Aetna, Inc.

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: [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: 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: 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: 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: Aetna has repeatedly denied claims for insurance coverage. They've gone so far as to even tell doctors that I am not a member of Aetna, then lie and tell me that the claims from the doctors were never made.Desired Settlement: I want Aetna to cover my in-network medical expenses.

Business

Response:

Hello,

Review: Aetna refused to pay my Dental claim on 06/03/2015. It was not made clear to me at any point that I would have to wait a year for major dental work. in addition to this Aetna contends that I should wait and jeopardize my safety health and my teeth to wait for their time period to elapse. I wanted to give them a chance to do the right thing before I make it public-ally known they do not care about their customers safety over their bottom line and unfair stipulations in their policies.Desired Settlement: Pay their $651 portion of the dental claim as that is the whole point of having dental insurance. I do not want to have to involve a lawyer because Aetna failed to consider human safety and general well being over their bottom line.

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 Claims department to verify if the claim was denied correctly. We were advised that the member was within the waiting period of 12 months to have any Type C Services dental work done and the claim was denied correctly.

As stated in the Benefit Plan Booklet-Certificate:

Your Effective Date of Coverage With respect to Type A and B Services, your coverage takes effect on the later of:

-- The date you are eligible for coverage; and

-- The date you return your completed enrollment information.

With respect to Type C Services, if you are then in an Eligible Class, will be the Effective Date of this Plan. Otherwise, your coverage takes effect after 12 months of continuous service under the Plan.

Type C Expenses: Major Restorative Care

...

Inlays/Onlays

...

Our records reflect your original effective date is October 1, 2014, with a 12 month waiting period. Since this criterion was not met, benefits are not eligible under the plan for the service performed June 3, 2015. Unfortunately, your claim was denied based on your plan's limitation on Type C dental work; therefore, we are unable to pay your claim.

Aetna does care about the safety and health of our members and I empathize with your situation. While we understand your concerns and recognize this is not the resolution you sought, our decision remains unchanged. Our actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants. We have attached the member's plan documents which explains the coverage waiting period.

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].

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Consumer

Response:

Review: [redacted]

I am rejecting this response because:Basically this was a necessary procedure to fix my Dental onlays so my teeth don't rot out of my mouth. That is like saying that you have a bullet wound but need to wait to have it removed because your insurance wont kick in until next month. This is a MAJOR safety and health concern that it is not something that could wait until October. I find it Extremely unethical to reject a claim based on something procedural where safety and ones health is concerned. And again this was just trying the ethical approach before calling Aetna out on Social and mass media for caring more about their policy regulations than my health and safety of my teeth. It is in Aetna's best interest to pay the claim that they should have covered because my teeth are more important than some rider in a unfair policy. Several contacts Media outlets expressed interest in the story and will consult a legal advisor on the best course of action to pursue next. Exactly how much business are the willing to loose over this issue ?

Sincerely,

Business

Response:

Dear Ms. [redacted],

Please see our response to complaint #[redacted] for [redacted] that was received by us on October 08, 2015.

The records indicate that Mr. [redacted]’s original effective date is October 1, 2014, with a 12 month waiting period. Since this criterion was not met, benefits are not eligible under the plan for the service performed on June 3, 2015.

We had the claim verified with our Dental department to review if there was any way any exceptions could be made; we also reviewed the original appeal information. However, our decision remains the same. Based on the guidelines of Mr. [redacted]’s policy that were provided in our previous response, the plan has a 12 month waiting period for type C services. The service performed June 3, 2015 was a type C service. Therefore, an exception could not be made. Our actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants.

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]’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Regards,

Julian C[redacted]

Executive Resolution Team

Consumer

Response:

Review: [redacted]

y.

I am rejecting this response because: Regardless of their policy there should Always be exceptions when it comes to NECESSARY dental work. Basically I feel Aetna has put their policy before my Health and safety. Was I just supposed to wait for their 1 year deadline as my teeth rot out ? I appealed through Aetna and they rejected that appeal. and I just wanted to give them ample chance to repair the situation before going to less preferable means and causing negative publicity and cost much more in the long run but if that's that it takes to get them to do the right thing so be it.

Sincerely,

Review: Hello, In July 2013, I received an authorization for a vacation supply of month of my prescriptionUpon retrieving my RX, the pharmacy charged $251.99, instead of my $co-pay which would have been $They said is was due to the insurance filing my RX as a Brand, when in fact is was GenericI contacted Aetna and was advised to file a personal claim, which I promptly did a week later in AugustI contacted them a week later and they told me it was approved and I should received a refundI have yet to receive my refundIt has now been monthsMy patience is at an end after going above and beyond patience with rep after rep informing me that a check had been cleared for payment, and despite my requests to numerous customer service representatives in Oct, Dec, Jan, Feb, and Mar of to speak to an authorized supervisor, I was given a complete run-aroundOn March 7, 2014, I was finally able to obtain a supervisor after having to be very rudeHe said he would check on the back end and call me backWhile on the phone he said he called my pharmacy to get receipts (which they should have already had given numerous reps told me a refund was being processed) He said it takes days to process and it has been daysI now demand my entire original amount of $be issued to me within days as I feel the $copay is more than enough to cover the months of hassle I have had to deal with Aetna on a constant basis to receive a minute sum considering the amount of money they have to cover this claimPlease email me and I can provide my Identifications numbers and a reference number for the file they have set up on thisSincerely, [redacted]Desired Settlement: I wish to be refunded my original amount of $within days to the address below:[redacted]
Business
Response:
Thank you for your inquiry received on April 2, 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 concernThey advised this case is still being worked on by [redacted] to fully resolve for the memberThis issue was escalated as high priority to have it resolved and the member reimbursed urgently
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address these concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
On 04/22/2014, the following information was documented:
The claim has been reversed and reprocessed and the member will receive a reimbursement of $
We apologize if this information was not submitted to Revdex.com as a resolution to the member’s complaint within the timeframe allowed
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
The complaint was finally handled when I posted on their [redacted] page, and the rep [redacted] (who should be commended for handling this in days versus everyone else that took a year) had a check issues the next day to me despite the fact he Pharmacy Supervisor said it has been mailed days prior, but the check was cut after she took the time to escalate it and send the check immediatelyI have received the payment thanks to her diligenceI suggest that these departments initiate a better form of communication within call centers and ones between supervisors and customer service repsIt seems if you want better service, the Social Media Department is the better choice
Sincerely,

Review: I signed my son up for a trip to go to [redacted] for June of 2014. The account is [redacted]. Circumstances happened and my husband lost his job. I submitted all the required paper work that was requested after there was miscommunication the first time that I needed to cancel the trip, back on January 24, 2014. And was told it would take 30-60 days for a decision. I then was calling for updates because I never received any correspondent or email or even phone calls to let me know the status. I finally called in one day and they stated that my claim was denied.(I didn't receive anything in the mail or email, or phone call. so if I didn't call I wouldn't had even known) I was then told I needed to file an appeal, which I did and was received April 9, 2014. I was told that it would take another 30-60 business days for the appeal, it is now July 22, 2014. Which I last called on 7/21/14, and I was told that my case is still under review. This has been going on since January 24. Almost 7 months later and I'm still waiting. The account that I'm referencing is [redacted].Desired Settlement: I would like the $500 refunded, that I'm entitled because under their own rules they say if loss of job is a reason, I would be refunded.

Business

Response:

Thank you for your inquiry received on July 22, 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: The health care plan I have with Aetna represents that preventive care is 100% covered, no co-pay required. However, when I went to my doctor for my annual well woman visit and she ordered a routine, preventive HPV test, Aetna would not honor their 100% coverage for preventive care, I was required to later pay my co-pay becasue they do not consider the test preventive. I believe this is false advertising, at best, and that my doctor is the only person who would be able to determine the test as preventive or otherwise. If a doctor is ordering a routine test during a preventive care visit and coding it as preventive care, I do not see how it can be considered anything else.

Desired Settlement: Aetna should pay the co-pay they have refused to cover.

Business

Response:

Business Response /* (1000, 5, 2013/04/23) */

Thank you for your inquiry received on April 9, 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 copayment was applied based on the cause of the member's illness submitted on the claim. The claim was sent back for reprocessing with a corrected diagnosis to be paid as preventive service. We apologize to the member for any delay and inconvenience.

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

Review: I need my drugs filled.I need Aetna to call my cobra administrator to expedite my enrollment.My cobra administrator already emailed and FAXed to Aetna all my enrollment details.The agent rejected my request.

Desired Settlement: I paid my insurance premium starting July 1st.I have not gotten insurance reinstated yet.For all the dates I do not have insurance, I want my insurance premium refunded to me.Also, I do not want them to cancel my insurance. I need it.

Business

Response:

Business Response /* (1000, 5, 2013/08/09) */

Thank you for your inquiry received on July 26, 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 issues. Based on their records, the member was terminated from the original plan effective July 1, 2013, which was loaded into the Eligibility system on July 26, 2013. The member's eligibility was updated with Aetna on July 29, 2013, for enrollment in the new plan effective date, July 1, 2013.

On July 30, 2013, the eligibility file was passed to Aetna Pharmacy Management and loaded into the system. They contacted the member's [redacted] and they said the member last had prescriptions filled on July 24, 2013, and have not tried to fill any medications that rejected.

The member's eligibility record is now showing active and the member can have their prescriptions filled. The member has incurred no lapse in coverage.

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

Consumer Response /* (3000, 7, 2013/08/13) */

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

1) The drugs I bought are without any insurance.

2) I had to delay my [redacted] drug refill because

it is expensive and I had no insurance coverage.

I was under health risk.

I still demand refund of my premium money for the dates that I was not covered.

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

Thank you for your inquiry received on August 14, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We again reached out to the Aetna Pharmacy Management for assistance with the member's issues. They advised for any claims that the member paid out of pocket for before the eligibility being updated, the member is entitled to submit a claim for reimbursement.

The forms can be obtained from Aetna Navigator�.

The member can mail or fax the Prescription Drug Claim Form with Detailed Prescription Receipts to:

Aetna Pharmacy Management

[redacted] XXXXX

[redacted] XXXXX-XXXX

[redacted] X-XXX-XXX-XXXX

Since the member was loaded into the COBRA plan retroactive, there are no dates for which the member is not covered by the plan. The member is entitled to submit a claim for reimbursement of any charges incurred while the enrollment under COBRA was completed.

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

Consumer Response /* (4200, 11, 2013/08/31) */

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

I did that before. It did not work.

There are discounts involved that I do not understand.

I paid full price. But then the insurance company

did not agree with the full price because they never pay full price. It was more complicated than I could comprehend. In the end, I did not get

anything back.

Therefore, I refuse to do it that way and just want my premium back to me, at least that portion.

Review: Failed to pay for medical services

I incurred medical debt in 2012. Aetna student health denied the claims based on a pre-existing condition. They had no right to do so as I had previously had medical coverage. Upon calling them, they told me they would send me forms in the mail to appeal the claim. I called once a month for a year and never received the forms. This caused massive damage to my credit and caused me a lot of trouble. I was finally able to get them to review the claims, but the damage to my credit had already been done.Desired Settlement: I would like aetna to contact wood all of the sources of bills that were denied as well as the credit companies to remove negative marks from my record.

Business

Response:

Thank you for your inquiry received on August 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 Aetna Student Health (ASH) for assistance with the member's concerns. They advised claims were under review for pre-existing and not denied. It was determined on August 13, 2013, that pre-existing did not apply as examiner received proof of uninterrupted previous coverage under member's [redacted]'s plan. All the claims pending pre-existing investigation from April 23, 2012 to February 17, 2013 were reprocessed and allowed.

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

Review: On or around June 7th, I was considering enrolling in Aetna through COBRA. This was because my mother had gotten laid off and I didn't have insurance access through my job. I wanted to know if my deductible would carry over, because at that point I had met $2734.45 out of the $3,000 deductible. One of Aetna's member-services personnel spoke with me on the phone on or around June 7th and said that YES, my deductible would carry over. Because she told me this, I made the decision to stay on Aetna via COBRA. And because of what this Aetna representative told me about my deductible carrying over, I did not enroll in my new job's insurance because I did not want to pay another deductible. Now, after using Aetna and racking up medical bills, I was just told by Aetna that in fact, my deductible DOES NOT carry over.Desired Settlement: I want all of my deductible to be carried over to my current plan (all $2,734.45 of it), just as your representative promised it would. And I want to be reimbursed for my medical bills that would have been covered after meeting the original deductible, since after I enrolled in Aetna through COBRA.

Business

Response:

Thank you for your inquiry received on October 9, 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 trying for several months to get reimbursed by Aetna for a pharmacy prescription dating back to January 2013. Despite mailing and faxing my receipts several times, Aetna has so far been unable to complete the reimbursement even though over the phone they tell me that the charges are reimbursable. They have the paperwork in their system, they just cannot seem to cut the check to make the reimbursement.Desired Settlement: I want the missing payment of 69.99 less copay refunded to me immediately. I would also like a call from a C level executive of Aetna apologizing for the inconvenience, and for Aetna to send my wife flowers for the inconvenience caused by multiple phone calls to well meaning Aetna telephone staff who were unable to help us.

Business

Response:

Thank you for your inquiry received on 02/12/2014 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 Aetna's [redacted]) department for assistance, [redacted] advised there is no claims on file for [redacted], his spouse, or his dependent for the date of 01/18/2013 for $69.99, as stated in his complaint. We attempted to reach out to [redacted] for additional information, but were unsuccessful. If [redacted] could advise of the name of the medication, correct purchase date, and which member the prescription is for, we can then review his issue further.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]'s

concerns. If 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: They are mistaken. I have in front of me a copy of a denial for 69.99, from Aetna, with no explanation. I cannot believe that your system has no record of this, as it shows up in my Aetna online account.

I do not wish to put the personal medical details in this Revdex.com system due to privacy concerns, however I will send an email to the address indicated.

Review: I am trying to cancel the Aetna international insurance coverage provided by [redacted] wich operates globally as http://www.aetna.com/They refuse to cancel my membership and continue to charge me $183.21 per month. I sent cancellation request form , called the phone number ( ###-###-#### ) that [redacted] from ###-###-#### provided and left the message. You dont get to speak to anyone. You can only leave message for some lady [redacted]. I am not getting any response. Even their cancellation request says that you can cancel only within 14 days of coverage which seems completely illegal. See this please . [redacted]We have been with them for 6 months and do not need any further coverage from them.I need to cancel the coverage and any further charges.Member id is [redacted]Desired Settlement: Cancel the coverage and charges immediately!

Business

Response:

Thank you for your inquiry received on April 17, 2014. We reached out to the Aetna Global Benefits (AGB) department for assistance. Unfortunately, they were unable to find this member. If possible, please supply additional information such as a member ID number, usually beginning with a “W” or a social security number. Thank you.

Consumer

Response:

Details of Coverage

Customer Name: Mr [redacted]

Policy ID Number: [redacted]

Effective Date: October 01, 2013

Location: [redacted]

Product: [redacted]

Policy Type: [redacted]

Monthly: 1st monthly payment of $183.13 and the 11 subsequent monthly payment of $183.21 (total annual amount 2198.44)

Sincerely,

Business

Response:

Thank you for the information submitted. We again reached out to the Aetna Global Benefits (AGB) department for assistance. Unfortunately, they need the member ID number that is located on the member’s ID card. It would begin with a “W”, followed by 9 digit number or they need a social security number in order to further assist the member. We do apologize for the delay and inconvenience. Thanks.

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

This is beyond ridiculous! They dont even now where to find me and in what system to look.

Review: It is beyond my comprehension how this company, who I have been insured with for many years, claims to have sent a letter to notify me of changes to my account, which was never received, and just dropped my policy without any proper notification or personal contact with me. On top of this, my insurance agent was never notified either. How does this happen??? I have called multiple times and so has my agent and the only answer we get is "We sent a letter by mail." This is not sufficient. If you are sending such important information, this should go certified mail with a return receipt. What kind of company can do this to a client who has always paid the bills and cancels a policy and insurance coverage without any warning or contact? I need answers. I have been on autopay for this policy since I enrolled, never missed a payment and only by accident found out one day out of the blue that I had no coverage for the past 6 months. I am beyond disappointed with Aetna and how they neglect to handle this situation. I have since then had to restart a new policy at a much higher premium and different benefits. This is not right. I should have been properly notified and I should have been given options to renew my policy and not just left off in the deep end.Now, for the second time my insurance coverage was dropped, and they decided to put me back on my old plan( again without my knowledge or consent) and want me to pay $1,946 in premium for the time I was not covered to have this plan reinstated. I never asked for this and I didn't have insurance coverage so why do I owe money for a time I didn't have coverage? This is absurd, unprofessional and I need answers.Desired Settlement: I would like to be on my old plan, which both my doctors are on, and not be responsible for paying Aetna for a 6 months of back-dated premiums in the amount of $1,946 for not being covered.

Business

Response:

Thank you for your inquiry received on 06/04/2014 regarding complaint #[redacted] for J[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 Aetna’s Individual Billing department for assistance, and the member stated that she never received the Repurchase letter last year and was upset that her policy terminated as of 12/31/13. She applied for and was enrolled under the [redacted] effective 05/01/14, but that policy was voided (per member request) since several doctors were not covered by that plan. As an “Exception” to the member, we allowed her to go through with the repurchase of her old plan. This was processed in April. The repurchase is retroactive to 12/01/13, which means the member owes the difference in premium for December (since the rate increased with the repurchase) and the premiums for all months after. We are not going to waive all premiums from 01/01/14 to 05/31/14. The member is responsible for making those payments and may have any claims during that period resubmitted. If no payment is received, the policy will be terminated.

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].

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: On September 24, 2014 I received a bill from Aetna claiming that they paid for a prescription of mine in error , and they would like for me to pay them back the amount of $58.24. They claim that they paid for this prescription on 9-24-2013. My company ended our coverage with Aetna on 7-31-2013, and I was no longer an Aetna customer. After receiving documentation from my pharmacy, Aetna never paid for a refill for the drug in question on that date, or any date near there, in 2013. Furthermore, the prescription number Aetna claims they paid for was actually filled on 7-14-2014, through my current prescription provider. The amount in question, mg of drug, billing date, etc are all different. Aetna's records are wrong, and I have documentation from my pharmacy to that end. They have made an error, that does not involve me, and now they want me to pay them.Desired Settlement: I would like Aetna to drop this charge for $58.24, as this claimed error has nothing to do with me. Aetna should stop all billing requests to me, and make sure that they do not make any more "errors" on their end.

Business

Response:

Thank you for your inquiry received on 10/13/2014 regarding a prescription filled by [redacted] Pharmacy on 09/24/2013 for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Health insurer would not provide full plan brochure until AFTER sign-up. Forcing consumers to contract for services without knowing all of the terms.

I was researching insurance plans and found [redacted] (an Aetna company) on the [redacted] marketplace. There was a summary of the plan on the marketplace, but I wanted to compare the details of the actual plan's full brochure (usually a 100+ page document). I went to the company's website and again, the only available information was a plan summary (about 8 pages) and a marketing brochure (20 pages). I called the company to request this information. The company required me to provide my name, birthdate, phone number, and physical address before they could even transfer me to someone who could help. I explained that I felt uncomfortable providing personal information in order to view a plan brochure (I was still in the process of comparing insurance, I said, and once I decided on a plan I would happily provide everything on the member application). With no other choice, I provided the information. After being transferred 3-4 times, I was told that the company would not provide the plan brochure until AFTER I signed up with them. I asked them, did they realize their company is forcing consumers to enter into a contractual agreement without knowing all of the terms? This is a fraudulent practice. The company stated that "everything I needed to know" was in the plan summary, but this is outright false. There are details in the 100+ page insurance document that help me choose which plan is right for me, and I have a right to access that information before I enter into an agreement with a company. I should be able to compare those details between plans and among different companies before I choose which insurance plan to go with, because I am contracting for coverage for a full year and with the expectation that I will be spending at least several thousand dollars during that year. Please help consumers get access to these plan brochures as soon as possible. Withholding this information is a fraudulent practice that is hurting consumers.Desired Settlement: Correct the current, fraudulent practice and make full plan documents (detailed plan brochures) available on the company's website or at the very least, upon request. Other insurance companies have full insurance plan documents readily available on their websites.

Business

Response:

Thank you for your inquiry received on December 15, 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.

We reached out to our Enrollment department for assistance; please accept our sincere apologies for any difficulties that were encountered with our website and or representatives. It is our goal to provide quality service and regret any incidents that created the perception that we have not provided Ms. [redacted] with adequate service. These actions are not consistent with Aetna’s service standards and we appreciate you notifying us of the experience. We would like to assure Ms. [redacted] that we have taken the appropriate actions to address the service issues that were experienced and will take her feedback and improve the access to our plan information available to our customers in the future.

Review: My wife had a very rare ocular tumor which there was only one doctor in New York City that we could go to, according to the Ophthalmologist at [redacted] Ophthalmology. As this doctor was out-of-network from my in-network only Aetna insurance plan, I contacted Aetna and was told that I need to be "pre-certified" in order to have the services be covered. I went through the process, and the pre-certification was approved. As the doctor's policy was to have the patient pay the cost out of pocket and be reimbursed from the insurance company, I spoke with an Aetna customer service representative who told me that I would be covered for 100% of the services that I paid out of pocket. I do not remember the term she used, but she said there was a difference between being covered in-network with negotiated rates and being covered for out of pocket expenses and that I can rest assure that I would be covered for all costs out of pocket. On 10/27, I spoke to a customer service representative and was told that for my wife's appointment on 10/10 for which I paid $830 out of pocket, I was approved to be paid $399 back from Aetna. She said it was a mistake on Aetna's part and once I receive the check in the mail (as it will be mailed to me not the doctor), that I should then call back and have them reprocess the claim and I would receive the difference of about $470. As of 11/11/2014, I still have not received a check so I decided to call back and talk to another customer service representative named[redacted]. I was either on hold or on the line with [redacted] for 58 minutes on 11/11/2014.[redacted] told me that I am not eligible to receive anything back from the difference. [redacted] also informed me that my wife's surgery/biopsy performed on 10/22 is still under review for the $29,000 claim, but the preliminary amount to be paid back is about $1,500 but that amount is still pending and no one can help me until 12/1 when the claim is finalized. This difference leaves a shortage in total of about $27,650 (if my math is correct). [redacted] told me that his direct supervisor is out of the office today, but that he could try to have a supervisor to get back to me by the end of the week. I asked him if there was a corporate line that I could call to try and resolve this issue and he put me on hold and told me he would ask around but that phones were very busy and he did not think anyone would be available to give him that information. I was put on hold for about 2-3 minutes, and when he came back he said he would put me back on hold as he was still searching for an answer. I told him that I did not want to be back on hold and that I will just wait for a call back from his supervisor, or anyone that could help me, by the end of the week but otherwise I'd call back on December 1 when the claim was finalized. [redacted] really made me feel like I was an it and I could not believe that someone in "customer service" could talk down to a customer like that.Desired Settlement: In a perfect world, Aetna would be able to produce a recording of all calls between myself and their customer service representatives. This will show that I was told multiple times that anything paid out of pocket would be fully reimbursed. I do not know if they record and save all conversations between customers and reps, but I hope that they do. I also believe that an almost 6 week wait time is quite long for a claim to be processed, when I was told originally it should be about 7-10 days.

I believe Aetna should fully cover per the doctor's billing amount for any pre-certified claims.

Business

Response:

Please see our response to the complaint # [redacted] for[redacted] received on January 07, 2015.

Review: I am trying to get several reimbursement claims resolved. I fax the reimbursement claims to the number listed on the claim form ([redacted]), after about 10 days I receive a letter regarding my claim stating that it has been denied. I call their customer service (and get transferred 3-5 times because there is no direct # to reach the reimbursement department) to explain that the claim should not have been denied and they tell me that they do not have access to the reimbursement claims that are submitted. I ask if I can speak to the department that can see my claim and customer service say no that they can send an email to that department and call me back within 72 business hours. I wait over five business days and have to call back again only to be transferred multiple times and be give generic answers that I need to resubmit my claim. I practically have to force the individual on the line to simply read the notes on my account to find evidence that the situation has already been escalated. On multiple occasions I have been able to get the agent to see the notes indicating that the claim has been resubmitted and that a mistake was made but each agent indicates that they cannot 'see' the claim in the system. Answer this question HOW CAN I HAVE A DENIAL STATEMENT W/O THERE BEING A CLAIM IN THE SYSTEM??? I have four denial papers with different dates on each. I have resubmitted claims with corrected information to only get the same result. This is an endless loop where I send forms and get the same answer that they cannot see anything in they system and yet I can still get information in the mail from Aetna about my claim. I want to be able to call Aetna to get the status of my claim. I want the agent to have direct access to the information I have submitted. I cannot understand how a multi-million dollar company can have such terrible customer service. I feel like it is Aetna's goal to keep giving me the run around about my claim to avoid giving me reimbursement for my pharmacy claim.Desired Settlement: I would like for Aetna to recognize their terrible customer service. I would like for Aetna to find my claim and make sure it is processed correctly. I would like an apology for all the time I have spent dealing with this process trying to get a resolution. At the end of the day I would like for my claims to processed and my money reimbursed for my pharmacy claim.

Business

Response:

Thank you for your inquiry received on December 05, 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.