Chevron USA, Inc.

Complaint: [redacted]
I am rejecting this response because:
Sincerely,
[redacted]

Hello, Thank you for your inquiry, regarding complaint# [redacted] for Robert C[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 Claims department for claim review. We...

determined that the services should allow up to the 80th percentile of Fair Health for emergent services. The emergency claims for date of service: July 30, 2015 have been reprocessed. The member and provider will receive an explanation of benefits within 7-10 days. The claim for date of service August 27, 2015 was determined that it processed correctly. The member’s plan states that follow-up care is not considered an emergency or urgent condition and is not covered as part of any emergency or urgent care visit. We apologize for any difficulties and inconvenience 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 Mr. C[redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   LaShonda C. Complaint and Appeal Consultant Executive Resolution Team   Tell us why here...

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.
We apologize if our previous response was misunderstood or upset the member in any way, we assure you that it is not our intent to mislead or misrepresent any information that was relayed to the member regarding the payment. We mailed a check to the member on July 30, 2015, to the home address on file. Our records indicate that this check was received and was cashed on August 13, 2015.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mrs. [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

Dear Ms. [redacted]   Please see our response to complaint #[redacted] for [redacted] that was received by us on July 06, 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 Claims department to have the claims on file reviewed. We were advised that all claims on file have been processed and paid to the provider. We were not able to reimburse the member directly since the claim’s assignment of benefits was filled out to pay the provider directly, and by law we are not able to change this assignment.   If the member paid out of pocket for any services that were paid to the provider, please have the member contact the provider to reimburse the member directly. If the member wishes we can contact the provider’s on their behalf to seek the reimbursement. Please have the member send the provider’s names and the dates of services to the email address listed below and we would be more than happy to contact the providers directly.   We also consulted with our Eligibility department who confirmed there was not any mishandling on Aetna’s side for adding the child to the policy. We received the electronic file from the employer on December 28, 2015, to add the child to the policy. The file from the employer requested we back date the effective date to December 03, 2015, the child’s date of birth. We apologize for any inconvenience 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 Mrs. [redacted]   Sincerely,   Ashley W. Complaint and Appeals 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 your complaint, we contacted our claims department to address your concerns. We have found that the claim for [redacted] recent hospital stay on date March 17, 2016 through discharge date March 23, 2016 has been adjusted and reprocessed. The provider should expect payment within 7-10 business days. The claim was initially denied for no authorization. We reviewed the authorization request and approved the in-patient visit based on medical necessity. I apologize for the frustrations and difficulties you have experienced while attempting to obtain payment for this claim. 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, Tanika K. Complaint and Appeal Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:I am waiting to see if the payment has been applied to the account at the proper provider. I contacted Forward Dental New Berlin on Friday 2/12/16 and spoke to Jessica---who said they are working with Aetna. Until the payment is actually posted, I do not consider the matter resolved--as the money has not been posted to the account. If Aetna would have paid Forward Dental New Berlin instead of Forward Dental Appleton---we would not continue to be having this issue. It appears they could clearly deny the claim to the proper provider when it first came in, but they can't seem to pay the proper provider when trying to correct the claim they initially denied.
Sincerely,
[redacted]

Dear [redacted]    Please see our response to complaint #[redacted] for [redacted] that was received by us on October 23, 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 Claims department to have the member’s concerns reviewed. We were advised that all claims on file, including the treating physicians’ claim, are processed as participating for services rendered on September 04, 2017. The physician claim [redacted] shows a member responsibility of $43.36 towards the 20 percent coinsurance that was due and $173.42 was paid to the provider on September 19, 2017. Please have the member contact us directly at the email listed below if she is being balance billed any additional money outside the $43.36 that applied to the coinsurance.   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,   Ashley W. Complaint and Appeals Consultant Executive Resolution Team

Dear [redacted]
* Please see our response to complaint #[redacted] for [redacted] that was received by us on June 24, 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 Disability department to have the member’s concerns reviewed. We were advised that the member’s disability claim was approved and the approval has been communicated the member. The Disability department is also sending a letter with the details of the approval to the member.   I apologize for any difficulties the member encountered with the disability case manager.  It is our goal to provide the member with quality service and I regret any incidents that created the perception that we have not provided the member with adequate service.  These actions are not consistent with Aetna’s service standards and we appreciate you notifying us of the member’s experience.  I would like to assure the member that we have taken the appropriate actions to address the service issues the member experienced.   We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted] concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
* Sincerely,   Ashley W. Complaint and Appeals 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 your inquiry, we contacted our
Billing department regarding this member's complaint. We have confirmed that the employer, specifically The Office of Personnel Management, changes
the premiums each year on their website. For 2015, general information was
released on 9/29/15 and can be found at the link: [redacted] .
The premiums are also notated in every plan brochure, available on
line. The federal government has a “Green Initiative”, and does not distribute
brochures. The
eligibility I currently show continues to be enrollment code JS1 for single
coverage [redacted] which indicates the member should still be paying the $105.17
premium. We cannot change the member’s plan or refund any monies paid toward
her premium. Ultimately, she must resolve her intent with her payroll
department as stated previously. 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, LaShonda
C.  
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 had our files reviewed to verify that we had...

the member’s name correct in our system. Our records indicate we have the member’s name in our system just as it shows in the Revdex.com complaint. Our records also indicate that we do not carry this employer’s medical benefits, only dental benefits. The employer’s medical benefits are with any of the following carriers: [redacted], [redacted] and [redacted]. Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those records. Please contact your medical carrier to request a corrected medical ID card.
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

this issue has been resolved. please close thx

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

department for the member’s employer to verify why there was an increase in premiums. We were advised that this member has the [redacted] plan. Aetna does send out notifications each year of the benefit changes and rates. Federal members have a choice; it is a passive enrollment, meaning if they do nothing, they will stay in the same plan. This letter is sent to all members and is mandatory from Office of Personnel Management (OPM). The member needs to refer to her Human Resources department in regards to the premium amounts, as Aetna has no control in the premium rate changes, Aetna is strictly an administrator in the plan benefits.
This member has been receiving this letter each October since she has been a member with Aetna. The address that we have on file is [redacted], [redacted], **, [redacted].
Also, the member is still in the old enrollment code. We continue to send her letters to switch her enrollment code to the correct one for her area. I have attached a copy of this year’s letter that has already went out to members.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’s concerns.
If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Dear [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...

Dental department to address the member’s concerns. We reviewed the member’s current [redacted] Dental benefits effective July 01, 2017. We found that they are based on a list of dental procedures determined and agreed upon by your employer. Unfortunately, it does not include orthodontic treatment as an expense eligible for reimbursement. The member’s prior [redacted] Dental plan effective from November 1, 2016 through June 30, 2017 had coverage for orthodontic coverage. The member changed the plan during mid treatment, which means it changed the coverage. We determined that the claim was processed correctly, according to the information we received, and no benefits are available for this service. 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, LaShonda C. 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]

Revdex.com:
I have reviewed the response made by the business in reference to complaint [redacted]4, 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 contacted our Pharmacy department to address the member’s...

reimbursement request. We found that the member owed a balance for a prescription [redacted] filled on 01/20/16. The member disputed the charges with her credit card company and the card did a charge back to the account for 220.00 on 02/19/2016. On 02/24/2016 her card was charged again because it was the default card on file. The member disputed the charges with her bank again on 03/08/2016 and card did a charge back to her account on 03/08/2016. We have reviewed the member’s file and determined that some of her medications were applied to the plan deductible in error. We have reprocessed the claims. Once completed, a payment will be mailed to the member within 7-10 business. 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, 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 April 11, 2018.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.   We reached back out to our Claims department to have the member’s additional concerns reviewed. We reprocessed the claim for date of service October 17, 2016, to pay an additional $933.20 to provider. The payment was released to the provider as an electronic fund transfer today, April 20, 2018. We paid the provider directly to take the member out of the middle of the billing since the collection company stated to her that her debt was paid in full and owed nothing more for the services rendered.   Please accept my apology for the delay in processing the member’s claims correctly, and that it required multiple attempts on her part to resolve the issue. Unfortunately, in some instances, errors do occur. When they do, 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 this 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 [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   Sincerely,   Ashley W. 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.
Sincerely,
[redacted]

Thank you for your rejection notice received on 07/17/15 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 Plan Sponsor Liaison contact for assistance, and were advised that our records show coverage for the period 05/24/15 through 07/04/15, which will be refunded. The refund amount of $109.62 will be included on this Friday’s (07/24/15) paycheck and no additional deductions have been taken.
 
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].

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
Eligibility...

department to have the member’s concerns reviewed. We were advised
that the policy will be re-opening with the effective date of January 01, 2016.
The member stated he made a payment, however the payment never posted on the
policy causing the policy to cancel as never in force.
The member would need to make his binder payment allowing
24-48hrs to post in the account. Then the member could call back to make a
payment for February and March. The member could reach us at ###-###-#### and
speak directly to a customer care associate to be able to take his premium
payment and be provided with a confirmation number. Please have the member
reference case number [redacted] when calling to make his binder payment. Once the
payment is processed and posted in the account the welcome packet and the
member ID card will be sent to the member within 7-10 business days after
payment posts.
Please accept my apology that we did not provide the level
of service that you rightfully expect and deserve, and my assurance 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