Chevron USA, Inc.

Thank you for your inquiry received on 07/29/regarding complaint #*** for *** ***. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
We reached out to our Claims Department for
assistance, and were advised that both claims for dates of service 02/06/and 03/06/were processed correctly at the “in-network” level of benefitsThe charges were applied to the member’s deductible responsibility as it had not been met, and no copayment applies
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mrs***’ concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

Complaint: ***
I am rejecting this response because: I received an email stating "Upon receipt of the complaint we immediately reached out to our Claims department to have the member’s claim completedThe claim was finalized on July 29, under claim ID *** and was paid to the member on July 30, 2015." This is untrueWe still have not received payment and were certainly not paid on July It's August 5thThis has been exactly the kind of thing that has been frustrating during the whole process
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because:Clearly we won't mutually agree ever on this point Unless you plan to resolve your billing process I still believe I am correct
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because:I decline to accept that AETAN can cancels a health insurance policy and is under no obligation to notify the policy holder that an issued policy has been canceled.
Sincerely,
*** ***

Dear
MsShea,
Please
see our response to complaint #
for Robert
Whiteside that was received by us on February 17,
We
would like to advise that the specific supporting information MrWhiteside
submitted was received from a Department of Insurance inquiry on February 16,
and a response will be provided by March 08, after the received
information is reviewed.
I
would also like to again advise that Aetna did not attempt to intimidate,
threaten, delay or deceive MrWhiteside, nor did it attempt to discourage
submission of claimsIn 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 MrWhiteside’s issues to
determine if Aetna had appropriately handled his claimsIt was not Aetna’s
intention to infer that MrWhiteside was being investigated; only that Aetna’s
handling of his claims and concerns was being investigated.
I
apologize for any difficulties or confusion this may have caused MrWhiteside
We take customer complaints very seriously and appreciate you taking the time
to contact us and giving us the opportunity to address MrWhiteside’s concerns.
If there are any additional questions regarding this particular matter, please
contact the Executive Resolution Team at [email protected]
Regards,
Julian
Cano
Executive
Resolution Team

Hello,
Thank you for your inquiry, regarding complaint *** *** *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
Upon receipt of the complaint we immediately reached out to our Claims department to have
the member’s claim history from February through October reviewedWe have confirmed that all the member’s claims have been processed and paid to the provider for the calendar year
I apologize for the frustrations and difficulties you have experienced while attempting to obtain payment for your claims, and we regret that your customer service experience was not consistent with Aetna’s service standardsOur goal is to pay claims timely and accurately, and to promptly resolve issues when they do occurI am sorry that this matter required additional follow ups from you in order to facilitate a resolutionWe 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 MsMartin’s concernsIf you have any additional questions regarding this particular matter, please contact the *** *** *** ** ***
Thank you,
*** **
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: ***
I am rejecting this response because:It appears that there may still be some issues with the actions taken by Aetna, and I will need those clarified before I can accept the issue as being resolved.I do see that the claim has been re-processed, however, it appears it has not been officially sent to the provider yet. Additionally, it appears that the wrong provider is listedThey have the provider on the re-processed claim listed as FORWARD ***. In actuality, the actual provider was FORWARD *** *** ***So, I still have concerns that this has not been completed properlyI'd like Aetna to confirm payment to the PROPER providerIt does not do me any good to presume the issue is resolved if they are sending payment to the wrong provider for the services.So to clarify----the service was not provided at Forward Dental in AppletonThe service was provided at *** *** ** *** *** I would like proof and confirmation that the proper provider is being paid and provided the explanation of the claim
Sincerely,
*** ***

*** *** *** Please see our response to complaint # *** for *** *** that was received by us on June 29, Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of the complaint, we contacted our Network
department to address the provider’s concernsOur network team has reached out to the providerWe will work directly with them to ensure contract negotiations are completedWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected] or contact me directly at *** *** *** Sincerely, *** ** Complaint and Appeals Consultant Executive Resolution Team

Dear Ms*** *** Please see our response to complaint #*** for *** ***s that was received by us on June 30, Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of the complaint, we contacted our Claims department to review the January 14, claims from Labtrust When the claims originally processed on February 16, 2016, we sent an explanation of benefits that stated “Your doctor didn't bill us correctly and we've asked for a corrected claimWhen we get that, we will consider this charge.” We found that the provider submitted a corrected claim on March 28, We have confirmed that the claim processed correctly based on the plan benefitsThe claim processed at an out of network benefit and was applied toward the $deductibleAt the time of service the member’s deductible had not been met, so it applied toward the member’s responsibilityThe member has a second level of appeal available if he wishes to pursue another review of the claimWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr*** concernsIf there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** LaShonda CComplaint and Appeal Consultant Executive Resolution Team

Dear Ms*** *** Please see our response to complaint # *** for Jake C*** *** that was received by us on July 05, 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 review the member’s fileWe have confirmed that claims from December 1, 2015, December 8, and December 11, have been processed for paymentThe payment for December 8, will be sent to the provider on July 19, in the amount of $We spoke to the provider and confirmed that a credit is on file for the member’s accountThe office states that once they post our final payment to the account, a check will be mailed to the memberWe also contacted the member to discuss her concerns but she was unavailableWe left a message and have not received a return callWe apologize for any difficulties and inconvenience this has caused the memberWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MsD*** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Complaint: ***
I am rejecting this response because:
The response from Aetna does sound like a response from an attorney rather than anyone actually addressing my concernsThis is just a summary of the benefit that is so couched in "legalize" that I am not sure that my actual issue was addressedThat is, the response of the individuals, the representative and her supervisor, in addressing my concerns
Since I did send an email to the company CEO, I did receive immediate feedback (within 1/hours) from someone with the corporate office who was able to answer my questions (that the initial Aetna representatives could not)It is a travesty that a paying customer should have to contact the CEO in order to obtain a response to a reasonable question about benefits
Additionally, while I communicated my concerns in my complaint using my name as Power of Attorney for my mother, I notice that their response on this public website uses her full name and potential need for hospice servicesSince this is protected health information I wonder if there has also been negligence in this
It almost seems malicious unless the person writing the response is not familiar with HIPPA requirements
Sincerely,
*** ***

Hello,
Thank you for your inquiry, regarding complaint *** *** *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
Upon receipt of the complaint we immediately reached out to our Aetna Student Health (ASH)
Claims department to have the member’s concern addressedWe were advised that the member’s plan has a $annual deductibleThe visit on July 07, 2015, was for an urgent care visit (sick visit) and was applied to the 2014/plan year deductible in the amount of $The member would be responsible for this amountThe visit on December 07, 2015, was also an office visit (sick visit) and was applied to the 2015/plan year deductible in the amount of $The member would be responsible for this amount as well
The plan renewal date is based on the academic year, not a calendar yearThe plan renews on September 01, 2015, therefore the member’s deductible is renewed as well
The member did have two other claims on file that were paid in March of 2015, but those visits were preventative visits, and under Health Care Reform, are not subject to the deductible and are paid at 100%
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MsTran’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Hello, Thank you for your inquiry, regarding complaint # *** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon the receipt of our complaint, we reached out to our Medicare marketing and communications
department to have the complaint reviewedWe have been advised that a $gift card has been ordered for *** *** as of May 12, 2016, and should arrive within the next business days to the address provided in the complaintThe delay in distributing the $gift card resulted in the Aetna not showing a record of the business response card ever being received in our officesI sincerely apologize for difficulties you have experienced surrounding this issueWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***Thank you, Tanika KComplaint and Appeal Consultant Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint #***
for *** *** Our Executive Resolution Team researched your concerns, and I
would like to share the results of the review with you
Upon receipt of the complaint we immediately reached out to
the provider’s office, as well as the facility to find out what had been
received by each officeWe have confirmed that both offices have received
their single case agreements and the negotiations are fully executedI
contacted the member directly this morning to let her know the outcome of the
complaint
We take customer complaints very seriously and appreciate
you taking the time to contact us and giving us the opportunity to address *** *** concernsIf you have any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

*** *** *** *** Please see our response to complaint *** for *** *** that was received by us on September 14, 2016. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. Our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occurI sincerely apologize for the difficulties the member experiencedAs previously stated, the member’s medication required precertificationThis is not ***s way of saying that the member did not need the medication or to cause any delaysPrecertification is required for many different medications Again, the two day delay was due to our Precertification department not being contacted until August 31, The medication was denied at the pharmacy on August 29, 2016, due to the precertification requirementThe provider called two days later to request the precertification and it was approved on the same dayThe member and the provider were notified of the approval and the member picked up the medication that same day Based on our records, we have addressed *** *** concerns on previous complaintsTherefore, 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 Mr*** ***s. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
*Sincerely, As*** **Complaint and Appeals ConsultantExecutive Resolution Team

Dear *** ***: Please see our response to complaint #*** for *** *** that was received by us on April 3, 2018. Our Executive Resolution Team researched her concerns, and I would like to share the results of the review with youUpon receipt of the complaint, we reached out to
the area that works closely with the plan sponsor for *** ***’s policy. We were advised that the calculation for coordination of benefits has changed so that the $deductible is patient responsibility when *** is the primary insurance carrier. There are $and $copays that apply for primary care physician and specialist office visits respectively. Once the deductible is met, there is also a 20% coinsurance that applies for hospital servicesWe confirmed that an explanation of the coordination of benefits calculation is given in the plan documentation. This is the relevant language: “When *** is the primary payor and the provider accepts *** assignment, our allowance is the difference between ***'s allowance and the amount paid by ***We do not pay more than our allowanceYou are still responsible for your copayment, deductible or coinsurance based on the amount left after *** payment.” We did also check on the status of the reimbursement for *** ***’s prescription claim. It was found that a check was issued to her on April 4, 2018, in the amount of $136.99. The amount that *** *** paid was reimbursed to her minus a $copayment. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Regards, Chris BComplaints and Appeals Consultant Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint #*** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
Upon receipt of the complaint we immediately reached out to our Marketing department to verify
when the member would be receiving the gift card for going to the seminar on October 19, We were advised that the customers could receive a gift card one of two waysFirst, fill out a BRC (business response cards, which are distributed to attendees at the Sales Seminars) either online or return by mail, as indicated on the BRC itselfCustomers can also call one of the telephone number’s advertised in the TV/Direct Mail in the areas, where Sales Seminars are not available
According to our records, we did not receive a valid BRC from Mr*** and the numbers that he called were not valid phone numbers for this year *** card promotionThe numbers called were general Seminar Finder lines and last year’s gift card telephone numberDue to the confusion, we will issue a gift card to Mr***, which he should receive in the next weeks
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***.com
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

When I called in to Aetna on 6/22/and spoke with *** she informed me that *** did not do her job correctly when she did the precertification *** said it was the responsibility of *** to determine how the claim would be billed Since *** did not do the leg work correctly when she did the precertification that Aetna would honor the information that *** had given me and I would owe a $copay for each visit I would have never seen *** *** if it was going to cost me more than $per visit
Complaint: ***
I am rejecting this response because:
Sincerely,
*** ***

Hello,
Thank you for your inquiry, regarding complaint #*** *** *** *** Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
Upon receipt of the complaint we immediately reached out to our Aetna Student Health
department to have the member’s concerns reviewedWe were advised that the member called Aetna on February 17, 2016, requesting for his 1099HC formOn the call it was discovered that the member did not receive the form because he did not have a Massachusetts address on file (which is what triggers these forms to be sent)He previously lived in Florida, and had not advised Aetna to update the address with us prior to the call on February 17,
During the call Aetna was able to update the address with our representative, and the representative processed the request for the formThe form was created on February 19, 2016, and was mailed on our next issue date of February 26, The member should receive the form sometime this week
On the call we explained the reason the member didn’t receive it, and we also gave him all of the information from the form that he needs to file taxesThe actual form is not needed to file with their taxes; they simply transcribe the information from the 1099HC to their tax formThe only time the actual form is required by the IRS is the event of an audit
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: ***
I am rejecting this response because:Dear Revdex.com,As you can clearly see from the response from Aetna, they can not even get my name correct in the correspondence about correcting my name!!! Please see the red areas below for my comments.While I will agree that the term "medical" may have been a poor choice for a description, what I was referring too in my complaint is my Aetna Vision cards. Ashley is correct that Aetna carries my Dental coverage, but she is incorrect when she states that is all. Aetna carries my vision as well. Please see the attached pictures. On my dental information, my name is listed correctly, on my vision information, it is listed two different ways on the same piece of paper, and both are incorrect And as far as contacting my employer for corrected cards, they do not issue the cards, they only provide information to the carriers who distribute the cards to the members. When I signed up for the insurance, I filled out the paperwork correctly and with my full legal name.Bottom line is that I need my legal name reflected on my vision cards and other pertinent information related to insurance coverage.And to the Revdex.com, your system doesn't have my name listed correctly either. If I have a complaint about the Revdex.com, who do I send that too.I have attached some pictures for your viewing pleasure. I look forward to a response and mitigation of this matter*** * *** **
Thank you for your inquiry, regarding complaint # *** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of the complaint we immediately had our files reviewed to verify that we had the member’s name correct in our systemOur records indicate we have the member’s name in our system just as it shows in the Revdex.com complain** Our records also indicate that we do not carry this employer’s medical benefits, only dental benefitsThe employer’s medical benefits are with any of the following carriers: ***, *** and *** *** ***Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those recordsPlease contact your medical carrier to request a corrected medical ID cardWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
*** * *** **