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Aetna, Inc.

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Reviews Aetna, Inc.

Aetna, Inc. Reviews (441)

Review: I am being harassed by Aetna, and I want it to stop!!!! Back in November (I belive, if not it was October) I planned to sign up with Aetna Health insurance through the [redacted]. Well before the plan was to begin, I changed my mind and called both the [redacted] and Aetna to say I did not want a policy with them. I was told in no uncertain terms that I did not have a plan, it never began, and I was not enrolled with this company. I am constanly getting mailings and worste yet phone calls saying that my bill is overdue. I want them to leave me alone. Stop calling me with automated messages saying my bill is past due when there was never any bill to begin with. Also, stop mailing me regarding an account that never was.Desired Settlement: I want a letter in writing stating that I do not have an account with them, I never did, and furthermore I want it in writing that they will stop harassing me by mail and phone calls.

Business

Response:

Thank you for your inquiry received on 02/24/2015 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.

We reached out to our Business Operations department, and according to our records, we never received a cancellation from the [redacted] for this plan. Since [redacted] had not paid the premium, the system automatically terminated her back to the original effective date when the termination was processed and voided the account. In addition, we have placed a permanent system override so that Ms. Clark will not receive any further reminder calls or messages. We apologize for any inconvenience this may have caused her.

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]

Review: My daughter had a major dental work that required anesthesia. An Anesthesiologist provided the service and AETNA is denying my claim because the information they have for the Anesthesiologist shows that he is a General Practitioner instead of a Specialist. I have provided them with the Service Providers Medical license number so they can verify themselves and also a copy of the license that shows he is a specialist and they still deny my claim.Desired Settlement: I would like to be reimburse for the money I paid to the Anesthesiologist

Business

Response:

Thank you for your inquiry received on December 17, 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: Not reimbursing the money as promised by customer service Representative.

Product_Or_Service: [redacted]

Account_Number: WXXXXXXXXX-XX

Desired Settlement: Aetna should reimburse the money for the equipment as Customer Service Rep provided the wrong information.

Business

Response:

Business Response /* (1000, 5, 2013/07/19) */

Thank you for your inquiry received on July 10, 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 issue. According to claims history, it shows that we advised the member that the coverage was 100% for the [redacted] for participating providers. The store that the member received the [redacted] from, [redacted], is not an Aetna provider, so it was based on the member's nonparticipating benefits, which are 60% after the plan deductible, which she did not meet. The $290.91 is correctly applying to the deductible.

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, 2013/07/23) */

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

Initially I ordered the [redacted] from preferred provider but they were out of stock, so I talked to Customer Service Rep what to do, she assured me that I can buy it anywhere even at [redacted] and it will be covered and reimbursed. So I cancelled my first order and bought it from [redacted]. But later they denied the claim. If CSR has not told me to buy it from [redacted], then I would not have bought it from there and waited for my other order.

Thanks

Business Response /* (4000, 9, 2013/08/07) */

Thank you for your inquiry received on July 24, 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 Claims department for assistance with the member's issue. According to contact and claim history, it does show that we told the member that the coverage was 100% for the [redacted] for participating providers. The provider that she received the [redacted] from was not an Aetna provider so it was based upon her nonparticipating benefits which are 60% after the plan deductible that she did not meet. That is why the $290.91 is applying towards the deductible. Unfortunately, the claim was processed 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].

Consumer Response /* (4200, 11, 2013/08/14) */

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

Thanks for following up and the response. Problem is not with the participating providers. Problem is that when we called Aetna, the representative told that it is ok buy the [redacted] from [redacted] and it will be covered 100%. I called multiple time to make sure I get the [redacted] from a provider where it is covered. Now Aetna is making excuses to hide their error. If was the fault of Aetna representative who gave wrong information and told me to cancel my order from a participating provider and buy it from [redacted] and then file the claim as it does not matter, [redacted] is covered 100%.

Business Response /* (4000, 13, 2013/08/30) */

Thank you for your inquiry received on August 16, 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 Claims department for assistance with the member's issue. They again listened to the call. The representative told the member if she gets the [redacted] from a participating provider, it is covered at 100 %. The member asked the representative if she could get the [redacted] from [redacted], since she "had spoken to someone some days back" and the representative stated she would not be able to get [redacted] from there and that if the member purchases anywhere who is not participating, it is covered at 60%.

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: My father passed away 2/24/13 and we had his funeral on 3/1/13. We sat down with the funeral company to assist us with filling the life insurance claim for my dad with Aetna Company. He had a $10,000 life insurance policy. We made a claim with SRC an Aetna company through the funeral company. The claim form was submitted sometime in March 2013. We didn't receive correspondence from SRC that there was information missing from our claim until 4/23/13. But we were receiving correspondence that they were paying his medical bill claims from the hospital when he died. So I contacted them and provided the missing information. They paid the funeral home immediately but delayed paying my siblings and I the remaining balance of the $10k policy which was roughly $800 to be split 3 ways. It is now June 28, 2013 and we still haven't been paid. I have made numerous calls to get the claim issued. I've even received a claim benefit statement that they paid all of us our claims but no checks were included. This company has made such a difficult time in our lives so difficult. Because there were other expenses outside of the funeral that we need to be reimbursed for.

Account_Number: WXXXXXXXXX

Desired Settlement: They owe each of us the money. An apology written to my family would also be nice since each time we had to call it reminds us that our dad is deceased.

Business

Response:

Business Response /* (1000, 5, 2013/07/12) */

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

We reached out to Strategic Resource Company (SRC) for review of the member's concerns. They advised on March 25, 2013, Life Claims received information and started to review. The benefits were signed over to funeral home. Additional information was needed from the funeral home and a Tax ID letter request was sent. Two checks were issued to the funeral home, one for $3045.00 paid April 25, 2013 and $6193.10 was paid May 6, 2013. The member had a $10,000 benefit and once the funeral home was paid there was a balance left of $761.90 to be divided among the 3 beneficiaries.

There was no social security numbers listed for the children so a letter was sent on April 23, 2013 to request SSN's and they received the requested information on April 26, 2013. On May 20, 2013, there was a Supervisor call wondering where the rest of the checks were. A Life Claims processor was contacted and 3 checks for $253.97 each were processed May 23, 2013.

On June 7, 2013, beneficiary called to check on checks and a Customer Service Representative (CSR) advised that the checks were processed on May 23, 2013 and went out May 24, 2013. On June 28, 2013, the checks were still not received. It was determined all 3 checks were sent to the member's address incorrectly, this was an error of the processor. CSR requested to have checks stopped and reissued to the beneficiary's address. On July 1, 2013, the checks were voided and reissued to be sent to the correct address. We apologize for the delay and inconveniences this has caused the family. We sincerely are sorry for their loss and this situation caused additional stress during an already difficult time.

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 have an Aetna [redacted] plan that administers my Medicare Part B coverage (Medicare replacement plan). [redacted] selected this plan and partially subsidizes it for me. I like this plan because it covers 100% of my Medicare Part B expenses once I meet my $400.00/year out of pocket maximum. Although most medications are covered under my Part D plan with another company, I take two medications ([redacted] and [redacted]) that are covered under Medicare Part B. These expensive medications keep my body from rejecting the kidney transplant I received 3 years ago. Last year, I met my $400 out of pocket maximum in early January. After that, Aetna covered those 2 medications at 100%.

My insurance plan has not changed. My January antirejection medications cost me $373.94; which is 20% of the actual cost of these meds. I thought this money would be applied toward my out of pocket maximum as it had last year, but it was not. Instead, this year Aetna has told 3 different pharmacies that I must pay 20% coinsurance each month telling them that as of January 1, my coinsurance is now 20%. However, when I call the benefits office, they confirm that my plan has not changed and that my coinsurance is 0% once I meet my out-of-pocket maximum. Representatives at the Medicare B help line at Aetna confirmed that my $400.00 out of pocket maximum is met for this year. But they do not see any claims from pharmacies and have not applied the $373.94 I have already paid toward my out-of-pocket maximum. I owe $400.00 to other vendors.

After many, many phone calls from me, my daughter-in-law, 3 pharmacies and kidney transplant support team, we have yet to reach a resolution. We are all transferred countless times from representative to representative and spend many hours on hold. Through this, my daughter-in-law has discovered that as of January 1st, it appears that pharmacy claims are being processed through the pharmacy division of Aetna that handles Part D. The pharmacy division sees the claims by the pharmacies that provided me with antirejection meds. However, the Part D pharmacy division has no information about my Part B plan so they decided to cover those medications with a standard Medicare 20% coinsurance instead of following my Aetna Medicare Advantage health insurance plan.

At the same time, the Part B medical division of Aetna cannot see that pharmacies have submitted Part B requests. So my January antirejection meds were not counted toward my out-of-pocket maximum and are only being covered at 80% instead of 100%.

This discrepancy was discovered on April 29th, 2015, when a manager from Aetna's pharmacy division and a manager from Aetna's medical division compared the information they could each access during a conference call with me and my daughter-in-law. This call resulted in the formation of an internal review (reference # [redacted]). I thought that the issue would finally be resolved and that Aetna would begin covering my medication according to my insurance plan. My daughter-in-law was asked to call back in a few days using that reference number to discover the outcome of the internal review. Unfortunately, after three calls back and another 5 hours of being transferred from person to person within their company, she wasn't allowed to speak to the person who created the internal review. But she did find out that the result of Aetna's review was that they established that I do not have Part D with them, only Part B. I know that and they knew that before the review! In other words, nothing was resolved. They say that they are conducting a further review. This is ridiculous! Each review takes 7-10 business days. Because no one will give us a direct line, it takes hours to wade through the screening system to find someone to discuss the reference number they gave us to call about.

I am proud to have beaten [redacted], 5 years of [redacted] and a resulting broken hip to get to the point where I was able to receive this kidney transplant. It has changed my life. I am a retired homemaker and have a modest fixed income. I cannot afford to pay up front for my medication and get worried that the money I already paid will not be reimbursed. Pharmacies will not give me my medications unless I pay them. I am almost out of my antirejection medications. If I run out, my body will reject my kidney transplant and I could die. I cannot keep waiting for 7-10 business days at a time to find out yet another thing that I already know and I don't want to spend another 5 or more hours on the phone trying to find out the result of the reference number they gave me.

My daughter-in-law, [redacted], has taken the lead on helping me with this because it is so confusing for me and my age-related hearing loss prevents me from catching and understanding everything Aetna says. I live with her and my son. Tracy is completing her PhD in Pharmacology and helps me with my many medicines. She helped me write this to you too.Desired Settlement: I would like Aetna to cover my Part B medications according to my Part B insurance plan with them. According to my insurance plan, my Part B medications should count toward my out-of-pocket maximum. Therefore, Aetna needs to readjust who I pay my out-of-pocket maximum to. Since my out-of-pocket maximum was met in January 2015, Aetna should cover 100% of the cost of my Part B medications ([redacted] and [redacted]) from February through December.

Aetna should pay out 100% of the cost of those two medications directly to the pharmacy the same way they did last year. I am concerned that they will decide that I should pay up front to the pharmacy and submit a form for reimbursement each month. Because I am on a fixed income, this is not an acceptable solution.

Another very much desired outcome is that I want a direct phone number to someone in the company that is involved in this case. This way, my supporter and I don't have to spend hours on hold or being transferred from person to person who claim they cannot access the reference numbers they gave us to call about. It would be great if my daughter-in-law were compensated somehow for the many hours she has spent on the phone with Aetna on my behalf over the last few months.

Business

Response:

Thank you for your inquiry received on 05/12/15 regarding complaint #[redacted] for Anna Knight. 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 Pharmacy Management department (APM) for assistance, and were advised that the prior authorization entered to cover these medications under the Part B benefit was incorrectly set up and was not calculating the Part B accumulators. The prior authorizations have been updated and corrected. This should not happen in the future for these medications. Also, the claims already filled are being reversed and reprocessed. We apologize for any inconvenience this has 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:

Aetna's response to my Revdex.com complaint ID [redacted] on May 27th, 2015, is "The prior authorizations have been updated and corrected. This should not happen in the future for these medications. Also, the claims already filled are being reversed and reprocessed." To confirm that the issue is resolved, my daughter-in-law, Tracy Schatteman, contacted Aetna on Friday, May 29, 2015. I listened in on the speaker phone. The representative at Aetna told us that my Part B medication claims have not been paid out to the pharmacy yet and that the Part B medications have not counted toward my out-of-pocket maximum. In other words, Aetna has NOT rectified the situation as they claimed in their correspondence to you!

Review: In August of 2013 our Aetna plan, through my husbands place of employment, was changed to a new Aetna plan under the [redacted] Health Network. Unknowingly, our primary care physicians were no longer in-network after this change. However, we were not aware of this until we received additional bills from our doctors in the first few months after the change, even after paying the co-pay at the time of the office visit. Since then we have incurred a lot in medical bills and we have had nothing but problems with new claims being paid. We are now afraid to go to the doctor for even the simplest problem since we are fearful of the bills we will receive afterward. One would think this could be avoided by checking network information on doctors with Aetna before going to the doctor. However, we have discovered, with Aetna, there seems to be no way to verify wether they will pay a claim for a doctor or not, as I will prove in the following circumstances.The first problem we had was in October of 2013 when I took my son to the emergency room because he could not breathe. After determining he had pneumonia and would need to stay in the hospital he was admitted. He stayed in the hospital for two more days before he was well enough to go home. When we received the bill from the hospital it showed that the emergency room had not been paid with the $200.00 deductible as the Aetna Coverage and Benefits page showed, but rather the amount was added to my deductible with 30% co-insurance. The total emergency department services were $3,796.00, and based upon Aetnas coverage pages should have been only a $200.00 deductible. I called Aetna and asked about this on three occasions, but I was told since my son was admitted it was no longer an emergency room visit. Nowhere in the Aetna coverage and benefit information does it mention ANY exclusions for emergency room, but states very clearly emergency room services - $200.00 co-pay (for in-network and out of network providers) and under limitations and exceptions it states : no coverage for non-emergency use. It makes no mention of any change due to in-patient care. In February, 2014 an Aetna customer service representative suggested that I did not have a full packet of coverage and benefits information and offered to send me one, to which I agreed. When I received the packet it showed, as did the one I already had in my possession, the same information regarding the $200.00 deductible for emergency room, with no other exclusions except that which I already noted.After realizing that we had subsequently lost our family doctors with the change in insurance and received all the extra bills we had not expected, I was very careful to check to make sure I was going to see doctors that were part of our Aetna plan. I needed to schedule my yearly exam so when a doctor nearby was highly recommended to me I called the doctor to check if they were part of our network. The doctors office told me they did accept Aetna, but I should check with Aetna to make sure that doctor was in fact part of our plan. I called Aetna and was told that particular doctor, a Doctor [redacted], ob/gyn was part of our plan as an in-network provider. My daughter had just become pregnant and was on our Aetna insurance at the time. She also called Dr. [redacted] office and Aetna and was told [redacted] was a provider within our network. Additionally, the office manager of [redacted]s practice, [redacted], called Aetna and was given benefit information reflecting the in-network status including referral numbers to prove Aetnas admission of in-network benefits. I visited [redacted]s office on February 10, 2014 and paid my $60.00 co-pay per my insurance benefits for an in-network specialist provider. A few weeks later I received a bill from [redacted]s office for the balance due of $56.50. Aetna billed it as an out-of-network doctor. Since then I have record of 15 phone calls to Aetna trying to get this issue taken care of. Since my fourth phone call on March 19th, 2014 I have been told that the claim is being sent back for re-processing on March 14th and will take 7-10 business days to complete. That was 103 business days ago. On 7/22/14 I spoke with Marge in customer service at Aetna, my 11th phone call, and was told that the claim had re-processed and payment of $190.45 was finally being sent to [redacted]. She told me it would take 7-10 days for payment to be sent. On 7/30/14 I called Aetna back to make sure the check to [redacted] had been sent. I spoke with [redacted] who told me that the claim had been re-processed and the check would be released on August 5th. By this time the bill I owe to [redacted]s office is about to be sent to collections and [redacted] offered to call [redacted], the office manger the next day and explain the status of the check. [redacted] also said she would call me back the next day with information on another claim which I will explain next. [redacted] did call me, and [redacted] and told us both that the check would be sent by August 5th. I called Aetna back again on 8/4/14 and spoke with [redacted]. She told me the claim for [redacted] had been re-processed and the payment of $190.45 would take 7-10 days. [redacted] said she would speak with a supervisor and call me back the next day. [redacted] never called back. As of today, I still have no concrete answers regarding the status of the check that is supposedly being sent to [redacted]. I have been told the same information over and over, but there is never any action to back up the words. Aetna needs to fulfill their obligation immediately and send this money to [redacted]s office.On May 22, 2014 I took my son to a pediatrician in my area on Aetnas list of in-network providers (see attached sheet from Aetna provider website which shows this doctor is accepting my insurance) to get a physical for boy scout camp. According to my benefits, physicals are covered 100%. On July 29, 2014 I received a bill from the pediatricians office for $313.72 due forDesired Settlement: I want Aetna to pay the doctors bills per my policy and the information I was given by Aetna.

Business

Response:

Thank you for your inquiry received on August 08, 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 Claims Department for assistance, and [redacted] claim for date of service February 10, 2014 was reprocessed and paid on August 5, 2014, under her “in-network” benefits for [redacted]. The claim for date of service March 7, 2014, for dependent [redacted] was reprocessed and paid on July 15, 2014, under her “in-network” benefits for [redacted]. The claims for dates of services October 18, 2013 and May 22, 2014, for dependent [redacted] were processed correctly according to his out-of-network benefits. No additional payment is due. If the member disagrees with any of the determinations above, she can submit an appeal request to the following address:

Aetna- [redacted]

The appeal request should include name, date of birth, Aetna member ID , address, contact phone number, claim details, and any other documents or records they would like to be reviewed and considered.

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:

The May, 2014 appointment for [redacted] should absolutely NOT be out of network as I found this provider information on the Aetna provider site when logged in under my account. Neither does this address the issue of my son's hospital bills, specifically the emergency room fees which Aetna has said they are not going to pay according to our contract but rather attach the fees to coinsurance instead of paying the $200 deductible according to my policy information.

Sincerely,

Review: Joined and made my March payment with the only option to sign up for automatic billing. Was not sent an invoice via mail or email. Apparently they did not take out my April payment. So instead in May took out two months worth of payments in turn bouncing my checking account. Will not refund the $35.00 over draft that I incurred as a result.

[redacted] took the time to read off a billing statement and at that point said that auto draft sometimes takes a month to kick in. If this is the case a statement should be sent out and processed in the month that payment is due. You do not just take out double the payment in the next month. If your only option to the customer is automatic billing then as a company you need to be responsible for taking the payment out at the beginning of each month not just catching up when you see fit.Desired Settlement: A refund of the over draft fee.

Business

Response:

Thank you for your inquiry received on 05/26/15 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.

Review: Three times my mail order pharmacy will state at the end of my order one price and when I get the rx the bill is always higher. According to [redacted] in the past it was due to a "glitch" in system stating I need to meet my deductible which is false. Recently I was charged a different amount they claimed it was due to a coding error and I was being charged a DAW penalty. I asked them to provide documentation of this penalty that they say I have paid in the past they state they are unable. There is no mention of a DAW penalty on my statement.

Often during customer service calls we are hungup on and the [redacted] never returns the call. We a waiting for our refund, one customer service rep states it will be in form of a check and other states it will be a vis a adjustment and it has not arrived. Customer Service is not consistent.Desired Settlement: I would like my refund and I would like to know when and in what form it will be. I would like a "glitch"resolution.

Business

Response:

Thank you for your inquiry received on 06/23/14 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: My husband requires medication that is essential for keeping him alive and well. Without this, he will die. I have been asking Aetna the status of his prescription since the beginning of the year. The physician's office does their job. Been using them for 4 years and NEVER had a problem. The problem is Aetna Specialty. I called them again on 1/13/2016 and was told they never received the paperwork. The rep called me back and said he spoke with my husband's doctor and/or prescriber and that they will re-fax everything. I called again on 1/14/2016 and was told the prescription was "in process and in the system" and that someone will call to arrange for delivery. No one called. I gave them a little leeway and decided to check up on this on Monday, 1/15/2016. The office was closed for MLK holiday. Right now, my husband has no medication despite the fact I've been trying for over 2 weeks to get it. I am getting tired of all the phone calls, lack of decent communication and most of all, the lack of care Aetna Specialty exhibits. My husband is in danger of falling ill and dying without these medications. We are at our wit's end and stressed out to the max. I don't understand this as all our previous insurers never gave us a problem. Unfortunately, I cannot use [redacted] with my current plan. Ridiculous. I have contacted his doctor and they confirmed they sent the prescription to Aetna Specialty. I have the emails. We are being forced to use Aetna Specialty Pharmacy, despite the fact that Aetna's website (my personal account with them) lists many pharmacies to use when I enter this particular drug into their system, using my account with them. False information and no communication. I've had enough.....my spouse NEEDS his medications and I just want them to deliver the goods as promised! Please help!Desired Settlement: Please mail us the prescription and do not make me go through this every month!

Business

Response:

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 your complaint, we contacted our Pharmacy department and confirmed that the prescription has been shipped and delivered to the member. We have spoken to the member and confirmed receipt of his medication. We apologize for any difficulties and inconvenience this has caused the member. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Consumer

Response:

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

I thank you all very much for quickly responding and the courteous follow up call from Aetna's Complaint Dept.

Sincerely,

Review: I needed a crown because the current crown I had was not sealed correctly and was causing me alot of pain. My dental office called Aetna to verify this procedure would be covered. After giving them my information they got the ok. A month or so later I went back to the dentist and they again mentioned the crown was needed, I agreed to schedule it, I was sceptical a bit because I knew I would have to pay a substantial amount out of pocket. But I had pain so I agreed to schedule the work. The receptionist again called and verified it was ok and that they would cover it since a month had passed. I had the work done, paid my amount and now the insurance claims it wont be paid because even though the rep gave an ok it does not imply or guarantee they will pay. When I called I was just toldi it was denied and someone should have checked 8 years back. Shouldn't the insurance rep be responsible and knowledgeable of their job. Its their job to give correct information. Its unfair I should have to pay for the "miscommunication" and lack of knowledge pertaining to the product they sell. Had they told my dental office No it would have sufficed. The reps work there is to furnish correct information. If they do not then why am I paying for this service/ product. They arent delivering either or.Desired Settlement: I want Aetna to pay their portion of the claim. I paid my portion and thats only fair.

Business

Response:

Thank you for your inquiry received on May 28th, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: My father passed away and had a life insurance policy. Aetna notified me by mail on Feb. 11 2015. about this policy. I filled out all forms talked to their representative 7 times and still not received the insurance money from that policy.Desired Settlement: Pay me what is due from the policy

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: On January 13,2014 I call Aetna Insurance company to Cancel the Insurance Health Care policy that I had set up for my wife [redacted]. After waiting some 40 minutes on hold. I was greeted by a hostile worker, who over talk me (would not allow me to get a word in the conversation) who told me that I must go to the web site and cancel the policy that I had with Aetna. The only two reasons on why I called Aetna was to ask to have a letter sent to me on the amount that I paid during the tax year of 2013, and to Cancel the policy that I paid for my wife. I was currently unemployed, paying $711.00 per month for my wife. I've recently have become in employed with Healthcare benefits. My name appears on the monthly statement every month, as the payer of this policy. This hostile worker inform me that I was not granted a refund, but my wife would be granted a refund. As I write this letter todays date is Febuary 9, 2014. NO REFUND has been received.Desired Settlement: All I would like to have, is a statement showing the ammount that I [redacted] paid during the TAX YEAR PAID (2013) for [redacted]. And I would like my refund , due to us canceling the policy before the Month of January 2014 began, $711.00 is owe to me. I want the check made out to Mr. [redacted], since I'm the payer of the policy.

Business

Response:

Thank you for your inquiry received on February 10, 2014. Our [redacted] Team researched your concerns, and I would like to share the results of the review with you.

Review: On February 17, 2015 I was advised by my Manager at office to file a [redacted] because on February 11, 2015 I was advised by my Dad that he has not been able to walk for approximately 90 days. He is 87 years old and main caretaker of my sister, [redacted] suffered stroke approximately 10 years ago. In past 4-5 years [redacted] was bedridden and my Dad took care of her 24/7. My Dad called to say [redacted] was in the hospital, in ICU, and that he needed me to travel to ** from ** because he was not able to help with [redacted] medical care. Also, he needed to get to doctor's office due to his not being able to walk any longer.

I sent my manager an email and/or text advising that my Dad needed me to travel to ** to help him with my sister's care as well help him get the medical attention he needed to see what medically could be done to help him in his pain, inability to walk.

I left my office 11 a.m. on Thursday Feb. 12, 2015 and went to **. On 2-17-15 my manager told me I needed to file [redacted] if going to be out period of time. I did so at which time I said when asked who I was filing for I said my Father and my sister. When they said need to pick one I said my sister since she was physically in the hospital at the time. No one ever told me my sister was not covered under [redacted] until Denial letter came.

The adjuster never spoke to me. I spoke to people who answered the 800 number who would never tell me her last name or extension. They put notes in their file that I called and they told me they sent her note to call me. The adjuster had 2 phone numbers and an email to contact me. I was using my Mother's P.O. Box in [redacted] I received the initial package there to complete.

To this day after employees at company saying they sent her note to call me, and my leaving message in their computer system, and leaving 2-3 voicemails for her specifically in past 7-10 days Catherine Manarange NEVER spoke to me before issuing a denial.

She left message on one cell phone Feb 18 and possibly Feb 19 and/or Feb 20. She had another cell and my email to contact me she did not choose to attempt to reach me by either of those. I was in the hospital most of the day and then making sure my Dad had lunch, dinner, etc. in meanwhile as well.

If she would have used the other cell and/or my email I would have seen her attempt to call and return them those days. I was not checking my voicemails on the phone she called but more times than not had my work cell which is one she never called me on. I checked my email throughout the day and never one email sent.

She never spoke to me and she denied the claim. If she would have spoke to me I would have amended the claim to my Father vs. my sister. There was not attempt to gather facts about medical issues revolving around either.

An adjuster has a duty to contact the person to get first hand information and inform the person what the [redacted] act is and what is covered before flat out denying claim. She sent the denial out before I sent the [redacted] paperwork in. She did not attempt to find out facts, speak to me or assist me with filing my Father vs. sister since Father is covered under [redacted]. She chose to deny claim and this is wrong and reason I am reporting it. Also, staff of Aetna repeatedly told me they could not give me adjuster's extension so I could dial directly to her to reach her.Desired Settlement: To speak to the adjuster and amend the [redacted] to a covered person, my Father who had it not been for his not being able to walk, I would not have needed to go to ** to help him and/or my sister who was in ICU at the time. and to have the time away from the office be a covered [redacted] claim to protect my job and eliminate the chance I could lose my job for taking off without advance notice.

Business

Response:

Review: [redacted], the insured, Aetna ID #[redacted] GRP # [redacted], submitted a claim for medications on January 30, 2015. This was within the coverage period of the then current Aetna group health insurance policy. According to [redacted]. in Aetna's Department of Prior Authorizations, the claim can not be processed as the coverage is no longer in force. The cost was incurred within the period of coverage and should therefore be paid by Aetna. Please have Aetna pay this claim. Attached is a copy of the Aetna claim form, the Insured ID, and the bill for the medication.Desired Settlement: Please have Aetna process this claim as it was incurred during the time of coverage.

Business

Response:

Thank you for your inquiry received on 02/06/2015 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.

We reached out to Aetna’s [redacted] for assistance, and the prescription for [redacted] submitted by the [redacted] on 01/30/2015, was denied as Precertification is required for the medication. The message to the Pharmacy was for the member’s physician to contact the Precertification Department at [redacted]. Submitting a claim for processing does not guarantee payment or coverage as the formulary requirements still apply. To date, there is no approval on file for this medication. Therefore, the claim is not eligible for reimbursement.

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

Review: I had major back surgery in [redacted] on 7/30/2014. I was readmitted through [redacted]. Hosp. ER due to intractable pain. I was discharged on 8/6 with instructions to report immediately to an ER if the symptoms recurred since they may indicate a serious complication. The pain returned even worse on 8/11. I could not walk. My family physician was on vacation. Following my surgeon's instructions, I reported to [redacted] Gen. Hosp. ER. I was billed $2031.20 by [redacted] Gen. Hosp. because Aetna decided that it was not an emergency issue and refused payment. I was notified on 10/10/2014. I submitted letters from my surgeon and family physician confirming the emergency nature of the situation. I also submitted supportive medical records. The [redacted] General Hosp supervisor confirmed that it was an "emergency."

I filed three appeals with AETNA. The first two were ignored. A written response by Aetna to the third indicated that I would be contacted by an Aetna representative. I wasn't. I spoke with several Aetna individuals on several different occasions after negotiating a maze of recordings. I spoke with "[redacted] and"[redacted]" at customer service. Both told me they couldn't help. I contacted the Aetna Medicare Grievance and Appeals Unit. "[redacted]" told me she only handles correspondence. "[redacted]" told me they didn't have to respond until 12/24. I was told that "[redacted]" was handling my case but she's not accessible. I contacted the corporate office "Executive Resolution Team" and spoke with "[redacted] who promised to investigate and call me back that day. He didn't. My last call was today. I spoke with "[redacted]" who said they have another 30 days to respond but she'd send an e-mail to [redacted]. There is no question that AETNA is responsible for the charges. The "Prudent Layperson Standard" alone is sufficient justification. "Severe Acute Pain" is a "de facto" medical emergency. It's obvious that I'm being "sandbagged" while my credit rating is in jeopardy due to non-payment of the hospital bill. I'm requesting Revdex.com advocacy.Desired Settlement: Payment of medical charges.

Business

Response:

Thank you for your inquiry received on December 11, 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: Despite cancelling my policy with AETNA in September because my employer provided insurance policy had kicked in, AETNA auto drafted my bank account by $115 on Nov 3, 2014. On Nov 4, 2014 they explained it was a mistake and that they had actually taken money not only from my bank account but also a credit cart and the total was $225. When the money did not arrive the following day, I spoke with AETNA at least an hour per day on Nov 4, 5, 6, & 7th. On the 7th the manager had me convinced I would see my money no later than Wednesday November 12, 2014. Now it is Thursday November 13, and the funds have not been returned to my bank. My checking account has become over drawn and I am unable to access any funds. Today I am told that my refund cannot be done electronically and I must now wait for a check to be mailed to me. Only after I receive this check will I be able to deposit it and get a statement of all the overdraft fees that I then need to submit back to AETNA to see if they will cover the ancillary fees. This situation ahs caused be considerable financial distress as I have now for over a week not been able to buy gas or basic things for living.Desired Settlement: I believe AETNA should not only get my refund to me overnight, but that they should instantly agree to paying my over draft fees which may now surpass what they stole from me.

Business

Response:

Thank you for your inquiry received on November 14, 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: On December 12, 2014, I received an email from my employer,[redacted],[redacted], reminding me that it was my last day to elect insurance with this employer. I clicked on the link provided and inquired about the different insurances. I looked at several policies before realizing that insurance with them was too expensive. Not once did I ever select to "enroll" or "submit" my request. I backed out of everything to ensure no information was saved. I went to the marketplace and realized I could get insurance cheaper than the insurance offered by my employer. So, I elected to have insurance with [redacted] through the marketplace.

On December 24, 2014, I noticed that money had been taken out of my payroll check so, I called [redacted] to inquire about these amounts. I was told to call ###-###-####, Aetna Insurance. I spoke with a young lady who advised me that I had elected insurance with them and that it couldn't be cancelled because I had to have it, and that I couldn't get a refund. I replied no, I never elected insurance with your company, that I inquired, however, I never elected the insurance. We went back and forth for a minute until she suggested that I fax my complaint and new insurance information to the [redacted] department for research regarding this complaint. As advised, I faxed my disagreement and new insurance from [redacted] information to ###-###-####, which is the[redacted] department on December 26, 2014. On December 29, 2014, I called Aetna to to see if the fax was received. The gentleman I spoke with said that he had no way of verifying that. I asked if he could call someone to see if the information was received. He said he couldn't. I asked if he could review my notes and give me a turnaround on how long it would take to receive my refurnd. He said I coundn't get a refund because I elected insurance with them. I explained to him the same thing I explained to the young lady on December 24, 2014. He told me that if I am on the website inquiring, somehow the system reads me as wanting to enroll, so the system somehow enrolled me, Really????? I thought to myself. I didn't take that too well and he said that he would speak to his manager and call me back. He called me back later stating there was no way he could go online to figure out exactly what happened. We had a small conversation then I asked to speak with this manager. I spoke to a young lady named [redacted] who said she understood, however, there was nothing she could do. I asked if there was an IT department that could look at what transpired that day. At first, she said no. I asked if the call was being recorded and she said yes. I asked her again, if there was an IT department that could research this transaction. She then stated there was, however, they were not located in her building. I then explained to her that if IT looked at what actually happened on December 12, 2014, they would see that I never elected to have their insurance. After we went back and forth, she ended the call with saying I'll see if someone could look at it, but I doubt it.

The bottom line is, I inquired about insurance on this website but, I never elected to have this insurance. I feel as though they were trying to cover their mistake by not finding out if my fax had been received, by not trying to actually research my complaint, and by brushing me off to avoid refunding y money. When I sent them information on my new insurance, the drafts should have stopped and I should have been refunded my money. This insurance company made me feel as though I had to have insurance with them and they were not going t o accept me having insurance elsewhere.Desired Settlement: I want a full refund of the amount of $285.05 that was taken out of my payroll check on 12/24/14.

I want a full refund of the amount of $285.05 that was taken out of my payroll check on 12/31/14.

I want a fulll refund of any other monies taken out of my payroll check on or after 12/31/14.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on December 31, 2014.

Review: I had a policy for benefits that covered hospitalization through [redacted]. I called [redacted] directly on or around the end of Feb2015 . Spoke with a customer service rep. They reviewed my policy with me and my wife over the phone. We told the representative that we wanted to cancel the policy and asked about the process. The rep from [redacted] informed us that she could go ahead and cancel the policy for us effective immediately over the phone. This was consistent with what I had been told when I originally agreed to the policy. I told her I would like it cancelled effective immediately. I asked if there was any additional information or signatures required. She said that there was not. She also said that she processed the cancellation and that we would NOT be billed further.

This has not happened. I have continued to be billed. I called [redacted] to request a refund for the additional months that I have been charged. They first said that I could only cancel during the open enrollment period. I told then that was not the case. This was a "voluntary" policy and I could cancel at any time. They asked to call me back. They called me back and now they changed their story - saying that I had to cancel through my employer. I told them that their representative told me that requesting the cancellation directly through [redacted] was all I needed to do and that my cancellation was in fact completed. They said they had no record of the cancellation and refused to offer me a refund for the additional months that I have been billed.

My wife and I we're both on the cancellation request call in late feb with the [redacted] representative and can attest to the fact that she told us our policy was cancelled effective immediately and that we would not be billed further.Desired Settlement: I want a full refund for charges for this policy that occurred after Feb. 2015 when I cancelled the policy. I'd like annualized 12% on my funds and $150 for time lost having to deal with resolving this issue.

Business

Response:

Hello,

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

Upon receipt of the complaint we immediately reached out to our Eligibility department to verify the effective date and termination date of the policy. Our records indicate the policy was effective on November 10, 2014, and terminated on January 01, 2015. We received a retro-termination request from the employer to back date the termination to January 01, 2015.

[redacted] does not have control over the termination or premium refund requests. Any termination requests are forwarded to [redacted] from the employer. If the member is seeking a refund for the policy he must contact his Human Resources department, [redacted] is not able to refund premiums.

Our records indicate that there is only one call on file from the member inquiring about the eligibility status on January 05, 2015 at 12:15pm. I apologize for the frustrations and difficulties you encountered while attempting to resolve this issue and regret that this matter required your time in order to facilitate a resolution. Unfortunately, we are unable to honor your request for compensation.

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

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

[redacted] stated in their response that the policy was "terminated" Jan 1, 2015. Why then have I been paying them for this coverage all of 2015? They just made my case for me. Thank you. I want a return of my premiums for a policy that I am paying for that was cancelled, Jan 1 2015, according to the response from [redacted]. Also [redacted]s response indicates that they do not keep accurate and/or comprehensive records of EVERY call from their members. I called Atena at least 4 times about this issue. Including a call on or the day before I filled this complaint with the Revdex.com. I have a record of that call and I received a call back from a manager out of their South Carolina office. [redacted]s response doesn't indicate a record of those calls to and from [redacted] therefore they CLEARLY are

Review: I visited Dr.[redacted] on 9/23/2014 to show my daughter. As per the doctor's office, Aetna is a preferred insurance which I have already. I provided that information to the doctors office. On 10/26/2014 I received a bill from the doctors saying I have to pay the $477 for the visit. After talking to the doctors office, I came to know that the doctor was recently transferred to that office and they submitted the documents to the insurance company to include him in the network. After talking to the insurance I found out that the doctor is out of network and they will work with the doctors office to update their system. On 10/28/2014 I was informed that they have received the information and processing it after talking to the doctors office. On 11/14/2014 I contacted the insurance to find the status. Now they informed me that they did not receive any information from the doctors office and the doctor is out of network. Today 11/22/2014 I received the bill again from the doctor saying the insurance did not pay the amount even though they submitted the paper work long before in September.Desired Settlement: The insurance company has the information about Dr.[redacted] and my bill also. They have to process the bill and pay the doctors office immediately.

Business

Response:

Thank you for your inquiry received on November 24, 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 am a mental health provider in the state of [redacted]. I have a contract with Aetna that credentials me as an in-network provider as of March of 2015. Every claim I have ever submitted to Aetna has been rejected. I was told I was not in network. I reminded them of my contract, which they had no record of. They then stated I was in network only in a state I had previously practiced in. Again I reminded them of the signed contract I have for my business in the state of [redacted]. Today I was told I am now in network for some of the plans in [redacted], but not all and the only way to tell if I could file a claim would be to call on a case by case basis, which I already do, and they have never told me I can not take an Aetna client until today, after the fact and after I have already treated the clients repeatedly. It feels like they will do anything to avoid paying a claim. I have been trying to resolve this for months and keep getting told it's being taken care of and to call back in 10 days. Each time I learn that it is in fact not resolved.Desired Settlement: I would like to be paid for the claims I have submitted and I would like it if they would correct my file once and for all.

Business

Response:

Hello,

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Description: Insurance Companies, Insurance - Accident & Health

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

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