response /* (1000, 11, 2013/07/26) */

Thank you for your inquiry. 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 Pharmacy department for assistance with [redacted]'s concerns. Since Ms. [redacted] is not covered under the plan, they did try to contact Mr. [redacted] on several occasions; unfortunately, the call was transferred to his voice mail. Our Pharmacy department will try on Monday, July 29, 2013 to contact Mr. [redacted] directly; or he may reach us at the below email address.

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].

Business Response /* (1000, 14, 2013/07/31) */

Thank you for your inquiry received on July 1, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to the Pharmacy department for assistance with the member's concerns. The issues with the authorization were corrected and the Pharmacy department has reprocessed. We apologize for the delay and inconveniences this has caused the member.

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

Business Response /* (-10, 17, 2013/08/01) */

The Pharmacy department also advised that the member was trying to get the drug from [redacted]. An authorization has been entered for 1 year (until July 25, 2014). This will allow the drug to continue to process on a monthly basis until that time. After that date, a new authorization will need to be entered.

The Pharmacy department contacted the member's pharmacy and they reprocessed the June claim and indicated they will refund the member upon their return to the pharmacy with the receipt. The July fill has also been processed and is being prepared for the member.

Aetna Pharmacy department has been trying to contact the father numerous times to let him know the medication can be picked up and our systems have been updated.

Consumer Response /* (2110, 18, 2013/08/01) */

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

It is sad that a Revdex.com complaint had to be filed for an action to occur when I had contacted the business personally on numerous occasions. Since the result I wanted was for medicine to be approved on a monthly basis I can not state whether the result was conclusively resolved for another month.

Review: Last month, Aetna deducted more than 3 months premium. I had to call them and was told the amount was deducted in mistake. I finally called my bank to not pay that and paid Aetna the correct balance. In March '14, they have again deducted more than 2 months premium without sending me an invoice EVER.Desired Settlement: I want the extra amount refunded AND Aetna to pay any and all charges imposed by my bank due to a unreasonably large transaction exceeding my current balance. I also want Aetna to correct my account to deduct the proper amount next month onwards.

Business

Response:

Thank you for your inquiry received on March 3, 2014. We reached out to the Individual Billing and Enrollment department for assistance with the member’s concerns. They reviewed the account and the member opted to set up his account on Autopay. In these cases he will not get an invoice. They are billing him correctly as his first payment was returned as NSF, so the system will continue to bill for the full amount due. If the member wants to get invoices, the member may terminate the Autopay and pay by a different method. At this time, there is no refund due and they would not be able cover overdraft fees as the member chose to initiate the Autopay himself.

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

I only authorized auto-deduct for amount properly due. For 2 months in a row, Aetna has attempted to deduct more than 3 months premium, even though I only have one months premium due. For example, last month they attempted to withdraw $1497, when they should have deducted $930.42. Again this month, they have deducted $1031.58, when the correct amount due is only $448. Calling their customer service is of no use, because the agent always says the amount due is much lower than what auto pay is deducting and they don't know why the erroneous deduction happened, after making us wait 70-90 mins on the phone. They never get back.

Sincerely,

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: 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: 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: 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].

Review: I went to doctor for preventive visit (annual physical checkup). Our company policy for adult Preventive Care Routine physical exam states that "In Network: 100% covered, no copay/no deductible; includes lab & x-ray;..." My doctor did an x-ray on me and submitted the bill with routine code per the policy provided by Aetna. However, Aetna declined the 100% coverage as specified in the quoted company policy above. The medical bill showed up with charge for copay ($20) and x-ray ($72.20). I am sure that those should be covered by Aetna. I tried to resolve this with Aetna directly and have exhausted the appeal process through Aetna. I have been very disappointed by their response, which just kept avoiding the policy statement and just declined the coverage.Desired Settlement: I would like to request the fulfillment of the full coverage (100%) for x-ray during the annual physical checkup. I have not paid the medical bill yet so Aetna should pay the medical bill.claim id: [redacted]The service date is [redacted]The total liability should be $92.00

Business

Response:

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

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.

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: 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: 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: 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: 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: I am 22 years old and in September of 2014 I had my [redacted]. I have my Medical Insurance through [redacted]. I had no idea until I received a collections notice from the Anesthesiologist that there is a supplemental coverage through Aetna Insurance. I was told I must contact Aetna to remedy the issue. I called the Customer Service line and received no help, only given another number [redacted] to call. Called that number and apparently that is only an employee number of someone who would work for [redacted]. No help. Called back the customer service phone number and requested a Supervisor. Agent insisted on account information and the only information I have is an account number of [redacted]. I don't know who owns this account or why I'm on it? I have never approved or signed anything approving Aetna Insurances? No one is helping me resolve or even giving direction on how to. I requested a Supervisor again. I was told no. I persisted.... The agent put me on a very long hold to note the account, then finally came back on the line to inform me that she NOW was going to transfer me to a Supervisor. She purposely transferred me to a Supervisors voice mail of one that was out until February. Called back. Again asked for Supervisor. Told no again. Wanted account info that I don't have. Asked to have Corporates number and this agent refused. Again requested anyone above her and she said no and going to disconnect call and hung up. Called back again. My frustration is now at peak! Every time I get an agent on the phone and no matter what tone or words I use, I could not get to a Supervisor, Manager or even a Corporates phone number. Terrible Customer Service and I'm to be held accountable for a bill that should NOT be my responsibility! I am looking for resolution or even direction on how to resolve. I have no idea who put me on this or why I'm at all involved with this medical Insurance? Please assist in having someone with authority and real knowledge call me.Desired Settlement: As stated above, I would like this resolved or even to talk with someone of authority and real knowledge to help resolve this.

Business

Response:

Please see our response to the complaint #[redacted] for [redacted] received on January 15, 2015.