Chevron USA, Inc.

Hello, Thank you for your inquiry, regarding complaint #*** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of the complaint, we contacted our Claims department and determined that the claim for date of service: 09/11/15, has been reprocessedThe service was billed as a routine service and the claim was reprocessed and paid percent on 10/05/under claim ***The member has no patient responsibilityWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***. Thank you LaShonda C. Complaint and Appeal Consultant Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint #*** for *** ***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 Claims department to
have the member’s concerns reviewedWe were advised
that the claim correctly denied the service rendered as experimental and
investigationalI understand the member’s concerns
and recognize this is not the outcome she desiredHowever, we must make
coverage decisions in accordance with the plan of benefits and our medical
necessity guidelines
This claim would need to be
reviewed under an appeal for medical necessity to determine if the services
rendered could be reconsidered for paymentThe member has the right to
appeal, as well as the provider, and can send the appeal request with any
information that they wish to provide for reviewThe member can send the
appeal request to:
Aetna Appeals Resolution Team
P.O Box
Lexington, KY
We take customer complaints very seriously and appreciate
you taking the time to contact us and giving us the opportunity to address *** *** concernsIf you have any additional questions regarding this
particular matter, please contact the Executive Resolution Team at [email protected]
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: ***
I am rejecting this response because:July 17, 2015*** *Complaint and Appeal ConsultantExecutive Resoution TeamI disagree with your decision that a refund is not due! I never received a policy with guidelinesI never received an insurance card until the day I filed this complaint which was well after the policy was cancelledI was never able to use this insuranceIn the first place, when I enrolled in Aetna Voluntary, I signed up for Extended Hospital with RX, Life, Dental, and VisionMoney was taken out for each of these coveragesI had to call member services because I had no cards and was told that the extended hospital with RX was not on thereI had to get out my paystubs and tell them how much was taken out for each coverage and the datesI was told that it would take to days to correct thisThe next time I called,weeks later after the next pay period, this was still not taken care ofI had to go to an Urgent care to get an antibiotic for an infection and now have a $bill from them and had to pay out of pocket for the prescriptionI feel I am due a full refund for their (Aetna's) incompetencyI need a full time job and would gladly work for Aetna, but their member services staff is in the ***They need to bring these jobs home to the USA and things would run more smoothly.*** ***
Sincerely,
*** ***

Thank you for your inquiry, regarding complaint #*** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of the response, we confirmed that we have mailed another copy based on the previous complaintThe member can contact the Executive Resolution Team at *** once the provider submits the documents to Aetna for reviewWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concerns Thank you, LaShonda C.Complaint and Appeal ConsultantExecutive Resolution Team

Tell us why hereHello, Thank you for your inquiry, regarding complaint# *** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of your complaint, we contacted our Pharmacy department and
confirmed that the information received was incompleteWe contacted the *** pharmacy and obtained the necessary details to process your claimA check has been mailed on May 05, in the amount of $A copay of $was applied to this claimWe apologize for any difficulties and inconvenience this has caused the memberWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***.LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint #*** for *** ** ** ***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 member and emailed her
for more information on November 04, 2015, so we could investigate the complaintUnfortunately, at this time we have yet to hear back from Ms** ** ***If she wishes to pursue this complaint further please have her email us the following information to the email belowWe need the employee’s full name, DOB, as well as the medical office/group name this is related to
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms** ** ***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: ***
I am rejecting this response because it is nonsensical and offensiveWhat does "that premium waiver would require home office exception" even mean? How is that relevant in any way? I expect the premium waiver to compensate for my time and damages incurred by having to fight Aetna to stop harassing me and sending me their pharmacy sales advertisingIn Virginia, it is illegal to use existence of my coverage to encourage purchasing ANY form of insurance, including additional mail order prescription coverage, which I have repeatedly told Aetna I don't want.Aetna is not taking this complaint seriously, as evidenced by this continued non-response and continued harassment to purchase their unwanted prescription serviceResponding to something I haven't complained about (denial of coverage) is further proof Aetna continues to refuse to acknowledge my complaint or its wrongdoingAetna will NOT send me more junk mail trying to get me to give their drug dealer partner my prescription businessI have the right to use my local pharmacy; Aetna claims my local pharmacy is an approved pharmacy, and I therefore expect this to be honored without continued interference and continued harassment. I now expect months of premiums to be waived as a result of this continued obfuscation and harassment
Sincerely,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***

Tell us why here... Hello, Thank you for your inquiry, regarding complaint# *** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of your complaint, we contacted our Pharmacy department and
reviewed the denial for the member’s prescriptionThe basis for the original determination was that the member’s condition was not covered per Aetna’s Pharmacy Clinical Policy BulletinsThe policy states that this drug can be authorized if the member has a documented diagnosis of *** *** *** when specific criteria requirements are metThe member does not have that diagnosis which is the reason for the denialWe received a second level appeal request on May 18, It is currently under review and will be resolved by May 28, The member will be notified when completed.We apologize for any difficulties and inconvenience this has caused the memberWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Complaint: ***
I am rejecting this response because: I contacted *** *** *** Billing today times, was put on hold each time and then an automated message asked that I leave my name and numberI have already, months ago, contacted the person in charge of physician contracts and TIN numbers and she assured me that the matter would be resolvedHer name is *** *** and her number is ***I spoke to her and her office at least twice beginning in AprilShe assured me that Dr*** has ONLY ONE TIN.Aetna on both occasions was cited as having made the error since Eisenhower does not even have the TIN Aetna claims to have used
Sincerely,
*** ** *** NAME CORRECTION PLEASE NOTE

Complaint: ***Aetna made no attempt to remedy or contact me (or Insurance Broker) Complaint is valid, may I attach the supporting documentation here and if so what is the time allowed to do so?
Sincerely,
*** ***

Hello,
Thank you for your inquiry, regarding complaint #*** for *** ***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 provider and emailed her
requesting more information to investigate the complaintWe sent an email on November 06, 2015, to the email listed in the complaintIf the provider wishes to have us resolve the complaint we would please need the following information: the Tax Identification Number (TIN) or Provider Identification Number (PIN) so that we may locate the correct contract for this providerOnce we receive this information we would be more than happy to investigate and resolve this issue for the provider
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Dear
*** ***
"Times New Roman"">Please
see our response to complaint #*** for *** *** that was received by us on April 4,
In
reviewing *** *** complaint, it was noted that ultrasounds are not
considered to be part of the Preventive Care benefit, which means there is a
member cost share that applies for them.
The plan certificate states that coverage for prenatal care under the
Preventive Care benefit is limited to pregnancy-related physician office visits
including the initial and subsequent history and physical exams of the pregnant
woman (maternal weight, blood pressure and fetal heart rate check). The plan certificates for both and
are attached to this response
While
not covered under the Preventive Care benefit, the ultrasounds are still
covered under the Outpatient Diagnostic Radiological Services benefit. In 2015, this benefit applied a $copay for each date of service. In 2016, the
copay increased to $60. The application
of the copay for pregnancy ultrasounds is compliant with the Patient Protection
and Affordable Care Act’s rules regarding coverage for women’s preventive care
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ***
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***
Regards,
Chris
B***
Complaints
and Appeals Consultant
Executive
Resolution Team

Revdex.com:
Spin doctors must have worked late at the *** ***I suggest Aetna read the formThe form specifically singles out AetnaStates over 50% Aenta insurance error rateI will be sending a copy to the Aetna board of directors.
Sincerely,
*** ***

Hello,
Thank you for your inquiry, regarding complaint *** *** *** ***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 Disability
department to have the member’s concerns addressedWe were advised that the member’s claim has been approved through March 08, 2016, based upon the review of the medical records received on February 2, 2016, and February 9, The Disability case manager called on Thursday February 11, 2016, to advise the member of the claim approvalShe will also receive a letter in the mail describing the claim in detail and any next steps she may need to takeWe apologize for any inconvenience this may have caused the member
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Dear *** *** *** Please see our response to complaint # *** for *** *** that was received by us on May 16, Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of the complaint, we contacted our Claims department to address the member’s concernsWe requested that the claim for date of service August 27, for *** *** ** *** *** *** be processed immediatelyWe confirmed that a payment of $was issued to the provider on May 19, under payment ID # ***I contacted the provider’s office on May 22, and spoke to Kimberly who confirmed that the payment had been receivedKimberly also indicated that member had already paid the coinsurance amount of $in 2015; therefore, the account will reflect a zero balance once the payment has been postedThe member should allow two to three business days for the provider to update their recordsWe sincerely apologize for any inconvenience or difficulties this has caused the memberWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address the Ms***’s concernsIf there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***Sincerely, Mickey SSrComplaint and Appeal Analyst Executive Resolution Team

Dear *** ***: Please see our response to complaint #*** for *** *** that was received by us on April 10, 2018. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of the complaint, we reached out
to *** *** to determine the exact issue she is experiencing. She advised that she had received letters from Aetna seeking a payment of $to recover an amount paid to her in error for a claim. She indicated that she had last contacted Aetna in the middle of February regarding this issueThe last contact event we were able to locate was initiated on January 24, 2018. *** *** had asked an Aetna representative if the funds could be recovered from the provider of the services on the claim since she had paid the $to them. The representative sent an e-mail to the Overpayments department asking if that was possible, but no response was received. The representative then called *** *** on February 2, 2018, and left a message advising that a response had not been received. We regret any frustration or inconvenience that *** *** experienced by not receiving a final response on whether Aetna could collect the funds from the provider of servicesAs the recovery was never abandoned and no attempts were made to collect from the provider, the recovery proceeded through the standard cycle. A total of three letters were sent by Aetna and then the recovery attempt was turned over to Aetna’s collection vendorThat vendor is the company that sent the most recent notice to *** ***Prior to initiating an attempt to collect from the provider now, we spoke with the provider’s office and were advised that a refund for $had been sent to *** *** on April 10, 2018, for the date of service in question. When she receives that check, she will be able to cash it and send the funds to Aetna to satisfy the recovery attempt. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Regards, Chris BComplaints and Appeals Consultant Executive Resolution Team

Dear MsMadelyn Sola: Please see our response to complaint #*** for *** *** that was received by us on May 14, 2018. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.Upon receipt of the member’s concerns, we
immediately reached out to a plan representativeThey researched this issue and have provided a responseThe member stated that on March 08, 2018, she received a lapse notification letter with a refund checkThe member states that she couldn’t have known her policy lapsed because she sent payments for April and May of 2018.In reviewing these concerns, the plan representative stated that effective January 01, 2018, the member’s premium changed and Ms*** was not sending the correct premium amount. We received a check on March 04, 2018, for the February premium and on April 03, 2018, for the March premiumThe amount of the checks was applied but it left a balance due on the premium.On May 16, 2018, the supervisor of policyholder services contacted Ms*** and explained the difference in premium and the reason for the lapseWe received additional premium payments from the member the same dayDuring the conversation, she agreed to have her billing changed to a monthly electronic draftThe policy is active with no gap in coverage and paid through June 01, 2018. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***.Sincerely,Michael H.SrComplaint and Appeal AnalystExecutive Resolution Team

Complaint: ***
I am rejecting this response because the insurer never notified me that it would pay the bill quarterly, and that it would use this delay tactic to deem itself free of obligation to pay its share of the billI've kept all paperwork and email correspondence from the insurer, and have reviewed it several timesThe payment policy was never communicated to meI'm sure Aetna created this payment policy for that specific reason, and is most likely applauded by its shareholders for doing soBut I believe this information needs to be shared with its policyholdersOur son's orthodontist did not bill for the service quarterly, so we were confused as to why the insurer would draw out the paymentBut we figured that as long as it was paying its share, we saw no problems with its methodsI find it ridiculous that a party can default on an obligation by delaying its payments, but totally unacceptable that they do so without disclosing their intent
Sincerely,
*** ***

Dear *** *** ***: Please see our response to complaint #*** for *** *** that was received by us on May 18, 2018. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the
member’s concerns, we immediately reached out to a plan representativeThey researched this issue and have provided a responseOn November 27, 2017, the member went to have a procedure done at *** *** ***The member said that he called Aetna before he went to the hospital and the Aetna representative is the one that gave him the providers name and address informationThe member stated that he later received a bill informing him that the provider was “out of network” and that he had a balance dueThe member said he called Aetna back and requested the call records for that day because, he stated that the Aetna representative is the one who gave him the provider’s information In reviewing these concerns, the plan representative looked through the member’s call historyThe call notes indicated *** *** was discussed, but the representative advised the member that this particular place would be out of the network We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Sincerely, Michael HSrComplaint and Appeal Analyst Executive Resolution Team