Chevron USA, Inc.

Dear *** *** ***: Please see our response to complaint #*** for *** *** that was received by us on May 22, 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
concerns, we immediately reached out to a plan representativeThey researched this issue and have provided a responseThe complaint is concerning denied multiple claims for the member’s doctor visits from December and The member states that she has received multiple bills from the provider and that she has called us three times and each time we have assured her that we will reprocess the claims, but nothing has been corrected yet In reviewing these concerns, the member’s claims were impacted by our transition into a new systemAll the member’s claims have been reprocessed and the explanations of benefits (EOB) have been sent out We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Sincerely, Michael H. SrComplaint and Appeal AnalystExecutive Resolution Team

Complaint: ***
I am rejecting this response because:
Sincerely,
*** ***1) For two months my wife carried a (supposedly valid) AETNA health insurance card with group numbers, ID numbers for a fully paid up AETAN health insurance policy.2) When it was found to be invalid, AETNA never once made any attempt to offer assistance or resolution .3) Would it have been an unreasonable expectation for AETNA customer service to connect me with someone who could deal with the issue, and if that person had to confirm that information with the *** ** ***, to them offer to do so to resolve the issue caused by an AETNA administrative error?3) I got absolutely NO assistance from AETNA at all4) The reason the *** ** *** had to request the account be rescinded was because AETNA established the account incorrectly and seemed to be unable or unwilling to admit or to correct their administrative error.5) Resolution was only possible because an AETNA representative was physically present in Wichita dealing with other issues.When the problem was presented to the AETNA representative they had to physically return to their office with an administraive access computer to to rescind and reissue a valid policy.Explain to me again how this makes it a *** ** *** problem over which AETNA had no control?I find AETNAs cavalier and indifferent position that this was not their problem, they had no responsibility to attempt to proved customer service and resolution both arrogant and reprehensible

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 this complaint our office had already received a letter from the member
regarding the same complaintThe consultant reached out to speak with the member to let him know we would research the issueThe member was advised that his claim was processed correctly according to his coordination of benefitsThere will be no additional payments made on the claim
I understand your concerns and recognize this is not the outcome you desiredOur 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 Mr***’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 Christophe and Stephanie SilvestriOur Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
Our records indicate that the provider originally sent in the wrong procedure to be reviewedWe have since reached out to the provider’s office to have a new pre-authorization request submitted on both the member’s behalf with the correct procedure that is to be done reviewedOur Medical Director reviewed both of the member’s pre-authorizations and a decision was made to allow both Mrand Mrs*** surgeryWe have contacted the members and the provider’s office to advise of the approval and schedule the surgery
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mrand Mrs*** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Thank you,
*** **
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: ***
I am rejecting this response because:We are not contesting the bill from DrF*We paid him out of pocketThe *** Hospital sent us the bill for Dr***, who was told I didn't need precertificationAnd when I appealed the bill, the insurance said I was denied because it was after days past the date of serviceThere was no mention of Dr*** at allHe was paid separately and in entirety prior to the procedure.
Sincerely,
*** ***

Dear MsShea,
Please see our response to complaint *** *** *** *** that was received by us on January 11,
During our review, we reached out to our Disability department to address Ms*** concernsIt was determined the denial was accurateThe Disability department sent Ms*** a letter dated December 11,
The letter has the appeal instructions Ms*** can follow if she does not agree with the determination and explains the decision in detailThe letter states Ms*** may appeal within days and send the appeal in writing to:
Aetna Life Insurance Company
TriNet Group, IncAppeals
PO Box
Lexington, KY 40512-
Fax: ###-###-####
I apologize for any difficulties or confusion this may have caused Ms*** We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf there are any additional questions regarding this particular matter, please contact the Executive Resolution Team ** ***
Regards,
Julian C***
Executive Resolution Team

Thank you for your inquiry received on 07/06/regarding complaint #*** for *** ** ***. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.We made several attempts to reach out to Mr*** for additional information
and were unable to get ahold of him via email or telephoneVoicemail messages were left with contact phone number for him to call us back so we can assist himTo date, Mr*** has not returned the phone calls or emailFurthermore, the Pharmacy department reviewed Mr*** file, and found no denials on file for any medications to date.We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr*** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

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 receipt of the complaint, we contacted our Customer Service department to review your concerns
The supervisor contacted the member on May 17th to address his concernsThe Executive Office also attempted to reach the member but there was no answerThere was no voice mail option availableWe 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, LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Complaint: ***
I am rejecting this response because:
While it is true that in the conversation with the Aetna representative prior to the procedure I was told that Aetna would only cover (a portion of) services after I had me the $6,deductible, it is also true that in that same conversation the representative told me that the negotiated price for that procedure at that particular hospital was just over $400, rather than roughly $2,that I've been billedPlease listen to the call again, we even discussed what "negotiated price" meantYou will find that I also asked for the price information in writing, to be sent by email but the representative regretted, she couldn't email it. I was very keen to know the price because I had done some research before hand and learned the cost varies from one place to anotherIn the research I had found a different place where I could have gone, where the don't take insurance and they charge $I wanted to go to the cheapest place, and that's why I asked the price through Aetna before handIn that conversation with Aetna I was told I would be responsible for $at that particular hospital, and I ended going there because I was lead to believe it would be the cheapest optionI was indeed misled, whether they intended or notMoreover, when I called again (after realizing the price would be different from the quote) the second representative I spoke again quoted a in the same range (over $300, which was afterwards "corrected" to over $400) which makes me believe perhaps their system gave them wrong information that then passed on to me.
Sincerely,
*** ***

Dear *** *** *** Please see our response to complaint #*** for *** *** that was received by us on June 27, 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 Medicare department to have the member’s concerns reviewedMedicare confirmed that the letter does not state we are sending the member to collections but that we are sending one letter to request the overpayment that is due by the memberWe were advised that the Medicare formulary shows that the member’s medication brand has the 150mg and mg on the tier three preferred brand name drug tierThe mg has a quantity limit (QL) of per daysThe mg has a QL of per days The member contacted the Medicare department to request a QL exception or lower the tier and make a tiering exceptionWe approved the member’s request for the QL for the 75mg and lower the tier for the 150mgThe request was approved by Medicare in early March and retro-activated the effective date to January 01, The member requested Aetna Medicare to reimburse her for the $that was paid on January 20, 2016, for both strengths of the medicationWe were advised this request was denied because the member stopped the payment on the credit card and the money was never deducted, therefore Aetna never received the paymentWe will reimburse the member for an overpayment the member made of $minus the applicable $copay Aetna Medicare is sending the member a check for $since the deductible should not have applied to the tier one or tier two medicationsThe remainder of the member’s claims have been processed correctlyThe member will receive a detailed resolution letter from Medicare within 7-business days. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***. Sincerely, Ashley W.Complaint and Appeals ConsultantExecutive Resolution Team

Dear Ms*** *** Please see our response to complaint #*** for *** *** that was received by us on June 22, 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 Billing and Enrollment department to have the member’s concerns reviewedWe were advised that the dependents were terminated as requested effective November 30, The member’s premium rate changed for the period of December 01, to December 31, 2015, after the dependents were removed from the plan Aetna has processed a refund in the amount of $back the member’s credit card account on June 24, and the refund should appear on the member’s credit card account within three to five business daysPlease accept my apologies for the difficulties the member has encountered with AetnaAetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processesI want you to know that we appreciate the feedback because it gives us the opportunity to listen to our customers and make any improvements to our processes and the service we provideThe member’s 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 Ms*** concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at s***
* Sincerely, Ashley WComplaint and Appeals Consultant Executive Resolution Team

Complaint: ***
I am rejecting this response because:
That is clearly incorrect according to my plan coverage informationAetna is using different language to get out of paying, when they in fact have a duty toThey are trying to find ways for my deductible to apply when it doesn't, yet they have not applied it to my prescriptionsAetna tried to pay $on my most recent doctors visit.
Sincerely,
*** ***

Dear Ashley S.Re: Complaint ***Please note I have not received any messages from Aetna direcly to solve this situation. All the calls I have received have been from the collection agency. However, here is the information requested:Employee Name: *** ***Date of Birth: ***Employer: *** *** Aetna Account Number ***Thanks for your prompt response. *** ** ** ***cc: Revdex.com

Hello,
Thank you for your inquiry, regarding complaint # *** received on 09/22/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 contacted our Claims department
and confirmed that the claim from Dr*** was denied correctlyThe authorization on file was for *** Hospital and Dr***. Dr*** was not included in the authorizationUnfortunately, we would not be able to make an exception to allow this claim without an authorization
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Thank you, LaShonda CExecutive Resolution Team

Dear Ms*** ***: Please see our response to complaint #*** for *** *** that was received by us on December 02, 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 Network department to have the provider’s concerns reviewedWe were advised that the department was first made aware of Dr***’s participation request on June 03, 2016, via customer serviceOnly a W-was submitted at the time the request was receivedThe Network Manager reached out to Dr, ***’s office to request a roster, and a valid email addressNumerous attempts were made to the provider’s email address at *** as well as a fax being sent explaining the attempts made to contact *** the office manager and the roster paperwork that was neededLater *** sent an email in late July indicating that the office was having issues with emailsOn September 06, 2016, the Network Manager sent an email with a blank roster template for the office to use at their new email; and again on September 29, 2016, to yet another email addressLast month *** reached out to the network representative, requesting to send an agreement to yet another email address, still without a roster, necessary to release an agreement Based on the complaint sent to the Revdex.com we had another outreach made to *** at the provider’s office and we have confirmed that a roster was received by our department on Thursday, December 08, An electronic agreement will be sent to the office early this week and they have my direct contact information if any additional assistance is needed We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Dr***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Sincerely, Ashley WComplaint and Appeals Consultant Executive Resolution Team

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID *** I do hope Aetna will make the needed service and technology improvements.
Sincerely,
*** ***

Thank you for working with me on this issue Total cost dropped from $to ~$300, much closer to the quoted prices we received prior to care
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***

Thank you for your inquiry received on 09/01/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 Disability department, and were
advised the member’s claim was overpaid due to his Social Security Disability benefit awardThat calculation was processed on 04/17/2015, and an overpayment letter seeking repayment from the member was mailed on that same dayA second letter requesting repayment from the member was mailed 05/04/In total the member had days to repay the overpayment, or contact Aetna to make payment arrangements prior to referring the overpayment to a collections agencyThe letters sent to the member also referenced the following: “Please be aware that pursuant to Long Term Disability (LTD) plan, Aetna reserves the right to suspend or adjust future benefits, or possibly refer the matter to a collections agency for handling.”
The collections agency originally received the referral on 06/23/Once a referral is made to and received by the collections agency, any repayments are to be handled by the collections agency directly
The member contacted Aetna on 06/29/2015, and we agreed to stop collections activity to allow him time to provide the requested documentation. As of 08/06/15, we have not received the documentationTherefore, collections activity resumed
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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

Complaint: ***
I am rejecting this response because: I'm going to wait until this claim is actually processedBecause of the major delay in coming to a resolution, I'm skeptical about whether or not this will really get processed properly and promptly
Sincerely,
*** ***

Dear *** *** ***: Please see our response to complaint #*** for *** *** that was received by us on March 20, 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 Customer Service department to have the member’s concerns reviewedOur Customer Service department was aware of the member’s request and were working to reissue the checkWe completed the request and overnighted the check to the memberThe *** tracking number was ***This was delivered to the member’s confirmed address on March 27, 2018, at 10:14amPlease relay my apologies for the difficulties the complainant has encountered with AetnaI’m sorry that our representatives were not able to assist her when she calledOur goal is to provide quality service and satisfaction to our members, and I sincerely regret that *** *** did not receive the service she should rightfully expect and deserveHer concerns have been forwarded to our management team for improvement opportunitiesI hope that going forward we will be able to regain *** ***’s confidence in usRegarding her request for reimbursement for her time, we are unable to provide compensation to any complainant.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 ***Sincerely,William B.Complaint and Appeals ConsultantExecutive Resolution Team