Aetna, Inc.

Review: Lies about contract agreement.I am a 68 years old male who has not only been healthy, but extremely well all of my life. Most of my life I worked as a contractor, so had no health coverage. I signed up for Medicare when required by law at 65. I only sign up for part "A" and part "B" a year later. I then received mail suggesting great benefits for signing up with a HMO. Communicated with Aetna [redacted](email- [redacted]), (cell ###-###-####). I fully disclosed that I had no previous health coverage, nor part "D", and would never enroll me in any plan that would require it. Ms. [redacted] offered me a plan at no cost in an Aetna HMO, which would include prescription drug coverage, with no billing from Aetna. Email evidence to prove this. Medicare supervisors, Aetna representatives and [redacted] all confirmed it was legitimate and there would be no charge to me, except for paying directly to Medicare for part "B", knowing that I had not enrolled in part "B" with Medicare the first year. The plan went into effect on July 1, 2013 and I immediately received a bill for late enrollment in part "D" from Aetna. Medicare supervisors have repeatedly verified, before and after July 1, 2013, that I am not enrolled in part "D" and never have to enroll for any reason without ever being charged a penalty. Aetna offered me this coverage without any charge and lied.Desired Settlement: Correct the information they have given [redacted] Commission of Insurance to be the truth. What Aetna offered was not delivered me and, in my opinion, they slandered me.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on December 22, 2014.

Review: On 12/31/14 we placed an order with [redacted] for a maintenance prescription. Aetna charged us the co-pay of $127.16. The order was never received with Aetna telling us it was lost in transit and we should contact our local post office for help. After three phone calls later, a representative said they would overnight ship the medication to us. Upon a fourth phone call, we were told that in order to re-ship medication we would have to pay another co-pay, in additon to what we already paid and they would deduct a refill from the count. So, Aetna wants two co-pays for one order of medication. This is completely ridiculous. Clearly Aetna has no regard for their customers health. Every representative we spoke with promised something that did not happen. It is now 1/22/15 and we still do not have the medication that was ordered and paid for over three weeks ago.Desired Settlement: I want the prescription order cancelled and a full refund to my credit card IMMEDIATELY.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on January 23, 2015.

Review: We use the online pharmacy. We ordered a prescription 4 times and they kept cancelling it. Due to issues with thier system. We ran out of medication. We use the online pharmacy. We ordered a prescription 4 times and they kept cancelling it. Due to issues with thier system. We ran out of medication. Due to this is caused extreme stress to my family and myself. They messed up not us and all they did was say so sorry can't have it till tuesday or wendsday because they only use [redacted]. There are other carries and they could have used them to get us the needed medication asap.Desired Settlement: I just wanted to document this so they can fix the lack luster customer service. Plus if my spouse ends up in the hospital over this I have a case to sue them.

Business

Response:

Thank you for your inquiry received on 01/28/2015 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 Pharmacy Management department (APM) for assistance. An override was entered by Customer Service to bypass the refill too soon rejection on 01/23/2015, for [redacted] medication [redacted], as the next eligible fill date was 02/02/2015. The order shipped overnight on 01/23/2015. Per the tracking # [redacted] the order was delivered on Tuesday 01/27/2015.

Aetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processes. We 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 we trust that you will not hesitate to contact us when you need assistance.

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

Review: Patient was seen, benefits were obtained prior to any office visits, or surgeries. The benefits given were incorrect. Specific questions were asked concerning a surgery, and the limitations and coverage for that particular procedure was not divulged. Now after the patient has had their surgery, the patient is financially responsible for more than what was quoted prior to the surgery. Upon speaking to a customer representative, the reason given was coverage for that particular service was different than what we were quoted. I explained I had a reference number and name of the person that had given us original benefits, if she would direct this back for an investigation, but I was told it was too late being I had previously called regarding the patient's bill. I explained, even when I inquired back then, no-one told me of the benefits I was being quoted now. She would not transfer me to her supervisor because the supervisor would just relay everything she had already told me.

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

The claim should be paid according to the original benefits given. That is what was told to the patient and facility, and that is what needs to be honored. The patient was only $2,032.02 from meeting his out of pocket, then the insurance would cover 100%. Now he is faced with $18,855.08 in medical bills that the insurance should pay.

Business

Response:

Hello,

Review: Despite a phone transcript in which Aetna confirmed that [redacted] codes [redacted] and [redacted] are covered under my plan, Aetna has refused to honor their commitment to reimburse this submitted claims (see attached phone transcript), even though we have provided documentation to show they were medically necessary.Desired Settlement: A fair resolution to this problem is that Aetna pays the claim in accordance with the coverage statements made, which amounts to $1,437.80 (70% of eligible out of pocket expenses) for CPT Codes [redacted] and [redacted]

Business

Response:

Hello,

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

We show that this complaint was already reviewed and responded to under previous Revdex.com case [redacted]. We had the complaint reviewed again to make sure the original determination was correct. We verified that our previous response was correct regarding the coverage for codes [redacted] and [redacted]. We mailed a check to the member on October 08, 2014 for $1,227.80 for code [redacted]. The procedure code [redacted] is not being denied at this point for medical necessity, the procedure is being considered incidental to code [redacted] so an additional payment of $210.00 will not be allowed. We have had this reviewed under appeal case [redacted], where a medical director agreed with this determination. When a code is incidental the charge for the service ([redacted]) is not payable because it is considered part of another procedure ([redacted]) performed on the same date and is included in that payment of [redacted].

While we understand your concerns and recognize this is not the resolution you sought, our decision remains unchanged. Our actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants.

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

Thank you,

Complaint and Appeal Consultant

Executive Resolution Team

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: Under my insurance coverage online it states prenatal is covered 100% no limitations and exceptions. When I call customer service I get a different response from every rep. Today I spoke to two different reps who stated my coverage covers prenatal except ultrasounds and pregnancy test among other prenatal related items. They are not providing the coverage I pay them for since it clearly states prenatal covered no limits and exceptions!Desired Settlement: DesiredSettlementID: Other (requires explanation)

ALL prenatal office visits and in office ultrasounds covered and any money I have paid refunded.

Business

Response:

Thank you for your inquiry received on 05/27/2015 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 Customer Service department, and were advised that Customer Service representative [redacted] contacted the member on multiple occasions to speak to her and go over any questions and concerns the member has regarding her benefits. On 06/03/2015, the member spoke to [redacted] and advised that it was not a good time to talk and requested that [redacted] call her back next week after 12:00pm. [redacted] advised she would call her back next week.

In regards to the member’s benefits, below is the information showing what is covered for pre-natal under the member’s plan.

· Prenatal and postnatal care - Prenatal: No charge. Postnatal: 10% coinsurance

· Delivery and all inpatient services: 10% coinsurance

· Limitations and Exceptions – None

This means there is no limits to the pre-natal visits she has (but the care has to fall within the pre-natal guidelines below ) and there are not exceptions to what is covered. Coverage for prenatal care is limited to pregnancy-related physician office visits, including the initial and subsequent history and physical exams of the pregnant woman (maternal weight, blood pressure, and fetal heart rate check).

Items not considered preventive include (but may not be limited to):

· Inpatient admissions

· High Risk Specialist Visits

· Ultrasounds

· Amniocentesis

· Fetal Stress Tests

· Certain Pregnancy diagnostic lab tests

· Delivery including Anesthesia

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:

First it says my initial visit is covered which is not true I was charged a $50.00 copay. Second it says no limits but then in the next paragraph it states prenatal is limited to.... . They are contradicting themselves. Ultrasounds are routine to prenatal how can they not be covered? Meanwhile I have an email from another Aetna rep stating my ultrasounds are covered 100% and I am only responsible for a $50 copay.

Review: [redacted]

I am rejecting this response because:

Sincerely,

Review: I flew into [redacted] from [redacted] to visit family on 10/11/12 and noticed my red, itchy eye had gotten worse. Presuming I had conjunctivitis, I went to a local urgent care clinic, of whom I confirmed prior to the office visit accepted Aetna health insurance PPO. Conjunctivitis was confirmed, and a prescription was written to be filled. On 12/26/12 I received my first bill from the urgent care clinic for the full price of the service rendered. I inquired as to why my deductible was not applied to this claim, and was told to call Aetna. After initiating an appeal on 1/7/13, I received a response on 1/18/13 "We handled the charge by the out-of-network doctor correctly." I filed a second appeal on 3/14/13, and in my letter wrote "Additional relevant information concerning this claim will be forthcoming." I worked to obtain a detailed billing statement and detailed medical records from the health system, but received a denial to my claim on 4/9/13, prior to the submission of my "additional relevant information." The denial letter stated "Based on our review of the above information, we are upholding our previous decision to maintain the out-of-network reimbursement for the office visit applying the out-of-network deductible." I submitted additional detailed medical and billing information obtained from [redacted] to Aetna on 4/17/13, including the previous letter saying additional information would be forthcoming. On 5/29/13 I received a letter from Aetna dated 5/10/13 stating "...you have used all your internal appeal rights. Please refer to the enclosed appeal resolution letter..." which was an exact copy of the previous denial letter that was sent to me prior to my additional documentation being received and considered by Aetna.

Account_Number: ID WXXXX XXXXX

Desired Settlement: My claim and office visit are covered under my former Aetna PPO medical insurance coverage, as the [redacted] is indeed a participant with this service provider. Furthermore, my additional documentation was ignored completely and a denial letter sent to me before the additional information had even been received by Aetna.Requesting a refund in the amount of $96.00 for the payment I made to [redacted] on 6/7/13 for my visit to urgent care, which was within all guideline

Business

Response:

Business Response /* (1000, 5, 2013/06/23) */

Thank you for your inquiry received on June 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 issues. The claim listed the hospital as the billing provider and the system pulled the incorrect individual provider number. If the claim was originally billed by the provider with the urgent care group as the servicing provider, the system would have selected the right pin. We do apologize for this error and inconvenience. The claim was immediately sent back to rework to pay the provider as participating under the urgent care group. The claim was reprocessed under Sparrow Urgent Care on June 21, 2013 and the member should be only responsible for the $50 copayment.

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

Review: During the calendar year 2012, Aetna was the administrator of my Flexible Health Care Spending Account, which I funded with $1000 (pre-tax money). I used this money in a single transaction, and provided Aetna with the receipt and appropriate documentation of the medical service provided, the provider name, NPI number, and Federal Tax ID number. Aetna requested this information of me at least 3 times over the course of 2012 and I complied every time. In December 2013, I received a notice from the IRS claiming an under-reporting of my income by $1000, and demanding additional payment of $250 as these health care expenses were considered "unverified." Once again (23 December 2013), I faxed all information to Aetna's FSA documentation number, and, after spending at least 2 hours on the phone with various unhelpful representatives, one finally assured me that I would receive an email confirmation of the receipt of the information as well as a corrected 1099 form to send to the IRS to address the Automatic Under-reporting Response. I received neither. Lacking the promised corrected 1099, I sent all available information to the IRS in hopes that it would be sufficient. The IRS response has been to send me a notice of tax deficiency for 2012, and I will have to petition the tax court to reverse this. I am outraged that I am being penalized $250 because of Aetna's continued incompetence. This is completely unacceptable.Desired Settlement: One of Two Ways: First, as this is due to almost two full years of Aetna's repeated inability to handle my money correctly, I think it is only fair for Aetna to take responsibility for the $250 the IRS claims I owe. I will not pay this money out of my own pocket because Aetna is incapable of administering their own FSA system. An alternate solution is that Aetna locates the documents I have shared with them at least four times and delivers to me the promised corrected forms by 31 March 2013.

Business

Response:

Thank you for your inquiry received on March 7, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: My checking account was charged $657.27 on January 9, 2015 even though I had cancelled my policy effective 12/31/2014. I had requested cancellation 12/11/2014 and received confirmation on the cancellation from Aetna in the form of a statement dated 12/22/2014 showing a balance due of $0.00. I contacted an Aetna representative on January 12, 2015 and was told I would have the refund in my bank account within two business days. I called Aetna four business days later on January 16 only to be told that I should have been told it would be three business days not two. Given that modified time frame has also had passed I asked when I should expect my checking account to be reimbursed and was told they could not guarantee me that it would be done by any particular day. Having received nothing in writing from Aetna I am not confident that this matter is under any reasonable consideration or that it will not happen again in the future.Desired Settlement: Refund to my checking account in a timely matter and confirmation that not more charges be made to my said checking account.

Business

Response:

Please see our response to the complaint #[redacted] for[redacted] received on January 20, 2015.

Review: I have Aetna as my health plan through my employer for the last few years. Last April 2015, my doctor referred me to speech therapy sessions as I was having problem with my voice after a cold earlier that year. The medical clinic of the speech therapy asked me to check with Aetna to make sure Aetna would cover the speech therapy before starting the sessions. The medical clinic gave me 3 different procedure codes to check with Aetna. I called the Aetna member service around May 2015 and asked them if they would cover that speech therapy with that 3 procedure codes. Aetna member service told me that they would be covered and I only needed to pay $40 co-payment for each therapy sessions. However, when my medical clinic filed for the claims of the speech therapy sessions for Oct 2015, Aetna denied them in Jan 2016 based on the EOB, saying they were not covered. I called Aetna members service on 1/21/2016, the member service told me that the claims should have been covered as the procedure code should be covered by Aetna and I only need to pay $40 co-payment each session. The rep gave me reference # 4[redacted] to confirm the conversation. So, twice, the member service confirmed that the speech therapy were being covered by Aetna. The rep told me she would send it back to the claim department to reprocess the claims. Then on 2/2/2016, the same rep left me a voice message saying that the claims were correctly denied as the procedure code was not covered.Desired Settlement: Twice when I called the member service, they told me the speech therapy (with that procedure codes) would be covered. Based on that, I started the speech therapy sessions. But not they denied the claims even thought it was Aetan who confirmed that I was covered to have speech therapy. It looks to me Aetna has an internal issue as they don't know if the procedure codes were covered or not. However, since I did check with Aetna first to get the confirmation May 2015, and then re-confirmation in Jan 2016, before I started the speech therapy, Aetna should cover that as it was their internal mistake. I, being a patient, relied of what the Aetna told me before starting the "approved" medical treatment. So now, I am stuck with a high medical bill that I cannot afford to pay.

Business

Response:

Hello,

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

Upon receipt of the complaint we immediately reached out to have the call pulled to verify the benefits that were provided to the member prior to services being rendered. We confirmed that the customer service representative (CSR) quoted that the procedure would be covered when you have a medical condition that covers/warrants the services. At the time the member had not been seen by the provider so was unable to provide the CSR with the diagnosis code to completely verify the coverage under the plan.

When the claims were submitted to Aetna they were denied as not covered based upon the diagnosis that was sent to us. As a one-time exception, we have reprocessed the claims for the two dates in October of 2015 to allow services rendered.

Please allow 7-10 business days for your provider to receive any payment made on the claims.

Going forward if the member wishes to seek these services the member or provider must call our pre-certification department to request a review be completed for coverage under the plan or the member could be responsible for any billed expenses.

Please accept my apology that we did not provide the level of service that you rightfully expect and deserve, and my assurance that your concerns are getting the highest level of attention at Aetna. I would also like to thank you for sharing your experience with us. It is feedback like yours that helps us address issues and prevent them from reoccurring.

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

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Consumer

Response:

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

Review: Aetna Dental denies legitimate claim based on "information not sent". Have had Aetna dental for about 10 years and only 2 claims is that time. Each time Aetna has shown to be totally incompetent in organization of file information. Claiming they can not find or do not have information regarding claim sent to them. Then when they put you on hold for hours, they return to say they found the information. We have each time asked the representatives if that is all the information they need and at least 4+ times they say "yes, that will be everything to complete the claim", only to follow-up a week+ later and they say they need more information and or saying they can't find the information, only to search and find the information someplace else within their file system. They have now denied the second claim based on "information requested not received" which is totally false! Everything Aetna has requested has been properly and promptly submitted. No customer deserves such treatment, especially one who is 74 years old. It appears that Aetna is dragging their feet and has certainly proved to be incompetent to me in processing the simplest of claims. I expected better from such a company, but the "B" rating they currently show here on the Revdex.com gives good indication that Aetna has some serious problems they need to address.Desired Settlement: Prompt and proper payment of claim.

Business

Response:

Thank you for your inquiry received on December 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 Dental department for assistance with the member’s concerns. They advised the services were done in [redacted]. Out of country claims are reviewed for accuracy. Information was requested and some information was submitted but some radiographic images were either not labeled or dated, so this information was requested. The information requested was patient records, progress notes, dated and labeled pre-treatment X-Rays and dated and labeled [redacted]-treatment X-Rays. Once all the requested information is received they will be able to continue with the review and provide a response under separate cover. We apologize for the delay and inconvenience.

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Sincerely,

Review: Aetna health and dental insurance services were provided to myself and other members of group plan [redacted]. Plan ID [redacted].On April 2nd 2014 Aetna retroactively cancelled the plan by voiding the contract due to non-payment of premium from the employer. I called Aetna customer service on April the 7th after learning from and third party that the coverage had been voided. I was told that Aetna had retro-actively voided the contract and would be charging back all claims to the original health care providers.Having made multiple calls on the 7th, 8th, 8th and 10th of April I was told that a letter would be sent out to all members on the plan explaining what took place and that HIPAA certificates would be provided so the effected parties could qualify for Cobra or a qualifying event and added to their spouses insurance policy etc. Aetna has not been consistent or followed up on their commitment. When Aetna Rep [redacted] was notified she promised to get a timely response from her company and legal department. [redacted] has since stopped responding to emails and inquiries. Only one letter was sent out to a [redacted], explaining why the coverage was terminated and that HIPAA certificates will be sent to her home address.Aetna Insurance group appears to have washed their hands of the situation leaving the individuals effected by this decision left to fend for themselves. The employees that participated in the plan did so in good faith and at no time was made aware that their employer had not paid premiums. At no time did Aetna disclose to these employees/Plan participants that in the event their employer did not pay the premium they would be charged for any services used.Desired Settlement: Aetna must do the right thing and pass along the bad dept. to their collections department to collect from [redacted] not from the individuals that were employed by [redacted] or by charging back the Providers who will in turn charge the plan participant this is wrong.

Business

Response:

Thank you for your inquiry received on April 30, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Hello , I am filling this complain against Aetna insurance company. I never signed up with them , I was a student at [redacted] until July 2013 and than I dropped out from college and since that day Aetna is sending me latter which says " This is not bill , Keep this for your record" but it actually mimics just like a bill and says explanation of benefits and track your health care cost and every month the billed amount is getting increase. I had contact them about 6 times in the past and every time I call they tell me I am not a member with them but I am getting these latter because I have medicaid and medicaid is sending them latter and they are forwarding me those latter. Their explanation doesn't make any sense at all.I directly contacted Medicaid office and they told me they have no record of Aetna Insurance on file for me and that is exactly what my side of story is. Aetna customer service didn't help me at all instead they kept on telling me to contact Medicaid when Aetna is the one who is sending me these latter the recent later show amount you owe $ 1,882.61 and on the right it says it's not a bill.Desired Settlement: All I want at the first step is to be informed why am I getting this latter and why Aetna is being so careless about this ? I left school in July. From my knowledge I never had any student health insurance. I want Aetna to stop sending me these latter that are very confusing just as their customer service is.It seems to me that they are some kind of Fraud company.Please , just help me resolve this.

Business

Response:

Thank you for your inquiry received on June 2, 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 Aetna Student Health department for assistance, and it was advised that all students at [redacted] are enrolled into a Mandatory Accident/Injury Plan. An eligibility letter will be mailed to Mr. Ahmad that simply explains the coverage dates and what type of plan he had. When Aetna receives claims, we process them according to the member’s benefits. We then send out an Explanation of Benefits (EOB) to the member and to Medicaid explaining how the claim was processed per the member’s accident/injury only plan. Medicaid would have to decide not to bill Aetna unless it is truly related to an accident or injury and that would stop or reduce the number of EOB’s that the member is receiving. If the member has any further questions or requires assistance, he may contact Aetna Student Health at ###-###-####.

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: As far as I am aware I never had Aetna Insurance because even if did Aetna or my school no one care to informed me. I had an injury in 2012 and I used my Medicaid card for the hospital expenses. You didn't bother to send me any latter about enrollment when I was enrolled in school and right after I left school in june/july 2013 you started sending me these latter. I have continuously tried to resolved this with you and with Medicaid. I am not going to contact Medicaid or any one from Aetna from this point on.

Review: I pay for health insurance every month. It is automatically taken out of my husband's paycheck for our entire family yet I have been repeatedly denied coverage by Aetna saying that I am not covered/enrolled under his insurance plan. Every time I call their customer service to complain and ask why it's happening they tell me they don't understand what's going on that it clearly shows in their system that I am covered and have been since the beginning of the year. They also tell me they will fix it and send the claims for reprocessing so the bills are paid by them correctly. Although I have been told this on 3 separate occasions starting around the beginning of March it's now half way through the year and I still have bills from January that are continuing to be denied coverage. I am still paying for my insurance on time Every month yet still being denied coverage. I am concerned that this will begin to affect mine and my husbands credit because of past due bills they keep denying. They have told me once again that it will be fixed and corrected today but I have little to no faith that is true since I have heard the same thing several times before.Desired Settlement: I want Aetna to properly cover the bills like they should have from the beginning and I also think I should be compensated for my time and hassle since they have not been doing what I have been paying them for from the very beginning and they have repeatedly admitted to me that it should not be happening. I continue to pay my premium on time Every month to get nothing but a hassle and waste of my time from them for over 6 months.

Business

Response:

Thank you for your inquiry received on 06/30/2014 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 August 18 I ended up hurting my back. I ended up going to the emergency room and I have been out of work since that time.

As soon as I realized that I could not return to work, I let my insurance company know about my situation and then I applied to receive my short term disability.

Between august 18 and present, they still have not reviewed my claim due to not enough info.

Between ALL the notes and paper work sent by my doctor (personally), the doctor's office and myself. This should be more than enough info to continue with my claim.

Its very disappointing that when I take out insurance for situation that I am in now. That this company gives you the run around!Desired Settlement: To review my claim and make a payment for the coverage that I should receive according to my policy.

Business

Response:

Thank you for your inquiry received on 09/15/2014 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: In October of 2013 I contacted [redacted] on the Aetna sales phone line. I was in need of new insurance for 2014 and had an out of state doctor I needed to keep. I was told on three separate occasions by [redacted] that my physician, [redacted] was in network with the Aetna [redacted] plan that I was purchasing at full price. I DID NOT purchase this plan through the marketplace, although I qualified for a subsidy, because the physician noted would have been out of network. I am now being told by my physician that Aetna is refusing to cover services stating they are out of network, when as I noted above, I was told repeatedly they should not be out of network. My physician representative stated that Aetna informed them that I had purchased a [redacted] plan, which again, I did not, and I am still currently paying for a full price, [redacted] plan. I am now facing ever increasing medical bills to cover the cost of Stage IV cancer that I did not budget for based on the information sold to me by Aetna prior to purchasing the plan. This is absolutely terrible behavior on the part of Aetna, taking advantage of a young woman sick with cancer, who by all measure, did the right thing and researched for the proper coverage needed prior to the new healthcare implementation. How am I supposed to accurately make a decision when the information given out is not only not honored, but changed?Desired Settlement: I would like Aetna to honor the product they promised me and cover my physician as in network. Logically speaking, why on earth would I have purchased a more expensive plan unless this doctor was covered? If I had known they were going to retract their promise I would have saved myself money on my premium and purchased a subsidized [redacted] plan.

Business

Response:

Thank you for your inquiry received on September 23, 2014 regarding complaint #[redacted] for [redacted]. Our [redacted] Team researched your concerns, and I would like to share the results of the review with you.

Review: in September 2013 I left my job for a new job and dropped Aetna insurance from my old job and went onto my husbands insurance [redacted]. at the time I was on a medication called [redacted]. I notified the mail order pharmacy-[redacted], that I had changed insurance companies. in October 2014 I received a bill from Aetna for $2418.14. they are trying to bill me for [redacted] that was sent out after my discontinued date from their insurance. I spoke with [redacted] pharmacy and they said legally I am not responsible for this bill-it is Aetna's responsibility not mine. I spoke with Aetna again and told them of this and they said they would submit it to their management. I again received the same bill in December 2014 from Aetna. I spoke with [redacted] at aetna and she continued to tell me it was my responsibility for this bill. I again spoke with [redacted] pharmacy and they told me the same information-I am not legally responsible for this bill. I did my part and informed [redacted] pharmacy of my insurance change-they continue send me a bill for a mistake they made not me. Product_Or_Service: [redacted] rxDesired Settlement: DesiredSettlementID: Other (requires explanation) for Aetna to take responsibility for their mistake and stop harassing me with bills. they are sending this bill for a problem they made over a year ago.

Business

Response:

Thank you for your inquiry received on 01/22/2015 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 Pharmacy Management (APM) department for assistance. The member’s termination information was received and loaded into the system on 10/26/2013, and back dated to 10/14/2013. The members claim was billed by the pharmacy on 10/14/2013, to the Aetna plan instead of the member's new coverage carrier. Aetna paid this claim in good faith that the member was still covered at the time services were rendered. When a member’s coverage terminates, the member is responsible for any charges submitted to the plan after the expiration date. The member can submit a copy of the bill along with a copy of the pharmacy receipt to the new carrier for consideration. Aetna is unable to suspend the billing for this claim. If the member would like to request an appeal, she may do so by submitting a written request to the following address:

Aetna- CRT Member Appeals

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:Sincerely,[redacted] according to your records you stated that I was terminated 10/13 and you received this bill on 10/14-my former employer did not inform you I was terminated until 10/26-that is not my fault. so according to Aetna-you will pay out any claim and then charge the patient the full price if they are not active? that's unlawful and I am not responsible for this bill. I did my part by informing [redacted] pharmacy of my new insurance information. it is not my responsibility that my former employer waited so long to inform atena of my termination. I quit my former job 9/13/13 and they waited until 10/26 to inform you of my termination-that is not my fault.

Business

Response:

Review: I am bring denied an MRI so that I may get the required surgery. After numerous requests,I keep getting told that they need more information. The requirements for approval keep changingDesired Settlement: Approve the MRI.so I may get the needed surgery

Business

Response:

Thank you for your inquiry received on 03/04/2015 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: Today March 10, 2015 I called my dental insurance plan to confirm the Dentist change I made online. I spoke to a representative who advised me that the change was made but that I wouldn't be able to see my new assigned dentist (DMO) until 04/01/2015. I had called a few weeks prior and a different representative advised me that I could make a change ANY time and that all I had to do was either call member services back or go online and make the change. I was never told that the effective date of my new Dentist would be until the following month. Right now I am in extreme dental pain and I am unable to see a dentist. I explained to the last rep that I moved to a different city and that I am unable to see my previous dentist whom I have never seen or received services from. I don't understand how Aetna dental can take my money (monthly fee) for years now and deny services when I am in need.

As the last rep told me that if I decided to go to my new assigned dentist that they would deny eligibility and I would have to pay out of pocket. Very disappointed that a retro change was not allowed. I had to cancel my emergency appointment with my new assigned Dentist. Thank You Aetna. I will make sure I have my company know about this issue and work hard for my employer to cancel you as our insurance plan. Definitely unbelievable.Desired Settlement: For Aetna to retro my Dentist change to 03/01/2015 or effective as soon as possible so that I can see my dentist.

Business

Response:

Hello

Review: I believe Aetna is engaging in unethical business practices. I was reviewing my bills from last year and I believe Aetna uses a practice of reprocessing claims in order to keep me from reaching my copay deductible limit of $250 per person and $500 per family.

My Daughter [redacted] has gone through many doctors visits and dozens hundreds of early intervention home visits which during the year copayments where removed to $0. She also had several blood test done which I pay about $100 per exam, yet only once was I reimbursed for hitting the deductible limit. Immediately after I was reimbursed, they reprocessed the amount out of pocket payments in order to keep me from hitting the limit again.Desired Settlement: I really wish an outside firm would audit Aetna's reprocessing practices. I know I am being railroaded because every time I call about any bill they immediately re-assure me they will re-process the claim but it goes no where. I want someone to evaluate accurately my co-payments from last year and explain how once you hit the limit on personal and family deductible it doesn't stay true for the rest of the calendar year? I know I'm owed money I can't even speculate how much. This is besides the fact I've spent dozens of hours talking to customer service at Aetna, hospital billing departments etc all trying to keep up with who owes what. It's taxing and unfair.

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.