Chevron USA, Inc.

From: [redacted] [mailto:[redacted] Sent: Saturday, June 25, 2016 1:26 AMTo: [email protected]: Complaint #[redacted]To whom it may concern:I realize that my complaint is still being worked on, but today I just received a notice in the mail that Aetna sent me to collections for the amount I disputed and contacted you guys about.  I am so sick about it, and my anxiety is causing me a lot of pain. I am sick and really scared they are going to destroy my credit, which up until now has been very good.  I have never not paid a bill and always pay on time. I don't know what to do, mentally, I cannot handle dealing with Aetna anymore. I can't sleep, and my nerves are a mess. I don't know what I did to deserve this mess. It is almost the end of June now, and I have been trying to get this mess resolved for almost half a year now. Somebody please help me![redacted]

Complaint: [redacted]
I am rejecting this response because:  I want to know the exact date they sent requested information to the medical provide.  Which provider, the doctor's name, and what address was this request for information sent to.  I have heard repeatedly they request information so it would be important of me, the patient, to follow up with the doctor to make sure they received this information and respond to Aetna.  I appreciate Revdex.com to go back to Aetna with this request for additional, more detailed information.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:  This is not the information that [redacted] in the pre-certification department [redacted] gave me when she did the pre-certification.  I have tried to contact [redacted] multiple times and have yet to received a call back. I contacted Aetna because I couldn't find anyone in my area that was covered for the food allergy services I needed.  [redacted] found this person and sent me to them.  I only did what Aetna told me to do. Every time I call Aetna I get a different story.  When [redacted] filed the appeal she told me that [redacted] didn't do the leg work correctly when she did the pre-certification.  I have been told the pre-certification was not working because the doctor that was billing was [redacted] versus [redacted].  Then the next person told me they couldn't even see that [redacted] was the one billing.  I haven't been able to get any consistent answers from anyone at member services.This is the worst customer service I have ever experienced.  I just want this to be taken care of.  I have been dealing with this for over 6 months now.  I have been trying to get this resolved on my own and I feel like I have no other choice than to do it this way.
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.
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.
We requested a copy of the letter to confirm the information
the member is requesting. We were able to verify the medical records request
was mailed on September 14, 2015, to address:
[redacted]
[redacted] [redacted]
[redacted]
Records were sent to the main office address on file instead
of to the individual doctors since the member was seen by more than one doctor
in the date range records were requested. We requested records for any services
rendered from August 20, 2015 through September 19, 2015. Once the records are
received we will be able to review the claims on file for any benefits
available under the plan. If the provider has not received this letter, they
can contact our Provider Service Center and have the letter regenerated. They
can reference document control number: [redacted] when calling for a copy of
the letter.
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] 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 addressed. We were
advised that the claim was finalized on February 17, 2016, and the case manager reached
out to him the same day to advise of the claim decision.
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] 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 now have 2 sets of  cards, both with the incorrect name.This is such a BS game your playing.  PLEASE SEND ME CARDS WITH MY NAME ON THEMAnd Revdex.com, please fix my name.  your just as bad as Aetna is!  When this form populates, it does not include [redacted]  Please fix
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:I dont have the cards in hand.  Once I receive the cards, I will review them to ensure they have the correct information and I will be in touch.I will not close the case until 100% certain the cards are correc**Revdex.com, can you fix my name on your website?Thanks
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:
I did call and talk to the market place and they said that I had to go through Aetna. I called both places three times and no one called me back and let me know what was going on. And each time nobody could tell me anything. Passing the buck to each other. As far as autopay I never set up Autopay with Aetna. so why did they Autopay my account. Plus I payed them $100.00 on July 1st. What happened to that money. And when I talked to Aetna last month they stated that they could not found out anything because my Account was closed for the time in question.  Aetna need to straighten this out. And yes I did turn in all of my paper work. And no I don't have Autopay with Aetna set up. They took that apond themself and set that up themself. Aetna needs to fix this, not the market place. This is Aetna's problem.
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.
We sincerely apologize the effective date was a typo in the
previous response. The policy is effective for everyone on the policy effective
January 01, 2016, and shows as active in all of our systems.
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,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

From: [redacted] Sent: Friday, May 20, 2016 1:57 PMTo: Revdex.com Subject: Re: You have a New Message from Revdex.com Serving Connecticut Regarding Complaint #[redacted]Please be advised that the check was sent; however, there was no apology.Nor was there additional compensation for the year-long wait my client had to go through. Nor has Aetna offered to pay for all of the attorney's fees generated by Aetna's failure to promptly pay.This company deserves an "F."[redacted]

Complaint: [redacted]
I am rejecting this response because:  1)   If my health care policy had been "terminated" after I received policy information and been had issued 2016 ID cards then why did AETNA not so notify me?2)  How come I was still paying for it?3) The first time I contacted AETNA customer service in February of 2016  I was told that the policy was effective for myself,  but not my wife.....which was opposite of the way it should have been.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: Unfortunately, I have not received a full complete resolution. Ashley is correct, the doctor and myself has received approval for the requested procedures but the final piece has not been completed.  Following my conversation with Ashley yesterday, I spoke with the doctors office whom advised me that they had not received a follow-up from Aetna in a week regarding the negotiations. I do not want to be one of those cases that get to the finish line and the insurance company doesn't see there part to completion. This has been a very complicated process. I am hoping to receive an adequate resolution ASAP.
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 Eligibility department to...

verify the member’s termination date. We confirmed it should reflect terminated on June 30, 2015, not May 11, 2015. We are having our eligibility department update the termination date to reflect June 30, 2015. We also had our Claims department adjust any claims that were affected by the incorrect termination date on file. Both dates of services on May 29, 2015, were sent for reprocessing and have been paid to the provider. The new claim IDs for the member’s records are: [redacted]- paid $555.08 and [redacted]- paid $105.48.
Please accept my apology for the incorrect termination date on file which led to a delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issue. Unfortunately, in some instances, procedural 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.
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

Dear [redacted]:   Please see our response to complaint #[redacted] for [redacted] that was received by us on January 31, 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 immediately reached out to our Claims and Customer Service department to have the member’s concerns reviewed. We were advised that the claim was submitted electronically to Aetna with the incorrect member information and our system processed the claim without the logic of the member’s demographic information not matching. Unfortunately, this is a learning curve for Aetna and we are working to have our system distinguish this information going forward to try to prevent this type of situation occurring for our members. Our records indicate that we have corrected this claim and zeroed out this claim under [redacted]’s policy and have processed the claim under the correct member at Aetna. The provider has also been educated on the issue and to be sure the correct information is submitted to Aetna for their patients.   Concerning the customer service the member experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur.  I sincerely apologize for the difficulties the member experienced and that we did not provide the level of service that the member rightfully expects and deserves. These actions are not consistent with Aetna’s service standards and we appreciate the member for notifying us of the experience. I would like to assure the member that we have taken the appropriate actions to address the service issues the member experienced.   I apologize for the frustrations and difficulties the member encountered while attempting to resolve this issue and regret that this matter required much of your time in order to facilitate a resolution. We do appreciate the member’s patience during the time involved in researching and resolving the issue.   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,   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 contacted our Disability department and confirmed that his...

request for Short Term Disability was denied due to insufficient clinical information. His case manager called him on 04/11/16 to advise of this denial however there was no answer and no voicemail available. A letter was sent to [redacted] to explain the denial and provide his appeal rights. We contacted [redacted] on 04/18/16 to discuss his complaint. He understands what is needed to support disability and the lack of supporting information. We have advised him that we will determine if we can offer a peer to peer review even though the claim is denied or if he must file an appeal. We will contact him tomorrow, to advice of the next steps. He expressed appreciation with the call. 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 [redacted]’s 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

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.
please note - although the monies I paid out of pocket have been reimbursed, it took several weeks to do so. Also, please advise Aetna to check their records. Yes, my son is shown to have been added but due to a 'glitch' in their system it was not being shown properly, therefore causing the doctors office to charge me as if I had no insurance coverage. I was told this by multiple representatives upon calling Aetna. I hope this will not happen again, as this has caused unnecessary stress
Sincerely,
E[redacted]

Complaint: [redacted]
I am rejecting this response. This has happened again just today. Aetna rejected my claim from the same provider siting the reason of "no diagnosis code" on the claim. The diagnosis code is clearly provided on the claim.  They do this every time! I can provide documents and claim numbers as I have copies of the submitted claim.
Sincerely,
[redacted]

From: [redacted] Sent: Thursday, May 05, 2016 9:12 PMTo: [email protected]: My Complaint v. Aetna Insurance Co. No. [redacted] Thank you for finally getting someone at Aetna Insurance Company to respond. Despite the information provided in my complaint,...

Aetna claimed it needed more.  I provided it.Then Aetna next said that it needed a signed Authorization from my client in order to communicate with me.  I provided it.An authorization is not necessary, as I am the attorney for the beneficiary under an Aetna Life Insurance Co.  I have been requesting payment from Aetna since February 2015.   All documentation has been provided to Aetna (birth certificate of the beneficiary, who is the son of the decedent, the death certificate, and other documents verifying the familial relationship).   According to one Aetna representative, Aetna completed its review in October 2015.  However, Aetna never paid the benefits.  I have been making numerous telephone calls to Aetna for the past year.  I have been promised return telephone calls, but no return calls are EVER made.  Then on March 21, 2016, I received an email from an Aetna adjuster, Angela P[redacted], who is handling this matter, stating that payment would be made.  She asked "where to send the check" and I provided the mailing address.  However, no payment was made.  I sent a follow up email requesting the status to Ms. P[redacted], but she ignored my inquiry.   After I filed a complaint with you, I did receive a request for more information and an Authorization as stated above.  I provided the Authorization, even though I am counsel for the beneficiary and I have provided Aetna with all of my client's documents.   I expected a response from Aetna, but there has been none.  I find it unconscionable for Aetna to withhold the payment of benefits when its policy states, in black and white, that payment will be made "within 10 days" upon proof.   If Aetna completed its review in October 2015, payment should have been made then.  Instead Aetna waited five (5) months to even communicate its acceptance of the obligation to pay, and even further, Aetna has still refused to make its payment to the beneficiary.  The failure of Aetna to respond to my inquiries, and its neglectful handling of my client's claim, is simply outrageous.   I hope that there is a remedy, not only for my client, one that will penalize Aetna for its sub-standard business practice.  Aetna should pay my client the policy amount, plus attorney's fees and costs, and damages.   If not, I will be filing a claim for bad faith.   Thank you,[redacted]

Dear [redacted]    Please see our response to complaint #[redacted] for [redacted] that was received by us on November 30, 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 member’s complaint we reached out to our Consumer Business department to have the member’s concerns reviewed. Based on review of the bill the member received, we confirmed it was generated in error. The $15.87 was written off and the member is currently showing a $0.00 balance.   I apologize for the frustration this situation has caused the member. Aetna’s goal is to provide prompt, accurate responses to inquiries from our constituents.  We regret that this matter required additional follow up from the member in order to facilitate resolution.  This is not indicative of Aetna’s standards and we appreciate the member’s patience during the time involved in researching and resolving his issue.    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