Aetna, Inc.

Review: I have been in the process of Aetna's medically supervised weight loss provision as to gain approval for weight loss surgery.My medical team called me to inform me that during my last month, I gained 4 pounds during the last month of supervised weight loss and I am no longer eligible for my surgery that is scheduled for this coming Monday. It had been well documented that I was power lifting during this duration (4 months).My medical team has been over their criteria for the supervised weight loss numerous times and they said that there was no stipulation to how much weight I could or could not gain.My medical is set to change at the beginning of next year and I will be required to pay more for the operation than I would now and there's also a deductible that will also have to be paid.Now that I have been denied, my surgery is now expected to not happen.Desired Settlement: Allow the surgery to go through (likely not possible now that they've waited until only 4 days to deny the operation). If my surgery does not happen as scheduled, I would like them to keep the original claim with my current medical contract through my employer.

Business

Response:

Thank you for your inquiry received on December 16, 2013. Authorization number [redacted] remains denied; however, there is an appeal under Case number [redacted] for clinical review. Once a decision is made they will get a response from our Provider Resolution Team under separate cover with a decision.

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: Aetna has circular filed my application for coverage by an out of network provider due to a network deficiency in my area. This application is to try to get a prescription for a piece of durable medical equipment covered.Additionally, Aetna seems to have circular filed my complaint about the wrong out of pocket amounts being applied to my out of pocket limit.Desired Settlement: I would like my application for coverage of my durable medical equipment needs by [redacted] without further need to submit separate applications if I need additional equipment in the future.I would like my out of pocket amounts for 2013 and 2014 reviewed, audited, and corrected.Additionally, I would like an apology from either Aetna's CEO or Aetna's head of customer service for the way that I have been treated regarding these matters.

Business

Response:

Thank you for your inquiry received on July 21, 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 Precertification department and the Claims department for assistance on the member’s requests. The member has been contacted with the following information. The precertification request for the 4-wheeled rolling walker was approved and the member can use the nonparticipating provider [redacted] Pharmacy. The member will receive a letter under separate cover advising of the durable medical equipment (DME) approval.

In regards to the member’s request for a review of her out-of-pocket amounts for 2013 and 2014, an audit has been completed. Based on the 2013 claim audit, $6,000.00 was correctly applied toward the member’s out-of-pocket amount. For the 2014 claim audit, claims for January through April dates did not apply to the out-of-pocket amount, most of the claims where a deductible or copayment that was applied. For May through present dates of service, claims are applying correctly toward the out-of-pocket amounts. [redacted] out-of-pocket amount to date is $308.75. In addition to the above information, the member also requested a review regarding custom orthotics. Under the terms of the member’s plan benefits, orthotics is a non-covered service and was denied correctly.

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

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: My ex wife was given a FSA card for our children to pay for medical expenses. She ended up using the card for her and her boyfriend. She said she would pay it back it has been almost eight months. Two months ago I opened a fraud claim with Aetna. The said they would send the paperwork which they did and I filled out and returned. They then told be I cannot dispute because the purchase happened in February, this was not a purchase for my children this was a purchase made for her and her boyfriend for medical goods and or services. This is Fraud.. Aetna swears they are against fraud but they will go ahead and let my card be used for just whomever chooses to use it. I tried to go through the correct lines of communication but just received refusal of assistance because they seem too lazy to open a fraud case and treat it as a lowly dispute. So why my children's money for medical expenses for the year are being taken they will sit on their laurels and just let it happen.Desired Settlement: I would like my children's money placed back on my card and a investigation opened. Or is it ok with this company to just let anyone use my money for their medical care?

Business

Response:

Thank you for your inquiry received on September 22, 2014 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Aetna has confirmed on multiple dates per Aetna verification #[redacted] and reference #[redacted] that dental implants for my husband [redacted] would be covered under the Aetna Medical Coverage in the amount of $8,926 paid to in network provider Dr. [redacted] and a copayment of $40 from [redacted]. Numerous requests have been requested to place this in writing but have never been received. We have been promised this coverage on numerous occasions and need it in writing so that the surgery can be completed.

We have also asked for transcriptions of the conversations re the above noted verification and reference #s but have yet to receive same.

Aetna ID [redacted] grp:[redacted]Desired Settlement: Confirmation that the payment of $8926 will be made to Dr. [redacted] and that our only out of pocket expense will be a $40 copayment.

Business

Response:

Thank you for your inquiry received on November 19, 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 just finished explaining to my new bride that Aetna voided her insurance. And did it without telling us! I was not a pleasant conversation with the wife.

I spoke to two representatives of Aetna today (Jan 5th 2015) who both confirmed my wife's coverage was voided, and could not tell me anything more than that, and that the effective date of being voided was Sept 1 2014. They were[redacted] in website tech support and[redacted] in member services. [redacted] provided a reference number of[redacted].

My Insurance ID # is[redacted], my company [redacted] Inc

My date of employment is May 8 2013

I have had continuous coverage since I've been employed and with Aetna ever since my company switched to them. Prep for adding my wife started well ahead of our marriage. But adding my new wife took a couple attempts. After the 1st attempt, I was told she was covered. I later found out she was not! Then after the 2nd go around, finally, it was confirmed by the broker [redacted] Services and I was provide a temporary Insurance card for[redacted].

More recently, she had been trying to fill prescriptions and was of the assumption that these medications were not covered. Now after all the holiday hasles are over I was attempting to research the issue and this is what I came up with. Her insurance had been voided back to the day of initial coverage, and I was not even informed, totally Unacceptable.

I believe this is probably something Maryland should also investigate.

http://www.[redacted] Sorry for the frankness of the letter, but If I was to have an attorney write this, I'm sure it would sound less pleasant.

Thankyou in advance for your prompt attention to this matter.Desired Settlement: 1) I demand Aetna to quickly reestablish[redacted].

2) I expect Aetna to not cancel coverage without sufficient notice and per federal and state requirements of the Maryland [redacted] (for which I'll be investigating a parallel complaint)

3) I wish reimbursement to my company (and ultimately to me) charges I've paid to have coverage for my wife (listed as self + spouse) yet Aetna in their own admission has failed to provide.

Business

Response:

Please see our response to the complaint #[redacted] for [redacted] received on January 06, 2015.

Review: AETNA WEBSITE SHOWED DOCTOR WAS "IN NETWORK " AND WE USED SAID DOCTOR AND NOW AETNA REFUSES TO PAYDesired Settlement: AETNA STOP FALSE INFORMATION ON THEIR WEBSITE AND PAY THE BILL , ALSO THEY SHOULD PAY ME FOR HARASSMENT AND MY TIME DEALING WITH THEIR MISTAKE

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: Aetna and/or [redacted].com have failed to properly manage my health savings account.

I am a ** physician enrolled in a high-deductible health savings account ([redacted]) with Aetna since Jan 13. At that time, [redacted] was administered by [redacted]). Shortly after establishing [redacted], I was able to invest [redacted] funds into various mutual funds through [redacted].

In Feb 15, I was advised by Aetna that Aetna had made the decision to change the administrator of [redacted]s from [redacted] to [redacted]. I was not asked if I wanted to switch but told that I needed to liquidate investments with [redacted] and place the funds into a cash account so they could then be transferred over to [redacted]. I complied with Aetna's directions and liquidated my [redacted] investments on 26 Mar.

On 31 Mar, I received a letter from Aetna advising me of my new routing number ([redacted]) and 17-digit account number. I personally made changes with my human resources (HR) department that day and verified that both numbers were correct. I enrolled on-line with [redacted] also.

I then noticed that my contributions, which were each $252.00, were not being credited to my [redacted] account despite those contributions being deducted from my leave and earnings statement. Specifically, there were three contributions (27 Mar, 10 Apr, 24 Apr) missing. I began contacting [redacted] personnel [redacted]on 24 Apr inquiring about the missing funds. On that particular date I spoke with [redacted], supervisor, and expressed my concerns regarding the missing funds. He advised me he would find out what the problem was and call me within three business days. He did not call me.

On 27 Apr, I contacted my HR department ([redacted]) and verified that the routing and account numbers were correct. Mr. [redacted] subsequently submitted a ticket to Defense Finance and Accounting Service (DFAS) to track the funds to determine where they were.

On 28 Apr, I again called [redacted] and spoke with another supervisor ([redacted] - [redacted]). I again expressed my concerns and was assured she would research the problem and call me back. She did not call me and did not return my phone calls after two messages were left on separate days (01 May and 05 May).

On 05 May, I again contacted [redacted] and spoke with another supervisor (April). At this point I was basically told that I needed to contact my HR department to find out what to do. Later on this date I contacted Aetna and spoke with [redacted] to express my concerns (Ticket #[redacted]). He stated he would file a complaint against [redacted] on my behalf and that he would also send an email to his supervisor requesting further guidance.

On 08 May, I received communications from DFAS that the receiving bank (unspecified) had rejected my [redacted] contributions due to the account number being incorrect. These same routing and account numbers continue to be listed on [redacted]'s website. Mr. [redacted] advised that my lost [redacted] contributions would be returned to me.

On 08 May 15, I again contacted [redacted] to inquire if there had been a change to the routing/account numbers. At that time [redacted] staff advised me they would forward my concerns to their accounting department. Really?

I have multiple complaints. First, I am locked in to my current health insurance and unable to change until the open season returns in Nov. Aetna unilaterally made a decision to change administrators in the middle of the year requiring me, for all intents, to liquidate investments in profitable mutual funds to a cash account that receives a negligible interest rate. Second, on three separate occasions money was pulled from my paycheck to fund my [redacted] and the funds were not credited to my account despite using the routing and account numbers provided to me by Aetna and [redacted]. Third, I made multiple phone calls on multiple dates and spoke with multiple supervisors without any assistance. I would consider all of the above to be very poor management, organization, and customer service at best and possibly breach of contract or fraudulent activity at worst.Desired Settlement: First, I expect my [redacted] account to be managed in a professional, competent manner. I expect my routing and account numbers to work the first time, every time. Second, I expect supervisors in an organization to act like supervisors. Seek responsibility and take responsibility. At the minimum, I would expect my phone calls to be returned. Third, I have likely lost money based off Aetna's decision. I have definitely lost time, as I have spent hours and hours jacking around with Aetna and [redacted]. Aetna/[redacted] can't predict the market, nor can I. But, my time is valuable to me and I do expect to be compensated for it.

Business

Response:

Thank you for your inquiry received on 05/12/2015 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: This complaint is in reference to a billing issue with Aetna

I called Aetna July 14, 2014 for pre certification for two scheduled procedures

I spoke with Roxanne exployee # [redacted]

the reference for my review with Roxanne is Ref [redacted]

I explained to Roxanne that my Doctor does the procedures not through her office, but through an outpatient center.

Roxanne confirmed the following regarding the procedure:

-no pre certification was required

-the procedure is 100% covered

-there is no deductible

-there will be a $50.00 copay

I recently spoke with my doctor's billing department and was told that Aetna has not paid them for the procedures. I called Aetna today and spoke with Amy employee [redacted] was told that they have not paid because I have not paid the copays. I said that I did not receive a bill for the copays. Amy says that there is a copay balances for $ 201.26 and $304.33 for the procedures.

I reviewed with Amy my notes from my discussion with Roxanne before the procedures. Amy says that Roxanne had given me incorrect information and that the copays are higher because my doctor does not perform the procedures in her office but through an outpatient facility. I explained to Amy that I gave the name and address of the facility to Roxanne during the call review.Desired Settlement: The desired outcome is that Aetna should stand by the information that was given to me before the procedure which is that there is a $50.00 copay for each procedure. Aetna should revise their billing and issue payment to my doctor for the services rendered.

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 have the call pulled to verify the information that was provided to the member. Our records indicate that the member advised the customer service representative that this procedure would take place in the provider’s own facility, with the doctor’s name and procedure code. Based upon that description the general benefits were provided to the member.

Information provided through member services is not a guarantee of benefits under the plan. The claim that was submitted to Aetna did not list the services rendered as being taken place in the office setting, instead in an ambulatory surgical center as outpatient surgery. Due to the way the claim was billed it triggered the deductible instead of an office visit copay. The claims in question were processed correctly in accordance to your plan benefits.

I realize that understanding your benefits can be challenging. It is our goal to be there for you when you need us, and I apologize that the assistance you received from our customer service representatives did not meet your needs.

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

Review: on December 2, 2015 I contacted Aetna regarding my new Aetna Leap plan for 2016. I noticed the rate that they were billing me ($437.07) was different from the quote I received on Aetna.com (397.34). I addressed this issue with several departments and kept getting the same thing. No one would notate the system so I would have to explain the situation over and over again. I even had a license sales rep quote the premium for me and she was also coming up with the same rate I was of $397.34. I specifically asked her if they could be rating my husband and I as smokers and she told me no that they do not charge more for smokers. This was a lie as I went back on Aetna.com and did a quote for the smoker and non smoker rate and sure enough they are charging my husband and I as smokers which we are not and never have been, As I pursued this issue I was then sent over to the billing and enrollment department who I spoke with a rep that had her manager Toni change us to non smokers bt the rate still had not changed. I have been calling Aetna almost every other day and they still have not corrected the premium to the non smoker rate. Every time I'm told they sent in a request to fix the rate I'm told it will be 24 to 48 hours. I had the manager Toni approve me to pay the non smoker rate of $397.34 and now I am getting emails and letters in the mail threatening that they will terminate my policy for non payment all of this after I had sent in an attestation form stating my husband and I are non smokers and was reassured by some one named Silvio that since this was their mistake they cant cancel my coverage. After further research it turns out that When Aetna automatically enrolled me in their 2015 plan they rated us as smokers then as well. They told my husband that there is nothing they can do on the 2015 plan because the policy is now terminated even though we contacted them when the policy was still in force and sent over the documents they asked of us. They are thieves and it is not legal for them to charge a smoker rate to non smokers. They lie every time I call in and never once have called me back even thought I have been promised several times a call back.Desired Settlement: I would like the money I over paid for 2015 returned to me and I would like my 2016 plan to be rated correctly and the premium to reflect the non smoker rate of $397.34 and not to have my coverage terminated because I didn't pay the smoker premium because I am a non smoker.

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 Premium Accounting department to have the member’s concerns addressed. We were advised there was a system error that was causing the incorrect premium rate to be reflected on the invoices. It was confirmed that we have updated the member’s premium, in all of our systems, to reflect the non-smoker premium.

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

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Review: On 11/1/12 Dr. [redacted] of [redacted] made an inquiry to Aetna Life Insurance Company on coverage of [redacted]. An Aetna representative informed Dr. [redacted]'s office that the [redacted] was covered under my insurance. The final bill I received with the completed insurance payment adjustments was on 4/23/13. I called on [redacted]'s billing department to close out the account and they informed me that the balance of $630.00 was my responsibility as the insurance denied this claim. I was then advised to call Aetna to resolve the matter. On 5/31/13 I called Aetna and through a prelim investigation the rep did state that there was a note made on my account that the [redacted] were indeed covered but that it was told to my doctor's office in error however since I am out of the 180 days that I will be responsible for the error the Aetna rep made. An appeal was sent to the Resolution department on 5/31/13 and on 6/4/13 and a Too Late to Appeal letter was sent to me stating that they will not look into this matter at all because it's pass [redacted] days.

Account_Number: WXXXXXXXXX

Desired Settlement: DesiredSettlementID: Other (requires explanation)

The error an Aetna represented made has been very costly to me. The fair resolution would be for Aetna to cover the amount owed. I am aware that is the patient's responsibility to know what is and is not covered. As those details can often be confusing to the average patient; Aetna has a department to specifically explain benefits and coverage and due diligence was done in verifying coverage of my [redacted]. My Dr. could have easily adjusted my old [redacted] if we were told the correct info.

Business

Response:

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

Thank you for your inquiry received on July 12, 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. According to the claims history, the provider, Dr. [redacted], is a participating provider and benefits quoted are not a guarantee of benefits; however, on November 1, 2012, the provider was told [redacted], with a diagnosis of [redacted] is allowable but the claim was billed with a [redacted]. There was no call documented on file for May 31, 2013, from the member or provider, however, since the provider was given incorrect information we will allow a one-time exception for date of service, November 1, 2012 and the claim was resubmitted for processing.

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 11/5/2012 I went in for lab work, and similar to a previous time, the [redacted] mishandled the specimen and it had to be repeated. I had to drive out again on 11/30/2012 from [redacted] the ** to have the work redone (the doctor said he needed the results all at the same time to be meaningful) I dispute having to pay the $40 co pay twice. This happened a year ago, This time however [redacted] tells me to take it up with Aetna. I have on several occasions not I hear nothing. I refuse to pay and now my account is in collections. My Primary Care researched the handling of the specimen and I have a VM from him indicating that their office handled it properly and it was at quest that it was messed up and required everything to be rerun.

Product_Or_Service: Health Ins

Account_Number: WXXXX XXXXX

Desired Settlement: I think im entitled to have the CoPay for either the 5th or 30 waived, and after having gone through months and months of battles for only $40 , I would like to have them both waived (i.e. $80 waived) .I also don't like how Aetna has no records of the previous inquiries.

Business

Response:

Business Response /* (1000, 5, 2013/08/13) */

Thank you for your inquiry received on July 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 concerns. We contacted [redacted] and they stated the lab work was requested by the member's physician for dates of service, November 5, 2012 and November 30, 2012. The member's physician states they billed correctly. We have approved as a one-time exception to allow the claim for date of service, November 30, 2012 to reprocess without a copayment of $40.00. We apologize for any delay and confusion this has caused.

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

Consumer Response /* (3000, 7, 2013/08/15) */

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

I appreciate the refund , but question the explanation. Correct they did not bill for the test that could not be completed on the 5th, but that caused me to have to come in and retake them all over again, and I had to may the Co Pay twice. That is what I had issues with. Your response says that is how it should be, and if this is only a one time courtesy, whats to happen if this situation occurs again?

Business Response /* (4000, 9, 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.

In this case, both providers did not feel they did any error with the processing of the member's claims. In order to avoid the member to have further issues, we made the exception to allow reprocess of the copay. If an error occurs again, we would review on a case by case basis depending on the issue involved and the evidence presented. Thank you.

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

Review: Aetna has failed to correct an error of my plan's calculated used 2012 deductible. My son and I received treatment for the same ailment at a medical center in December 2012. The facility billed Aetna for both of us correctly, the same treatment received on the same day for the same amount. Prior to this visit we received Aetna statements, explanation of benefits, which showed our in-network deductible had been met. I match this information to bills from providers and could see it was correct to this point. The subsequent Aetna statement we received for the claims above had deductible amounts changed, indicating we owed odd amounts that didnt match up to our plans guidelines even if we had not used the entire deductible. I called Aetna in February to have this corrected and the customer service representative said it would be corrected. In fact, my visit was corrected and the medical center received correct payment. I was then billed correctly. However, my sons amount was not corrected. I have in the months since spoken with Aetna representatives online and by phone to no satisfaction. I am told only that they will perform an audit and contact me. No such action has occurred. In the meantime the medical center has threatened to send my account to collections, so I started a payment plan with them in June expecting the matter to be resolved before I paid them more than I should have owed. I informed Aetna of this escalation and they claim to have contacted the facility to ask for a 30-day hold. Apparently this did not occur because I received a second bill and the online account indicates it is active. There is another separate, but similarly ignored matter that has not been resolved by Aetna which has been sent to collections. In June my wife sent a letter to Aetna requesting they address both of these matters, as they may be related in how they affect our calculated deductible. There has been no communication from Aetna in the 2 months since the letter was sent.

Product_Or_Service: Health InsuranceDesired Settlement: Correct the 2012 deductible, pay the claim to the medical facilty, and send me a corrected EOB for 2012.

Business

Response:

Thank you for your inquiry received on August 26, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to the Plan Sponsor Services department and Claims department for assistance with the member's concerns. They corrected the member's financials, reprocessed the member claim and payment was issued September 2, 2013. The plan sponsor was notified of the issue by phone followed up by an email.

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

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], but no message was visible. However, the complaint was resolved in full and the resolution is satisfactory to me.

Sincerely,

Review: [redacted], incurred a medical problem on November 2, 2012 in Germany.It required 2 physician visits with bills of 250 Euros and 230 Euros (total on credit card of $616.27. Medical coverage from the cruise company will not pay their share until I have documentation from the primary health insurer of what they will pay. I filled my claim with aetna on Dec. 10, 2012. I have followed up the written claim with 7 phone calls. The first two responses were that the claim was at the translation department. 3rd call they stated that a check had been sent and it had been cashed. I then requested a copy of the check which turned out to be a claim made for Feb.11,2012.The 4th call was made to explain to them the the check was for a claim 2/11/12 (Germans transpose the day and month so that the the doctor's bill was dated 2/11/12 which is 11/2/12 USA. I was promised a follow that up. No response so I again called explaining again the misconception.Ten days later I received a check for $209.09 dated for of Feb.11.2012. Today,6/18 I called again for an interpretation of all the codes on the statement accompanying the check. Again they told me the only claim they had was for Feb. 11,2012.and that had been paid.I cannot believe that Aetna with it's prestigious reputation has so many stupid people answering their phones. The last 3 calls I requested a supervisor and received no satisfaction. I have explained that I sent you the original doctor's bills but have copies and they replied that they did have the bills.I have explained that if Aetna will not pay the bill PLEASE send documentation of why so that I can collect from the cruise medical insurance. I am running out of time to file with them.Desired Settlement: My documentation for Aetna is that $300. I would like either a check for the $300.19 or documentation why for why they will not pay, so that I can file with the cruise medical insurance. I AM RUNNING OUT OF TIME, PLEASE RESPOND QUICKLY. Remember Aetna has the original bills

Business

Response:

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

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

We reached out to the Claims department for assistance. They advised the claim for February 11, 2012 were processed incorrectly with the incorrect dates of service and the claim for November 2, 2012, pended in error for a request for a Medicare EOB. We have reworked the claim and reprocessed to pay the additional $259.06 to the member on July 3, 2013, under payment number XXXXXXXXXXXXXX. We apologize for the errors, the delay and the inconveniences this member received.

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]@aetna.com.

Review: My recently passed mother has aetna life policy, no named beneficiary. I as court appointed executor of her estate was told by aetna, to send certified death and legal executor documents. Aetna acknowledged receipt of all required documents 12-23-2013 was told 4-6 wks to receive estate check.going on 8 wks called customer service numerous times which is in india by the way.all I get is run around.Desired Settlement: Request penalty for late charge and interest for far exceeding 4-6 week period.

Business

Response:

Thank you for your inquiry received on 02/19/2014, 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 for assistance to Aetna's Life Insurance department, and they were unable to locate Mr. [redacted]'s mother, [redacted] in their system. We contacted Mr. [redacted] for additional information to assist us in our review, such as, the phone number of the Life Insurance department at Aetna he's been contacting and/or who he's been dealing with, as well as, additional information on his mother's life insurance policy. Unfortunately, no response was received. This information is still required for Aetna to review further.

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

Consumer

Response:

Review: [redacted]

I am rejecting this response because: life insurance check was finally received on feb28 2014 for estate of [redacted] my mother. Aetna claims they had no files of her was totally untrue . They had already acknowledged her policy and receiving all required documents of her death and my certification as executor of her estate on dec23 2013. As far as my communication with there customer service reps, there was only 1 service # given to call on there policy statements and given they had all required info to send check , they knew the customer service department I communicated with. Which by the way was in INdia, until complaint was filed with Revdex.comc I was given run around and ignored. Once Revdex.comc got involved issues were quickly addressed by aetna, without them I sincerely think I would still be getting the run around. Thank you Revdex.comc.

Review: I currently have Aetna health insurance. My son has a prescription for medication that he takes 3x/day which is necessary for his condition. The dosage is prescribed so that he can receive the full benefit of the medication and is considered titration. Our health plan does not cover this dosage unless it meets one of three criteria, with titration being one of the criteria. In July 2013, Aetna denied coverage for my son and I filed an expedited appeal (Case #[redacted]). Upon review of all applicable information, Aetna reversed this decision in our favor and issued a letter dated July 18, 2013 approving the dosage. Aetna honored their decision for the next several months until March 2014 when we refilled the prescription. Again, Aetna denied the coverage based on the quantity. On March 22, I received a letter from Aetna denying coverage. I called Aetna to remind them that this dosage is covered as titration. I waited on hold for over 30 minutes before getting a customer service representative. [redacted] (who was extremely helpful and patient) transferred me to the pharmacy department. [redacted] (#[redacted]) was rude and said there was nothing she could do because the pre-cert department was closed until Monday. I indicated that I have a letter with the approval and if she could just look it up in her system, she would be able to see that the dosage is approved. I impressed upon her that this does not require pre-cert - that the claim was denied not due to pre-cert requirement, but due to coverage. She was short and rude. I requested to speak to her manager. We waited on hold until [redacted] from Pharmacy Mgt picked up the call. [redacted] gave her the case number and DCN number but [redacted] insisted that she could not override a quantity denial without authorization. I told her that the authorization was in the letter. They told me to call back on Monday. I called on Monday and was told to call later since their system was down.Desired Settlement: Aetna needs to ensure that communication regarding coverage extends to all appropriate departments and ensure swift and simple communication when there is a denial. It is causing serious distress for my family and if it is not resolved, we will have no other choice but to take legal action. It is quite simple. Improve communication between internal depts. and with your customer (us).

Business

Response:

Thank you for your inquiry received on March 31, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. We reached out to Aetna Pharmacy department for assistance with the member’s concern. They advised the drug allowed 3 per day was approved only from July 17, 2013 to October 17, 2013. The member was still able to fill for 3 per day beyond that date by an override that was placed on the account in error. We received an approval for a one-time exception to allow the member to get 1 more fill of the [redacted] at 3 per day. They contacted the Pharmacy and they have processed the claim; however, the member must go through the Precertification process to have the medication approved for future fills.

Review: I have requested a refund because my insurance was cancelled on the same day issued on the phone..recorded call, with rep that signed me up. She told me the premium was $416.73 and I thought she said 16.73....misunderstanding on amount. I ask her on the phone when she took the application to cancel it because I misunderstood amount she said. She said it was too late because she has already sent it to my bank, but someone would call me before drafting my account and not to worry. She said she had cancelled, but I called back and it was never cancelled. [redacted] drafted my account after cancellation 2 different times caused an overdraft fee of $35.00 and again another overdraft fee of $35.00 totaling $70.00. I had to eventually call 2 times after the first cancellation with the rep on the phone that took the application. [redacted] asked that I faxed proof of overdraft fees to them at fax # ###-###-#### with case# [redacted] which [redacted] & [redacted] bank managers at ###-###-#### did send 4 different times. [redacted] said they never received. After the first 2 faxes sent, they said they had received and to wait about 10 days for refund that I never got in Feb 2014. I then called back about refund and they said never got fax. So I called the corporate office and spoke to [redacted] at ###-###-####, she told me she would handle it, took all the information and my email of the fax that my bank finally email to me. She finally called me back and said that they need additional information showing my balance prior to overdraft which I didn't understand because it should have never gone through my account in the first place. Now it is April 2014 and I still don't have my refund. I was told many times that a supervisor would call me back and on several calls to them no one never called me back and gotten many hangup calls from the call center. I could never speak to a supervisor and have been getting the run around. [redacted] have all the documentation needed to get my refund. Help. ThanksDesired Settlement: Refund of $70.00 overdraft fees only. Mailed or put in my bank account.

Business

Response:

Thank you for your inquiry received on 04/26/2014 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: My daughter is insured with Aetna Better Health.I contacted the company for an Oral Surgeon to have her wisdom teeth extracted because she is in pain and they are becoming infected.She can not eat or swallow.Her surgury was set up for 6/3/2014.The Surgeon called me and informed me Aetnea Better Health/ [redacted] is not paying for the surgey.Three different dentists told us they must be removed or she will become very ill.Desired Settlement: My daughter is in pain ,her wisdom teeth are now infected.Her mouth is swollen.She lost 6 pounds and can not eat or swallow.She has been in bed with ice on her face drinking ony fluids.I am a single father on SSD.The doctors told me if Aetna better health/[redacted] does not approve payment she will be hospitalized.The surgeon and dentist sent in all the proper forms and begged Aetna/[redacted]t to approve the surgery.Please help my daughter !

Business

Response:

Hi [redacted],

We are unable to locate [redacted] information in our system. We reached out to [redacted] via email today 06/01/2014 requesting additional information.

Once received, we will advise you so you can update the case.

Thank you.

Sincerely,

Business

Response:

Thank you for your inquiry received on 06/02/14 regarding complaint #10072554 for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Today, I was informed that my Aetna insurance account was termed in December. I was unaware of this until I checked my bank account and noticed that I was no longer being automatically debited for my premium since December. I had no reason to think my automatic payments had stopped. No changes to my policy were made to suggest this would happen. Not long ago, I was also informed by my pharmacist that Aetna had the wrong date of birth on my insurance account. I'm not sure if that's related to the cancellation. Im not sure what happened that my automatic payments stopped, but apparently the only correspondence I ever received to alert me of this was mailed. I recall getting, at most, two mailings from Aetna. Both inconspicuous and I threw them out as they looked like junk mail, and I was already enrolled with auto payment, and had no insurance claims outstanding. I was not contacted by email or phone to alert me of this situation AT ALL. To make matters worse, my insurance agent looked further into this and informed me that, according to Aetna, I had both written and called to cancel my insurance. I have had ZERO correspondence with Aetna since December, so this is simply impossible.Desired Settlement: At this point, I feel as if Im being treated very unfairly as a customer and would like my insurance reinstated retroactively. I am willing to pay all premiums back to December to get my insurance back.

Business

Response:

Thank you for your inquiry received on 07/11/14 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: Aetna has sent me a bad check I have tried over the last two weeks to resolve it over several days worth of phone calls. To have it reissued. I have had several bank fees as a result of their bad check and they refuse to call me back and either direct deposit or even send out another one after theirs failed to be valid even after trying to deposit twice as they asked me too. The original check was for $440.00 and now I have two fees resulting in $10.00 more dollars and I am unable to pay several bills due to their lack of follow up. I have spent a total of at least 4 hours trying to get a email, call, etc back from the finance dept. AS I understand I am not alone in this problem, it was not just my check. I was just the first to notify them. I am a health practitioner (massage) and I am asking to be reissued the funds immediately. I would just like my due amount. The original bill was sent two months ago. This is bad business.Desired Settlement: I would like a direct deposit or check sent overnight immateriality so that I do not incur other problems and can deposit monies owed. A call back would be nice. Compensation for bank fees of $10.00 and a apology.

Business

Response:

Thank you for your inquiry received on 07/22/14 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: A recording from Aetna is calling my home phone on a frequent, recurring basis. Their call today (8/29/14) was shortly after 2pm. They are attempting to sell upgrades to "my" insurance policy, even though I have never been a customer of theirs. I have asked them to stop, but they say they are unable to remove my phone number from their system unless I am a customer. I believe they are attempting to use the continual harassment in order to scam me into purchasing insurance from them.I have verified the number (###-###-####) is a genuine Aetna phone number. At first I believed they were simply calling the wrong number since messages were left for someone named [redacted] or [redacted] or [redacted]. However, the unwillingness of Aetna representatives to even attempt to resolve this has led me to believe they are using a fictitious customer name in order to circumvent the Do Not Call list and pressure individuals with no business relationship to become customers. (This is my second complaint. I will continue to file complaints every time Aetna calls me until somebody in their office figures out a way to stop this.)Desired Settlement: They need to stop calling, stop selling my phone number to medical supply affiliates, and notify all of their affiliates who have already been provided with my phone number to remove me from their lists. Since these calls started, I have been inundated with medical-related recordings from dozens upon dozens of companies.

Business

Response:

Thank you for your inquiry received on 09/02/14 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.