Aetna, Inc.

Review: I am trying to get a pharmacy to give me the [redacted] shot either by allowing me to pick the vaccine up from a pharmacy ([redacted] or [redacted]) and take the vaccine to my door to administer or allow them to give me the shot. Aetna has given me the run around for two years and I still don't good information on how to get the shot. I have been told to contact doctors that only give the vaccine to their patience's, to pharmacies that will not give me the vaccine. I need some help in getting this doctor recommend vaccine. I am a [redacted] survivor and my doctor has recommended that I take the shot. Saying it has been difficult is an understatement.

Account_Number: [redacted]Desired Settlement: I would like to get authorization to take the shot at either [redacted] or [redacted] and that it be covered. I was told by one of Aetna's representatives that if Aetna declines the claim, I would have to appeal it. I find this ridiculous. Either they cover it or not.

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: I became active with Aetna April 1st, 2013. They rejected claims for dates following April 1st that are covered by my policy.

I have called Aetna at least three times regarding claims from April with two different physicians. They stated at each phone call that the physician services should have been covered and they were going to reprocess them through the claims department. I have continued to receive bills from these MDs and they state Aetna rejected the claims. It is not a matter of coverage. My plan absolutely covers these appointments, as I have been told each time I called, but they are not paying the physicians. Desired Settlement: Aetna needs to pay for these doctors visits. A visit on 4/10/13- pending 323.04$ due from Aetna. A visit on May 21st that Aetna owes for as well to a different physician. They need to stop saying I am not eligible for coverage from the claims dept as I clearly am covered since April 1st, which they have told me repeatedly but apparently have not communicated this to their claims department.

Business

Response:

Business Response /* (1000, 8, 2013/08/01) */

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

We reached out to the Claims and Eligibility department for assistance with the member's issues. They confirmed this member is covered and they have the correct information in the eligibility system. The April 10, 2013 claim for $715.00 was reprocessed and payment issued on June 19, 2013. The May 21, 2013 claim for $125.00 was reprocessed and payment was issued on July 25, 2013. They went through the claim history again and found no other outstanding or denied claims. There are a few which the entire negotiated amount was applied to the annual deductible, but they are processed and benefits applied correctly. We do apologize for the delay and inconvenience this has caused. 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].

horrible service with aetna, outsourced their business customer service is a joke, representatives always say they will get something processed. Call back in a week and nothing has been done or even processed.
worst company ever

Review: Aetna Health Insurance claims to be an LGBT friendly company ([redacted]). However, after more than a year of pursuing health coverage for transgender related health issues with employee-sponsored Aetna insurance, I have learned that Aetna's policies regarding transgender health is not to cover anything ([redacted], etc) until states mandate it by law.

This is absolutely false advertising. They should not be advertising themselves as LGBT friendly when they are only so when compelled by law to be so. They particularly should not be advertising themselves as a trans-friendly company (see HRC link above) when they clearly categorically are not.Desired Settlement: They either need to put their money where their mouth is and cover trans related health care or stop claiming that they do and stop advertising themselves as an LGBT-friendly company. Studies show that coverage does not cost more money for the insurance plans to cover transgender related care. ([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 your complaint, we contacted our Benefits department and determined that this member is currently enrolled under the group, ADP Total Source. ADP Total Source does not cover transgender reassignment services. Aetna, however, is a LGBT friendly company which means that Aetna supports the community. We apologize for any inconvenience this has caused the member. However, we must make coverage decisions in accordance with the plan benefits. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Review: My name is [redacted] I was out of work for 8 weeks and I put in a short term disability claim in and haven't received my check yet and they tell me it's on the way and its been a year now I just want to get paid for the weeks I was out....

Desired Settlement: Just the money I am owned I think it should be around a 1,000

Business

Response:

Business Response /* (1000, 5, 2013/05/09) */

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

We reached out to Strategic Resource Company (SRC) and the Disability department to review the member's concerns. They received the disability form on March 26, 2013 and the Attending Physician's Statement, shows the member's total disability was from April 27, 2012 through April 30, 2012. The boxes for Partial Disability were blank. On April 12, 2013, the file was closed and a letter was sent to the member stating that the claim was denied because our records show benefits are not payable until a 14-day waiting period has been met. Therefore, no Short Term Disability (STD) benefits are payable. If the member or doctor has more information to help support 8 weeks of total or partial disability, the Disability department would need that information to review the 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].com.

Review: I had a student dental policy from Aetna, it was a rather poor policy to begin with but seemed better than nothing. I purchased it during the fall semester with a maximum coverage amount. The policy cost approximately $300. At the end of the semester, I had used all but $84 of the coverage amount. At the change to the spring semester, Aetna gave me the option to pay $300 for what appeared to be a new policy for the new semester. Since it was a student/semester policy- it made sense that I could start again in the spring. So I paid my $300 in the beginning of the spring semester but then the policy only allowed me to use the $84 left from the fall. Even their own customer service representative expressed that this was obviously unclear and a common problem. For the spring I paid $300 to have $84 of coverage- that is insane! Not only was it a waste of $216 I had dental work done expecting coverage that I had to pay out of pocket for.Desired Settlement: I actually believe that I should be refunded the full $300 amount but could understand only receiving 216 at the very least. Also, they should be required to clarify the information they release so that this isn't so confusing.

Business

Response:

Thank you for your inquiry received on 06/12/14 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: Our Aetna insurance company frequently mis-processes claims. Most times there are mistakes and I need to look over everything and waste my time calling. However, this particular incident is just over the top lousy customer service/processing. The claim is in regard to my son, [redacted], who had testing done through direct labs. This testing was paid in full by me and the claim was sent to Aetna for processing. There was a box on the form that said "check here to have the payment sent directly to the provider"...I DID NOT check that box! But low and behold, the payment was sent to direct labs. This was months ago and after 5 phone calls to try and straighten it out. Each time I call, I get a different story of why it wasn't sent out.

Product_Or_Service: Health insurance

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

I would like to get the check for the claim money that they owe us!!

Business

Response:

Thank you for your inquiry received on 05/11/2015 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: I submitted several claims all at once on March 16 and March 26 via fax. I also submitted the same set via certified mail on March 26. I have called in several times to check for status on these claims. Each time I am told either it was not received, Or that it had been received but had not been processed and that the turnaround time is 7 to 10 business days. It is now been seven weeks. I just called in again today, May 7 and I was told there isn't a file in the system pending. I have even spoken to a manager by the name of [redacted] within the last few days. She sent me a letter via fax concerning the dates, but they do not address the services in question: vitamin drips. I was told months ago that vitamin drips would be covered and have been paying for them out of pocket for months now. I am waiting to be reimbursed.

I am going through stage four cancer. I am extremely upset and frustrated. This is called causing me a good deal of stress that I cannot afford to go through. I have additional claims to submit but have not done so because the first set has been mishandled. This is unacceptable service.Desired Settlement: I would like reimbursement of the sub-bills I have submitted and I would like someone assigned to me to help me expedite future claims.

Business

Response:

Thank you for your inquiry received on 05/11/15 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: Signed wife up on healthcare.gov. Was shown available plans based on info submitted. (city, state, and zip) Picked a plan for my wife and signed up for it. Received confirmation letter with policy number( [redacted] ). Created online account with Aetna and paid premium. After paying the premium, I received a letter on 1/19 stating, The Aetna plan you enrolled in is only available in [redacted] and [redacted] counties. We live in [redacted] county. This policy is worthless. We were never informed during the process that this plan was only available in [redacted] counties. If we were, we never would have bought it. Why was it ever offered to us in the first place? On 1/9 I called Aetna. They said to call healthcare.gov. I did. They told me to call Aetna. I did. By now Im fuming. I ended up having a three-way call with both parties. Aetna can not refund until healthcare.gov cancels the policy. Seems the policy was locked and healthcare.gov could not cancel, so they would escalate issue to a case worker. Received call from healthcare.gov the next day asking if I had been contacted by a case worker yet. I told them no. I called healthcare.gov on 1/19. I spoke with four different people. No one can give me an answer. They can not even tell me when they will get back to me. They have no clue!!! They said they would escalate even higher. Healthcare.gov called on 1/20 about changing plans. My wife told them we never mentioned anything about "changing plans" that we wanted this one canceled and a refund made. They had no clue again. Im tired of the run around. Even though we signed up for the policy (which NEVER should have been offered to us in the first place!) on healthcare.gov, we paid the premium directly to Aetna. I have read an article on the internet about another person that took 6 weeks to cancel her policy. I would like this worthless policy cancelled and a refund made immediately so I can use MY money to purchase a policy for my wife that we can use!Desired Settlement: Policy cancelled and refund made.

Business

Response:

Thank you for your inquiry received on 01/21/2014 regarding refund and Exchange plan issues for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Review: Without authorization by me Aetna requested refill prescriptions from my physician, and then filled them, again without authorization from me.

Without authorization by me Aetna requested refill prescriptions from my physician, and then filled them, again without authorization from me.

One of the meds [redacted] is to be taken when needed only. I don't need it and haven't ordered it for more than a year. I called customer service to request a refund because I haven't ordered that medication and I don't need it but the request was denied. On 5/6/13 I filed a first level appeal to Aetna (case number XXXXXXXXXXXXX) but the decision was to uphold the original decision because Aetna has a rule that when a physician sends a new prescription they automatically fill it. This response completely ignores the fact that it was Aetna that requested the refill prescriptions in the first place without even notifying me. I have an affidavit from the physician's office stating that they received such a request from Aetna and in response to it sent the prescriptions. I filed a second level appeal on 5/30/13 but still have no response from Aetna. I want a refund for that medication that Aetna forced on me.

Desired Settlement: I want Aetna to pick up the copay in the amount of $105.00 for [redacted] which it forced on me.

Business

Response:

Business Response /* (1000, 5, 2013/08/21) */

Thank you for your inquiry received on August 7, 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 Aetna Rx Home Delivery for assistance with the member's issues. They stated they did not ask for any new prescriptions from this member's doctor. Aetna Rx Home Delivery only contacts the member's doctor to get a new prescription when the member has placed an order for a prescription that has no refills remaining or has expired.

When Aetna Rx Home Delivery requests a new prescription, the doctor is only required to fill out and sign the renewal authorization form and return it to Aetna Rx Home Delivery by fax. However, Aetna Rx Home Delivery never faxed the member's doctor a renewal authorization form.

On May 1, 2013, Aetna received a faxed prescription from the doctor for the [redacted]. When the doctor submits an order on the members' behalf, that order is processed as per the physicians' request. When the member has provided a Default Credit Card to use, Aetna Rx Home Delivery will process and ship medications to the member that fall within the thresholds set by Aetna Rx Home Delivery.

The member is contacted if the copayment/co-insurance for one drug or the entire order exceeds $250.00. Aetna Rx Home Delivery only accepts returns when an error was made by Aetna. Any drug that is returned must be destroyed and cannot be redistributed. This plan does not allow for the reimbursement of the plan copay when the doctor orders a drug in error.

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 scheduled an appointment around June 2, 2015 for an allergist. Before the appointment, I called Aetna, my insurance company, to verify that this particular doctor was in my plan. I was told that yes, he is a participating doctor. A few weeks later, I receive a bill from the doctor. No money was paid to him by Aetna as Aetna denied the bill. I called to find out what happened. I was then told that the doctor is in fact NOT covered. The representative went and listened to the recorded initial conversation where I was told that the doctor IS covered and he filed an appeal on my behalf. He stated it would take 15 days for a resolution and in his experience, they will pay since it was their mistake. He also told me to call them if I receive another bill. Much more than 15 days go by and I receive another bill. I call Aetna to find out what is going on and I'm told that it's actually going to take 30 days and they will call the doctor to stop the billing for now. Much more than 30 days go by and I receive another bill. I'm now being told that it is still in review and nobody called to stop the billing. I spoke to someone Monday, August 10, 2015 and was told that they will monitor it and ask for it to be expedited and that the appeals board is backlogged. I'm telling them that this bill is going to go into collections soon and affect my credit report. This company is incompetent and bullying. They are dragging their feet because they do not want to pay when it was THEIR incompetency in the first place that created this problem!! They are bullying by taking their time full well knowing that this will go into collections and hoping I will be frustrated enough to simply pay it so it won't affect my credit score/report. Aetna is a disgusting insurance company who doesn't take responsibility for their mistake. PAY UP AETNA!!!!Desired Settlement: Pay the FULL bill to the doctor AS SOON AS POSSIBLE since YOU all made the mistake!! No more stalling and giving me the run around.

Business

Response:

Thank you for your inquiry received on 08/12/15 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 had the phone calls reviewed from the member, and the member called and said that she was going to see an allergist today (06/02/15), and wanted to see if [redacted] was covered. The Customer Service Representative (CSR) asked for the first name and the member said that she was unsure, but had the telephone number. The CSR clarified that the doctor was an allergist, and the member confirmed. The CSR then provided the in-network benefits, but did advise the member that this would be for an “in-network” provider, as they were unable to confirm participation of [redacted] without the provider’s first name.

Currently, the member’s concerns are being reviewed under appeal number [redacted]. The member will receive a resolution letter with an explanation 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 Ms. [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: I have yet to receive a resolution even though I was suppose to receive one a while ago. Their response to this complaint does not resolve anything.

Sincerely,

Consumer

Response:

Review: [redacted]

I am rejecting this response because: I'm going to wait until this claim is actually processed. Because of the major delay in coming to a resolution, I'm skeptical about whether or not this will really get processed properly and promptly.

Sincerely,

Review: I have been getting the same medication from the same dr for several years when I went to fill my prescription this month it was denied. The first time I was told it was because the dr wasn't a Aetna provider. This did not seem to matter in the past as I was only trying to get my script filled at a participating pharmacy, I wasn't asking to Aetna to pay for the drs services. They had been paying for the medication for years so I was quite surprised to hear this. When I called the next time they had a different reason for not filling the script. They told me they would but this through as urgent. Later that day I was called back by Aetna & was told it was under investigation. This time they gave me a whole other story that had nothing to do with the Dr but, that it was being investigated whether it was a HMO or ppo. We have ppo as long as we use their pharmacy in their network which we did The medication is not a drug that can just be stopped taking without serious side effects. I pay my bills on time every month & have never been late I feel as if I am being discrimantaed against. I was told that I can reach Aetna 24 hours a day 7 days a week 365 days a year but when I asked for the number they would not give it to me. I feel that they just don't want to pay & think I will be ok with that but, I will not let them take advantage of me. My id # with Aetna is wXXXXXXXXX.

Desired Settlement: I would like Aetna looked into for discrimantion for people on certain medications. I would also like a phone # to be published for 24 hour assistance. I would also like my medication to be approved without a hassle

Business

Response:

Business Response /* (1000, 5, 2013/06/17) */

Thank you for your inquiry received on June 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 Pharmacy department for assistance with the member's concerns. They reviewed the claims that were denied in May, written by Dr. [redacted] and the rejection message was advising that the doctor at this time has been state sanctioned. While a doctor is under sanctions prescriptions cannot be filled at the pharmacy until the sanctions have been lifted. The member will need to see a new doctor to have new scripts written. We apologize if the Customer Service department was not able to give a phone number for the member. Customer service is operated 24/7 and the phone number is XXX-XXX-XXXX.

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

Consumer Response /* (3000, 7, 2013/06/20) */

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

Because the doctor is NOT state sanctioned & by Aetna stating that they are slandering his name. I spoke directly to Dr. [redacted] & he is quite upset that aetna is salandering him. If he was state sanctioned he would not be able to write prescribtions which he has been without any problems other then aetna & my husbands 1 prescription (my husband had other prescritions filled that were written by Dr. [redacted] the same day) Now if Dr. [redacted] was state sanctioned how could the pharmacy fill the other scripts which we paid cash out of pocket for. Now we go to a Dr. that was referred by aetna they turned downed the bill because they say that he was not a aetna prescriber. I got his name from a list that aetna sent me in an email on May 28th 2013

Dr. [redacted] is not state sanctioned & how dare someone slander him.

Business Response /* (-10, 10, 2013/07/09) */

Thank you for your inquiry received on June 24, 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 the Pharmacy department for review. They are currently still reviewing this provider information to determine if our system has incorrect information concerning this provider. We will advise once this information is fully researched and we do apologize for the delay and inconvenience.

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].

Business Response /* (4000, 13, 2013/07/19) */

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

We apologize for the delay; we again reached out to the Pharmacy department for review. Our systems are still showing the provider as being sanctioned; however, we are working with our system technicians to research and discover how the claims can be processed without the sanctioned status. We will update once we can correct. Again, we do apologize for the delay and inconvenience this has caused.

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].

Business Response /* (4000, 17, 2013/08/01) */

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

We sincerely apologize for the delay, [redacted] and the Pharmacy department completed their review. They have updated their systems to allow claims to process for this doctor. They should not encounter any issues going forward. [redacted] is currently reprocessing the July claims, so the member can return to the pharmacy to pick up those medications. They advised the member paid out of pocket for claims for May 26, 2013 for [redacted] and June 3, 2013 for [redacted]. The member can fax in those detailed prescription receipts and scripts along with Commercial Prescription Drug Claim Forms to:

Aetna Pharmacy Management

[redacted] XXXXX

[redacted] XXXXX-XXXX

[redacted] X-XXX-XXX-XXXX

The member can submit detailed receipts for those dates of service and any others prior to July from this doctor so that they can be processed. The claims team will not be able to process what was rejected on file; they need the receipts to see what he actually paid for them.

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, 19, 2013/08/04) */

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

Because after they denied Dr. [redacted] prescriptions & was told by aetna in an email what doctor would be accebtable for them to accept with our insurance. In an email that I received from aetna they stated that Dr [redacted] of [redacted] would be a preferred Dr. as one of their subscribing doctors, I called them &[redacted] an appointment with Dr. [redacted] & explained the reason why we wanted to see him, the receptionist asked for our insurance information to pre authorize [redacted]'s visit. After providing her with the requested information [redacted] made an appointment & was treated by Dr. [redacted] later received a bill explaining that aetna would not cover Dr. [redacted]'s visit because he wasn't an aetna provider. When I called the office to ask them to resubmit the bill because I believed surely there was a mistake because, I got Dr. [redacted]'s name from aetna's website & Dr. [redacted]'s office explined to me that the bill aaas resubmitted & aetna picked up a portion of the bill.However when I went to pick up [redacted]'s prescription refill from Dr. [redacted] I was notified by [redacted] that once again the insurance company refused to refill [redacted]'s prescription that was written from the Dr. that aetna provided & approved his previous presription.

Aetna Insurance also denied me to have an echo cardiogram stress test that was recommended by my Dr. & by a [redacted] after an [redacted] showed an [redacted] that could result in a [redacted])

When I called aetna member servise & inquired about the denial for the stress test & asked if I head a [redacted] then would they cover the test, & I was quite surprised to hear them tell me that "yes if you have a [redacted] we will cover a stress test with echo cardiogram.

Too bad I nwould have to have a [redacted] first.

Now I inquire about my bill to find out that they have most likely been overcharging us every month, that was the last straw!

Business Response /* (4000, 21, 2013/08/21) */

Thank you for your inquiry. 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. They advised the claims for Dr. [redacted] did reject on August 6, 2013, for prescriber is not covered; howeer, this has since been fixed and the claims reprocessed.

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, 23, 2013/08/23) */

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

It is such a shame that aetna put us through all the grief & aggravation making my husband sicker because he could not get his medication in a timely manner. They did the same thing with his [redacted] which I was able to obtain by paying cash as it was only a few dollars at [redacted]. Once again aetna is declining my husbands medication(a different one this time) it is the generic for [redacted] that is being prescribed for [redacted] by his primary Dr [redacted] who works for [redacted] & has always & still does accept our insurance. We have a PPO not a HMO anyway. aetna has been filling this script for years & was last filled on July22nd 2013 without any problem. Yet they filled 2 prescribtions for myself the same day from the same DR,

My Dr also wanted me to Have a [redacted] because I had two [redacted]'s that indicate a blockage in one of my arteries. I have a huge history of family heart disease & they would not authorize it. My Dr consulted with a [redacted] & he absolutely agreed with my Dr's choice of testing method. When I called aetna they said that a different test could find similar results although my Dr disagrees with that statement. I asked aetna member services myself when I called & inquired if I have a [redacted] will they cover it then & the represintive said yes, if you have a [redacted] then we will pay for the test. I recently found out that they have been overcharging us since February & of course they cannot tell us when that issue would be resolved. If I could afford an attorney I would want to have them investigated for discrimination, gross negligence emotional stress & getting ill from noot having my prescribed meds or testing. I recently had an outpatient service done at [redacted] & called aetna before the procedure to find out the out of pockets expense to see if I could afford it at this time. I gave aetna the billing code & also looked on their website to get an approximate cost & what it should cost. Of course I am being billed 4 times the amount that they told me & also being billed by a different company for [redacted] which was supposed to be include in the price

Review: In mid April I joined AARP in pursuit of a legitimate health insurance plan since I cannot afford my Cobra plan. I live in [redacted]. I also included my 22 year old daughter, who is in college and lives 7 hours from me in [redacted]. I submitted the online form and received an email stating that a decision had been made. I called and was told that my daughter was approved but I wasn't. A charge of $165.00 was taken from my bank account, without ever getting a price quote, request for payment, confirmation of coverage, insurance card or explanation of benefits. This happened on May 2, 2013. It is now May 17 and neither my daughter or I have any proof of insurance. I have made phone calls daily and have gotten no where. I've been transferred, cut off, denied information, given privacy trivia, none of which has helped with proof of coverage.Today I called again to check on the address they have for my daughter since there must have been an error or she would have an insurance card to use. I was told that due to privacy they could not give me that address. I can find her address on google. And address is not private. I just spent Mother's Day with my daughter, I know where she lives. The last straw was being told that since my daughter lives in [redacted] her policy premium would be different than the one sucked out of my account. I will not give them another dime for nothing. They spoke to her, she gave them her info, if they are incapable of recording her address that's too bad. Aetna requested yet another blood test on me, I paid for it and faxed the normal results to them but I fear they will take more money out of my account without authorization. Their business practices are unacceptable. I have no idea what they would charge and they feel no need to supply a quote for approval. I am unemployed and have survived cancer. I need your help to get my $165.00 returned to may account. I would also like the $60.00 for the unnecessary blood work. Please help me.

Product_Or_Service: Health Insurance

Account_Number: Not given

Desired Settlement: I want Aetna to delete all my information on my daughter and me. I want the money that they took without a quote or permission and I want to be reimbursed for bloodwork that was not needed.I want a letter confirming that my requests have been met. Please do not make me talk to another employee of this company again, ever.[redacted]

Business

Response:

Business Response /* (1000, 5, 2013/05/22) */

Thank you for your inquiry received on May 22, 2013.

In order to better assist, we need more information to review the concerns. We need daughter's name, date of birth, current address and phone number, to continue with the review. Thank you.

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

Business Response /* (1000, 12, 2013/06/05) */

Thank you for your inquiry received on May 22, 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 Individual Underwriting, Billing and Enrollment departments for assistance with the member's concerns. They advised the primary applicant, Ms. [redacted], submitted an online [redacted]) application on April 19, 2013, for herself and daughter [redacted]. On April 24, 2013, medical records were requested for [redacted] and they were received on April 29, 2013. On April 30, 2013, the medical records were reviewed by underwriter and [redacted]'s application was closed due to no current [redacted]) results per review of the medical records. A letter went out the same day to Ms. [redacted], which noted that her daughter, [redacted], was approved with a May 1, 2013 effective date and [redacted]'s application was closed due to more information was required.

The approval/close out letter dated April 30, 2013, gave instructions if a temporary ID card was needed. On May 17, 2013, more information was received and reviewed by underwriter. An Approval with Rate Up Letter was sent to [redacted] on the same day, May 17, 2013. We apologize for any inconvenience and confusion this process has caused the member. [redacted]'s policy has been terminated as requested, effective May 1, 2013 and please allow 7-10 business days for the $165.00 refund check.

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 /* (2110, 14, 2013/06/07) */

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

For the record my daughter never received any communication from Aetna aside from one phone call for medical info at start of application. I never received ketter, email, phone call on anything.

If you were told we were contacted you were deceived.

Review: I have called 13 Doctors so far that I found on the Aetna "Find a Doc" webpage and so far all 13 of them have moved locations or no longer accept Aetna insurance. I called Aetna to ask what was going on, they sent me a list for my area and so far I have called 4 of those Doctors and none of them accept Aetna insurance. What is going on here?Desired Settlement: Aetna needs to revisit this. What doctors accept Aetna - This information needs to be up to date. Does anyone take Aetna in the [redacted] area?

Business

Response:

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

Review: Aetna Insurance is not paying bills submitted from my doctors. My doctors keep getting the bills back with a memo they are waiting for me to contact them confirming I do not have any other insurance coverage. I have called them 4 times to confirm I do not have any other heath insurance coverage yet they keep denying my claims.

Product_Or_Service: Heath insurance coverageDesired Settlement: DesiredSettlementID: Other (requires explanation)

Please contact Aetna to resolve this issue. I am kept on hold for at least 20 minutes each time and assured this matter would be resolved; it has not.

Business

Response:

Hi [redacted],

We received the “SECOND NOTICE” email from you on 06/02/2014. We attempted to contact Ms. [redacted] for additional information needed for us to review her complaint. However, she has not replied back to us yet. We asked her for the specific dates of service, billed amounts, and provider(s) name of the claims that are being denied? Once we receive this information, we will be able to complete our review. Any assistance you can provide would be greatly appreciated.

Thank you.

Review: On 3/11/2015, I visited [redacted] Hospital Medical Center for an emergency room visit. Shortly after, I received a medical bill from the hospital totaling $6,531.80. My medical insurance covered approximately $450 of the claim and I am currently being billed the remaining balance of $6,531.80. Under my insurance I have a 20% responsibility for the Out-Of-Network Emergency room visits and Aetna is responsible for the other 20%.

I spoke to three different representatives on three different occasions without any resolution. On 5/20/2015, shortly after I received my first bill from [redacted], I spoke to Michael and he advised that he would re-process the claim and it would take approximately 7-10 business days. I received a notice requiring urgent action on 7/13/2015 from [redacted] stating that my account was under review for placement with a third party collections agency.

On 8/5/2015, I spoke to another Aetna representative, Alisha, concerning my claim and she advised me that the claim was not correctly processed back in May. She was going to re-process the claim with [redacted] and, again, it would take 7- 10 business days.

On 9/17/2015 I realized that I had not received any more notifications from [redacted] Hospital concerning my bill, however, I called anyway to confirm that my insurance had paid their portion of the claim. They had not. I still had an outstanding balance. I called Aetna that morning and spoke to a representative named Omega. She contacted [redacted] Hospital with me on the line to confirm that [redacted] had been paid their portion of the claim (approx $450) because that was their contracted rate. The [redacted] representative advised Omega that the contract with [redacted] had been expired since January 1, 2015.

Omega advised me that she was, again, re-processing the claim under "Urgent" status and that she would call me in 3 business days to advise of the status. As of today, 9/22/2015 at 2 p.m. PST, I had not heard back from Omega.

I called Aetna for the fourth time at approximately 2:40 p.m. and asked to speak to a Escalation Specialist. I was connected with a Joe who advised me that Aetna paid 80% of their contracted rate with [redacted] (even though their contract expired back in January) and that Aetna does not pay more than that for the services [redacted] performed unless I file an appeal. I told him that I had worked with three different Aetna representatives over the course of 4 months and not one of them had EVER told me that. He helped me file and appeal and advised it will take up to 30 days to hear a resolution.Desired Settlement: I would like Aetna to pay 80% of the total billed amount from my [redacted] Hospital Medical Center bill from the date of service 3/11/2015.

Business

Response:

Hello,

Review: I have contacted Aetna about bills due on my sons pediatrician that were not billed correctly. They stated the problem would be fixed by 7/28/2014 by an aetna employee.. They were not. I spoke with [redacted] at Aetna on 7/31/2014 when I realized the problem was not solved and faxed her all of the bills that were not paid. Throughout 2014 I have tried contacting [redacted] K. at Aetna about this issue and it keeps getting diverted some way. On 8/7/2014 I had to re-fax everything to her again for a "meeting". She was supposed to call me back by 8/13/14 and did not. I called again on 8/27/14 and the issue was still not resolved, and again on 1/9/15 with the same outcome. The hospital has re-billed these to Aetna TWICE and they still have not fixed them.Desired Settlement: I just want all of the hospitals re-billed payments to be corrected. It's a lot of money that I do not have and would like it to be fixed ASAP.

Business

Response:

Hello,

Review: I cancelled my Aetna Health Insurance (Group #: [redacted]) effective 12/12/13. I had paid my health insurance up until 12/31/13. I have written Aetna two times requesting a return premium for December 12 - 31, 2013. Aetna has not replied about my return premiumDesired Settlement: Return prorated insurance from December 12 - 31, 2013.

Business

Response:

Thank you for your inquiry received on March 20, 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 Billing department for assistance with the member’s concerns. They advised changing the termination date to December 12, 2013, as requested. They also requested a refund check in the amount of $205.68. They advised calling the member on March 20, 2014 and giving this information. Thanks.

Review: I have been trying to work with Aetna since last fall (2013) in getting an [redacted] approved. I have scheduled multiple appointments to get an [redacted] and very time I have to either walkout or cancel at the last minute because Aetna can not get its paperwork straight and tell me a consistent story.In one scenario Aetna approved an [redacted] but when I went to have it done the facility indicated that what Aetna approved is not what needed to be done. In another scenario Aetna told me I was approved for a facility which I made an appointment at then the night before my [redacted] I called Aetna to confirm it was in-network and was told it was not.An [redacted] cost only a few hundred dollars but Aetna can spend months giving me the run around while taking my money in premiums and failing to deliver the health care they are supposed to provide. Aetna is not only negligent and operating under business malpractice but they are also, more importantly, denying me health care.It seems Aetna is more interested in protectuing its profits than it is in providing health care management services that consumers are paying for and expect.My doctor and I have been going back and forth with Aertna for over two months. To this date Aetna has failed to resolve the 'stalemate' they have forced us into.Desired Settlement: 1) Allow me to use my insurance to get an [redacted] on my foot since that is why I pay for insurance. Aetna is micromanaging the process and through this micromanaging I am unable to get the service done that my doctor has requested. Put it in writing and honor the service they are suppose to provide. 2) Provide my company point of contact such that I can make them aware of Aetna's negligence in providing the service they are being paid to provide.

Business

Response:

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

Review: Aetna offers a [redacted]. After using the plan, we quickly realized we could not get service for our son because he is over the age of 6 requiring pediatric work. We contacted Aetna to obtain the required authorization number & referral for a consultation with a pediatric dentist so they can determine what work our son would need. We gave both to the in network dentist. We made an appointment with the dentist. On the day of the appointment, the dentist informed us that we cannot see the pediatric dentist because our son is over the age of 6. We are paying for dental insurance and cannot receive care for our 8 year old son who requires 2 spacers and some fillings.This greatly affects the dental health & health of our son.Desired Settlement: We would like a refund for all of our son's portion of the dental insurance since we chose this [redacted].We would like Aetna to appologize and remove this in network dentist from their [redacted]. The Dentist is [redacted] located in [redacted] and [redacted].We want an explanation in writing as to why we cannot receive a consultation and treatment for pediatric work for our 8 year old son.

Business

Response:

Thank you for your inquiry received on 02/26/2015 regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.