Aetna, Inc.

Review: Credit card held on file and charged without consent, and company refusing to refund money.

On June 26th, 2013 my [redacted] debit card was charged in the amount of 250.00 dollars, for medication through Aetna's home delivery service without my consent, when I called to send the medication back I was told several different things, I had to file an appeal, something about having to put in a task so I can receive a shipping label, everything was denied by their billing department saying that since I've ordered medication from them in the past they hold on to credit card information and they refill medication and can charge your credit card as needed, even without your consent. At this point I was told I cannot return the medicine and get a refund, This is credit card fraud, there are online forums saying that people have had this same situation happen to them. The number to the Aetna home delivery service is X-XXX-XXX-XXXX

and the number for Member Services is X-XXX-XXX-XXXX

Desired Settlement: I would like to receive back the 250 dollars charged to my account.

Business

Response:

Business Response /* (1000, 5, 2013/07/31) */

Thank you for your inquiry received on July 17, 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 issues. On June 25, 2013, Aetna Rx Home Delivery (MOD) received a request for [redacted] and [redacted] for a

90-day supply from [redacted] at the member's doctor office. Order number XXXXXXXXXX was created and shipped on June 26, 2013 per their request by [redacted]. For each copay it was $125.00 for a total of $250.00. MOD intent was to fill the prescriptions per the directions from [redacted] at the member's doctor office.

On June 26, 2013, the member was advised by the Customer Care department that the order shipped and it was filled per directions from the doctor office. The Accounts Receivable department denied the request for a refund because the prescriptions were authorized by [redacted] at the member's doctor office and the Reship and Return department denied the return of the medications stating the order was filled correctly. The member called the Customer Care department several times from July 9, 2013 to July 11, 2013, and spoke to several representatives and per notes on file from each representative the member was advised the same information. The order was filled and dispensed correctly and that MOD does not accept medications back in house that was filled correctly.

In reference to the member's complaint regarding his credit card that was charged on June 26, 2013. The credit card was on his profile and was used on a previous order. When MOD received the verbal request from the member's doctor office the credit card was applied to this order.

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 visited my [redacted] for severe pain in my feet and she recommended that I should get orthotics. She suggested that I should call my insurance to verify if they cover orthotics, more specifically [redacted] (Durable Medical Equipment) or not.

I called the Aetna member services and provided all the details on 05/01/2015 at 11.50 AM. The representative whom I spoke to was [redacted]. She looked up my benefits and told me that since I have met my deducible, I am all set and insurance would pay for [redacted] (orthotics). I went to the Drs office and they took the size and ordered orthotics for me. When the Drs. office filed a claim, it was rejected by Aetna. Drs. office informed me about the situation and I called Aetna member services again. The representative who attended my called told me that orthotics are not covered in my plan. I immediately gave her all the details that the Aetna member service representative [redacted] confirmed that it's covered on 05/01 and that's why I ordered those. Why should I pay $600 from my pocket? She said, I don't have any option but to file an appeal, so I did that. The case id for appeal is: [redacted]. Since then I have made numerous calls, either they put me on long hold that the call get disconnected or sometimes when I made through the long hold, they would told me that no decision has been made. I have complaining since day 1 that they should listen to the call recording and make the decision. Aetna representative made a mistake and they should honor that but I guess they are waiting for the call log to be deleted so they can reject this appeal. Every time I have called the member services, they promise that they will let me know the status by next week which never comes. A worst customer service -- I have never experienced such service every in my life.Desired Settlement: I want Aetna to honor their mistake. I did my due diligence, called and verified if [redacted] was covered or not. [redacted] clearly said it is covered, she didn't inform it there were covered under some circumstances or not. I want Aetna to process the claim and pay the Drs office so they don't keep calling me for money. If nobody pays, the Drs. office will put it on my credit which would be disastrous.

Review: Aetna is taking money out my ay pay check when I declined health insurance with them I have emailed them and requested thay stop taking money out of my check and thay still take money out of my check

Product_Or_Service: health insurence

Desired Settlement: I want all my money back that I paid in 1025.00

Business

Response:

Business Response /* (1000, 5, 2013/07/16) */

Thank you for your inquiry received on July 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 Strategic Resource Company (SRC) to research the member's concerns. They reviewed the member's file and they do not have records of any calls or e-mails. The member's group, The [redacted], administers the enrollment via a vendor. The member may have tried to e-mail the enrollment vendor, the plan sponsor or an alternate e-mail address. We have no record of an e-mail requesting termination from plan and the member will need to contact his group. The [redacted] uses this vendor - [redacted] for enrollment. Eligible employees can also call X-XXX-XXX-XXXX for benefits.

They will need to review his case to see if he can cancel the plan outside of open enrollment and stop the deductions. The refund would be a separate issue based on the findings of the plan sponsor/benefits department. If the member has proof that he did decline the benefits, either a computer screenshot, e-mail or a phone record of call into benefits phone numbers, that maybe useful when he contacts the [redacted] explaining his case.

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'm having real problem with muscle spasm in my neck. My doctor prescribed a muscle relaxer but the insurance company won't pay for it. I also have a problem with [redacted] and my doctor prescribed med for this problem. The insurance company won't pay for it. So here's my problem, I can't get to sleep because of the pain in my neck, or the lack of sleep is causing me to have these spasm. I don't know why they're not allowing this, but I'm is great pain and haven't been able to sleep for a week. I'm still working at the age of **, but I can't work with these problems. Please help in getting this problem resolved .

This is a First Health Part D company of Aetna insurance company.

My Member ID is [redacted] Rx PCN: [redacted] Rx Group: [redacted]Desired Settlement: I would like First Health Part D to pay for these drugs, so I can get back to work.

Business

Response:

Thank you for your inquiry received on 07/06/15 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.We made several attempts to reach out to Mr. [redacted] for additional information and were unable to get ahold of him via email or telephone. Voicemail messages were left with contact phone number for him to call us back so we can assist him. To date, Mr. [redacted] has not returned the phone calls or email. Furthermore, the Pharmacy department reviewed Mr. [redacted] file, and found no denials on file for any medications to date.We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Review: Aetna charged me for health insurance in June 2013 and June 2015 ($2343 and $2779).

I am covered under my husband's health insurance since July 2012.

Aetna is committing Health insurance fraud. They charged me for insurance that I don't need, that I didn't request for, that I don't want. I already have health insurance. They charged me $2343 in June 2013 and again $2779 in June 2015. I have not received any insurance cards, notification, bills, statements, policy statements, policy numbers, etc. I have received nothing from them except a recent letter stating I need to submit my Social security number. This is how I found out they have been charging me without my consent.Desired Settlement: Refund my money for services I did not need, did not request for, did not apply for, did not receive notification for.

Business

Response:

Thank you for your inquiry received on 07/01/2015 regarding complaint #[redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I've been on short term disability since April 19th of this year. I am currently under care from a doctor that is treating my condition. My doctor moved his office to another location the beginning of June. Aetna has all my contact information mind you. telephone number email ect. Two weeks later I received a letter in the mail that my benefits have been denied. My employer was notified and put me on personal medical leave. I now have no healthcare benefits, I haven't gotten a check in about a month. They wanted updated medical records from my doctor to reopen my claim. The doctor has submitted the paperwork that they asked for and still today they claim they didn't get the last fax. all of this could have been avoided if the case manager that is in charge of my account would have done her job. The new phone number of the doctor's office was on a recording when u dialed the old number. She never even contacted me that there was a problem getting hold of the doctor. it is stated in their policy that they contact me in such matters. never did. The case managers name is [redacted]. In all my years I have never dealt with such incompetent people in customer service. When I call they never transfer me to a supervisor just their voice mailbox. it is getting to a point that I will have to seek legal council on this matter. please help me in getting this resolved. my claim # is [redacted] I'm writing to you not only on my behalf but so other people don't go through this. Aetna needs to evaluate the people they hire because right now the customer service horrible. Thank you.Desired Settlement: I need my claim reopened and I would like headquarters to know that its workers are incompetent.

Business

Response:

Thank you for your inquiry received on 06/30/14 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: A previous request has not been honored by Aetna. Here is there response to an email that was sent from one of the employees and Aetna's response stating that they would honor coverage through Dec 1, 2013, yet I received a bill for my prescriptions that were within this window. I called Aetna and was transferred 4 times to deal with this and the service agents continued to send me to the wrong depts! Please help.This is the original complaint that was sent from an employee.Dear [redacted] :This message is in regard to your complaint submitted on 4/29/2014 2:56:56 PM against Aetna, Inc.. Your complaint was assigned ID [redacted].Revdex.com has received a message from the business regarding your complaint. Please review this information below and provide Revdex.com with a written rebuttal. All responses with be copied to the business for their review.Please provide your response within 7 days so as to avoid closure of the complaint as assumed resolved.Sincerely,[redacted] Complaint Supervisor/ADR SpecialistMESSAGE FROM BUSINESS:Thank you for your inquiry received on April 30, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.We reached out to the area that handles this members plan for assistance with the members concerns. The members employer has failed to pay premiums on the plans since October 1, 2013 despite multiple notifications. We had initially terminated the plans effective October 1, 2013. We have now changed the termination date to December 1, 2013. The members employer is responsible for notifying plan participants of the termination of the plans. We have become aware that the members employer may not have notified members of the termination. We are in the process of providing notification to members on the new termination date. The letters will be mailed in the next few days. We will also mail updated HIPAA certificates separately.Additionally the member had asked Aetna to bill the employer.Desired Settlement: To honor the coverage they had requested including the prescription coverage for all employees.

Business

Response:

Thank you for your inquiry received on 06/16/2014 regarding complaint # [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Aetna denied coverage for my Asthma medication. They require a trial of two less-expensive medications, but I have already tried one unsuccessfully, and the other is contraindicated. Internal appeal was denied. Aetna refused to process external appeal.Contract specifically includes medically necessary medications.Desired Settlement: Cover medication necessary to treat asthma. Reimburse for out-of-pocket purchases already incurred.

Business

Response:

[redacted]Thank you for your inquiry received on 05/07/2014 regarding complaint#[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to Aetna’s Pharmacy Management department (APM) for assistance, and were advised that APM does not have any record of the member or her physician filing an appeal regarding the denial of the [redacted] prescription. A letter was mailed to the member on 04/30/2014, advising of the determination regarding [redacted]. As stated in the letter to the member, if the member or the physician wishes to file an appeal, they may submit a written request to:

[redacted].

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

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Expedited external appeal was requested by telephone, 5/5/14 6:13 PM, as advised by denial letter. No response was received.

Sincerely,

Review: I lost my job DEc23, due to a car accident I was in Oct10thMy injuries irritated my lower lumbar, which Ive had surgeries toI could not stand longer than hours without agrevating painI filed with Aetna Beginning of JanI did not receive my first check of until FebIt was only for weeks, they claimed I would not get a check for the first weeks because I was not hospitalizedThis was NEVER explained!! They sent a extension to my doctor FEb17thThe doctors office did not submit the extentions until April8thI called the company and explained the situationthey told me they filed the claim on the 9th and the check would go out on April 13thand that I would be back dated for the months missed! Another claim was also filed on April 13thfor that week in the amount of which was sent out on April 20thI received the check for that Friday but still have not received my back dated check in the amount of I called several times and got the same thinggive it 7-by the 14th days I told them I wanted the check to be reissued because I had not received it! I finally spoke to a supervisor on April 27th who assured me that she had stopped payment and was reissuing the check that dayand it was being sent priority and I would have it by WednesdayI called today because I did not get it and another agent said it was not sent! This is getting ridiculous as of now I'm going on 1/months with no incomeI have not paid my auto insurance, and my power is soon to be disconnected! I'm struggling and I do not understand why I can not get my benefit Ive been due since FebShe promised me that she was going to reissue a check and I don't believe her.!Desired Settlement: DesiredSettlementID: Replacement
They need to send me my check asap = over night with tracking!!
Business
Response:
Thank you for your inquiry received on 05/01/regarding complaint #[redacted] for [redacted]Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you

Review: In the listing of the services my medical insurance provides, there is a section listing preventive care. Each of the listings indicates 100% covered. When I contacted Aetna to ask what is covered 100% they indicate they are unable to tell me what is covered.Specifically I was asking about the following preventive care procedures:[redacted]The representative indicated I need to get the procedure codes from the doctor to determine is they are 100% covered. The Doctors office indicates they need to know what procedure codes the insurance covers. This is circular and I've exhausted all efforts to try to determine what services are covered at 100% by my insurance company.The server representative name is:Desired Settlement: I simply need to know what services are covered at 100% as indicated in the listing of the benefits covered in the preventative care section.I can be reached [redacted]

Business

Response:

Thank you for your inquiry received on April 9, 2014. We reached out to the Plan Sponsor Liaison department for assistance with the member’s concerns. They advised the published list does not include procedure codes because they are subject to change. It is up to the provider to choose the appropriate codes. Covered preventive services include:

Review: My employer[redacted] gives $1000 to Aetna to cover medical costs for 2015 for insured. Aetna has taken $896.91 out of that fund. The total expense spend for 2015 was only $689.77. Aetna has taken $207.14 extra out of my fund. I contacted Aetna 10 days ago by e-mail about this mistake and never got a response. I contacted Aetna by phone and I was informed that they made mistake in claims processing dated 2/6/2015. The claim was corrected but the excess of $207.14 was never returned to my fund.Desired Settlement: I like Aetna to pay me back the extra $207.14 they took from my fund.

Business

Response:

Please see our response to the complaint # [redacted] for [redacted] received on March 02, 2015.

Based on our review, we were informed that one of our Health Concierge Professionals contacted the member’s spouse, [redacted] on March 05, 2015, and was able to confirm that the funds have been returned to their Health Reimbursement Account (HRA).

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 was reinstated for service without my consent after being bumped off for non payment because I got bumped off auto pay for not having enough in the bank. Now they're telling me if I wanted out I should have cancelled in September when they reinstated my service against my will. Now because of this, I apparently owe them $720. I was sick three times and needed immediate dental care and did not use this service. On purpose because I didn't think I still had it. I thought there was a mistake in the billing department or something. I didn't have the common sense to assume that they would try to screw me out of this much money. I have brain damage. They took advantage of me. I would like the charges to my account to be dropped.Desired Settlement: I would like them to drop the charges for a service that I never used and never asked for.

Business

Response:

Thank you for your inquiry received on February 3, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I had a routine surgery ([redacted]) on 9-6-13. I called just days before the surgery to confirm that Aetna would cover the cost. In the past year, we have had to file multiple appeals to get Aetna to cover medical expenses for my husband's claims. I was assured that Aetna would cover this outpatient surgery. We understood that our portion of the surgery would include a 10% co-insurnace cost. However, we were recently notified by the medical system provider, [redacted], that Aetna would only pay less than half of the cost of the approximate $25,000 surgery. That is leaving us with a bill for over $16,000. [redacted] filed an appeal with Aetna, case # [redacted]. However, Aetna refuses to pay any additional money towards the cost of the surgery. Aetna says it was an "experimental surgery". However, there is NOTHING experimental about it. We are quite familiar with getting denied medical claims from Aetna. We had filed a half a dozen different appeals and wrote to the insurance commissioner last year because Aetna wouldn't pay for my husband's covered medical expenses. He had major surgery and the last appeal we had to make was to get them to cover the anesthesia for the surgery. They said that anesthesia was not medically necessary for that major surgery that required a 2 day hospital stay. Only after we got the ** department of Commerce involved did Aetna finally agree to pay for the bill. The problems we have faced with Aetna in the last year have been so severe that we recently switched our health insurance coverage to United Healthcare starting this month. We just are sick and tired of fighting Aetna over every single health claim that we have. We have wasted countless hours on writing appeals and contacting government agencies. We are also again contacting the Insurance Commissioner at the ** Dept of Commerce, in addition to this Revdex.com complaint to try and resolve this final claim we have with Aetna. We are hoping to have this matter resolved within the next month.Desired Settlement: Cover 90% of all medical expenses, as agreed in my health insurance contract. We want Aetna to cover the remaining balance of the approximately $16,000 medical bill (Claim ID# [redacted]) for the outpatient NON-experimental surgery that took place at [redacted]l on 9-6-13. Payment should be made directly to [redacted] Care System [redacted] Phone: ###-###-####. We would then agree to pay the remaining balance of 10% of the hospital bill.

Business

Response:

Thank you for your inquiry received on January 20, 2014 regarding the claim for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I applied for coverage 11/29. I was told if I turned in my application by the 30th I would have dental coverage 12/1. I had to send the application 12/04 because it could not be found. I called again 12/08 and they had no record of me and told me that week they were processing November applications. 12/24 I receive my card in the mail and a retroactive bill for December coverage that I did not have and could not use. I called the billing number. After 20 minutes I went to the website and emailed customer service. Today I was on the phone waiting 29 minutes. I called corporate and they transferred me to the same number and told me to wait. I called member services and I was given a number where I could win a free cruise but I can't fix my billDesired Settlement: I want my December bill deleted/ credited, whatever term is needed where I am not held responsible for their billing error. I did not have coverage I could use I should not have to pay retroactive fees for a company that could not process my application. I want to be given a real number to talk to a live person that actually knows how to do their job and help a person. This is absolutely ridiculous.

Business

Response:

Thank you for your inquiry received on December 30, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: My insurance company offers mail order rx at a cheaper rate than pick up at the pharmacy. Last time my dr faxed my script to aetna it was not processed. I called to see what the problem was and was told the pharmacist could not read the script. If I wouldn't have called would the rx have been processed or just tossed aside? I let it go. Three months later my dr faxed my rx again. Again it was not processed. I called and was told it may take 48 hours to begin processing. I waited. 72 hours later my rx was not being processed. I called my dr office to find out if they had faxed it. They not only faxed it but they had a confirmation number from aetna. I asked them to fax it again. I called aetna again. Again they had no record of the fax and I was told to wait another 48 hours. I explained that the dr office had received confirmation and asked what happened to the script. At this time I was told there was no way of knowing what happened to the fax,faxes get lost all the time! I can not believe that an insurance company would be so negligent with people's health! My rx is still not being processed. I don't know if I will receive my rx before I run out and its terrifying. Health insurance should not be this frustrating. I don't understand why this keeps happening.Desired Settlement: I would like my script to be faxed and my prescription mailed to me. It's that simple. I just want the people at aetna to do their job.

Consumer

Response:

From: [redacted]

Sent: Tuesday, June 17, 2014 10:12 AM

To: [redacted]

Subject: Re: You have a New Message from Revdex.com Serving Connecticut Regarding Complaint #[redacted]

Thank you for you're help. Although I have not received my rx yet, it is in the mail finally. My issue has been resolved at this time. However, I am still very angry about the way I was treated.

Review: I called Aetna prior to my last dental visit to discuss coverage for a visit that I had that day. I was told by the representative on the phone, prior to visting the dentist, that under my current plan, the Aetna DMO, that most work done my my Primary Care Physician would be covered at 100%, anything not covered at 100%, would be covered at 60%. The most I would be liable for would be 40% of the procedures. Once I received the claim info from Aetna, only $63 was covered adn I was responsible for $443. I had [redacted] and a [redacted], which is what I discussed with the representative prior to visiting the dentist, and I am now being told that it is not covered.This was my first visit on this plan, which is why I called prior to my visit. When I called to inquire about the charges, I was told by the representative that I should have called from the doctors office, with the procedure numbers, to inquire about the coverage amounts prior to having anything done at the office. That is NOT what I was told by the representative prior to the visit. If That is what the representative had told me to do, that is what I would have done. Claim ID [redacted]Desired Settlement: Aetna should cover the cost of the [redacted], and at a minimum, 60% of the [redacted].

Business

Response:

Thank you for your inquiry received on November 25, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: On 9/20/13 I noticed there was $172.50([redacted]-$27.50,[redacted]-$40.00 and [redacted]-$105.00) missing from my checking acct when I did a balance inquiry. I then did a history and saw Aetna RX Home Delivery did an unauthorized withdrawal from my acct for prescriptions I did not order. I called Aetna and they said my [redacted] Specialist's office order it in July. I did call the doctors office in July because my prescriptions needed a refill authorization. I received the order they are talking about 7/20/13 and $198.43 was taken out of my acct for 4 prescription. That being said the next refill wouldn't be until 10/20/13 ( I get a 3 months supply). I called Aetna again because they ordered 3 out of the 4 prescriptions I take. I received only 2 they ordered and the 1 I ordered, I think, on 9/25/13 or 9/26/13. I did not receive the [redacted]-$105.00. I called Aetna again and told them that I didn't receive one of my prescriptions. They told me I have to wait before 10 business days to look into this matter any farther. I called on 10/7/13 and told them I still haven't received my [redacted] They said I can reorder it and pay $105.00 again and one of my refills would be used. They also told me that after 60 days if I still haven't received it, they would credit my account and add the refill back. Right now, all I know is that I am out $105.00 plus no [redacted] which equals $210.00. I had my prescriptions transferred to a local [redacted] pharmacy 10/10/13 because the company I work for, along with Aetna, have an agreement that our prescriptions can now be refilled through [redacted] and not mail order only. I called my doctors office to have them transferred. When I called [redacted] last night, 10/10/13 to see if the [redacted] was ready and the cost, they told me, it was denied by Aetna because it was too soon to reorder. I am a heart patient and I don't need the added aggravation and stress!On Sunday, Oct 13,2013. 4:06 AM Aetna RX Home Delivery sent me an email alert...Refill reminder, act now...it's time to refill...Desired Settlement: would like a refund of $105.00 put back into my checking account. I also want Aetna to authorize [redacted] to fill my prescription.09/20/2013 AETNA RX HOME DELIVERY POS ###-###-#### [redacted]

Business

Response:

Thank you for your inquiry received on October 25, 2013. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Aetna proactively enrolling people without authorization. I did not have an Aetna plan and cancelled my plan

several month before. Yet Aetna enrolled me to their service and billing me.

Several calls to them did not result any result as they continue to call or send me mails regarding the service.Desired Settlement: Cancel all unauthorized services. Send me confirmation.

DO NOT CONTACT ME EVER AGAIN !!

Business

Response:

Thank you for your inquiry received on December 12, 2014, regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

We reached out to our Plan Sponsor Liaison through [redacted], Inc. for assistance. They advised that Mr. [redacted] is currently enrolled in a medical and dental plan offered through [redacted] to actively working employees. A member can only be enrolled in these plans through [redacted] and premiums are deducted by them through payroll. Aetna would not bill him for anything. Our records show that we do have claims on file for Mr. [redacted], which are pending for a primary carrier Explanation of Benefits (EOB). This would result in EOBs being mailed out to the member, but these are not bills.

The Human Resources department at [redacted] indicated that Mr. [redacted] was hired May 05, 2014, and benefits were elected on May 28, 2014. On May 31, 2014, there was a change from the low deductible medical to the high deductible medical coverage due to a life event. However, they do not have any information about Mr. [redacted] dropping coverage. Mr. [redacted] will need to contact the Human Resources department at [redacted] should he wish to cancel his coverage.

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: I was billed for a service that was supposed to be covered by my insurance. My doctor even gave me the diagnosis & billing code for the service/product & I called Aetna to make sure it was covered completely & they said yes. Then a couple months later, I get a bill saying I owe them almost $200! When asked why, they said that "covered" meant that only a part of it was covered, not 100%. But when someone says something is completely covered, any normal person would assume that means 100%. I guess the insur industry speaks a different English than the rest of us! So I've been calling every couple wks or so to sort this out & nothing was happening so I asked to be passed on to a mgr or someone w/ the authority to resolve this. They gave me her # & I left a message & have been waiting to hear back from her since Oct 2013!! This is totally unacceptable & Aetna should be ashamed. In the end, my husband paid them just so this wouldn't affect our credit or good standing. That is why I'm here - I want as many people to know about this awful service!Desired Settlement: I would like the amt I paid refunded. Exact amt is $196.16.

Business

Response:

Dear Ms. [redacted],

Thank you for your inquiry received on 01/09/2014 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team is reviewing the inquiry and will respond by 01/22/2014. Aetna reference # case [redacted], due by 01/22/2014.

Sincerely,

Executive Response Team

Business

Response:

Thank you for your inquiry received on January 9, 2014. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

The member’s concerns were reviewed and the claim has been submitted for reprocessing. The member will receive an explanation of benefits (EOB) under separate cover.

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 only partially satisfactory as it states that my claim will be reprocessed. I want it refunded as my husband has now paid it. So a full refund is the only satisfactory resolution to this issue.

Sincerely,

Review: When I enrolled in health insurance in 2012 with. Code EP1/221 my bi weekly premium was $80. Since then without my permission the code was changed to JS1 and my premium was raised to $138 bi weekly without my permission. This is robbery I called Aetna and spoke with representative Valerie she stated that it's up to me to check if my premium is raised which makes no sense . If I signed an agreement and they change something I should be informed. Aetna is a bunch of thieves and I intend to take this to the media, social media and any and every outlet that I can to warn people about aetnas unethical business practices. I will not tolerate being robbed. When I look on they're website there's no indication of the code JS1 nor of the price that they're charging me. I am very upset about this.Desired Settlement: I am seeking arrears for the overcharging that I've been charged for since my premium was raised from $80 to. $138.. I am willing to take this to court, the media whatever I have to do to expose this .

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 the Eligibility and Billing department for the member’s employer to verify why there was an increase in premiums. We were advised that this member has the [redacted] plan. Aetna does send out notifications each year of the benefit changes and rates. Federal members have a choice; it is a passive enrollment, meaning if they do nothing, they will stay in the same plan. This letter is sent to all members and is mandatory from Office of Personnel Management (OPM). The member needs to refer to her Human Resources department in regards to the premium amounts, as Aetna has no control in the premium rate changes, Aetna is strictly an administrator in the plan benefits.

This member has been receiving this letter each October since she has been a member with Aetna. The address that we have on file is [redacted], **, [redacted].

Also, the member is still in the old enrollment code. We continue to send her letters to switch her enrollment code to the correct one for her area. I have attached a copy of this year’s letter that has already went out to members.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [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

Consumer

Response:

Review: [redacted]

I am rejecting this response because: I was Never contacted by Aetna regarding changing my code except when I first enrolled back in 2012. I was told to change the enrollment code from Ep1 to 221. Thereafter, Aetna took it amongst themselves to change my code to JS1 a code that doesn't exist anywhere on aetnas website or brochure. My premium was raised by Aetna not my human resources office. This is ridiculous and robbery. I would like my plan changed back and all overpayment returned to me. I never signed nor agreed to change my plan to JS1. I was informed by Aetna that they were changing my plan without my permission. I plan to take legal action an continue to report these unethical practices until it is rectified.