Chevron USA, Inc. Reviews (361)
Chevron USA, Inc. Rating
Address: 2400 W Congress St, Lafayette, Ohio, United States, 70506-5549
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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 contacted our Eligibility department to verify if
the member should have [redacted] coverage with Aetna. We confirmed that the
member’s employer changed health insurance carriers to [redacted] in
2015. We have no record of receiving any [redacted] information for medical coverage. However
for 2016, this member has medical coverage with another employer: [redacted]
Her member ID is [redacted]. The member ID card has been mailed. Please
allow 7-10 business days. She can register for Aetna Navigator with the new ID number to get
a temporary ID card.
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[redacted] ...⇄ Complaint and Appeal Consultant Executive Resolution Team
Compl[redacted]I choose to respectfully reject this response because one has to keep in mind this resolution comes after:· Nine claims (nine opportunities).· A minimum count of twenty customer service calls.· Multiple fulfilled requests that EOBs be mailed to me due to not receiving EOBs at all and being incorrect online.· Escalation to level 4 supervisor.· Two appeals mailed with no response to date.All of which did not yield an efficient and timely resolution. However, ten months into this year, I am able to review claims on the portal and noting that perhaps multiple issues may be resolved.· The online portal is updated (issue).· The portal is currently reflecting the non-HMO provider reimbursement rate $65.00 (main issue).· In this one instance, I have received affirming communication (issue) from Aetna (via Revdex.com).Though I am left to believe this is more than "procedural errors" and wonder about all the other clients and providers who may continue to experience such "procedural errors". My recommendations to Aetna:· Adopt strategy to get it right, get it resolved, the first time.· Provide real time portal updates, i.e. Claims processing and EOBs.· Institute 24-72 hour issue to resolution response times (not 30 or 60 days as with appeals).· Make accessible to obtain and provide correct updated information and documentation in real time.· Use EMAIL between clients and client facing departments such as Appeals and Customer Service (work in the background so not to waste the client’s time on the phone).· Streamline internal processes so that one person can take charge and produce results on any given customer issue.· Most important - Always, always, always take care of the customer! Thank you for finally taking care of my issues and do know I appreciate it. I hope my comments do help improve customer experience. I just wish it did not have to go this far for resolution. 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 reached out to our Claims department to verify...
if the claim was denied correctly. We were advised that the member was within the waiting period of 12 months to have any Type C Services dental work done and the claim was denied correctly.
As stated in the Benefit Plan Booklet-Certificate:
Your Effective Date of Coverage With respect to Type A and B Services, your coverage takes effect on the later of:
-- The date you are eligible for coverage; and
-- The date you return your completed enrollment information.
With respect to Type C Services, if you are then in an Eligible Class, will be the Effective Date of this Plan. Otherwise, your coverage takes effect after 12 months of continuous service under the Plan.
Type C Expenses: Major Restorative Care
...
Inlays/Onlays
...
Our records reflect your original effective date is October 1, 2014, with a 12 month waiting period. Since this criterion was not met, benefits are not eligible under the plan for the service performed June 3, 2015. Unfortunately, your claim was denied based on your plan's limitation on Type C dental work; therefore, we are unable to pay your claim.
Aetna does care about the safety and health of our members and I empathize with your situation. 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 have attached the member's plan documents which explains the coverage waiting period.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team
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.
Sincerely,
[redacted]
They actually told me that if I did not receive the card in 2 weeks to notify them, not until June 30 as they told you that they told me, not true and I have the message from them stating so. However, I have since received the giftcard. Why in the world would they not answer the phones and say what they responded to above? The is pitiful poor customer service! Thank you for your help Revdex.com!
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.
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 reached out to our Claims department to have...
the member’s concerns reviewed. We were advised that the claim is processed correctly according to the plan benefits. There is not coverage under the plan benefits for routine services rendered by an out of network doctor. I understand your concerns and recognize this is not the outcome you desired. However, our actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants. The member may file an appeal, which must be submitted in writing to the following address: Aetna- CRT Member Appeals P.O. Box 14463 Lexington, KY 40512 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, Ashley S. Complaint and Appeal Consultant Executive Resolution Team
Complaint: [redacted]
I am rejecting this response because:i did not ask nor complain about a claim in OCT. The other 2 claims were may/june 2017 [redacted]. One for myself and 1 for my son [redacted]. Claim #[redacted] (filed 4/12 w/[redacted]) mine and my sonClaim# [redacted] (4/23 w/[redacted].) Mine [redacted]I WANT ALL PAID OFF AND CLOSED ANS EOB SENT TO ME SO I CAN GET THEM OFF MY CREDIT REPORT!
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 attempted to reach out to the facility to discuss the balance...
bill you were receiving. The facility was again unwilling to write off the amount the member owed. Due to the circumstances we had the claim reviewed under the member’s policy for balance billing. Our Claims department advised the member was eligible for balance billing reimbursement. The claim has been reprocessed and the member will be receiving a check for the balance bill difference. Please allow 7-10 business days to complete this request due to the check amount. Please note the member will be responsible for the deductible and coinsurance amounts, as this amount is not including in the balance bill check.
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
Thank you for your inquiry received on 06/30/2015 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.
We reached out to Aetna’s Eligibility department...
for assistance, and the member was on a low deductible plan from 04/01/2013 to 03/25/2015. Then, transferred to a [redacted] plan effective 03/22/2014, until 03/25/2015, and was on the correct plan. The member was only on the high deductible plan from 04/01/2015 to 04/30/2015. There is only one outstanding claim for both Mr. and Mrs. [redacted], which have been sent for reconsideration. A new Explanation of Benefit (EOB) will be mailed under separate cover within 7-10 days.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Hello,
Thank you for your inquiry, regarding complaint #[redacted]
for [redacted]. Our Executive Resolution Team researched your concerns,
and I would like to share the results of the review with you.
Upon receipt of the complaint we immediately reached out to
our Customer Service...
department to have the calls pulled prior to services
rendered to see if the member was advised incorrect information. We located
only one call on file prior to services being rendered related to the procedure on January 20, 2016, where
the customer service representative (CSR) advised the member would have to meet
her $6000 deductible prior to Aetna paying for the service.
We did locate a call that took place after the services were
rendered where the CSR did incorrectly quote the out of pocket responsibility for the member,
but after calling the facility and confirming how they bill this service and
where it would take place, the CSR corrected the amount the member would be
responsible for. The CSR apologized and did state the member would be responsible for
meeting her deductible and she was going to be responsible for more than what
she originally quoted at the beginning of the call. We assure you that it is not our intent to mislead or misrepresent any
benefit that may or may not be available under your health plan.
The claims in question were
processed correctly in accordance to your plan benefits. 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. I realize that
understanding your benefits can be challenging, and regret that you had
difficulty when you tried to obtain information.
It is our goal to be there for
you when you need us, and I apologize that the assistance you received from our
customer service representatives did not meet your needs. Be assured that your concerns are getting the
highest level of attention at Aetna. I
would also like to thank you for sharing your experience with us. It is feedback like yours that helps us
address issues and prevent them from reoccurring.
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,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team
Dear Ms. [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on October 08, 2015.
The records indicate that Mr. [redacted]’s original effective date is October 1, 2014, with a 12 month waiting period. Since this criterion was not met, benefits are not eligible under the plan for the service performed on June 3, 2015.
We had the claim verified with our Dental department to review if there was any way any exceptions could be made; we also reviewed the original appeal information. However, our decision remains the same. Based on the guidelines of Mr. [redacted]’s policy that were provided in our previous response, the plan has a 12 month waiting period for type C services. The service performed June 3, 2015 was a type C service. Therefore, an exception could not be made. Our actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants.
I apologize for any difficulties this situation has caused Mr. [redacted]. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Julian C[redacted]
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 reviewed all of Aetna’s records from this...
member’s previous complaints and appeals, and our responses which addressed in full detail all of the member’s concerns.
During the period in question, the member had coverage under two policies, one with [redacted] and one with Aetna Life Insurance Company (Aetna). However, the pharmacies were only aware of the individual policy with [redacted] and were not aware that [redacted] had an additional small group policy with Aetna. This resulted in numerous claims not being submitted to Aetna and the member being responsible for out-of-pocket expenses. Some of these claims were processed and then denied for various reasons, such as being filled to soon or pre-certification required.
Our records indicate that Aetna appropriately addressed each concern [redacted] presented to Aetna and the [redacted] (**I) over the past few years.
Aetna did not attempt to intimidate, threaten, delay or deceive [redacted], nor did it attempt to discourage submission of claims. In fact, where Aetna made reference to its legal department or compliance area reviewing the matter, we were only indicating that they were providing a higher level review of [redacted]’s issues to determine if Aetna had appropriately handled his claims. It was not Aetna’s intention to infer that [redacted] was being investigated, only that Aetna’s handling of his claims and concerns was being investigated. If the member has a specific claim or concern at this time that has not been addressed previously we would be more than happy to assist. Otherwise we consider this matter closed.
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 [email protected].
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team
Hello,
Thank you for your inquiry, regarding complaint #[redacted]or [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Upon receipt of the complaint we immediately reached out to our Eligibility department to verify...
if the member should have active [redacted] coverage with Aetna. We confirmed that the member’s employer switch to a new health insurance carrier in the middle of 2015 and the member is no longer covered by Aetna. We were advised that a representative from the member’s Human Resources (HR) will be reaching out directly to the member to confirm that her coverage is with United Health Care. The member will need to contact either her HR or United Health Care with any benefit or eligibility questions. I apologize for any inconvenience this may have caused for 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] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team [redacted].
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team
Complaint: [redacted]
I am rejecting this response because: Aetna has not made any attempt to contact me as indicated in their response. I have not received any emails from them dated Nov. 6th or otherwise. I even checked my spam folder. They already have my tax ID on file. It has been submitted to them with each call that I made to them. Also, a W-9 has been sent more than once. This is just a small example of what I have been experiencing over the past 5 months. No resolution.
Sincerely,
[redacted]
Complaint: [redacted]I am rejecting this response because:
It doesn't provide me with the laminated user Id card that I requested. Further, when I wish to change my DMO, the new DMO won't have the information for me on file as described in Aetna's response. Additionally I can't even find the Aetna home office phone number off line in my local yellow pages, much less remember it when calling or visiting a new DMO's office.
I find Aetna's refusal to comply EXTREMELY UPSETTING! If Aetna refuses to have a clerk print, laminate and mail a user id to me, I will at a minimum report this to the State of Colorado Department Of Law Office of the Attorney General. I found them to be very helpful in getting [redacted] to comply with a recent consumer complaint I filed. Sincerely,[redacted]
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 must add however that I called [redacted] today and they stated that a payment for $655.98 was made on May 25th and not earlier as Aetna said. The provider also told me that a payment is still pending and Aetna's payment is about $20 short but I will not be responsible for this as I already paid my coinsurance in 2015. Overall, I think I will no longer be billed because I am only responsible for the coinsurance.
Sincerely,
[redacted] [redacted]
Dear [redacted]: Please see our response to complaint #[redacted] for [redacted] that was received by us on May 21, 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 complaint we reached out to our Claims department to have the member’s concerns reviewed. Based on the review, we confirmed a payment was issued to [redacted] in the amount of $65.51 on March 07, 2017. The member had a $15.00 copay responsibility on this claim. A recovery letter was sent to [redacted] on January 18, 2018, and January 25, 2018. We did recover the payment in the amount of $65.51 on February 07, 2018. We do not have a claim on file for [redacted] in the amount of $132.25 that the member mentions in her complaint. Based on the member’s concerns, we had the claim reprocessed for services rendered to her daughter [redacted], on February 23, 2017, by [redacted]. A payment was issued to [redacted] in the amount of $80.51 on May 30, 2018. There is no copay responsibility on this claim. The member will receive a corrected explanation of benefits for their records. Please accept my apologies for the inconvenience and difficulties the member experienced while trying to obtain payment for their claim. Our goal is to pay claims timely and accurately, and to promptly resolve issues when they do occur. We regret that the member’s experience with Aetna was less than satisfactory and hope that we can better assist the member in the future. 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, Kim B. Complaint and Appeals 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 the Claims department to...
verify if the claim was processed correctly according to the member’s benefits. We were advised that according to the benefits for hospital emergency room services the claim was processed correctly. Hospital emergency room services are covered 85% after the deductible is met. The level of care was not a factor when considering the amount the member owes, it is strictly based upon the 15% due of the contracted rate of the provider’s billed charges.
We also had the calls pulled prior to the member purchasing the breast pump to see if incorrect information was provided to the member. The member was advised that a breast pump would only be covered under the plan if it was medically necessary, meaning there has to be an issue with feeding before it will be covered. She was advised that a letter would have to be submitted by the provider stating the reason for medical necessity and the customer service representative (CSR) again reiterated that it must be medically necessary. We also listened to the calls after the purchase of the breast pump and again the member was advised that it would only be covered under the plan if medically necessary. The member requested what would qualify as medically necessary and the CSR provided an example of if the child was born with a cleft palate or if the mother was discharged prior to the baby being discharged. The member stated she understood the benefits on both calls. I empathize with your situation and regret that our decision could not be more favorable.
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,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team
Dear [redacted]: Please see our response to complaint #[redacted] for [redacted] that was received by us on January 24, 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 complaint, we reached out to our Dental department to address the member’s concerns. As of July 1, 2017, the member enrolled in a new Dental [redacted] plan which no longer had orthodontic coverage. The member’s prior Dental [redacted] plan effective November 1, 2016 through June 30, 2017 had coverage for orthodontic treatment. The member changed plans in the middle of orthodontic treatment, which makes him responsible for the rest of the services. We confirmed that the claim was processed correctly based on the member’s new Dental plan. The Summary of Benefits (SOB) for the member’s prior Dental [redacted] plan does not mention how we pay the provider because that is the contract between Aetna and the provider. We paid all of the claims up until the member changed dental plans and orthodontic treatment was no longer covered. The plan documents are always available online through the member’s Aetna [redacted] account. The member could have verified that his new plan did not cover orthodontics. In the SPD section titled, “What The [redacted] Dental Plan Does Not Cover” it states: “Not every dental care service or supply is covered by the plan, even if prescribed, recommended, or approved by your physician or dentist. The plan covers only those services and supplies that are medically necessary and included in the What the Plan Covers section. Charges made for the following are not covered except to the extent listed under the What the Plan Covers section or by amendment attached to this Booklet-Certificate. In addition, some services are specifically limited or excluded. This section describes expenses that are not covered or subject to special limitations. …Dental implants, braces, mouth guards, and other devices to protect, replace or reposition teeth and removal of implants. …Orthodontic treatment except as covered in the What the Plan Covers section.” While we understand the member’s concerns and recognize this is not the resolution he 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]’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Kim B. Complaint and Appeals 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 thank you all very much for quickly responding and the courteous follow up call from Aetna's Complaint Dept.
Sincerely,
[redacted]