Chevron USA, Inc.

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,
*** ***

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 Claims department to have the date of service reviewedWe were advised that the provider submitted a corrected claim on March 28, 2016, which was processed correctly per the plan benefitsThe benefit for these services rendered, when completed by an out of network provider, is to cover any lab work at 60% after the deductible is metAt the time of service the member’s deductible had not been met, so it correctly applied the member’s responsibility to the deductible, for the services that were rendered While we understand the concerns and recognize this is not the resolution the member sought, our decision remains unchangedOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participantsThe member does a second level of appeal if he wishes to pursue another review of the claim We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrGibbins’ 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

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID *** and will accept the decision even though I do not agree with it

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 contacted our Enrollment department to review the
member’s concernsWe were advised that this member changed plan options for
The member changed from the CDHP plan, enrollment code EP1, to the Aetna
Direct plan, enrollment code ***
The
FEHBP brochure states in section 5: “If you terminate your participation in
this Plan, any remaining Medical Fund balance will be forfeited.” If the member
would have stayed in the same plan, the funds would rollover from year to year,
but due to the plan change the member forfeited the funds in the account
Aetna cannot allow an exception for a plan changeThe member would need to
speak to their Health Benefits Officer
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address MrFreedman’s 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

Dear *** *** *** Please see our response to complaint #*** for *** *** that was received by us on September 16, 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 member’s concerns reviewedWe were advised that the provider’s contracted rate is $for HMO productsThe $rate is for non-HMO productsAll claims have been reviewed and any that were incorrect have been reprocessed to show the correct rateThe explanation of benefits (EOB) should be available for the member within 24-hoursIf the member is not able to see the EOBs online please have him contact the email address below and we can email it to him All services are applying to member’s tier two deductible, however it appears based on the member’s complaint that the provider will owe the member a refundThe member stated he was paying the provider an additional $on top of the $for the claimsOnce the provider gets the corrected EOBs and the member gets the EOB the difference would be $ Please accept my apology for the delay in processing the member’s claim correctly, and that it required multiple attempts on his part to resolve the issuesUnfortunately, in some instances, procedural errors do occurWhen 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 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 frustrations and difficulties he experienced and that we did not provide the level of service that he rightfully expects and deserves. These actions are not consistent with Aetna’s service standards and we appreciate the member notifying us of the experience. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrSonta’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected] Sincerely, *** ** Complaint and Appeals Consultant Executive Resolution Team

Complaint: ***
I am rejecting this response because: I contacted Aetna was advised they paid which the maximum benefit is so they would pay a difference of $298.41 I spoke with a rep on 4/by the name of Sue and she said she was processing a paymentI thought this has been resolved spoke with another rep on 5/2/she did not see anything regarding the claim and the amount of $298.01 just want to get to this resolution.
*** ***

This is not the information *** had given me when she did the precertification for me to see *** *** I was seen in a doctors office I would have never seen *** *** if it was not going to be the $copay that *** had told me.
Complaint: ***
I am rejecting this response because:
Sincerely,
*** ***

Hello,
Thank you for your inquiry, regarding complaint #*** for Jared G***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 effective date and termination date of the policyOur records indicate the policy was effective on November 10, 2014, and terminated on January 01, We received a retro-termination request from the employer to back date the termination to January 01,
*** does not have control over the termination or premium refund requestsAny termination requests are forwarded to *** from the employerIf the member is seeking a refund for the policy he must contact his Human Resources department, *** is not able to refund premiums
Our records indicate that there is only one call on file from the member inquiring about the eligibility status on January 05, at 12:15pmI apologize for the frustrations and difficulties you encountered while attempting to resolve this issue and regret that this matter required your time in order to facilitate a resolutionUnfortunately, we are unable to honor your request for compensation
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrG***’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

Complaint: ***
I am rejecting this response because ::::::: I was able to make contact with AETNA and spoke with Ashley regarding my open complaint with AETNAThe case is still pending reviewWe are still in the process of working out the Medical Necessity and Need of ServiceThere has been a bit of back and forth on both Aetna and the referred physicianI would like to keep this claim open until a resolution is providedI am confident when saying if Ashley would have been the "sales" rep that I spoke with at AETNA this complaint would not existShe is truly helpful however; a resolution is what I needI am paying AETNA $monthly for health services that are not catered to my immediate health or lifestyleThe prolonging of this complaint with no resolution has caused me loss of time at work, stress both mental and physical and financial hardshipI would like AETNA to make this rightThis is becoming a complete nightmarePlease leave this case openWhile this is truly private in nature, going public may be the best form of action to prevent sales or lack of treatment/ assistant due to benefit deficiency Thanks for getting the ball rolling Revdex.comAs a Billion dollar corporation, AETNA should consider not outsourcing there business due to lack of training and development
Sincerely,
*** ***

Dear *** *** ***: Please see our response to complaint #*** for *** *** that was received by us on April 24, 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 complaint we reached out to our Claims department to have the member’s concerns reviewedWe confirmed that the file was closed due to not receiving the other insurance information requested in a Coordination of Benefits letter that was previously sentWe have now reviewed the file and made adjustments since the information has been received After the member’s record was update we had the claims reviewed. The claims for *** *** *** and *** *** at *** *** *** have been reprocessed and a payment was issued to the providersYou will receive an updated Explanation of Benefits within 7-business daysThe claim for services rendered on October 08, 2017, was processed and paid on January 12, 2018, to *** *** *** Please accept my apologies for the inconvenience and difficulties the member experienced while trying to obtain payment for her claimsOur goal is to pay claims timely and accurately, and to promptly resolve issues when they do occurWe regret that the member’s experience with Aetna was less than satisfactory and hope that we can better assist the member in the future. 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, Kim BComplaint 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
We have reviewed all of our records and confirm that this check was counterfeitThe member contacted Aetna and was advised that we would investigate the origin of the check and get back to himThe member did not wait and cashed the checkBy doing so the member accepted the risk of exercising the check without first waiting for Aetna to get back to verify the check or informing him that it was counterfeitWe will not be issuing the member a new check as there were no records on file for a life insurance policy, medical claims or pharmacy claims that would be eligible for a reimbursement check
If the member wishes for us to cover the fees occurred for cashing the counterfeit check, he must submit a bank statement showing the fees chargedWe will send this to our Business Unit department for review of reimbursement
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 Jada HeadOur 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 member’s issue reviewed
Due to circumstances surrounding the requests and privacy laws we would like to resolve this directly with the memberWe reached out to her directly by email today and provided a direct number to reach me to discuss how we can resolve this to the member’s satisfactionIf for any reason the member did not receive the email from today, please contact the email provided below
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

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 Claims department to have the claims in question reviewedWe were advised that the provider has billed (psychological testing) which requires precertification regardless of provider participationThe claim however should not have been denied but pended for medical records as this is from a non-par providerThe claim was not denied for diagnosis codes but rather medical recordsThe provider will need to call our precertification department at ###-###-#### to request this procedure be covered for future visitsThe other procedure the provider bills for the member, *** does not require precertificationI sincerely apologize for any inconvenience or misunderstanding this has caused
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,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: ***
I am rejecting this response because:what Aetna said all my claims are re-processed, simply it's not trueI logged into my account, as now the claim #***( part 2), #***, #*** are still wrongly rejected based on educational charges not covered, even thoughwe are covered and received the pre-certification letter in advanceand claim # ***, #***, # *** are all partially denied saying provider's charges are over the agreed rate The insurance need pay the agreed part, as before, such as pay ($out of $billed) as processed correctly before, instead of simply denied the whole charge.and what Aetna said they will start to process my claims correctly, this is also not true, a new claim on 9/17/just shows up and got denied againI called the provider - *** *** ***, she told me that she was still was owed about $from Aetna for the wrongly rejected claims and she is going to stop the service if she continue not to be able to get paidIn summary, what the Aetna said is simply not true and seriously damage our son's chance to get service and recovery
Sincerely,
*** **

Complaint: ***
I am rejecting this response because:Supervisor did not contact me on May 17. The problem has not been resolved as confirmed by my discussions just this morning (May 18) with Customer Service.We receive considerable unsolicited calls so we do screen our telephone calls. However we do have an answering machine which I confirmed today is working properly. I am happy to talk with the Executive Resolution team. HM ###-###-#### or cell ###-###-####
Sincerely,
*** ***

Dear *** *** ***: Please see our response to complaint #*** for *** *** that was received by us on May 15, 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 contacted the Disability department to review the member’s concernsWe confirmed that the medical records that were needed to make a determination were received on May 9, The claim was then under review until May 17, At that time the claim was approvedA resolution letter detailing the approval was sent on May 17, 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, Nicole EComplaint and Appeals Analyst 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 Eligibility department to
confirm what date the member should have on file as a termination dateWe confirmed that we had the incorrect information on file for the memberWe have since updated the policy to show terminated as of December 31, We also sent the member’s dental claim back for same day reprocessing and it was completed yesterday, January 25, The provider will receive the payment and a corrected explanation of benefits within 7-business days
Please accept my apology for the delay in processing the member’s claim correctlyUnfortunately, in some instances, procedural errors do occurWhen 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 recurrenceWe 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 Ms***’s 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

***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 reached out to Katherine at the facility and discussed the situation surrounding the claimKatherine advised that the facility has agreed to write off the members balance and he currently has a zero balancePlease contact the facility for any questions about the write offAt this time we are working with the facility to review Dr*** contractWe 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 Mr*** 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:
Sincerely,
*** *** My wife and I have received word that they are still denying the claim - now saying they will not coverage the procedure due to it be experimental.As per the bulletin that they are going by, the procedure is listed and approved by the insurance company.The link here *** is for that bulletin which discusses the procedures covered

Complaint: ***
I am rejecting this response because: Aetna are claiming that one drugs test are MUTIPLE SEPERATE TESTS My doc ordered a simple drugs test and Aetna are claiming one urine sample was multiple seperate itemized bills This way they can treat one bill as MUTIPLE visits Claiming one drug test are seperate itemized drug tests first of all, then changing to a blank "they are out of network" response is changing their story It's proven that random methods of deniying a claim are being used First it tells me one test is many tests and only one in a period of time is covered The next is a general "out of network" denial of coverage Which one is it Aetna? Lack of coverage due to what? Out of network or limited by multiple use (even though it's a single drugs test?)The initial drug screening was ONE test You claimed an itemized bill meant seperate tests do you only paid half Now you change your story?
Sincerely,
*** ***