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 youAs previously stated we have stopped all mailings as per the request of *** ***The Aetna mailings are not meant as harassment and we take all complaints seriously that come from our membersWe will only consider reimbursing a premium if the member was unable to use the benefits under the policyAt this time there is no proof the member was not able to use his plan benefits, so we will not being reimbursing the member the four months that is being requested because of the member receiving Aetna mailingsWe 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 SComplaint and Appeal Consultant Executive Resolution Team

Complaint: ***
I am rejecting this response because:
I know I called before I was admitted the call could have not been recorded or just been deleted on your partI am going to research my call records from January and submit themI know I called before I was admitted and was told the hospital was in network that is the only reason I was sent there
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 Premium Accounting
department to have the member’s concerns addressedWe were advised there was a system error that was causing the incorrect premium rate to be reflected on the invoicesIt was confirmed that we have updated the member’s premium, in all of our systems, to reflect the non-smoker premium
Aetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processesI want you to know that we appreciate your feedback because it gives us the opportunity to listen to our customers and make any improvements to our processes and the service we provideYour opinion is valued at Aetna, and I trust that you will not hesitate to contact us when you need assistance
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***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

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,
*** ***

Dear [redacted]: Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on February 13, 2018. We understand that [redacted] is requesting that we print the hospital, clinic, or medical group’s name along with the name of the physician on claims filed to us. Unfortunately, our systems do not currently have the capability of displaying the name of the group a physician is affiliated with if claims are submitted by the individual physician.  This information is based on how the providers submit claims to us and how the provider’s demographic information is loaded into Aetna’s systems.  If [redacted] does need additional information about any physician submitting a claim for him or his family, our Member Services representatives are available to assist him. As future opportunities occur to make system enhancements, [redacted] recommendation will be taken into consideration.  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] Sincerely, Christopher B. Complaint and Appeals Consultant Executive Resolution Team

Dear Ms. [redacted]: Please see our response to complaint # [redacted] for [redacted] that was received by us on January 11, 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 complaint, we contacted our [redacted] department to address the member’s concerns. We reviewed the member’s current plan benefits and found the member is enrolled in a [redacted] Plan. This plan does not include [redacted] prescription drug coverage.  The member’s pharmacy benefits are covered by [redacted]. The member can contact [redacted] Member Services at ###-###-####. [redacted] will be able to supply you with the information you need to get your prescriptions including the PCN and BIN numbers for their plan. They can also send you an [redacted] ID card. Aetna representatives aren’t able to give you the PCN and BIN numbers for an [redacted] plan because they’re a separate company. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. Gattermeyer’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected]. Sincerely, LaShonda C. Complaint and Appeal Consultant Executive Resolution Team

Thank you for your inquiry received on 08/21/15 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 reached out to the Flexible Spending Account...

(FSA) department, and were able to find the system error with the processing of the member’s claims.  All claims have since been reprocessed correctly as of 08/20/15, and a check was issued on 08/20/15. We 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 **. [redacted]’s concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Complaint: [redacted]
I am rejecting this response because:they make false claims:1. the diagnosis codes were there at the first submission...All the forms and receipts were the same (the same receipt) every week. However, they chose to randomly deny claims and have me re-submit them.2. They paid what they claim to be "usual and customary provider rate". This is a lie. I have quotes from several providers of the same service, and all of them came up with higher quotes that the one I went with eventually. 
Sincerely,
[redacted]

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 reviewed the member’s records to see what type...

of dental discount policy the member is enrolled in. We found that the member is enrolled in a Vital Savings plan purchased through http://www.[redacted].com. Aetna is strictly an administrator of this plan; Aetna does not control the enrollment or the billing.
All enrollments are handled through a Third Party Administrator ([redacted]) and the Billing is handled by the [redacted], not by Aetna. The participant makes the payments directly to the [redacted]; there is no pay roll deduction. Anyone requesting a refund of premiums or a cancellation of the plan must contact the [redacted] directly. You can call ###-###-#### or go online to the website listed above.
Please be aware that this plan is strictly a discount plan and is not insurance. There are no claim submissions of any kind and the member is responsible for paying the discounted price directly to the dentist. Aetna would have no way of verifying if the plan was not used by the member. Also any renewal information would come from the [redacted] directly to the member; Aetna is not responsible for any communications to the member.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address **. [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].com.
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

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 directly to the provider’s office to address the member’s concerns. We spoke with Dawn, at the New Berlin office, and we explained the situation that the claim was sent to us as performed at the [redacted] office. In our discussion with Dawn, we provided the payment ID and confirmed the address the payment was sent to and we were advised the payment went to their main office for Forward Dental, per the way the claim was submitted to Aetna by the provider.
We faxed the explanation of benefits to Dawn’s attention for review on Friday February 05, 2016. We called today, February 09, 2016, and spoke with Dawn and she advised that the main office submitted the claim incorrectly to Aetna, listing the wrong office, but that she was working internally within their offices to have the money applied to the member’s account.
The office was provided with my direct number for any future questions or concerns surrounding the claim. Unfortunately, we are not able to change the claim on file to show the correct office, the provider’s office would be required to submit a corrected claim for Aetna to be able to make any adjustments.
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 [redacted]
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint [redacted] Our Executive Resolution Team researched your concerns,
and I would like to share the results of the review with you.
Upon receipt of the complaint we immediately reached out to
our Claims department to...

have the member’s concerns reviewed. We were advised
that the claim was processed correctly according to the out of network
benefits. The member’s benefit when seen at an out of network urgent care
facility is reimbursed at 50% after the deductible is met.
Our records indicate that the
member did visit an urgent care facility in September but it was a different facility
than the one the member visited for the November date of service, which is why
the claims processed differently. It is ultimately the member’s responsibility
to verify the participation status of the provider. We did not locate a call on
file from either the member or provider prior to services being rendered to confirm
the coverage; therefore we are not able to make any exceptions for this claim.
The member will be responsible for any billed amount from the provider. While
we understand your concerns and recognize this is not the resolution you sought,
our decision remains unchanged. Our actions are solely guided by the plan guidelines
in order to administer fairly and equitably to all participants.
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]
 
Thank you,
 XE "Type Name"Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team XE
"Title/Business Area"

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 Billing department to verify...

if the member was due a refund for overpaid premiums after she was no longer employed with the prevoius employer. We were able to verify that the member is due a refund as the premium was overpaid. The City of [redacted] is aware of the situation and they are currently working on refunding the member as quickly as possible. Since the City of [redacted] creates these deductions, please contact them for any questions about the amount of refund that is due and when they expect to have this refund to the member.
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]
 
Thank you,
[redacted]
Complaint and Appeal Consultant
Executive Resolution Team

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. I will file additional complaints if the same "accidental" errors occur again in the future. 
Sincerely,
[redacted]

Dear [redacted]: Please see our response to complaint # [redacted] for [redacted] that was received by us on December 5, 2017. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. Upon receipt of the complaint, we contacted...

our Claims department to address the member’s concerns. We reviewed the October 16, 2017 claim and found that the claim originally processed under the incorrect contract for [redacted]. The claim initially allowed $189.00 and was applied to the member’s deductible. However, Aetna determined that an error was made and reprocessed the claim at the correct provider contract rate on December 2, 2017.  The correct allowed amount for the service should have been $283.50. This resulted in an increase of the member responsibility by $94.50.  The member is responsible for the $94.50 because his deductible was not met.We apologize for the inconvenience that this has 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 [redacted]’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely,LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Hello, Thank you for your inquiry, regarding complaint #[redacted] for Jared G[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 contacted our Eligibility department to verify the policy. Our records indicate the policy was effective on November 10, 2014, and terminated on January 01, 2015. We received a retro-termination request from the employer to back date the termination to January 01, 2015. Any termination requests are forwarded to [redacted] from the employer.[redacted] cannot refund premium payments. If the member is seeking a refund for the policy he must contact his Human Resources department to request.  I apologize for the frustrations and difficulties you encountered while attempting to resolve this issue. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. G[redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]@[redacted].com. Thank you, LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Dear [redacted]:   Please see our response to complaint #[redacted] for [redacted] that was received by us on May 29, 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 representative. They researched this issue and have provided a response. The member stated that she submitted a claim for her short term disability to be processed, and that she has called Aetna 10 or more times with no one returning her calls.   In reviewing the member’s concern, we see that the claim was reported on May 09, 2018, and records were requested from the provider. A representative spoke with [redacted] on May 29, 2018, and the claim was approved through June 06, 2018.   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 there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   Sincerely,   Michael H.                        Sr. Complaint and Appeal Analyst Executive Resolution Team

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 had the claims for the [redacted] family reviewed. We were...

able to verify that there were a few claims on file that were delayed in processing due to not have diagnosis codes submitted with the claim. Once we received the diagnosis codes we were able to process the claims in a timely manner. At this time all claims on file have been processed and finalized.
Most of the family’s claims on file were processed and finalized within 10-15 business days of receipt. If the member sees an out of network provider the payment of the claim is going to be based upon a reasonable and customary rate, not determine by Aetna, and will pay the percentage of the allowable. If there is a particular date of service that the member feel was not processed correctly or disagrees with the payment, the member may file an appeal with our Customer Resolution Team.
Please accept my apology for the delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issue.  Our goal is to pay claims timely and accurately, and to promptly resolve issues when they do occur.  When issues do arise, we take them very seriously and do our best to understand how and why the errors occurred and determine what we can do to prevent a recurrence.  We continually use feedback like yours to improve our service and prevent issues from reoccurring.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address 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

[redacted]   Please see our response to complaint #[redacted] for [redacted] that was received by us on March 21, 2017.  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 claimant’s concerns reviewed. We were advised that our Disability department initially called the wrong doctor’s office on January 10, 2017, and January 13, 2017. We then were informed [redacted]r was being treated at another Medical Center in Cincinnati and we made several attempts to obtain the information necessary to review the case. We faxed requests on January 18th, 19th, 27th, 30th, February 01st and March 06, 2017. We have obtained the information needed to complete the disability claim review and it has been approved. The claimant will receive a letter from the Disability department with the claim details. We sincerely apologize for any inconvenience this has caused the claimant.   We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]r’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   Sincerely,   [redacted]. Complaint and Appeals Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because: The claim presented was not for the procedure (9/11), it was for the consultation (dated 9/3).  The executive team has not responded back with any concerns or questions, and have not reached out to any of the providers as well.
Sincerely,
[redacted] ###-###-####

From: [redacted] [redacted]m] Sent: Tuesday, June 28, 2016 4:15 PMTo: [redacted]Subject: Aetna Executive Team- Regarding Complaint #[redacted]Hey Madelyn, I was able to get a resolution for this case. I believe this is another one that we did not get the first notification...

on. Can you reopen this case so I can put my resolution comments in it? I just don’t want it to go unresolved or affect the rating. If you are not able to reopen the case below is my resolution to the member: Dear Ms. [redacted]Please see our response to complaint #[redacted] for Angelique A[redacted] that was received by us on June 18, 2016. 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 Billing and Enrollment department to have the member’s concerns addressed. We were advised that the member’s plan was effective June 01, 2016, and they are covered by the Aetna Leap Specialty with a monthly premium due of $812.86. The policy premium of $812.86 is correct, as the primary policy holder listed himself as a smoker and the dependent a non-smoker. Currently the policy is active and paid through June 30, 2016. The original policy quote of $767.45 was based on both members being non-smokers but when the application was processed, the primary listed himself as a smoker; causing the premium to go up to $812.86. If this incorrect, please contact us immediately. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mrs. Allen’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at s[redacted]Sincerely,Ashley W.Complaint and Appeals ConsultantExecutive Resolution Team