Aetna, Inc.

Review: We pay out of pocket 100% for our medications and then the Aetna company pays me back the difference. It takes normally 30 days to get the check. I sent in our medical benefits request form November 6th,2013. My husband was sent back to the hospital at the same time. I called Aetna around the 2nd week of Dec,2013 and was told the check was in the mail. This went on for the rest of Dec until I was told by their supervisor [redacted] that the check will be re mailed to me. I've been told this until I called [redacted] supervisor [redacted]. I'm now up to [redacted] supervisor [redacted]. It is now Feb 3rd,2014. And still no check. All I asked of them is to do their job. No more, No less.Desired Settlement: I just want my money that the company owes us.

Business

Response:

Thank you for your inquiry received on February 6, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: On December 22nd, 2014, I submitted a payment of $307.00 for healthcare insurance with AETNA that was not delivered. I spoke to various representatives from December 23rd, 2014 all the way through January 10th, 2015. When I purchased the insurance on December 22nd, 2014, I was told that the plan to which I made payment was no longer offered, due to a company merger with [redacted], and a set of new plans of coverage forthcoming. I immediately asked for a refund, to which they stated it would be processed, reviewed, and sent by January 9th, 2015. They gave me a refund ID #[redacted]. When that date arrived, I still received no refund. Upset, I called a representative again (foreign/barely spoke English), and the representative maintained that the refund was in 'pending' status. Aetna's failure to implement a policy I paid for and initiated, due to their own corporate restructuring, caused me to cancel or postpone my medical follow ups and procedures. I have been severely inconvenienced by this and would like someone from the corporate office to assist in returning my funds, so that I may purchase insurance to maintain my healthcare. My Health Plan ID name was [redacted] My subscriber ID#[redacted]Desired Settlement: A full refund of my initial payment of $307.00 for my healthcare insurance that was not delivered.

Business

Response:

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

Based on our review, a refund of $307.00 was completed as of January 26, 2015. The refund of $307.00 was returned to [redacted] credit card ending in 2212. We apologize for the difficulties and inconvenience this situation has caused [redacted]

We take customer complaints very seriously. If you or the member have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Review: I hv Aenta PPO insurance now over ten years. I have had many issues with Aenta.They are notorious for not wanting to pay claims. The only reason I have this provider Is because of my job. My four year old got very sick. HerDoctor had her admitted in the [redacted] hospital. Both her doctor and the [redacted] hospital Are in network. All the sudden I get a bill over $200.00. I call to see why????Aetna is claiming tht the doctor in the hospital was not in network.This is just another way tht aetna is trying to take advantage of people.I was never told tht the doctor was not in network until they whammy me With a big bill. Aetna knows better and they are taking advantage of peopleThis is against the law. They can claim whatever they want. I have had many problems With Aetna.Desired Settlement: I don't want to be charged bogas payment for stuff tht theyJust make up. It's law tht they let the people know before they Do any work. Aetna had integrity issues and take advantageOf their own clients

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.

Review: Aetna has consistently billed me incorrectly and erratically. In the fall of 2013 I signed up for coverage starting January 2014, with a premium amount of $262.70, and had signed up for their autobill program that deducts it automatically. This is how they billed me:January: $262 at the end of the monthFebruary: NothingMarch: $524 at the beginning of the monthThough this works out to the correct amount I was disturbed by the erratic nature of the billing, so I asked them to please take me off of autobill and let me pay the bill manually, and they agreed. I was unable to get through to phone customer service and had to go through their [redacted] representative (who eventually emailed me.) End of March: I receive a paper bill for a premium of $301 plus a fee of $242 for "bill payment change" - not something that had EVER been mentioned to me when I asked to switch my billing. After waiting on hold for 40 minutes on two separate days (and waiting for a response via email, which didn't come in time for me to pay my bill) I managed to talk to a customer service agent who said "oh that's an error, you only owe $262.70", which I paid then. End of April: Another bill for $301 PLUS the "unpaid" fees from March, and a threat that they will cut off my coverage if I don't pay it all. And after being on hold for a full hour, they dropped my call. Trying again, but still have not gotten through. Every month I feel like I am being taken advantage of as I waste a day of my life sorting out their mistakes. To add insult to injury, their hold music is a painfully tinny, fuzzy, earsplitting loop that slowly drives you mad (in between recordings telling you that paying your premium is "quick and easy"- oh the irony!) The [redacted] rep actually responds and promises to "escalate your issue" but that's no help when your bill is due in two days.Desired Settlement: Fix my account so that my bill is for the proper amount and it no longer shows that I owe money. Stop threatening to end my coverage if I don't pay you money that I do NOT owe. Make your customer service actually accessible. When I was thinking of signing up for Aetna, I talked to several reps and was never put on hold- clearly their priorities are in new sign ups and not in keeping existing customers.

Business

Response:

Thank you for your inquiry received on April 29, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We have researched this complaint with our member services team that handles this member’s policy. This member’s account was billing an incorrect premium. The balance should be $262.70. This will be corrected and a correct invoice will be generated on May 17, 2014.

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].

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, IF it actually comes to pass. I cannot say for sure until May 17th when the new invoice is generated, however you requested that I reply within 7 days. (If the mistake is not fixed as they claim it is, I guess I will open a new claim.)

Sincerely,

Review: I recently switched to Aetna Health insurance through my wife's plan through her employer. I have existing prescription of [redacted] that I take daily. we received a letter in the mail from Aetna that said that we were required to use Aetna home delivery as our pharmacy in order for the medical expense to be applied to our deductible. I switched my prescription from my previous provider to comply with the letter. When I received my first delivery and looked at the bill, I noticed the cost of the drug is nearly 2 times as much($46.31) as my previous provider ([redacted] home delivery approx $22) and [redacted] ($24) for a 90 day supply.I called the [redacted], today and spoke with [redacted]. She indicated that I was required to use aetna Home delivery for prescriptions of this type and that there was nothing she could do about the price. This is unacceptable. I should be able to purchase prescriptions for whoever I choose, and shop for the best price.

Product_Or_Service: Health InsuranceDesired Settlement: DesiredSettlementID: Refund

option 1: Refund in the amount of $24, and reduce the price of [redacted] 90 day supply to compete with available retail outletsoption 2: abolish this communist plot to require all members of the insurance policy to utilize this non-cost effective service.

Business

Response:

Thank you for your inquiry received on October 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 Aetna Pharmacy department for resolution of the member’s concerns. They advised according to the member’s pharmacy benefit plan, he has a $3,000 integrated deductible and once that deductible has been satisfied he will have 10% copay for brand or generic medications at either a retail or mail order pharmacy.

The member’s pharmacy benefit does have a mandatory mail order pharmacy after a total of 3 fills, so he is required to use Mail Order Delivery (MOD) after the 3rd fill at a retail pharmacy. The copay he was charged is based on the contracted rate and is correct. Since this member’s plan is a self-funded group the Pharmacy department checked with the Plan Sponsor department to see if the Plan Sponsor would make an exception to bypass the mandatory MOD for this member. They advised the Plan Sponsor does not make exceptions to bypass MMOD.

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]/span>.

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: I was in an accident about a year ago. I have medical insurance through Aetna. I have sent in my paper work and been on the phone with Aetna- three or four times a month, every month, for over a year. I have had to send in my claims paperwork several times- I had mailed it in - emailed it in- faxed it in. Every time I call, the company gives me a different story about what is going on with my claims. Aetna has sent me a check for the wrong amount two times now (it has taken ten months just to receive a check at all). My name has been sent to collections from the Ambulance and Hospital companies because Aetna refuses to pay them. Aetna has refused to send me a write out that explains why they are even sending me the check amount. I am strongly considering hiring a lawyer. Maybe an insurance lawyer will not only be able to help me get the money to pay my bills but also help me to receive compensation for the pain and suffering I have had to endure because this insurance company has put me in a position to be harassed by collections agencies by refusing to pay what they owe in a timely manner. Spending a year on the phone with your insurance company to get the money to pay your medical bills is completely unacceptable.

Account_Number: W194446292-01Desired Settlement: DesiredSettlementID: Other (requires explanation)

$3,200 Total$1800- [redacted]$1400- Ambulance

Business

Response:

Thank you for your inquiry received on September 12, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: On October 16, 2013, I faxed over a reimbursement form to [redacted], An Aetna Company for [redacted]. I called them and asked if it was received and was informed that it was received. I then inquired as to how long it would take before I would get a reimbursement check. Then informed me that it would take 30 days and that I would get the reimbursement check of $82.00 by November 16th. November 10th, I sent a reimbursement form for my dependent in the amount of $100.00. I called to inquire if it was received. It was and once again, I was informed it would take 30 days for me to receive a check. November 16th comes and goes, no check. I call right before Thanksgiving and was informed that they didn't get to it until November 24th and it went out that day. I should receive in 7-10 business days. I call December 10th because I still had not received the check they claimed they sent out. The rep tells me that I have to wait until December 24th, before they can send out a new check for the $82. She then informs me that they sent my $100 check on December 10th and I should have that by Christmas Eve.Christmas Eve mail comes, no checks. I call [redacted] again. They tell me they will put a stop payment on it, a rush on it, and another check will go out by December 31. They also claimed they would put a stop payment on the $100.I call December 31, to make sure another check had gone out and was told that it hadn't yet. That the note was put in there, but nothing had happened and that it could take up to 5 business days for them to start the process of researching where the checks have gone. Needless to say, I was disgusted. I was then informed to call after the new year.I call after the New Year and was told it is investigation mode. I call January 16th and was informed that the checks went out on January 13th and I should receive my checks in a week.I've been calling and calling and given the run around. They tell me again they sent my check again via the same [redacted] but I probably won't get those either.Desired Settlement: I want my money back as per the agreement and service I signed up for. I want my money back and proof that it was sent via something I need to sign for. I want my money back immediately and don't want to wait another 3 months.

Business

Response:

Thank you for your inquiry received on January 31, 2014. Our [redacted] Team researched your concerns, and I would like to share the results of the review with you.

Review: I had been Aetna Individual Plan subscriber for 5 years. Aetna rolled me over into a new plan for 2015 and send me coverage information for the new plan in November 2014. Based on the coverage I was liable for 0% coinsurance for specialist visit and nothing else. My insurance was increased from 2014 in 2015 from $454 to $775 per month stating that old plan is no longer offered. I was charged for copay on 4/28/2015, 09/03/2015, 10/22/2015 of $50 and also charged to meet up the deductible for $175, $175, $225 in addition by the doctor based on claim processed by Aetna. I received a letter dated 10/23/2015 that Aetna did a mistake and has corrected my Summary of Benefits. It did not indicate what correction was made. I went back to online profile and checked my documents to know that I have been paying for something I did not buy. I have communicated 15 times to explain this to Aetna, provided them documentation and they keep on telling me that they have send a letter in 2014 to correct their mistake. There is no further documentation on what was sent to me as I have never received anything. I have by now spend over 10 hours in communication and have at last given up with last resort to resolve this through Revdex.com. Any assistance is much appreciated.Desired Settlement: I would like a refund of what has been paid and also doctor should be paid by Aetna for 2015 claims.

Secondly, I need compensation for all the time of 10 hours I have spent so far in resolving/researching this with Aetna.

regards,

[redacted].

[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.

Upon receipt of the complaint we immediately reached out to have the Summary of Benefits Coverage (SBC), Summary of Benefits (SOB), and the Certificate of Coverage (COC) pulled for the 2015 plan. We were advised that the SOB and the COC both had the correct information for 2015, but the SBC listed the incorrect responsibility for the specialist copay. It original reflected 0% coinsurance, when it should have stated a $50 copay responsibility. If the member called in to verify the benefits, he would have been provided the correct benefits as our system reflected the $50 copay as well being able to reference the COC or SOB.

Due to this error in the SBC, we have made a one-time exception to waive the copay on the two dates of services (04/28/2015 and 10/22/2015) that were processed with a copay and have the $50 copay reimbursed directly to the member. Date of service 09/03/2015 charged a deductible and all the correspondences had the correct deductible amounts and what they would apply to, so we are not able to make an exception for this claim.

I apologize for the frustrations and difficulties you encountered while attempting to resolve this issue and regret that this matter required some of your time in order to facilitate a resolution. Unfortunately, we are unable to honor your request for compensation. We do appreciate your patience during the time involved in researching and resolving your issue.

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].

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Review: I was covered under a [redacted] plan from [redacted] thorough my employer.

I filed for a claim for my wife and daughter on July 26th. The policy says they service the claim in 14 to 30 days. I have did not receive any correspondence until August 29th.

I have been following up with them ever since and had over 30 phone calls. Till date my claim has not moved anywhere.

Also every time I call the customer care I get conflicting information. this has been so frustrating.Desired Settlement: Just pay the damn claim. as after this I might ask for more than just my policy claim.

Business

Response:

Thank you for your inquiry received on October 30, 2014, regarding claims for dates of service July 14, 2014 to July 19, 2014, for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to our Claims Operation department for assistance, and they reviewed the claims and coverage for dates of service July 14, 2014 to July 19, 2014. From January 01, 2014 through August 15, 2014, the chosen policy only covered Single plus one. Beginning August 16, 2014 through September 15, 2014, the coverage was changed to family coverage. Therefore, the claim for the dependent child under claim #[redacted] was denied for no dependent coverage. At the time of service, only the spouse was covered, and the dependent was not. On October 20, 2014, the pre-existing questionnaire was returned to Aetna for the member’s spouse. Her claim #[redacted] was processed on November 04, 2014, and payment of $1,500.00 was sent to the member on November 05, 2014, under check #[redacted].

We apologize for the difficulties and inconvenience Mr. [redacted] experienced when contacting customer care and regret that he received conflicting information. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Review: Aetna filed the termination date for my daughter's medical insurance incorrectly. They filed the termination date as 5/11/2015 instead of 6/30/2015. The termination date for both myself and my spouse on the same policy was filed correctly for 6/30/2015. The issue this is still causing is that Aetna paid, but then redacted payment for my daughter's medical services on 5/29/2015d, citing the early termination date as the reason for the lack of payment. I currently have a large bill from my pediatrician despite the following measures taken to resolve the issue:

To fix the problem, Aetna began a 3 way call between myself and the human resources department at my employer, [redacted]. My employer confirmed on the phone that the policy for all three of my family members should have ended on 6/30/2015. I was told that once Aetna received the official documentation from my employer they would update the account information promptly (Events up until this point occurred approx. July 2015).

Sometime in the month of August, 2015, I was notified that my outstanding pediatric bill had still not been covered. I got in touch with Aetna to discover that they had not updated my daughter's account information to reflect to correct termination date. They showed no record of the forms that were to be sent by [redacted].

Thus, we began our second three way call with the [redacted] HR department. They confirmed once again that the correct termination date for all three family members is 6/30/2015. [redacted] proceeded to cite their records indicating that the official materials had indeed been sent to Aetna, thus ensuring that the error was not on their end. The conclusion of the call was that [redacted] would need to re-send the documents to Aetna so they could update the account accordingly.

Now, on September 23rd, 2015, I received a bill from my pediatrician indicating that Aetna had paid the portion of the bill they were responsible for on 6/30/2015, but that they acquired a refund on 9/8/2015. The refund was thus sought by Aetna after multiple confirmations that my daughter's coverage did not terminate until 6/30/2015. They have still not properly filed my daughter's policy termination date, an error which has no legitimate reason to have been possible in the first place. They need to fix the error and pay the bill, preferably without further contact with me, as I have put in more than enough effort to resolve the issue.Desired Settlement: Aetna needs to expediently correct the error in their system and issue payment for their portion of the bill, equal to the amount they originally paid before seeking a refund on the grounds of the incorrect policy termination date.

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 Eligibility department to verify the member’s termination date. We confirmed it should reflect terminated on June 30, 2015, not May 11, 2015. We are having our eligibility department update the termination date to reflect June 30, 2015. We also had our Claims department adjust any claims that were affected by the incorrect termination date on file. Both dates of services on May 29, 2015, were sent for reprocessing and have been paid to the provider. The new claim IDs for the member’s records are: [redacted]- paid $555.08 and [redacted]- paid $105.48.

Please accept my apology for the incorrect termination date on file which led to a delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issue. Unfortunately, in some instances, procedural errors do occur. When they do, we take them very seriously and do our best to understand how and why the errors occurred and determine what we can do to prevent a recurrence. We continually use feedback like yours to improve our service and prevent issues from reoccurring.

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].

Thank you,

Ashley S.

Complaint and Appeal Consultant

Executive Resolution Team

Review: On 10/16/2014, I saw my gynecologist for my annual exam. A Pap Smear is included in my benefit package. Aetna has refused to pay this, which is completely unjustified, since it is part of my very limited benefit package. I pulled my credit reports 3 weeks ago, and saw a collection for [redacted] in [redacted] for a balance due that is now in collections, has been reported to the credit bureaus, and is adversely effecting my credit. I called Aetna about this balance on 6/11/15, 9/8/15, 9/14/15, and today, 9/22/15. Each time I am told that it will be paid. On 9/14/15 I was told that they would contact the collector, and get it removed from my credit report, but this has not occurred. I was also told on 9/8/15 that the amount due would be paid. This balance has not been paid. I waited for over a half hour for a supervisor today, and hung up. I have had it with Aetna and their games. They need to pay the debtor the amount that they owe, as I paid my premiums for their policy. The collection agency, [redacted], has told me this will not be removed from my report, until this balance is paid.Desired Settlement: Aetna needs to pay [redacted] in [redacted], as they contracted to do, on my behalf, immediately. I also want confirmation that this has been erased from my credit report with the 3 bureaus, and that Aetna report to [redacted] and [redacted] in [redacted], that they should have paid this LAST YEAR, and that their mistake, and was not my fault.

Business

Response:

Hello,

I will not go into full details due to privacy, but I decided to go with Aetna's coverage through my company for fertility treatment. I had heard that their fertility coverage was very good. Unfortunately, I have found out the hard way that Aetna's coverage is only good if you jump through all the hoops they have artificially created to qualify for coverage. Fertility treatment is all about timing and being able to get your medication at a particular time. Aetna REFUSES to provide coverage for any treatment or medication without going through an extremely lengthy pre-authorization certification process. Unfortunately, they need certain lab tests that are only run about 3-4 days before you need the medication. Well, once Aetna receives those results from the doctor, it takes them over a week and sometimes longer to process...even though they tell you that it takes 24-48 hours. Every time I have called Aetna to get a status on my authorization, they give me a different answer. The customer service is horrible and the information is terrible. The departments don't talk to each other. The people are often rude and those that are not rude, unfortunately have no idea what to do to help.
Aetna also does not guarantee that you will get reimbursed if you have to pay for the medication out of pocket due to their delays. Fertility medication is incredibly expensive and after going through this process with Aetna multiple times, I suspect that they make preauthorization difficult so that they don't have to provide coverage for these medications and treatment.
I have nearly 300 dollars taken out of my paycheck a month for terrible service and barely any coverage. I would NEVER recommend Aetna and I certainly wouldn't recommend them for fertility coverage. My doctors tell me not to stress during this process since this can affect fertility, but I must say that it is impossible while having Aetna as my insurance company. At this point, if I am unable to have children...I would say that Aetna is one of the biggest reasons because of the undue stress and panic that they have put me through. For all this money, I should have support and understanding...instead all I have is stress and burden.

Review: I spoke to AETNA and they stated that they would waive the charges. I sent an appeal letter to AETNA that would disoute the charges. I did not receive any phone calls from AETNA that I would be getting billed in 2014. I do not find it fair that they starting charging for a medicare plan. I cannot afford to pay AETNA and it is not my fault that they started charging fees. I am being unfairly billed from AETNA. I have not used the AETNA insurance for medications in 2014 and it is wrong for them to charge me for services that I did not use at all. AETNA is greedy and charging unfair charges to me. I can file a report and report them to the federal government for billing me unfairly.Desired Settlement: AETNA should drop the charges to me. I never used their service in 2014 therefore should not have to pay.

Business

Response:

Thank you for your inquiry received on April 4, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We forwarded the member’s concerns to the Medicare Resolution Team for resolution. The member’s issues were reviewed and resolved on case number [redacted], letter dated April 10, 2014. They advised their records show the member had a low income subsidy, which was approved by the Centers for Medicare and Medicaid Services (CMS) to offset the cost of his copayments and premiums. The amount of the subsidy he received during the 2013 plan year was $28.60 per month. That was the same amount as his monthly premium; therefore the member did not have to pay anything.

In the beginning of January 1, 2014, the subsidy was $28.10 per month and his monthly premium had increased to $49.40, which meant the member was responsible for $21.30 per month. Every year, they review the Medicare plans for changes in cost. These changes often need adjustments in plan premium amounts, deductibles and copayments. The 2014 Annual Notification of Change (ANOC) package was sent to the member on September 5, 2013, which outlined the changes made to the Aetna Medicare Rx [redacted] plan. The ANOC explained that in the beginning of January 1, 2014, the monthly premium for the [redacted] plan was changing from $28.60 to $49.40.

According to our records, we received the member’s request for disenrollment on February 28, 2014. We processed his request and the plan was terminated as of March 1, 2014. We understand the member did not use the plan during the months of January and February 2014; however, since he had the prescription drug coverage available during that time, he is responsible for the portion of the premium of $21.30 per month for two months, totaling $42.60. The Medicare department advised they do not reflect any conversations during which the member was advised they would waive the outstanding balance due of $42.60.

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Sincerely,

Review: Aetna classifying prescription as maintenance medication when it should not be classified as maintenance medication

My health insurance plan contains statements that limit the number of times certain medications can be refilled. Medications classified as maintenance medications must eventually be filled in a 90 day supply through a preferred pharmacy or mail order.

I have undergone some surgical procedures this year related to treating kidney stones. As part of the treatment plan my doctor has prescribed 30 days of the [redacted] medication during each instance of treatment.

Aetna notes the medication can no longer be filled because they are classifying it as a maintenance medication. They require me to seek a 90 day supply from my doctor. I do not need a 90 day supply, and it doesn't seem reasonable to ask for a 90 day supply when I don't need it.

My argument is this medication should not be considered maintenance medication. I will not be on this medication long term (as someone would be with a medication such as blood pressure medication or depression medication).

My doctor has prescribed my medication specifically to help relieve pain and assist in kidney stones passing after treating me.

I contacted Aetna pharmacy services and spoke with an agent. The agent noted Aetna classifies this is a maintenance medication despite the reason it has been prescribed and treatment plan from my doctor. The agent attempted to receive an authorization to get it refilled and it was denied. This call was placed on 5/13/15, lasted approximately 50 minutes. I was provided with reference number [redacted].

The agent was unable to provide documentation about plan coverage that explains this policy. I have been redirected to another department that is closed.

I have looked through the Aetna member website and am unable to find any information about this policy.Desired Settlement: I can certainly understand and appreciate the reasoning behind this policy. It is likely cheaper for everyone involved to obtain a 90 day supply of medication if it is truly needed.

It seems my case in unique. Aetna considers this maintenance medication but it has not been prescribed in such a manner.

My desired resolution if for Aetna to contact me and grant the refill as soon as possible.

However my resolution request does not end there - I would like to be assured that policies and

Business

Response:

Thank you for your inquiry received on 05/18/15 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Aetna Health Insurance policy was cancelled in December 2014. Still the company charged my bank account by almost $900.Desired Settlement: I request a refund. Preferably with interest in the amount of 8% a year how I am charged by my financial institution.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on January 12, 2015.

Review: Aetna Insurance took a payment from my bank on 7/22/13 for the amount of $538.00 and also 8/19/13 for $269.00 . This is to cover for June, July & August insurance. They are now saying they never got the $538.00 and then say they refunded it to my bank, I have proof that both payments were taken from my account, and that no refund was ever sent to my bank either. I have proof of it all and it all has been faxed to Aetna, they still saying I owe them the $538 cause they applied it to my old account number( [redacted]) with them instead of my new one ([redacted]). They have my insurance account totally messed up and will not fix it at all. So my $538.00 is sitting there on their account and they will not fix it nor give me my money back. Again I have all my proof and bank statements, letter from my bank that no refund was ever doneDesired Settlement: I want them to either refund all my money the amount of $807 dollars to me completely, or I want them to fix the mess and get my account straight by putting the $538.00 on to the correct account ([redacted]) and be done with this all. I have refaxed today 9/16/13 @ 12:45pm again the copy of my bank statement where the $538.00 was taken from my account! I faxed it at least 5 times to them. I am tired of this all. I either want my money back or this fixed!

Business

Response:

Thank you for your inquiry received on September 17, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: My wife and I were told we could not have children without infertility treatment due to medical conditions. This was terrible news for us, but, we decided to use our employer's benefits towards infertility treatment that are provided through Aetna. Aetna has made the process so difficult for us that we are disgusted at this point. Aetna has caused problems for us at each step of the way and provided us with wrong information throughout the process. Our employer's benefit pays 50% of infertility treatment. However, Aetna is not paying the full 50% which it is required to pay according to our plan documents which is causing us to have to pay more. Aetna continues to process claim [redacted] and [redacted] incorrectly.Desired Settlement: Aetna needs to pay 50% for claim [redacted] and [redacted] as required by our employer's plan. Aetna cannot just pay the provider a discounted rate as the provider does not have a contract with Aetna. By Aetna paying the provider a discounted rate, that is making the provider bill us the additional amount that Aetna is responsible for. Aetna needs to pay the full 50% as the provider is not accepting the discounted rate. Aetna also needs to make sure these claims are processed as in-network like we were told they would be before we even got the procedure done. We made sure the procedure was approved and we made sure the services would be considered in-network and we were assured by the Aetna representatives the services would be considered in-network as the doctor we chose, Dr. [redacted], is in-network and also because Aetna does not have any in-network clinic that does IVF. Due to those reasons, we were assured the charges would be processed as in-network. Now, Aetna is telling us we needed to get “network deficiency authorization” prior to having the procedures so the charges could be considered in-network. We were never informed of that and nor was our doctor informed of that. The letters we got from Aetna that state we are approved for IVF do not mention that either.

Business

Response:

Thank you for your inquiry received on November 10, 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 write regarding issues with Aetna's customer service department and with their services generally. I began working as a temporary employee in the beginning of April and immediately applied for membership within this insurance agency through my current employer. I became sick with a rather uncomfortable cough/cold which I needed services to treat while I was waiting for the permanent insurance card to come in the mail. I have now had several upsets with regard to being able to receive care/prescription coverage while waiting for this card to arrive in the post. I have made numerous calls to both Aetna/my employer due to problems within Aetna's system for inputting data for its clients (my information has either been "incomplete" or not matching up with both pharmacy systems/doctor billing department systems). I was made to resolve these conflicts instead of the care provider taking care of these issues - this is not the responsibility of the customer (me) to chase my employer on Aetna's behalf for my client/record information. I have finally been able to have a doctor visit (after a horrible ordeal with the new patient/registration area at my doctor's office) and am now having problems with Aetna getting the correct information for me so that I can fill the prescription I have been given during my doctor visit. I was told someone would call me to resolve/talk about my prescription information issues before today's business day was completed (May 8, 2013) - no one contacted me OR the pharmacy that I gave the Aetna customer service provider, [redacted], the contact information for. I refuse to pay non-insured costs for my medical prescriptions when I am PAYING for an insurance service. I would never recommend this insurance firm to anyone as they have extremely poor customer service, practices and communication with their customers. I am beyond disappointed with this provider and it has definitely left me with a bad taste in my mouth about their business.

Product_Or_Service: Health and dental coverage

Account_Number: Net Premier

Desired Settlement: I would like the four weeks of services that I've paid for (approximately $39.00 per week) to be refunded to me. During the time that I've paid for these services (and have had to wait for my insurance card to arrive - it still hasn't), I have not been able to use the coverage I am paying for AND have had to go to work ill while waiting for the issues with my coverage to be resolved. I would like the prescription/coverage information to be sorted out so that I can pick up my prescription.

Business

Response:

Business Response /* (1000, 5, 2013/05/24) */

Thank you for your inquiry received on May 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 Strategic Resource Company (SRC), an Aetna Company, for assistance with the member's concerns. They stated the member enrolled on April 2, 2013. The coverage is effective weekly beginning on the Monday after member get a check with a payroll deduction. A payroll deduction goes to coverage in the future. The member had a payroll deduction and coverage became effective April 22, 2013.

The member's coverage is April 22, 2013 to May 19, 2013. As long as she continues to have payroll deductions, she will stay current with the group. If does miss deductions, she has the option to make a Missed Premium (MP) payment within 45 days.

Generally, premiums are not refunded unless SRC or Group Error. If approval to refund is allowed, no claims would be paid for the dates of coverage. The member's premiums are taken after tax, so if the member wants to cancel, she can at any time; however, it can take up to one to two pay periods for payroll deductions to stop.

On May 6, 2013, she called to verify benefits and May 7, 2013, the member called from the provider's office and had the Customer Service Representative (CSR) speak to the provider. She called about her ID and was advised to use Social Security Number (SSN), Group and name of plan.

On May 8, 2013, the member called and requested a supervisor and the CSR sent a request over to have the member called back. Supervisor call back should be handled within 24 hours or same day for urgent issues. The call back happened the next day and [redacted] spoke with the member and had an ID generated and information updated.

On May 14, 2013, the provider called to get a Verification of Benefits. SRC representative spoke with the pharmacy and she does show the member is in the Pharmacy systems and she did fill a script on May 9, 2013. The cost was $8.20, less than the copay, so the member would have paid the full $8.20. The Pharmacy benefit is $10 Generic and $20 Brand with a Monthly Max of $35.00 per month. If the member did pay more monies out of pocket for pharmacy, we would need those claims to consider for reimbursement.

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, 9, 2013/06/05) */

Aetna's response to my complaint is an exact example of why their customer service is horrible and why I had to write to the Revdex.com in the fist place.

None of my concerns were addressed and, in fact, they rehashed things that I already know (save for the payroll deduction week-long wait for coverage after that point).

I still stand firm that I insist on a refund for the weeks of service I paid for but did not receive because of their computer system and human resources errors/complications. This is not my problem; it has to do with issues within their system and their policies that should not impact the customer, but sadly, it does.

Who is doing the job that involves updating customer records at Aetna? Because I can tell you right now that they should be fired if they can't seem to get customer information updated properly and quickly.

My main issues with Aetna are that I couldn't get access to care, even though I was paying for it, and that each time I had to deal with their customer service representatives it created a headache for me and none of my issues were ever resolved.

All I wanted was to receive the care I was paying dearly for each week out of a near-minimum wage income.

Aetna's response to my complaint is beyond inadequate and I will continue to write to whomever is necessary to get my money refunded for the experience I had to go through in order to be able to access services I am paying for. Aetna's policies and procedures are reprehensible and are not the way that business should be conducted, period.

I demand that my money for service be refunded.

Business Response /* (4000, 11, 2013/06/20) */

Thank you for your inquiry received on June 6, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We again reached out to Strategic Resource Company (SRC), an Aetna Company, for assistance with the member's concerns. Unfortunately at this time, we would still not be able to refund this member because the member has claim usage. The member's information was loaded into our systems as of April 25, 2013, with an effective date of April 22, 2013. After the payroll deductions are taken they are sent to us to be loaded. This information is in the enrollment kit and Q&A on when coverage begins. When a person first starts it can take a little bit for coverage to be updated and new file created. The standard timeframe to get an ID assigned and an ID card is 3-4 weeks. If the person needs services before getting the card, she can use the temporary ID card in the Enrollment Kit or use Social Security Number and Group number at the provider's office. Providers can call Provider services to verify benefits. During the time of her first pharmacy fill, she did not have an ID yet and was not in the Pharmacy system yet. A supervisor call was on May 8, 2013, by the time of that call the information had been updated with Pharmacy department.

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, 15, 2013/07/03) */

The "resolution" suggested (i.e. I will not be reimbursed for the money paid for services I couldn't actually access) is beyond unsatisfactory and grossly inappropriate.

Aetna claims that "when a person first starts it can take a little bit for coverage to be updated and new file created" - really?

A) how is this MY problem as a PAYING customer and B) why is it that this ISN'T a problem for your competitor insurance carriers - i.e. [redacted], who, as I will be a client of theirs in the near future, have ALREADY sent me my ID card REPLETE with the information AETNA TOOK WEEKS TO GET UPLOADED in its system - and BONUS, they got this information to me (complete with no issues/missing information etc.) well in ADVANCE of my even officially in their system/access to benefits!!!!

I've not even paid them a dime and they've managed to get the information I will eventually need to me right away.

Tell me why this "takes time" with Aetna but with competitors it is done right away?! What kind of business are you running?!

You continue to cite that these things take time (in an age of heavy technology advances and instantaneous service capabilities) and that I wasn't due for coverage until the 22nd - at that point I had paid TWICE already for services. At the point that I had my first deduction, I should have been eligible for services, end of story. Anything else means that you business is not functioning properly and I shouldn't be punished by way of lost money for services I couldn't access.

Aetna offers beyond below substandard services/business that I am actually ashamed to say I am associated with and I pay for.

And all of this for what, a lousy $160.00? Let's face it, your company is being cheap, greedy, unethical and out of order on every level with this situation. I've lived abroad (UK) and I can tell you that this EXACT scenario is why the rest of the world think that our healthcare system is absurd and a joke.

I'm going to restate here that I should be refunded for the weeks (4 weeks) that I was unable to receive services (including prescription benefits) while Aetna sorted out its "internal issues."

I've already written to your complaints center, Revdex.com - will you really make me continue on the path of further public awareness about how unjust and horrible your company is? Because I have the time to continue to complain until I get the compensation I deserve and I'll do it. Stop "investigating" this and just refund my money.

Consumer Response /* (3000, 19, 2013/07/10) */

I am not requesting that the Revdex.com refund my money; I AM requesting that Aetna refund my money for weeks of coverage that I paid for but was not able to access services due to their poor customer service and internal communications problems.

Aetna - please resolve this issue before I need to file complaints with other organizations where I'm forced to cite, yet again, how incompetent your business is at providing care for your customers in a timely/organized fashion.

Business Response /* (4000, 21, 2013/07/17) */

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.

We again reached out to Strategic Resource Company (SRC), an Aetna Company, for assistance with the member's concerns. The member is requesting the first 4 weeks refunded, but the member did have claims during the 3rd week of coverage. Therefore, we will be able to refund the 1st and 2nd week only and the amount of the refund is $79.06. Thank you for your patience.

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 had been working with our network rep, Vanessa K[redacted], to update our group NPI/TIN. She did this, and our new contract with Aetna was effective April 1, 2015. She was supposed to be helping me update this information with Aetna Better Health. When I reached out to her to follow-up, I found she was no longer at Aetna. I received an email back from Chris G[redacted] directing me to Jennifer W[redacted]. I sent Jennifer all requested information on June 5, 2015. Since that time, Jennifer has not responded to any emails I have sent following up on this request or to determine a time frame for this to be effective.

In addition, Vanessa did not add one of our associates to the new contract. I was put in contact with Heather P[redacted], who had our associate sign the electronic agreement on June 17. Since then, Heather has been unresponsive to my emails about whether our associate was ever linked with our contract. I spoke with credentialing on July 29 and they informed me that our associate has NOT been linked with our contract. This should have been done in MARCH, and she should be effective with our contract on April 1, 2015.

The only phone number to call about this is [redacted]. The only way to get a representative on the line when calling this number is to enter a member ID number and go through all the benefit details. I went through this process on July 29 and I requested to speak with a supervisor. The rep told me there were no supervisors available, and that someone would call me back within 24 hours. I never received a phone call.

This is completely unacceptable that a) the changes to our contract were not made when they were supposed to be; b) there is no way to contact a representative; and c) that Aetna reps do not return emails or calls. Vanessa K[redacted] apparently no longer works there. Christine K[redacted] phone number is no longer working. Christine G[redacted]'s (our credentialing rep) email is no longer working. Heather P[redacted] and Jennifer W[redacted] are not returning emails. I have no contact person at Aetna and the best suggestion the rep gave me was to fax a letter to Provider Credentialing, which I did on 8/1/2015.Desired Settlement: I need a representative from Aetna to contact me immediately. I have called and emailed several representatives many times and never received return communication. I need immediate assistance with figuring out who a contact person is for our group. I also need to ensure that our associate is correctly added to our contract. Finally, I need our new information to be updated with Aetna Better Health.

Business

Response:

Hello,

Review: Back in September I filed a claim with this insurance company. I had dental work done when I was in Brazil last July. When I came back to the states I called them and asked if they covered dental work done outside the country. They said they did and for me to fill out a form and along with it to send a copy of the dentist's bill and description of the work done. The next month a letter came in the mail from this insurance company asking for more information. I mailed them everything they asked for then began to wait. I was told that the process would take about two weeks so after THREE MONTHS I decided to check on my claim. My claim had been FORGOTTEN the customer service representive didn't know how to explain what happen and didn't know why it just "fell through the cracks." This is completely unprofessional!!! I was then promised that it would be processed as soon as possible. Two weeks later I called again, this time the delay was because they needed more information. I informed them that I had already sent everything they were asking for. Two week after that I called again. They were now trying to contact my dentist, why I have no idea. I had sent them a copy of the bill, the description of the work performed, information on his practice such as location, full name etc. It is now May. In about three months it will be an ENTIRE YEAR since I first filed my claim!!!!! A claim that I was told takes TWO WEEKS TO PROCESS!! Why am I paying insurance if I can't use it?!

Product_Or_Service: Dental Insurance

Desired Settlement: I would like for them to give me the check for the amount that is owed to me.

Business

Response:

Business Response /* (1000, 5, 2013/05/17) */

Thank you for your inquiry received on May 3, 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 received Dental Benefits Request form from the member on September 27, 2012. There was no provider name and address on the claim. They sent a verification letter to the member on October 31, 2012 and asked for the name and address of the provider. The member called on November 8, 2012 and stated she did not get the letter from Aetna. We resent the letter on the same day and received the letter back on December 6, 2012 from the member.

On December 21, 2012, they requested records from the provider and there was no response. We resent the request on March 11, 2013 to the provider and received the information needed on May 6, 2013. The member's claim was resubmitted for review with this information and reprocessed on May 16, 2013, and payment was issued to the member on May 17, 2013. We apologize for the delay and the issues the member experienced with customer service.

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.

Consumer Response /* (2110, 7, 2013/05/27) */

(The consumer indicated he/she ACCEPTED the partial settlement response from the business.)