Aetna, Inc.

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: 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: 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: 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: 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: 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 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: 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: I started working for [redacted].com on January 26th 2015. In fact, I was already traveling (working) on Sunday January 25th to start orientation on the 26th from [redacted] to [redacted] said that Aetna should cover the prior few days to my start date since I needed to have the prescriptions for my travel and first week.

Aetna has denied my claim for prescriptions (birth control $130 and blood pressure $180) filled on 1/24 because I was traveling on 1/25 to start 1/26. Also they failed to reimburse for flu shot on 2/2 for $30. I did not receive my health cards until mid to late February 19th. Last, they are not covering annual blood tests that have always been covered by prior health insurance 3/3/15 for $84.35.

$425 approximately in out of pocket costs that should be covered by insurance. This is a very simple issue.Desired Settlement: I'd like to be reimbursed the difference of co-pay ($25 for [redacted]). I believe birth control and flu-shot should be covered in full along with the annual physical exam which included blood tests.

Business

Response:

Thank you for your inquiry received on 06/01/2015 regarding complaint # [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to Aetna’s Pharmacy Management department (APM) for assistance, and our records indicate the member’s effective date of coverage is 01/26/2015. If the member purchased medications prior to that date before her employment started, then there was no active coverage and the medications are 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 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: I purchased prescriptions after my employment date of 1/26/15 including the flu vaccination. You have not paid me for the prescriptions purchased in February 2015 and the flu shot. I will continue to escalate this as now you have not paid for general annual blood tests in the amount of $90.

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.

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: 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 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 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: 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 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: 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: 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: 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: 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.