Aetna, Inc.

Review: Aetna Student Health charged me $2,099.00 for insurance when I already have insurance and a health savings account. They have refused to refund my money. I did not enroll or agree to pay for there insurance. I do not need there insurance because I already have my own. I request a full refund without further delay. Thank you.Desired Settlement: I request a full refund without further delay in the amount of $2,099.00. Thank you.

Business

Response:

Hello,

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

Upon receipt of the complaint we immediately reached out to our Eligibility department to have the member’s concerns reviewed. We confirmed that they reached out to the member’s university and the department was advised that the member submitted a waiver on December 31, 2015, but it was rejected as they were unable to verify – “Policy no longer active” – on this date the policy was not active as it was not effective until January 01, 2016. On January 08, 2015, the member contacted the university was able to verify the coverage and process the refund.

The university bills the student’s the insurance premium, the students do not pay Aetna directly. Per the university, they have processed the refund for the student the amount of the Spring insurance premium of $2,099.

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,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Review: We have dental insurance through Aetna. Our dental coverage only covers dentists in [redacted], about 80 miles from us. Our insurance requires us to get an authorization to see a dentist locally every 90 days. We have been very consistent in doing this since 2010. For the first time it was overlooked at getting the authorization. This is the same authorization they approve every time it is requested. Services were done on my daughter and I received a bill for $858 since an authorization wasn't received. I sent an appeal in and it was denied. Understanding that it was our error, however, as it has in the past, the authorization would have been given if we had called in. Now we are having to pay the bill for the full cost of the dental services because we live in a town that doesn't offer an Aetna dentist, on top of the insurance premiums we pay. We truly do try to stay within the guidelines, but this time, it just got away from us and we feel it's not fair that the insurance refuses to pay for something they would have authorized.

Desired Settlement: I am requesting them to authorize the denied services since one phone call would have had them approved. My insurance should pay for services that I'm entitled to without saying "Mother May I"

Business

Response:

Business Response /* (1000, 5, 2013/06/25) */

Thank you for your inquiry received on June 11, 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. They advised they will allow payment on dates of service January 29, 2013 and February 19, 2013 as a one-time exception, since there are authorizations around that date of service, the last one being February 21, 2013. However, for the future, denial of these services will be upheld if precertification policy is not followed correctly.

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

Review: I recieved insurance starting effective feb 1 2013 I submitted a claim threw [redacted] treatment center I recieved a letter from my counsler telling me I was out of network but that aetna did say I was covered but I had to do my own billing . so I called aetna the numbers on my card and they went threw my policy and explained how to do the billing and that I had a 1000 dollor deductable and they would covert 50 percent after dedutable was meet so I paid my out of pocket 1504.00 I sudmiteed the claim it was processed and they said only 274.50 was processed I asked about the other money [redacted] id#aXXXXXX advised me it was processed wrong and they sent it back for reprosses.I called back and they said they needed more info and that 274.50 was applied to my deductable well we went threw this five times reprossed thirteen calls later and lots of time on the phone I was told how sorry they was and with all the paperwork and details that it was put in urgent status 48 hours so I called back it still had not been resolved I was told call again tomorrow so I called today they said the same 274.50 was applied to my deductable but that they other 1240.00 dollors should be resolved soon I continued to ask to speak to someone and [redacted] id# nXXXXXX told me it was preexisting after shes the one who put it urgent and said they should have a ck PREPAIRED FOR ME BY THE MIDDLE OF THE WEEK.First of all im forced to go out of network because aetna doesnt offer a dr in network for my services .I called back today to the pre authorization mental health and they told me they could contact [redacted] treatment and try to get them set up for in network and that they could also have it ran retro active so that I would be paid I explained what I was told today about prexisting and they looked at my policy and said they seen nothing of the sort and asked if I submitted a bill I told them I have and explained how it all went I had to go to work I called them back and no one knew what I was talking about.

Product_Or_Service: services out of pocket paid for

Account_Number: insurance policy

Desired Settlement: I would like AETNA to pay me back for services I have recieved that they said from the beginning were covered and for aetna to get a in network dr to treat my services so I dont have to go threw this again a month has went by and I submitted another bill the first was 1504.00 and the next is 695.00 so minus a 1000 dollor deductable and them covering 50 percent they owe me 599.50 and to continue to pay for my services per there agreement and my insurance policy that is paid up to date.

Business

Response:

Business Response /* (1000, 5, 2013/06/13) */

Thank you for your inquiry received on May 30, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to the Claims department for assistance with the member's issues. They reviewed a provider call from April 16, 2013 and a representative unfortunately provided incorrect pre-existing exclusion information to the provider; however, in reviewing the member's plan documents, they advised pre-existing condition information is needed to continue processing the claims. We apologize that this is not the resolution that he is seeking, but we must follow the specific guidelines of the plan.

The member can also find participating doctor's around his area by accessing DocFind�®, our online participating provider directory, at www.[redacted]

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

Review: On September 4th 2013, Aetna sent me a promotional e-mail. The headline was (precisely): FOR A LIMITED TIME, RENEW YOUR CURRENT RATES FOR 2014. There can be NO MISCONCEPTION OR MISUNDERSTANDING of what this means. It cannot mean "maybe we'll give you the same rate" or "giving you the same rate is conditional upon certain things". The e-mail goes on to invite me to use phrases such as "Maintain Rate Stability in 2014" and "Save On Monthly Premiums". The only conditions were that (1) application must be made by October 15th 2013 and (2) renewal would change from the current renewal date (in my case March 1 2014) to December 1 2013. In accordance with the instructions in the Aetna e-mail, I contacted my health insurance broker immediately and told him I would be willing to contract for a 12-month renewal as at December 1 2013. But Aetna came back with a renewal premium hike of 17.7%!! This is clearly deceptive practice advertising. I will pursue this matter to a resolution which is acceptable to me, and which is based upon the mutual understanding of the offer which was stated in Aetna's direct advertising. I have yet to discover whether they have published this type of deceptive advertising in other media. Please assist with this complaint.

Product_Or_Service: Health Insurance

Order_Number: Not applicable

Account_Number: [redacted]Desired Settlement: I expect Aetna to honor their printed, advertised offer. I expect to be able to renew my current policy, with its current coverages, at the current monthly premium rate, in exchange for contracting on or before October 15th for the 12-month period commencing December 1st 2013 and ending November 30th 2014. Anything less will result in my company seeking legal advice as to the consequences for Aetna of attempting to deceive its clients by such fraudulent means.

Business

Response:

Thank you for your inquiry received on September 10, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Every time I have a claim with Aetna it becomes a real issue getting the company to cover any of my medical expenses. I have had to spend hours on the phone with them on different occasions and everytime I call they are making me go through my issues again and again when they have all of the notes documented, very frustrating. They always have a new excuse as to why my claim is not covered yet. It should not take 4 months plus to get a claim resoled. First it is an issue if them putting in a wrong expiration date in the system, then it's we need more information on the claim then its there is no date on the claim and so on. I would just like my medical bills covered without this much hassle I do pay for the coverage. Also when you request to talk to a supervisor they refuse to speak [redacted] you to get the matter resoled. After calling about one claim in particular 9 times they still have not submitted a exceluration. Today I called again and they said it would be at least 30 more days.Desired Settlement: I would like to have my dentist paid!!!! He has been very patient.

Business

Response:

Thank you for your inquiry received on October 2, 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 Strategic Resource Company (SRC) for assistance with the member’s concerns. They advised the policy is a 10 year replacement for crowns. The original crown was July 22, 2003 and the replacement crown was done May 30, 2013. This was less than 2 months from 10 years for the replacement. They received special approval to allow payment and the claim has been reprocessed.

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

Consumer

Response:

Review: [redacted]

I am rejecting this response because:reprosessed??? They have told me that numerous times so I am not sure that this issue will be resolved and not in a timely manner. It has been 5 months, unacceptable!! That is a whole lot of time that this company could damage someone's credit which people work very hard for! Not to mention there have been 2 mistakes they have made in this process, for instance recording the wrong expiration date of my card. And this crown fell off why would it take 5 months to do this research?? This company has denied a claim before that I had with them that I was told would be covered so I need more information as to when this issue will really be resolved. They tell me something different everytime I call. It's certainly not fair that I have had to spend so much time on this issue! Poor customer service.

Sincerely,

Business

Response:

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 again reached out to Strategic Resource Company (SRC) for assistance with the member’s concerns. They advised the claim was paid on October 15, 2013 in the amount of $324.20.

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.

Consumer

Response:

Review: [redacted]

I am rejecting this response because: I was told by a gentleman that I spoke with on the phone, one of the numerous times that I called they would be covering over $400.00. I have not recieved anything explanation of this claim.

Sincerely,

Review: I am writing to you with a request to investigate the refusal by the Aetna Health Insurance company to pay for medical services that were rendered to me on February 27, 2013 at [redacted] Hospital in [redacted]. Aetna insurance only paid a portion of the claim where I was insured by the Aetna customer services that coverage for the services would be 100%.I have filed two complaints to the appeals board at Aetna Insurance which were both denied. I have included my original appeal and can also provide other correspondences pertaining to these two appeals. Aetna insurance is telling me even though they gave me wrong information over the phone that I am still the responsible party to pay the debt owed.I have contacted and worked with BP Advocacy, a service offered by my wife's employer that helps resolve disputes with the insurance company. Aetna Insurance admitted to [redacted] that they reviewed the call log from the 26th of February and it was proven that Aetna's customer service representative gave me incorrect information about my coverage. Whoever, Aetna told [redacted] that I had exhausted my two appeals and could not dispute the claim any longer. As all my communication with [redacted] team was done over the phone, I am unable to provide you with the written documentation. However, you can verify my statements by contacting [redacted] directly at ###-###-####. I am submitting this complaint to your office for review as a last resort to resolve this issue of unfair practices by Aetna.Desired Settlement: I would like Aetna take responsibility for the actions of its employees and either pay directly to the provider the amount previously not covered for the medical services I received or to reimburse me so that I could pay the medical provider.

Business

Response:

Thank you for your inquiry received on October 23, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Short term disability claim process. I wrote them, I had problems with this company trying to get my claim approved from the beginning. I tried to use their website as much as possible and I uploaded completed forms that at first they said was missing, then I talked to a supervisor and she had called me back to tell me they found them. My last day of work was June 13, and we had to put an estimated release date because the paperwork was done and in place prior to the surgery... My release date changed to August 1,2014 and this company needs forms to prove this, which I feel is fine and acceptable but I have a problem with their system... as they require info prior to really knowing what your release date back to work will be then they should send follow up to the doctor automatically to close your case if they want to use the estimated return to work date that we filled in their form prior to my surgery which was on 6/16/14. The process should be the same as when we start it up. Doctor required to fill out their forms, and if they are closing the claim then why would it not require the same process a release from the doctor AS A FINAL RELEASE DATE??? Delay in income is very stressful and this company is adding to what was an already difficult time. I understand we need proof, so why not request it when needed (as I see they did today after two phone calls)I would not recommend this company as our short term disability and I am also turning this in to our H.R. so when it is time to get our insurance evaluated I will vote against this company.Thank you for your attention and help! I also would like to add each CSR has differnt advise.Desired Settlement: Would like to help voice my concern on their process. I want others to know that have issues that looks like many of us has also had problems with this company. I hope this helps along the way, if not me someone else going through insurance release date issues with Aetna Short Term Disability.

Business

Response:

Thank you for your inquiry received on August 07, 2014 regarding complaint #10167929 for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: My mother passed away three years ago from cancer, Last week I received a letter from Aetna stating that she had a life insurance policy. requesting that I send the names, addresses, DOB, SS numbers and phone numbers of all her children and brothers & sisters if any. I took care of my mothers finances during her illness that lasted for two years and I never saw any information on an Aetna policy. I would think that if she did have a policy they would already have the information on the benefactor with that being me or one of my siblings and they would have contacted them directly. Furthermore I've gone on line and there is no office for Aetna in [redacted], **. I have contacted Aetna at their headquarters in [redacted] and left a detailed message. I thought I should contact you as well. Sincerely [redacted] Product_Or_Service: Fraud Life Insurance Policy

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Not applicable

No settlement required.

Business

Response:

Thank you for your inquiry received on October 31, 2014, regarding the validity of the Life Insurance policy 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 writing this email with regard to a claim for my wife I submitted for her birth on June 24, 2014 for her birth of my newborn son. I submitted the invoice from the out of network provider mid-wife out of the state of Washington, [redacted] (providing the services as the licensed mid-wife practitioner).After I had submitted the invoice Aetna [redacted] had submitted the balance of due on the behalf of the insurance provider to her old tax identification information and she never truly received nor processed payment as a result. It has been a long, over-due and cumbersome process to get that issue resolved and send true payment and processed to her and her associated business; as a result and fear of being penalized for Aetna [redacted] inability to get the issue resolved in a timely manner, I have been duties with paying the bill in its entirety to Mrs. [redacted] directly, assuming reimbursement; which has been promised to be submitted via direct deposit to my bank account on numerous occasions by multiple representatives, and yet I have still not received it. I have called over 50 times, and waited nearly 6 months and it is still not resolved. And it appears that every time I call Aetna [redacted] each representative has a different interpretation of what needs to happen, I find out many of the other representatives never tend to any of the issues they promise to resolve, nor is there any progress made. Your companies utter incompetence and lack of ability to resolve the issue in a timely manner (or resolve the issue at all) has caused me much financial grief and I am at the point where I dont believe anything I hear from any of your representatives as I have heard some many promises that have not been able to have been kept, that you leave me with no resort but to report your company to the Revdex.com.In addition to the issues that have stemmed from my wifes birth regarding her claim, I also had a claim that the doctor submitted as an invoice under my sons name for services tended to him immediately after the birth. I was told that it is your companies policy to process the newborn child under the mothers name and deductible for the first 30 or 90 days (I forget); and I mentioned that your company incorrectly processed that under my newborn separately even though it was the same day of the birth and a representative submitted it for reprocess; since then, it has been reprocessed again, under his name and deductible again, which is no change from the original complaint and violation of your policy. That shouldve been entered under my wifes name and deductible and I should receive a substantial amount from Aetna [redacted] considering I paid for all services to the provider myself and I Aetna [redacted] was supposed to incur some of that cost.Desired Settlement: DesiredSettlementID: Refund

I paid the midwife in full for both services; they owe me based on my wifes claim amount they expected me to pay approximately $3,100.23 and they were going to pay me $ 1,102.94 which they still owe.Regarding my son's claim, they were supposed to process that under my wife because it was still within the first 30 days so it should've gone toward her deductible which would've been meet so they would owe $1,095.00 .They owe me a total of $2,197.94 which is six months

Business

Response:

Please see our response to the complaint # [redacted] for[redacted] received on December 29, 2014.

Review: My wife and I both worked at [redacted], and had insurance through Aetna. She was initially the primary, but found a different job, which would allow me to become the primary on the insurance because of the services. She left her job in November. We both became ill at the end of the month, so we decided to go to the doctor's office. To make sure we were still covered, we called Aetna's customer service to verify, which the gentleman on the other line ran our card number, and said we were covered through November 30th, 2013. We made sure, because we would have gone to the doctor and paid out of pocket, which would have been a less expensive visit, but since we were covered, we would use it. Aetna initially paid the bill, but approximately 8 months later we received a bill from the doctors office saying it was unpaid, even after paying the co-pay. We are still getting bills, and I feel I should not have to pay the bill since we were told we were covered.Desired Settlement: To pay the bill, or at the very minimum split the difference between self pay and the insurance cost.

Business

Response:

Hello,

Review: I was in an automobile accident on January 23. 2015. We went to the hospital to make sure that we were okay. My auto insurance paid the entire hospital bill in full and came to a settlement with the doctor's bill. Despite the settlement, the doctor filed a claim to Aetna for the remaining amount, which they were supposed to write off. Aetna then started harassing us for information on how much my auto insurance paid for the bill. We told them to ignore it because it was paid in full, but they insisted. So judging it to be in good faith and that it was only for their records, I gave them the statement from the doctor AND from progressive that everything was paid in full. I recently discovered that Aetna paid the doctor and took it from my health fund.Desired Settlement: I want to remove Aetna from all liability for this claim until further notice. Return the money that was deducted from my health fund. If anyone owes money, then my auto insurance needs to be the first to know, since the bill was less than my auto policy's limit.

Business

Response:

Thank you for your inquiry received on 04/01/2015 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I had health insurance with Aetna for more than 1 year. I went to the doctor for an annual physical, and called to verify that the doctor was in network. Six months later I received a notice that insurance refused to pay, because the wrong [redacted] was listed on my account. I appealed, and was told that I have only six months to appeal, and time had expired. I spoke with Aetna on the phone, and they admitted their mistake and told me I need to only update my information and re-submit. I did this, appealed a second time, but they still REFUSE TO PAY.

[redacted] is threatning to send the account to collections.Desired Settlement: Aetna owes $330 to [redacted] for services rendered on April 28, 2014.

Business

Response:

Hello,

Review: Stole money from my pay check.

Back last Jan. I was wanting to see what health insurance would cost me on the [redacted] health care web site. I am a veteran and go thru the ** for all my medical. I looked at Aetnas health insurance for me and saw it would cost me 400 a month so I said noway then got out of the web site. I did not click onto any thing or accept any thing or agree to any thing. With in a couple of my pay checks I noticed my checks being shorted for some reason and did not know why? Long story short after over 2 months of missing 400 a month from my pay I found out that Aetna was taking the money from my check and I did not give them the right to do that. I contacted my employer and told them to stop and it was stopped and I talked to Aetna about it and said I want all my money back. I was told they messed up but it was not the first time, that it has happened before. I was told I would get my money back in 2 to 3 weeks but it has almost been 2 months??? Wheres my money. I am wanting to talk to a lawyer about this and my local TV station.Desired Settlement: I want all the money they stole from me and late fees and interest. If I see a Lawyer I will be seeking more.

Business

Response:

Thank you for your inquiry received on 05/14/2015 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: Hi, first off let me start with I think Aetna is great for Insurance. My husband has had it through his work for about 3 years and I've never ran into a bill like this before.

I was pregnant at 38 weeks and my OB doctor told me to go in to the hospital to get checked out and make sure all was good with the baby. I felt a little shortness of breath, nothing serious but wanted to make sure everything was good with baby. There admitted into ER and did a few minor test and monitored baby. was released within 3 hours and all good!

Admin pulled my husband aside and discussed the cost. Final cost was $290 after insurance and offered if we wanted to pay now upfront or get billed. We elected to get billed. She said this is final and what the cost will be after running out great insurance.

Now I get billed $1,100 for minor test! Categorized as level 5 ER which is life threatening which clearly this was not. I not only can't pay this but I won't because this isn't right. I should have been billed at most level 2 or 3 which would bring the cost down, on top of that I looked at the detailed codes on Aetna and most test cost were so inflated it almost gave me a heart attack and is still making me sick. I've tried talking with the billing and dignity health but not getting anywhere so all I want to do and will agree to is pay the $290 I was told I owed.

For example, I had a chest X-Ray that was billed to Aetna for about $900. According to healthcare blue book for cost for my area 95630, this is about a $50 procedure tops!!

This is just to name a few but they are trying to steal money.

Please help.

My WID number is [redacted] SOHLICH Member [redacted]Desired Settlement: I would like to only pay the $290 that was agreed on and not have to continue battling this when this is was I was told. I'm tired of them trying to rip me off.

Thank you.

Business

Response:

Hello,

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

Upon receipt of the complaint we immediately reached out to the Claims department to verify if the claim was processed correctly according to the member’s benefits. We were advised that according to the benefits for hospital emergency room services the claim was processed correctly. Hospital emergency room services are covered 85% after the deductible is met. The level of care was not a factor when considering the amount the member owes, it is strictly based upon the 15% due of the contracted rate of the provider’s billed charges.

We also had the calls pulled prior to the member purchasing the breast pump to see if incorrect information was provided to the member. The member was advised that a breast pump would only be covered under the plan if it was medically necessary, meaning there has to be an issue with feeding before it will be covered. She was advised that a letter would have to be submitted by the provider stating the reason for medical necessity and the customer service representative (CSR) again reiterated that it must be medically necessary. We also listened to the calls after the purchase of the breast pump and again the member was advised that it would only be covered under the plan if medically necessary. The member requested what would qualify as medically necessary and the CSR provided an example of if the child was born with a cleft palate or if the mother was discharged prior to the baby being discharged. The member stated she understood the benefits on both calls. I empathize with your situation and regret that our decision could not be more favorable.

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 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,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Review: I am filing this complaint due to the poor service I have received from Aenta Student Health and its staff after being hospitalized in [redacted]. I am a graduating medical student at [redacted] and am a member of Aenta's student health insurance program. I was required to pay 100% of my medical bills up front (a ridiculous requirement in and of itself as my insurance covered me internationally) and told I would be reimbursed ASAP at 80% of the total cost. Aetna was prompt in reimbursing me for a large portion of the medical bills I submitted, with a balance of 242.83 needed to go through an appeals process due to the way a portion of the expenses were documented (the documentation process in [redacted] differs than what is typically seen in the United States). These were all submitted in late December 2013/early January 2014 and I have yet to receive any decision on the remaining balance despite my persistence. Worse yet, I have been given false promises on several occasions. I have been told I would receive a call on a specific date 3 times but received none, I have been told I would be updated within a week on multiple occasions but then receive no call or email. Not until I call or email do I get a response which typically contains an apology and another promise that goes unfulfilled. Now my past 3 attempts to contact Aetna have been unsuccessful (phone call, email, and phone call from our [redacted] Practice Manager). I am graduating and leaving the student health insurance plan and therefore need to get this outstanding claim resolved, and I have portrayed this information to Aenta to no avail. I have records of our email conversations and can supply them if necessary. My last email contact was with [redacted] (my main contact at Aetna) on 4/16/14 where I was told "we should have this wrapped up by the end of the week."Desired Settlement: I would like Aetna to reimburse 80% of the $242.83 in unsettled claims. I have submitted all documentation I obtained for the medical services I received, and have responded quickly to all of Aetna's requests, even when this included paying upfront to be reimbursed later, and obtaining paper copies of all services performed in a country where this is not always the norm.

Business

Response:

Hi [redacted],

We were unable to locate this member in our system. We’ve reached out to [redacted] on 06/02/14 for additional information. Once received, we can then review his complaint.

Thank you.

Sincerely,

Business

Response:

Thank you for your inquiry received on 06/02/2014 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 resigned from [redacted]. July 1st, 2014. Prior to putting in my resignation I spoke to multiple people from the HR help desk about my insurance and when it would expire. Per the people I spoke with as well as documentation that I have my benefits will end at the end of the month in which you left the company which would take me out to July 31st.I am to have a medical procedure on July 17th, 2014. I also have a pre op appointment schedule for July 14th, 2014. I received a call from my doctors office July 9th, advising me that my insurance was inactive effective June 30th. This is unacceptable. Someone has dropped the ball in this needs to be fixed immediately. My last working day at [redacted] was July 1st. I have called and verified with [redacted] of my last day. I also spoke with Aetna who stated that it showed my insurance went inactive on June 30th. June 30th was not my last working day. A representative was to expedite my issue but I cannot wait due to time and things that need to be done.Desired Settlement: My insurance needs to be activated ASAP. Both medical and dental. Extend it for additional month for the trouble that this has caused me.

Business

Response:

Thank you for your inquiry received on 07/10/14 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 canceled my AETNA policy, because I was enrolling in a different program. AETNA retroactively changed my cancellation date, to avoid paying claims.

On Thursday November the 13th, after 2:00 pm, I called Aetna customer service associates because I wanted to terminate my Aetna insurance and the reason why I wanted to end it is because I was just added to my husband's insurance. I told Aetna that I would like to have it terminated on Friday November the 14th and they accommodated me with that. Unfortunately, on Friday the 14th, I found out that the effective date of my husband's insurance actually starts on the 1st of January 2015. I called Aetna back on Friday to ask whether they could reinstate my insurance since I did not want to stay uninsured, but it was too late to call that day because it was after the working hours, so I decided to call back Aetna on Monday, November the 17th at 9:30am. I explained my situation to the Aetna associates and was told that the termination process will be cancelled because the process was not finished yet and that I would not have to worry about it. They asked me if I would like to have a new termination date on the 31th of December and I agreed. They also mentioned that they would send a letter stating this date. I had two doctors' appointments made that week and I told the AETNA representative in my Monday phone call about them. One on Monday the 17th (same day I wanted my insurance reinstated) and another one on Thursday the 20th with my primary Physician. I had to have my thyroid function checked which means I had to have some blood taken and have it sent to the lab.

Later, I received a letter that was sent out the same day I reinstated my insurance, November 17th, saying exactly what we agreed to: "You asked us to change the termination date of your Aetna plan. Your plan was cancelled on 11/14/2014. The new termination date is 12/31/2014. This is based on when you sent us your last premium payment."

However, several days later I received another letter that was sent out on the 21st of November, the day after my doctor's appointment, which stated: "You asked us to change the termination date of your Aetna plan. Your plan was cancelled on 12/31/2014. The new termination date is 11/14/2014. This is based on when you sent us your last premium payment." This is nonsensical.

I did not think much of the letter and thought it was sent to me by mistake. But at the beginning of December, I received a bill from [redacted] for $573.46 which was for the blood work I got done on 11/20/14 and found out it was not covered by the insurance and that I was not insured all this time. In addition to that, I got another "bill" from Aetna, dated for 11/24/14, in the amount of -$181.00, in an apparent attempt to refund my November payment for coverage through December.

It appears that Aetna was knowledgeable of my intention to have the policy extended through the end of the year, and decided to retroactively remove my policy after receiving a billing request from my doctor. I had multiple reasons to believe I would be covered for this doctor's visit per the conversation I had with the Aetna representative on November 17th, along with the letter detailing the termination date of 12/31/2014, also dated November 17th.

Use of the AETNA website to file a complaint resulted only in error messages, and an email to AETNA customer service has been unanswered.Desired Settlement: I want AETNA to honor its obligations under my insurance policy and assist in the compensation of my medical bills that I received while I was under the reasonable assumption that I was insured by AETNA.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on January 02, 2015.

Review: Dear Mr. Bertolini,

I am writing to inquire of someone of authority with Aetna. I am POA for my mother who is a customer with Aetna though the [redacted] program. It appears that Aetna is using the old "smoke and mirrors." That is, my mother is in need of hospice and I contacted Aetna to locate preferred providers. The Aetna representative [redacted], walked me through the Aetna website to find providers for my mother's plan. I printed a list of 67 providers directly from the Aetna website that she directed me to on 1/27/2016. I asked her to review my mother's benefits with me for hospice and after a 5 minute hold I was told that Aetna does not cover hospice care. She was unable to explain why hospice providers were listed on the website. Incredulous, I requested a supervisor (I cannot find her name) who confirmed that Aetna does not cover hospice care.

I have already contacted my congressional representatives about Aetna's egregious breech of the public trust by this willful misrepresentation of healthcare services to customers who are sick.

Since Aetna appears quite organized when collecting funds from my mother's [redacted], I would expect a reasonable response as to why my mother cannot receive services. Further, in a separate conversation with an Aetna supervisor last month, I was told that my mother would not qualify for Home Health Services, yet she was unable to direct me to a written description of this policy or mail/email a copy of the Aetna policy or benefit description.

From my perspective, you have unknown Aetna Representatives on the telephone interpreting benefit policy information with no understanding of health care or medical issues.

The services I seek were recommended by a board certified neurologist as being medically necessary for my mother's medical condition and I respectfully request a response of why my mother's health insurance with is funded by the government is denying her coverage for medically necessary service.

Respectfully,

[redacted] for [redacted]

###-###-####Desired Settlement: 1. I would like a written description/definition of her benefit SPECIFICALLY pertaining to Home Health and Hospice care (not a 500 page book written by lawyers that contains more than a reasonable person can read).

2. I would like Aetna to approve payment for hospice service providers that were listed on the Aetna Website on 1/27/2016. In other words, honor what was described on their website

Business

Response:

Hello,

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

Upon receipt of the complaint we immediately reached out to our [redacted] department to have the member’s concerns reviewed. We were advised by the [redacted] department, that The Annual Notice of Change (ANOC) and Explanation of Coverage (EOC) The Centers for [redacted] & [redacted] require us to send a combined ANOC and EOC mailing each year. The ANOC describes the changes to the members plan for the upcoming plan year. The EOC is the actual contract that provides the members plan benefits and guidelines. All of our booklets and mailings are approved by [redacted] and are written according to [redacted] guidelines.

We reviewed the members ANOC/EOC and found the following: Page 54 states: Hospice

The member may receive care from any [redacted]-certified hospice program. The member is eligible for the hospice benefit when their doctor and the hospice medical director have given the member a terminal prognosis certifying that the member is terminally ill and has 6 months or less to live if the members illness runs its normal course. The member's hospice doctor can be a network provider or an out-of-network provider.

Covered services include:

- Drugs for symptom control and pain relief

- Short-term respite care

- Home care

For hospice services and for services that are covered by [redacted] Part A or B and are related to the members terminal prognosis: Original [redacted] (rather than our plan) will pay for hospice services and any Part A and Part B services related to the terminal prognosis. While the member is in the hospice program, their hospice provider will bill Original [redacted] for the services that Original [redacted] pays for.

For services that are covered by [redacted] Part A or B and are not related to the terminal prognosis: If the member needs non-emergency, non-urgently needed services that are covered under [redacted] Part A or B and that are not related to the terminal prognosis, the cost for these services depends on whether the member uses a provider in our plan’s network:

-If the member obtains the covered services from a network provider, the member will only pay the plan cost-sharing amount for in-network services

-If the member obtains the covered services from an out-of-network provider, the member will pay the cost-sharing under Fee-for-Service [redacted] (Original [redacted])

When a member enrolls in a [redacted]-certified hospice program, their hospice services and their Part A and Part B services related to their terminal condition are paid for by Original [redacted], not Aetna [redacted] Select Plan (HMO).

Hospice consultations are included as part of Inpatient hospital care. Physician service cost sharing may apply for outpatient consultations.

Aetna Compassionate Care Program This program offers case management and services to members and their families who are managing the complex and emotional issues involved in advanced illnesses. A nurse case manager by the name of Sue L. will be in contact with you.

We strive to provide the best customer service experience possible and we expect that in all of our departments. We have reviewed your concerns and verified the calls made into our Member Services. We forwarded the issue to the representative’s direct supervisor for education and/or re-training.

Aetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processes. I want you to know that we appreciate your feedback because it gives us the opportunity to listen to our customers and make any improvements to our processes and the service we provide. Your opinion is valued at Aetna, and I trust that you will not hesitate to contact us when you need assistance.

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,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

The response from Aetna does sound like a response from an attorney rather than anyone actually addressing my concerns. This is just a summary of the benefit that is so couched in "legalize" that I am not sure that my actual issue was addressed. That is, the response of the individuals, the representative and her supervisor, in addressing my concerns.

Since I did send an email to the company CEO, I did receive immediate feedback (within 1 1/2 hours) from someone with the corporate office who was able to answer my questions (that the initial Aetna representatives could not). It is a travesty that a paying customer should have to contact the CEO in order to obtain a response to a reasonable question about benefits.

Additionally, while I communicated my concerns in my complaint using my name as Power of Attorney for my mother, I notice that their response on this public website uses her full name and potential need for hospice services. Since this is protected health information I wonder if there has also been negligence in this.

It almost seems malicious unless the person writing the response is not familiar with HIPPA requirements.

Sincerely,

Business

Response:

Hello,

Thank you for your inquiry, regarding complaint #[redacted]. Our Executive Resolution Team researched your concerns, and I

would like to share the results of the review with you.

Upon receipt of the complaint we immediately reached back

out to our [redacted] department to have the POA’s concerns reviewed. We were

advised that they have sent the POA a new letter today, February 23, 2016, that

addresses all of her concerns.

Please know that all the information shared in our last

response is private and your complaint is not available for public view. All

member names, addresses, complaint numbers, Dr. names, claim IDs etc. are

starred out by the Revdex.com if they make it available for public view. They also

block complaint numbers from the public view. Only the analyst who is assigned

the complaint and the member or their representative can view the HIPAA

information provided in a resolution by clicking on the link supplied in an

email separately to Aetna and the member/representative with a log in and

password. We verified on the Aetna Revdex.com website that your complaint is not

available for any public view.

We sincerely apologize if you were not happy with our initial

response to you, as this was not our intent. We are here to assist our members

and if you have any further questions or concerns about the plan please feel

free to contact the number listed on the [redacted] resolution letter mailed

today, or you can email the address below.

We take customer complaints very seriously and appreciate

you taking the time to contact us and giving us the opportunity to address Ms.

[redacted] concerns. If you have any additional questions regarding this

particular matter, please contact the Executive Resolution Team at [redacted]

Thank you,

Ashley S.

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 currently have Aetna SRC insurance. I have had their insurance for six years out of the ten that I have been employed at my current job. The terms of their insurance plan state that if I see an in network doctor, they pay up to 100% with a $15.00 copay. I have visits from 9/6/12, 10/25/12, 1/31/13, and 2/21/13 that they are only paying at 50%, leaving a balance of $233.81. I have called them ten times since January to get them to fix my bills. Every time, they say that the bills have been forwarded to a manager for a review. The last time I spoke to a gentlemen named [redacted], who assured me they would be forwarded to the proper department for handling and that he would follow up with me in a week. He did follow up with me and left me a voicemail on my phone a week later stating that the bills were fixed and payment would be issued to [redacted] in [redacted] and that I was only responsible for my $15.00 copay. This was in February, Shortly after that I recieved Explanation of Benefit statements in February that showed the corrections and that I was only responsible for $15.00. My bills were still never paid. With the amount of calls that I have made and due to the fact the bills still have not been paid, it is clear that this company is a fraud and ripping off the consumer. They should be investigated. Is there anything that you can do to get them to follow my insurance policy and pay my bills. I have copies of everything, the corrected EOB's and their voicemail on my phone. My insurance is Aetna SRC GRP#[redacted]. ID#[redacted]. Aetna's phone number is [redacted]. Their Address is [redacted]. Upon looking up information about them, their are numerous complains online from other people not getting their bills paid. They should be held accountable. Thank you for your time.

Product_Or_Service: AETNA SRC

Account_Number: ID[redacted]

Desired Settlement: I want them to pay the $233.81 balance that they are responsible to pay. I have since paid my $15.00 deductable as they stated, in word and writing that I was responsible for paying. These bills have been left unpaid for months now. I have called them ten times and they are refusing to follow through and pay them.

Business

Response:

Business Response /* (1000, 5, 2013/04/25) */

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

We reached out to Strategic Resource Company (SRC), an Aetna Company, for resolution of the member's concerns. The claims for dates of service, September 6, 2012, October 25, 2012, January 31, 2013 and February 21, 2013, have been reworked to show member responsibility as $15.00 copayment only. They advised they will contact the provider with this information. We apologize for any confusion and delay 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].com.

Review: Aetna Student Health has failed to issue an out-of-network patient reimbursement in a timely manner. There are clear efforts to delay payment.

The health insurance claim in question is task #XXXXXX, the beginning of the claim rejections was January 4, 2013. The total of the bill sent by my therapist is $1,105.00, to which according to the Aetna Student Health policy, approximately 80% of reimbursement is owed. The bill was first rejected on 1/4/2013, claim #PXXXXXXXXX. The reason sited originally was a lack of tax ID number. This was the only reason originally cited. The next time the claim was rejected, it was cited that much more information was missing. I have reason to believe the claim was repeatedly rejected to purposely delay claim payment. Customer service throughout this issue was unprofessional, the most recent issue being that when the therapist was attempting to give CPT codes over the phone, she was hung up on and had to call back to continue giving CPT codes as requested in a letter by Aetna Student Health. Previous to this, I was given a series of contradicting or misinformation, representatives unwilling to contact the therapist and supposedly having difficulty finding the claim, the claim was even lost at one point. When my therapist has asked to speak to the individual that contacted her directly from Aetna Student Health, she was at first told the individual and the identifying information did not exist, after two more calls she was finally directed to the individual's voicemail. My repeated attempts to receive clear information as to what exactly was missing from the bill resulted in either explaining that diagnosis codes, CPT codes, both, or my identifying information were missing. My identifying information was never missing. Checking the website now, I can see the information concerning the rejection of the bill was changed, I'm guessing to cover up the reason for the bill being rejected on the first attempt.

Desired Settlement: Reimbursement for out-of-patient behavioral therapy based on the guidelines outlined in the Aetna Student Health [redacted] School of Medicine description of benefits, 80% of $1105.00

Business

Response:

Business Response /* (1000, 6, 2013/06/19) */

Thank you for your inquiry received on June 5, 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) and the Claim department for resolution of the member's concerns. First, let us apologize for any delays and multiple contacts concerning these issues. They advised the claims for dates of service November 2, 2012 through April 12, 2013 were denied because they were submitted with missing service codes and diagnosis codes, that were needed to process the claims and it was not intended to delay payment.

On May 15, 2013, we received the claims again; however, there were service and diagnosis codes on the claims that were missing. We requested the information from the provider and the requested information was provided on June 3, 2013 and claims were immediately sent to a processor. The claims were reworked on June 4, 2013 and paid on June 6, 2013 under payment number XXXXXXXXXXXXXX. In conclusion, we had requested service and diagnosis codes, which were required to process the member's claims. Unfortunately, this caused the delay in processing and we apologize for this.

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].