Aetna, Inc.

Review: In November 2012, I called Aetna (my insurance provider at the time) to request the name of an in-network provider. The customer service rep gave me several names and numbers to call. I asked specifically whether there would be any charges in addition to my $25 copay and she said no. This call was recorded. I received bills that indicated that the provider was out of network, which meant I had a 40% liability for the payments and a higher ($42) copay. When I called to complain, the Aetna rep reviewed the recording and agreed I had a valid complaint. Aetna denied my appeal. I have taken this issue to my company's benefits rep and 6 months later I still have no resolution, despite frequent assurances from Aetna reps via email that they will correct the problem. My provider is being billed by Aetna for overpayment, because they paid her as if she was in network, yet charged me as if she was out of network.

Product_Or_Service: [redacted] health insurance

Account_Number: WXXXXXXXXX

Desired Settlement: I want Aetna to pay my provider as if she was in network and send me written evidence that they have done so and written evidence that I am not liable for out of network charges.An apology for the significant run-around would also be nice.

Business

Response:

Business Response /* (1000, 5, 2013/06/18) */

Thank you for your inquiry received on June 13, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to the Claims department for assistance with the member's issues. They advised the claims have been reprocessed and corrected with provider confirmation. They informed the member by e-mail on June 11, 2013, providing the breakdown of claim payments.

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

Review: I purchased health insurance from Aetna I was told they didn't do auto take out I got automated phone call incoices were late never got my card but they did withdrawl over 600 dollars out of our account without us knowingDesired Settlement: I want to cancel and make sure they don't do this to anyone else we are not rich or prepared for this my husband and I both work he gets laid off in winter I was not aware until I was embarrassed by the fact they took it out and my card was declined

Business

Response:

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 contacted our Eligibility department and found that this member's plan is active and paid up to current. I contacted the member to advise of the resolution on June 15, 2015. I informed the member that the auto-debit option was selected when she enrolled in Aetna Navigator. I also explained that the balance of $611.90 was applied for payments due from April, May and June. After the initial phone call, I was notified that the member must cancel her plan through [redacted] @ [redacted]. Aetna can not cancel this policy because it is an exchange plan. In follow up, I made several attempts to contact the member at [redacted] and left a message advising to cancel through [redacted]. If you have any further questions, please contact us at [redacted].

Review: To whom it may concern,

I am writing in regards to a trip to the Emergency Room I made on 3/6/14 ([redacted] in [redacted]). The doctor who treated me was Dr. [redacted] with Emergency Group of [redacted]. Emergency Group of [redacted] billed Aetna for $740.00. Here is the sequence of events:

04/01/14: Aetna EOB says I owe $0. Aetna paid provider$216.10

05/06/14: Aetna EOB says provider asked to re-process

10/06/14:Rec'd Invoice from Emergency Group of ** saying I owe $109.90

11/03/14: Rec'd Invoice Rec'd 11/11/14 from Emergency Group of [redacted] saying I owe $109.90

10/12/14: I sent a letter to Emergency Group of [redacted] with copy of Aetna EOB saying I don't owe anything.

11/13/14: I called Aetna. I was told Aetna will send the additional $109.90 payment to Emergency

Group of [redacted]. Provider should receive in 3-5 days.

11/14/14:EOB (online) says Aetna paid additional472.90 (Total $740, entire amount billed).

11/21/14: I received a check for $513.21 from Aetna. Apparently, they paid the amount they owed to

Emergency Group of [redacted] to me instead of giving it directly to Emergency Group of [redacted].

11/22/14: I called Emergency Group of [redacted] to see how they wanted me to get the money to them. They said I only owe $109.90. I paid 109.90 by [redacted] by phone on that date.

03/19/15: Aetna EOB says they paid an additional $99.21 ($839.21 total to date, $99.32 more than

Emergency Group of [redacted] originally billed).

03/27/15: I received a letter from Aetna dated 3/21/15 requesting the $513.21 back (they had made a mistake).

03/30/15: I called Emergency Group of [redacted]. They never got anything more than the original

$226.79 from Aetna and $109.90 from me. They said to call Aetna.

3/30/15: I called Aetna. [redacted], an Aetna representative, told me to send a check for $403.31 to Aetna

(not the whole $513.21 because I paid $109.90 to Emergency Group of [redacted]).

3/31/15: I sent a check to Aetna for $403.31 ($513.21 - $109.90) along with a letter explaining why I

didn't return the whole $513.21.

5/2/15: I received a letter from Aetna, claiming I still owe $109.90 and they will turn me over to a collection agency if I don't pay it.

I do not owe Aetna $109.90. The Explanation of Benefits form I received shows that the patient's share is $0.00. When Aetna sent me the check for $513.21, and I called Emergency Group of [redacted], I was told that I should pay the $109.90 to Emergency Group of [redacted] because Aetna was supposed to but didn't, even though they said

they would on 11/13/14. I did that. N 3/30/15, Aetna's own representative, [redacted], told

me to send back $403.31 ($513.21 minus the $109.90) because Aetna should have paid the $109.90 to Emergency Group of [redacted], but sent the check to me instead.Desired Settlement: I don't understand why Aetna keeps making mistakes in this matter. I don't understand why I should have to pay for it. Aetna should step up and do the right thing. I hope this makes sense to you. Please help me get this mess straightened out.

Business

Response:

Thank you for your inquiry received on 05/26/2015 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I pay $402.00 a month for insurance, a Platnium Plan. However, I can not get an appointment with ANY doctor! The list they provide on their website it full of wrong names and numbers. It's a compete sham. I will be writing the White House as well.Desired Settlement: I want a refund for the last month I paid, I am switching companies, but I dont have 400 bucks to WASTE!

Business

Response:

Hello,

Review: I have been searching for a new primary care physician as mine relocated out of the state.

1. Website technical issues. The first time I used the Aetna website to search for doctors, the website was not working and every search resulted in an error message. Trying again a couple of weeks later, the problems are still occurring but seem to be intermittent. I have submitted two emails to customer service and clearly there has not been any resolution to these issues as they continue to occur with their website

2. Incorrect / false information on the website. I have searched for a variety of physicians and have called into each of them to confirm that they are accepting new patients and accept my insurance. In two instances, the physicians do not accept my type of insurance. In one instance the physician was listed as as 'Internal Medicine' yet when I called they were an allergist.

3. Incorrect / false information from a phone representative. Given the inaccurate information I received on the website. I called (and was routed multiple times to my dismay) to speak with a representative who might be able to give me accurate information. Again, I was provided with information that was inaccurate. For one, the representative had the misinformation and showed that the doctor I called was covered. Further, they provided alternative physicians. After calling the others I was told that they accepted Aetna but only HMO at the time.

This is incredibly infuriating and unacceptable. If I cannot trust the information that is conveyed on the website and by your customer service representatives. Than who am I to trust and where can I get true and correct information from?Desired Settlement: 1. Fix your website. In this day and age it should be easy to have the most up to date information on your website.

2. Address your customer service issues. Your reps should have the most up to date information and provide your customers with accurate information

3. I want a letter from an executive with specific information and details as to how these problems are going to be addressed. I would be happy to take screenshots of your the website, show where the incorrect information is and share it with sources who might be able to draw better attention to this issue than I can.

Business

Response:

Thank you for your inquiry received on 03/31/2015 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: [redacted] has mandated insurance or pay penalty. I choose Aetna this year for coverage. Aetna mistakenly gave me two policy numbers and continues to call me on the cell phone from their number at [redacted] threatening to cancel my insurance even though they have cashed all of my checks and debited my account and I am paid up to date (until April is due). After many phone calls to Aetna and speaking to many people who tell me this was corrected, it still remains an issue in Aetna billing dept. They have not deleated the wrong group ID number and are not crediting me my payments that I have made to the above account. I have had it with Aetna and will file a complaint with the [redacted] and the Revdex.com.Desired Settlement: I want Aetna to stop calling me with their automated threats. I want Aetna to get their billing straight and to delete the incorrect group number from my account so I no longer get these threatening phone calls. I want Aetna to reprimand their billing dept. responsible for this repeat error which has gone on since Jan. 1, 2015 and continues as of today.

Business

Response:

Thank you for your inquiry received on 03/19/2015 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: 18th April 2014. Initial Complaint to [redacted] abbreviated I started the process of applying for medical coverage thru Aetna under [redacted] on 3rd October2013. Due to web site glitches, I was unable to enroll until March 2014. In December 2013, [redacted], my medical doctor, was listed as a provider with Aetna as was [redacted] However, in January, Aetna informed [redacted] that he would no longer be a provider for the Health Care reform plans. He was not given an option of accepting or rejecting the plans. Unknownst to me, I lost my 15 year physician as well as [redacted] as part of the in- network providers by signing up with Aetna.May 20th: No response from Aetna or from [redacted]May11th- Received an EOB for lab work at [redacted]. No mention of negotiated rate as a member that I would pay to [redacted]. Instead I owed the full $769 billed by [redacted]. Called Aetna @ member service number listed on insurance card. (###-###-####) Kept getting automated instructions. No opportunity to talk to someone live. After 1 hour of trying, looked up the Aetna info guide and called the billing number (###-###-####) who told me they cannot help. In frustration, told them to cancel my auto pay with a view to cancel insurance which did not allow my doctors/hospitals or lab work at negotiated price. On my insistence, the billing finally after 30 minutes, got me someone live. After additional 15 minutes, they acknowledged Aetna was negotiating with [redacted] the Health Exchange negotiated rates for services. Ignore the EOB sent and I would get revised EOB. They could not confirm what they said to me in writing by e-mail nor could they tell me when to expect a revised EOB.May 17th 2014: I got EOB of my Office visit to [redacted] on May 1st 2014. Again no member rates and so same [redacted]ion? what do I owe the doctor. Aetna does not have all its procedures in place for the health exchange related plans. The contact numbers are not accurate and not enough personnel assigned to address customer issues. Getting hold of them is impossible. I [redacted]ion the legality of some of their arbitrary decisions of not including doctors and hospitals to be part of the network. Such practices have been challenged in other states. There is no answer from Aetna regarding my complaint with [redacted]. I feel I am in a situation where I have a totally useless health insurance coverage, paying $566 per month for it. The insurance company has no interest in serving me as a customer. So I would rather reluctantly pay the Federal fine for no coverage than continue with this coverage (I will challenge the fine also)21st May 2014: Called Aetna at ###-###-####. Cancelled auto pay in preparation for cancelling this policy.Desired Settlement: 1) Aetna to respond immediately to this complain. It cannot arbitrarily drop doctors from their provider list without giving them an option to participate.2) For me specifically, I want them to give [redacted] an option to participate and become in-network provider. He has indicated he would be willing to do as he does participate with other non health exchange plans3)If they do not want to do that, I will have to cancel the plan effective June 1st

Business

Response:

Thank you for your inquiry received on May 21, 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 the area that handles the [redacted] Exchange plans and have found that not all commercial Aetna contracted providers are in the [redacted] Exchange due to refusal to participate. [redacted] decline participation in the [redacted] Exchange and subsequent physicians associated with the hospital were not included in the [redacted] Exchange due to affiliation to a non-contracted [redacted] Exchange hospital for anticipated inpatient services. There are no identified deficiencies with hospitals and specialists in the [redacted] Exchange plan.

We regret that [redacted] is not satisfied with his policy. Being that [redacted] has re[redacted]ed that his policy be terminated, effective immediately, if [redacted] and [redacted] are not allowed to participate on his policy, we will honor his re[redacted]. However, please be advised that we are unable to terminate the plan retroactively, and must have a two weeks notification (according to the Marketplace guidelines) before the cancellation. Therefore, the termination will be processed on May 31, 2014.

It is important to note that [redacted] understands that voluntary termination does not make home eligible for a Special Enrollment period. Once he terminates his policy, he cannot enroll in an Exchange-based benefit plan until open enrollment begins on November 15, 2014, which will result in a new effective date of January 1, 2015. Furthermore, if he is receiving any Advanced Premium Tax Credit (APTC) subsidy with his premiums, voluntary termination will eliminate that APCT for the remainder of the year.

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

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Plena se see below e-mail sent on 25 th May which was an update as well as resolution sought

Review: 12/27/18 I paid for new [redacted] with 2 charges on my 2014 payflex account $ 438.00 and $40.00. Aetna had no problem processing this right away.

1/13/15 the [redacted] doctor realized they overcharged me and sent a refund of $112.60 to my 2014 payflex account.

I uploaded the paperwork backing up why there was a refund that same day.

I called about a week later, the first time, and forgot to write down the day, and they said they had not received it.

I called again on 2/2/15 and was told that they did receive the refund information, but that refunds weren't done by computer but by people and took longer. But it should be done within the week, just keep checking.

I called today, and was told by [redacted] that he sent a message to the department and that I should call back in 24 to 48 hours. I informed him that this was intolerable and that I was filling out a complaint.

It is now 2/9/15, I have called at least 3 times asking why the refund is not reflected on my 2014 payflex account.

I have a grace period until 3/15/15 to use up any 2014 payflex money left. This is money that I had taken out of my own paycheck and don't want to lose it, but I feel that they are stonewalling for just that reason.Desired Settlement: I will accept a refund to my credit card if it is on or before 3/10/15 and I am notified that day (in a way that guarantees that I get the message) that it is there.

If it is after 3/10/15 or they do not notify me in a way that guarantees that I get the message, then I want to be refunded by check.

Business

Response:

Thank you for your inquiry received on 02/10/2015 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 the Flexible Spending Account (FSA) department for assistance, and the credit refund has been processed and applied to the members FSA account. The refund will show on the members account by tomorrow 02/12/2015.

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:

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

Review: **I am a type 1 (insulin-dependent) diabetic of 32 years and I have been blessed to have an insulin pump for approximately the last 10 years. Last September 2013 I upgraded my pump to a [redacted] Insulin Pump System which came with a [redacted] Glucose Meter that was all covered for payment by Aetna This [redacted] communicates wirelessly with my insulin pump and the ** results have scientific proven accuracy with this particular pump, therefore, it is the only one that is warrantied and supported by my pump Company, [redacted]. As of mid April 2014, Aetna has repeatedly denied filling my prescription for the needed [redacted] test strips - they say I must use other ** meters/test strips that #1)do not communicate wirelessly with my pump #2) are not supported by my pump Company, [redacted]. I have been thru 2 appeals, so far, and have been denied on both. The frustrating thing is they have no logical explanation or reason other than "you need to use these other ** meters/test strips". I even encouraged Aetna, as a Company, to contact [redacted] Diabetes Therapy Consultants at ###-###-#### Ext. [redacted] to learn more about and to update their information on Insulin Pump Therapy and the supported ** meters that go with the pumps they offer. I believe they have outdated information on file. I even pleaded for them to rethink their decision about covering the [redacted] test strips as this is a life choice I have chosen to be able to take care of myself to the best of my ability. I asked them to please not deny me this opportunity to continue using the newest and best products available to manage my Type 1 diabetes. I have had many years of success with my insulin pump and it has literally been a life saver for me. I was told by [redacted] that Aetna should cover these strips if it was filed under "Durable Medical Equipment" which is how I get my pump supplies but when I asked this question, Aetna said they still would not cover them.Desired Settlement: DesiredSettlementID: Other (requires explanation)

I understand these strips are expensive. This ** meter communicates with my pump wirelessly and is supported by my pump company - no other meter is. If I didn't have a pump I would understand why Aetna would want me to use a cheaper ** meter - I get that. However, this is clearly not the case. I have always had good insurance thru my employer and have been able to utilized my resources wisely to be able to take the best care of myself that I

Business

Response:

Thank you for your inquiry received on 06/24/14 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: My allergist ordered once monthly [redacted] for me, and Aetna approved this through the Prior Authorization process (good for dates Dec. 21, 2012 through June 21, 2013). I received [redacted] on Jan 21, 2013, March 19, 2013, April 18, 2013, and June 5, 2013. Aetna claimed that I did NOT have Prior Authorization approval, and communicated to [redacted] to bill me, not Aetna. In spite of more than 20 phone calls from myself and my allergist to Aetna to try to resolve this (providing everything Aetna required, including a copy of the Prior Authorization Approval Paper, which Aetna had "LOST"), Aetna still has not paid [redacted]. In fact, I have been told on numerous occasions that I cannot speak with Aetna's claim dept. [redacted] has sent me to collections.Desired Settlement: I would like Aetna to pay [redacted], which they originally agreed to do when they approved the medical treatment via the Prior Authorization Process.

Business

Response:

Thank you for your inquiry received on March 12, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I work with [redacted] and our company insurance is through Aetna. Initially, there was a miscommunication between [redacted]'s HR and Aetna, where money, for my coverage, was supposed to be automatically pulled from my pay checks but was not. I had to later straighten this out and pay for gaps in my coverage, where I had doctor's office visits. One such case, for a visit in September, I was told would be covered by making a back payment. I later found out (a week ago) after I called for third time, that this payment didn't cover the office visit. It actually covered nothing. I was told that payments can only be made for gaps in coverage over the last 45 days, something the person I made the payment with, didn't disclose. If I'd known, I would have never given away $99 and just paid for the office visit out of pocket. While I was on the phone with Aetna, I asked if there was a way to get my money back, have the payment cover beyond the 45 or put it toward something else. It was to be deliberated and I called back 3 days later to hear the decision that my money was not to be refunded. Really? I've had nothing but issues with Aetna, having to explain my situation to a different person every time I call. Whenever there's a dispute, I'm not notified and again have to explain my situation to a new person every time I call.Desired Settlement: I'd really like my money back. We could put it toward the next payment due but since it's taken from my check automatically, I'm afraid I'd be paid twice.

Business

Response:

Thank you for your inquiry received on December 16, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to Strategic Resource Company (SRC), an Aetna company, to help with the member’s concerns. They advised contacting the member December 17, 2013 and gave the member two options – we would either honor the refund of $99.84 or pay the September 5, 2013 claim. The member chose the refund and SRC was able to get that to him and the member was satisfied.

Consumer

Response:

Dear Revdex.com

Review: My insurance member ID is [redacted]. I had a [redacted] vaccination at [redacted] and it cost me $39.99. Aetna is refusing to reimburse me for this even though my policy clearly states immunizations are covered. I've sent them multiple emails and faxes only to have them come back and ask for more faxes of the same information.Desired Settlement: I want a check for $39.99 as I should have never had to pay out of pocket for this at all.

Consumer

Response:

Attached is a copy of my receipt for the immunization that's supposed to be covered by my insurance.

Review: Back in 2007 I had a motorcycle accident abroad [redacted] where I was taken to a local hospital. Due to the injuries suffered on the accident, I was immediately taking in for a [redacted] surgery. a few weeks later a submitted a reimbursement claim since Aetna's policy covers emergency services abroad. After summiting all the paper work required by Aetna in more than one occasion, 5 years have passed without a definitive answer as when I will get reimburse.

Product_Or_Service: INSURANCE COVERAGE

Order_Number: Claim ID#:XXXXXX[redacted]

Account_Number: [redacted]

Desired Settlement: I would like to get my 4000 plus I paid out of my pocket when I was covered under Aetna insurance.

Business

Response:

Business Response /* (1000, 5, 2013/07/03) */

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

According to the coverage plan and our appeals policy, members or their authorized representatives have up to 180 calendar days from the date they got the original notice of a benefit decision to ask for an appeal. We did not get this request within that time. The service date was in 2007, and the claim denial date was June 1, 2012. We checked our systems and could not find any evidence the member contacted us to either discuss this claim or to ask for a review or appeal within the 180 calendar days. If the member can give a reason for their delay in their request, we may consider making an exception to review.

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

Consumer Response /* (3000, 7, 2013/07/09) */

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

Thank you for attending my inquiry. I first summited this claim about a month later after my intervention(june 2007), I got in my possetion dated cover letters sent from HR in the company, and letters I received from you back in 2007 that I could send to you any time. Back then I faxed my file [redacted], but I could not reach her any time later, then I talked to [redacted]aXXXXXX. After not getting a clear reason I was not getting a refund I talk to [redacted] we he came to our company, he told me he emailed [redacted]'s boss to check my case. [redacted]

Consumer Response /* (-5, 9, 2013/07/11) */

I suggest Aetna Executive Resolution Team to research the documents I uploaded to Revdex.com that include a letter from Aetna dated Nov 2007 which proves I submitted the claim within the time limit (less than 180 days) back in 2007. Also, I can provide additional documentation requested by Aetna which proves I submitted hospital receipts, bank account statements, and Aetna formularies in four different occasions. After talking to several Aetna reps, I have not received a straight answer for the denial of my legitimate claim; Aetna reps always suggest resubmitting all the paperwork again and again.

Business Response /* (4000, 10, 2013/07/19) */

Thank you for your inquiry received on July 11, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Since the member provided additional information, we will waive the timely filing and an appeal, Case number XXXXXXXXXXXXX, was opened to review the member's issue. The member will receive a response under separate cover once the review is completed. 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 about this particular matter, please contact the Executive Resolution Team at [redacted].

Consumer Response /* (4200, 12, 2013/07/29) */

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

They are still reviewing the case, I have not recieved a final resolution

Business Response /* (4000, 14, 2013/08/14) */

Thank you for your inquiry received on July 31, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

The resolution for the member's appeal, XXXXXXXXXXXXX was July 26, 2013. The decision was to uphold the denial of reimbursement for professional services rendered by Dr. [redacted], Dr. [redacted] and Dr. [redacted] while the member was in [redacted] for dates of service June 18, 2007 to July 1, 2007, in the amount of $3,000.00. We did allow reimbursement for the charges for services rendered while he was in [redacted] for dates of service June 18, 2007 to July 1, 2007 for the amounts of $26.40 for an [redacted], $249.19 for a [redacted] and $824.43 for [redacted].

Unfortunately, there is only one level of appeal through the member's Health Plan for [redacted] HMO members. The next level of appeal would need to go through the [redacted] Department of Managed Health Care (DMHC), which the member's resolution letter did advise. The partial claim payment will be processed regardless of the member pursing his next level of appeal through the DMHC.

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

Review: My insurance was cancelled without any prior notice being presented to me. I was current with my payments, yet received no notice as to cancellation. Only open receiving a notice of prior health care coverage did I see that my medical insurance had ended.Desired Settlement: I would like Aetna to reinstate my coverage at the previous premium of $145.67 per month. The equivalent coverage plan offered by Aetna is $520.00 per month. This plan would not be effective until next month, and I would like to be covered NOW.

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 am getting charged 109.00 per week for health insurance and they are only covering $35.00 total on medication for the month. This can not be legal, I have 3 meds that I need to pick up and one of them is now showing $130+ for it..what ever happened to the care in this state? What happened to everyone needs insurance? How can anyone afford to go threw this?So now is I need a medication this month then it is going to cost me full amount. This company I just found out does not even meet the requirements for Mass in order for us to show that we had insurance threw the year, which means since I have to have insurance I have to pay them every week and now pay at the end of the year a fine shwoing that I did not have insurance?

Product_Or_Service: Medication

Desired Settlement: They need to cover more of the medication for their clients per month and meet the requirements for Mass

Business

Response:

Business Response /* (1000, 5, 2013/06/18) */

Thank you for your inquiry received on June 4, 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 Pharmacy department for assistance with the member's issue. They reviewed the plan benefits and they do have a $35 Individual Monthly Maximum that is covered in which the members will pay their copay until the $35 has been used. Once used the member is responsible for the full cost of the drug for the rest of the month. Unfortunately this is the plan design that the group has selected for their employees and cannot be changed at this time.

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

Review: 1. Difficulty in receiving reimbursements for medical expenses when claims are filed.2. Claims "disappear" or are filed incorrectly leading to denied claims.3. Failure to properly notify members when: 1. Claims have been received. 2. Claims have been denied (no explanation/reason for denial). 3. Claims have been processed incorrectly or additional information is needed.4. Refusal to honor Direct Deposit Enrollment agreement.Desired Settlement: 1. Claims to be processed in a timely manner without members having to continuously call/email to get results.2. To be notified when a claim is denied and informed as to the reason for denial.3. Payments to be sent direct deposit as requested.4. To be notified at each phase of the claims process, that way if information is requested it can be provided before the claim is denied.

Business

Response:

Thank you for your inquiry received on 07/29/14 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: THE POLICY CLEARLY STATES THAT WE HAVE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY BENEFITS FOR 26 VISITS. THEY ASKED FOR THE MEDICAL RECORDS AFTER FAXING THEM SEVERAL TIMES WITH CONFIMATION THAT THEY REC'S THEM THEY KEPT STATING THEY NEVER REC'D THEM. SO FINALLY I FAXED THEM TO A DIFFERENT FAX NUMBER AND THEY REC'D THEM. AFTER AETNA LOOKING OVER THE NOTES FOR OVER 2 MONTHS THEY FINALLY DENIED MY SONS CLAIMS. MY SON HAS AUTISM WHICH IS A COVERED BENEFIT AND I EVEN GOT MY SONS PEDIATRICIAN INVOLVED ASKING HER IF HE NEEDED THE SERVICES AND SHE AGREED AND EVEN WROTE AN RX FOR THIS THAT HE NEEDED THE SERIVCES; HE EVEN RECEIVES THEM IN SCHOOL. THE POLICY WILL NOT PAY THEIR PORTION WHICH CLEARLY STATES 26 VISITS. HAD I KNOWN THEY WERE GOING TO TAKE OVER 2 MONTHS TO REVIEW HIS NOTES(WHEN THEY KEPT TELLING ME I WOULD HEAR FROM THEM IN 1 MONTH) ONLY TO DENY HIS CLAIMS, I WOULD HAVE NEVER TAKEN TO GET THE THEAPY HE SO DEPSERATELY NEEDED AT THAT TIME. HE IS A ALMOST 6 YEARS OLD AND HE FUNCTIONS AS A 2 YEAR OLD SO HOW THEY COULD SAY THAT AUTISM IS NOT MEDICALLY NCESSARY IS BEYOND ME, BUT THEY WONT EVEN GIVE HIM WHAT HE DESERVES UNDER THE POLICY WHICH IS AT LEAST 26 VISITS. THIS IS NOT THE FRIAST TIME I HAVE HAD PROBLEMS WITH AETNA AND THEY STATING STUFF IS COVERED THEN ONLY TO FIND OUT LATER ON THE WONT COVER IT NOW I AM STUCK WITH AN BILL FOR OVER $800.00 AND WITH NO HELP FROM AETNA. I HAVE APPEALED THEIR DECISION AND I AM NOT GETTING ANYWHERE WITH THEM, AND AT THIS POINT I AM FRUSTRATED WITH THEM AND THEIR POLICIES.

Desired Settlement: I WOULD LIKE THEM TO PAY THEIR PORTION WHICH MY SON IS ENTITLED TO THOSE BENEFITS FOR PT AND OT.

Business

Response:

Business Response /* (1000, 5, 2013/05/16) */

Thank you for your inquiry received on May 2, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to the Customer Service department for assistance with the member's issues. They reviewed the member's file and based on the current information and the member's benefits, the denial is correct and will be denied as a non-covered benefit under the terms of the member's plan.

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: I did not receive a deposit in my Health Savings Account for Dec 2015. [redacted] refuses to address it. I have a High Deductible Health Plan health insurance policy thru my employer's Federal Employee Health Benefits health insurance policy with Aetna for 2015. Part of this policy includes a monthly deposit of $125.00 into a Health Savings Account (HSA), which I have carried as part of this policy since Jan 2012. [redacted] assumed servicing this account in March 2015. The monthly deposits were delayed, and in December 2015, I never received the deposit. Premiums were paid to Aetna on time by both the employer's Agency contributions and by me by way of payroll deductions. I have tried to get [redacted] to assist me in locating the missing funds. The first call was made by me on Jan 4, 2016, and the customer service rep said they would investigate the missing funds and call me back w/in a week. I never rec'd a phone call regarding this. I called again on Jan 11, 2016, and the individual tried to place the problem back onto me, stating my employer had not sent the funds, though they would not have been able to see this from where they were sitting. They inferred that the employer had not sent the funds, but the funds don't come from the employer, they are passed thru from the insurance provider, Aetna. Aetna is sending me back to [redacted], stating they have no oversight into this, which is not entirely true, the money has to come from somewhere, and since Aetna is the one who is receiving the premiums every month from both me and my employer's contributions, Aetna does have some visibility into this. I phone [redacted] again today, to give them one more chance to assist, and the customer service rep was instantly defensive and hostile before the conversation ever began. Her name is Kathy. She accused me of being rude when I had not even begun to speak to her about the issue. I believe that this is fraud. That [redacted] has diverted this deposit and is refusing to address it. There are missing funds via a missing [redacted] for Dec 2015, and [redacted] is stonewalling addressing it, and Aetna just gives canned useless responses to my queries about this.Desired Settlement: Locate the missing $125.00 which belongs to me and deposit it into my HSA fund immediately.

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 compliant we immediately reached out to our Health Savings Account (HSA) department to have the member’s concerns addressed. We were advised that prior to receiving this complaint the member’s account was already updated with the contribution for December 2015. We confirmed the member’s money was deposited on January 13, 2016, and an email was sent to the member on January 14, 2016, advising her of the deposit.

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 Ms. Stiles’ 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:

thank you very much for addressing this promptly.

Review: for the last 2-months Aetna has advertised on tv that if you attend one of their seminars they would give you a 10.00 [redacted] gift card.I went to the seminar on October 19th.after the talk the Aetna guy said he new nothing about it.his name was gefory woodruff .his office phone is ###-###-####.however he gave me 2-numbers to call Aetna.###-###-####.then that guy on 10-19 gave me another number at ###-###-####.both said the card would come in 6-weeks.well its been 7-weeks and every time I call they have no answer for me as to when the card will be sent to me.or why the first card was never sent.and when the new card will be sent.or if someone from the company will call me for any or all of these answers.thank you-[redacted]Desired Settlement: please send the 10.00 gift card that you promised or you can double it for the inconvinence.

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 our Marketing department to verify when the member would be receiving the gift card for going to the seminar on October 19, 2015. We were advised that the customers could receive a gift card one of two ways. First, fill out a BRC (business response cards, which are distributed to attendees at the Sales Seminars) either online or return by mail, as indicated on the BRC itself. Customers can also call one of the telephone number’s advertised in the TV/Direct Mail in the areas, where Sales Seminars are not available.

According to our records, we did not receive a valid BRC from Mr. [redacted] and the numbers that he called were not valid phone numbers for this year [redacted] card promotion. The numbers called were general Seminar Finder lines and last year’s gift card telephone number. Due to the confusion, we will issue a gift card to Mr. [redacted], which he should receive in the next 2 weeks.

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].com.

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Consumer

Response:

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

Sincerely,

Review: Aetna refuses to refund Health Insurance premium because [redacted] has not sent notification of cancellation to Aetna. [redacted] does not send notifications of such. In fact, myself, [redacted] representative and Aetna representative were on a 3 way call verifying cancellation was made. I am caught in the middle and should not be held hostage. I cancelled this policy 3 days after purchase in January well before the effective date of February 1st, and have reference #'s of conversations to document such.Desired Settlement: I would like my $657 premium refunded.

Business

Response:

Thank you for your inquiry received on February 21, 2014. Our [redacted] Team researched your concerns, and I would like to share the results of the review with you.