Chevron USA, Inc.

Thank you for your rejection notice received on 07/21/15 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 Claims department, and...

were advised that we have have received one claim for the Emergency Room services which were provided by Dr. [redacted] on 06/11/14, and was paid on 07/04/14, in the amount of $114.04, with the member’s copayment responsibility of $30.00, under payment ID# [redacted]. Any remaining balance is a write-off for the provider and should not bill the member. To date, we have not received a claim from the Hospital/Facility for the Emergency Room services. Therefore, if the facility is participating they would need to resubmit the claim(s) with proof of timely filing to Aetna for consideration.
 
Aetna
Attention: Claims
P.O. BOX [redacted]
[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] 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:There is still no way for me to know who the so called provider us on the claim forms.They refused to provide provider information (hospital clinic medical group) for the persons name in the provider column on there forms.I have to spend hours trying to guess and find out who they work for to verify if each claim is legitimate. They have resently deleted the false claim I caught but the time I need to spend verifying 100's of claims by the end of the year will bealot of wadted time on my part because they refuse to let me know who the provider is.This is not personel information as they told me. What clinic name or hospital or medical group they work at should not be considered personnel infomation they cannot provide on there forms. The clinics and hospitals provide the info to Aetna it's Aetna that refuses to put that on  there claims. Only other option is to send Aetna all the names on the claim forms and request special permision to find out the address of the persons billing address. Then I would [redacted] the address to find out what building is there and maybe find out who it is. I then have to message my kids at collage to see if they went there for something on that date. Collage kids have short memories. When I asked them ladt time they only remebered half of the claims.
Sincerely,
[redacted]

Dear
[redacted]
Please
see our response to complaint #[redacted]
for [redacted] that was received by us on March 04, 2016.
During our review, we reached out to
our Dental department to address [redacted] concerns. It was determined that
the physical Dental identification cards are no longer available. I would like
to reiterate as advised in our previous response, that Dental ID cards are not required
to receive service.
However, as a onetime exception we have printed and laminated a copy of [redacted] dental ID card and mailed it on March 8, 2016.
I
apologize for any difficulties or confusion this may have caused [redacted]. 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 [email protected].
Regards,
Julian
C[redacted]
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]

Complaint: [redacted]
I am rejecting this response because: I was Never contacted by Aetna regarding changing my code except when I first enrolled back in 2012. I was told to change the enrollment code from Ep1 to 221. Thereafter,  Aetna took it amongst themselves to change my code to JS1 a code that doesn't exist anywhere on aetnas website or brochure. My premium was raised by Aetna not my human resources office. This is ridiculous and robbery.  I would like my plan changed back and all overpayment returned to me.  I never signed nor agreed to change my plan to JS1. I was informed by Aetna that they were changing my plan without my permission.  I plan to take legal action an continue to report these unethical practices until it is rectified. 
Sincerely,
[redacted]

Thank you for your inquiry received on 07/01/2015 regarding complaint #[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 Student Health department for assistance,...

and for [redacted], eligible students are automatically enrolled in the Aetna Student Health Plan, unless a completed Waiver Form has been received by [redacted] by the deadline date which would have been 08/01/2014 for continuing students or 08/04/2014 for new students.
 
We do have Ms. [redacted] enrolled from 07/01/2014-06/30/2015, which means more than likely she did not submit a waiver which shows proof of other insurance. If this is the case, then she is enrolled for the 12 months and is responsible for the insurance premium. 
 
We do have a Broker that handles all waiver and enrollment questions and issues. Ms. [redacted] (the student) will need to reach out to them directly if she has further questions or issues. Ms. [redacted] may contact HSA Consulting at [redacted]; or online at: [redacted]
 
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]

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] I am still disappointed that my coverage was changed from what I had under [redacted].  I was told by the person who called me that it was the same, but when I protested that I had had [redacted] surgery in the past I did not pay a $600 co-pay.  When he researched it he admitted I was right.  I was happy they resolved the medication compensation and he told me there had been an error in calculating my other co-pay and that it would be adjusted.  I am still waiting to hear about that.  I appreciate that they contacted me and made an effort to address my complaint.

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 [redacted]...

department. Our [redacted] department attempted to reach the member
on April 05, 2016, to find out more information regarding the complaint.
Unfortunately, our [redacted] department has yet to hear back from the member
about the details surrounding this complaint. Once we receive more information
and details about this complaint, whether it is related to benefits, customer
service etc. we will be able to research further. Please have the member
contact our [redacted] department if they wish to pursue the complaint further.
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

Thank you for your inquiry received on 07/08/2015 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 Dental department for...

assistance, and had the member’s file reviewed.  The Dental department did not locate any phone calls to customer service from the dental provider’s office or the member prior to the services being rendered.  However, there were several inquiries via the automated Aetna Voice Advantage (AVA) system, but no details as to what was discussed or inquired on.  The Dental department called the National Dental provider number to inquire and confirm through the AVA on the coverage information of code [redacted], and heard that this service was not covered under the members plan.  This is what the dental provider’s office would have heard if they had inquired via the AVA.  The AVA for members does not give information for this code.  The member would have been transferred to a live Customer Service representative in order to get this information.  To date, there is no record of a call from the member prior to the services being rendered. Additionally, there is no predetermination request on file that would have advised both the member and provider that the services was not covered. Therefore, the member was not misquoted nor given an estimate for the services in question.
 
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 have the call pulled to verify...

the information that was provided to the member. Our records indicate that the member advised the customer service representative that this procedure would take place in the provider’s own facility, with the doctor’s name and procedure code. Based upon that description the general benefits were provided to the member.
Information provided through member services is not a guarantee of benefits under the plan. The claim that was submitted to Aetna did not list the services rendered as being taken place in the office setting, instead in an ambulatory surgical center as outpatient surgery. Due to the way the claim was billed it triggered the deductible instead of an office visit copay. The claims in question were processed correctly in accordance to your plan benefits.
I realize that understanding your benefits can be challenging. 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.

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,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint #11103156 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 Accounting department to...

have the member’s concerns reviewed. We were advised by [redacted] that the claim needs to be submitted to [redacted] as they were given all the financial details and [redacted] will pay the claim.
The member did submit a claim that was received on December 31, 2015, but the claim was not processed until January 06, 2016. Per [redacted] will handle all Run Off and Grace Period processing. No further processing by will be completed by Aetna as of January 01, 2016.
We sent the request back to the member on January 06, 2016 and advised the member to resubmit to [redacted] since they are responsible for handling the Run Off and Grace Period. Please have the member send the information directly to [redacted] with their new account information. 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].
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

HelloThank 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 Customer Service department to review the member’s...

concerns. We listened to the phone call dated February 01, 2016 and confirmed that the member was quoted benefits that the diagnostic tests would be allowed at 100% after the $2600 deductible was met. The customer service associate explained that the member’s deductible had not been met. The associate did not educate the member on some of the procedure codes would be subject to medical review based on the member’s condition. We have provided feedback to the associate that handled the call. We also contacted our Claims department and verified that the member’s claim was processed according to the plan benefits. The procedure [redacted] was allowed and applied $952.93 toward the deductible. The procedure [redacted] and [redacted] were denied because they are considered experimental. The member's level one appeal denied on May 18, 2016. If the member disagrees with this decision, she may request a second level appeal. We can assist the member with the appeal submission. We attempted to reach the member on May 27, 2016 and left a message. We will make another attempt on Tuesday, May 31, 2016. The member can also contact me directly at ###-###-####.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 [email protected].  Thank you,  LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Complaint: 11[redacted]
I am rejecting this response because: This does not change the fact that I had to go 2 days with out necessary medication and due to Aetna playing doctor (deciding that my age isn't appropriate for a medication) my life was put on the line. I do not accept Aetna's absurd procedures and disregard of human life. It's not just my life that is put on the line. Daily Aetna plays this game with several of their customers and the evidence is right on their [redacted] page. Hundreds of angry people who are tired of the same thing. I will continue to keep this case open for myself and all the others like me who have been toyed with just so that Aetna could play doctor the prescriptions.  
Sincerely,
[redacted]

[redacted]
* Please see our response to complaint #[redacted] for [redacted] that was received by us on January 10, 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 Eligibility and Premium department to have the member’s concerns reviewed. We were advised that a termination file was received from the Marketplace on December 13, 2016 to terminate the policy with a date of December 27, 2016. The request for termination was completed on December 14, 2016, to reflect the term date of December 27, 2016. The member was refunded the prorated difference of $16.68 on December 16, 2016.   We verified our call history on file since the member stated he called to terminate the policy for the effective date of November 30, 2016, and was told by a representative that he did not have to take any action, but there are no calls on file related to this complaint. If the call was with the Marketplace, we do not have recordings for those calls, only the Marketplace would have a recording.   Unfortunately, the policy does not qualify to be terminated effective November 30, 2016, because the file received from the Marketplace was received with a termination date of December 27, 2016. If the member is still disputing the termination date, the member would need to reach out to the Marketplace appeals department a[redacted] to request the November 30, 2016, termination date. Only if the Marketplace appeals department approves the requested termination date would we be able to complete the full refund for the December premium.   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]   Sincerely,   [redacted]
[redacted]
[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 Network department to...

have the member’s concerns reviewed. We were advised
that both providers listed in the compliant are participating with the member’s
plan, and that our list of surgeons the member is locating online is up to date
and correct. We called and spoke with [redacted] at [redacted] office and
advised her that she was given incorrect information from our provider service center
and that the member was within the network if they wish to continue their
member/provider relationship. Our Network department will reach out to the
provider’s office to educate them on their contracts and plans they participate
with.  
Our goal is to provide accurate
and reliable information when you need it and to immediately resolve issues
when they do occur. Clearly, in your case, we fell short of that goal. We
regret that your experience with Aetna was less than satisfactory and hope that
we can better assist you in the future. I would like to assure you that we have
taken the appropriate actions to address the customer service issues the member
and the provider have experienced.
Aetna strives to provide the highest level of service, quality,
and satisfaction, and to continually improve our processes. I 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
provide. Your 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 [redacted]s 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"

From: [redacted]   Sent: Sunday, June 03, 2018 10:13 PM To: Revdex.com Subject: Re: You have a New Message from Revdex.com Serving Connecticut Regarding Complaint #[redacted]   Yes, I already responded to this email. I am completely satisfied with AETNA solution. I was contacted by AETNA & they solve my problem. Thank you to AETNA & the Revdex.com.

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 claims reviewed. We were advised
that the services rendered require medical records to be submitted by the
provider. At this time we have yet to receive the medical records requested
from the provider so we are unable to process the claim. Once they are received
we will be able to process the claims for any benefits available under the
plan.
Our goal is to provide accurate
and reliable information when you need it and to immediately resolve issues
when they do occur. 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. Your concerns
have been forwarded to our management team for improvement opportunities.
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 December 20, 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 Precertification department to have the member’s concerns reviewed. We requested that the Precertification department review the member’s request as soon as possible due to the delay the member was experiencing surrounding the request. We were advised that on Thursday December 22, 2016, our Precertification department spoke with the provider’s office and confirmed that the codes that were being requested did not require a precertification request and apologized that the request was not handled sooner.   The provider confirmed the member was aware she was using her out-of-network benefits and again apologized for the inconvenience the office and the member experienced. We have provided additional training and feedback to those involved in the handling of this request. The provider will contact the member to set up having the services rendered.   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 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 the complaint we immediately reached out to
our Dental Claims...

department to have the member's concerns reviewed. We were
advised that they were able to have the claim corrected and the provider is to
be paid the additional money due for services rendered this week. The provider
and the member will receive a corrected explanation of benefits (EOB) within
7-10 business days or on our Aetna Navigator in 72 hours.
Please accept my apology for the delay in processing your
claim correctly, and that it required multiple attempts on your part to resolve
your 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 yours to improve our service and prevent issues from
reoccurring.
Concerning the customer service you experienced, our goal is
to provide exceptional service to our customers, and immediately resolve issues
when they do occur. I sincerely apologize for the frustrations and difficulties
you experienced and that we did not provide the level of service that you
rightfully expect and deserve. These actions are not consistent with Aetna's
service standards and we appreciate you notifying us of your experience. We
have addressed your customer service concerns directly with the representatives
who handled your calls.
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

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 Customer Service department to review your...

concerns. We have confirmed that the name change was completed on May 4, 2016. A new medical id card was sent by mail on May 5, 2016. We have also reviewed your claim history and found that there are no claim denials due to this error. We apologize for the inconvenience this has caused you. 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