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 meSubsequent calls to Aetna have been met with enthusiastic response and attempts to help resolve pending issues *** *** *** is but one of the groups that are requesting payment for services I hope Aetna continues to work with its employees for further training so that similar incidents do not occur in the future.Thank you for your assistance with this issue
Sincerely,
*** ***

Thank you for your inquiry received on 07/10/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 Aetna’s Disability department, and
were advised that a check was issued on 07/17/However, it was the incorrect amount and did not contain the appropriate offset for ** *** ***, and was reversed. The benefit manager notified the claimant of this on 07/17/on the telephone, and understood he is not to cash check # ***We had to wait for confirmation of the stop payment before reissuing another check. The second check was processed today 07/22/15, and is scheduled to go out to the claimant on 07/24/In addition, the claimant’s claim is approved through 08/09/
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 you
Upon receipt of the compliant we requested that our Network Director reach out to the provider directly on Friday to have her concerns addressedWe were advised that Ms*** was able to speak with our Director and they discussed her concerns regarding her contracts with AetnaOur Director left the provider with her direct contact information for any issues that may arise in the future
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 AetnaI would also like to thank you for sharing your experience with usIt is feedback like yours that helps us address issues and prevent them 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,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: ***
I am rejecting this response because: I have contacted my HR Department and they said that Aetna sets there premium price.
Sincerely,
*** ***

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
member’s claim completedThe claim was finalized on July 29, under claim ID *** and was paid to the member on July 30,
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 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 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 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

Dear *** ***Please see our response to complaint #*** for *** *** that was received by us on April 29, 2016.Upon receipt of the complaint, we reached out to the representative of our Regulatory Resolution Team that was handling the complaint *** *** had filed with the Department
of Insurance It was found that our Billing and Enrollment department had received the information needed to locate the payment, which was then posted to her policy on May 5, With all the payments that have been posted to the policy, we now show that she is paid to current through May 31, We apologize for and regret any frustration *** *** experienced during the resolution of this issue. 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 B***Complaints and Appeals ConsultantExecutive Resolution Team

Complaint: ***
I am rejecting this response because: AETNA ignored the already verified TIN by *** ***, ***, *** *** *** in JulyAETNA has made no effort to contact HERShe is in charge of physician contracts
Sincerely,
*** *** First name SPELLING correction

Dear *** *** *** Please see our response to complaint #*** for *** *** that was received by us on March 09, 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 Disability department to have the claimant’s concerns reviewedWe were advised that the Short Term Disability (***) claim was denied because the surgery is considered *** *** is not a covered benefit under the *** benefitThe Family and Medical Leave Act (***) claim was initially denied for not enough hours worked to be eligible; once the claimant’s employer confirmed enough hours had been worked, it was denied for not being due to a serious health condition. A decision on a *** or *** claim is only completed when all forms and supporting documentation is received from the surgeryThis is why we would not have advised the claimant that her claim would deny prior to the surgeryThe claimant was provided appeal rights if she wishes to pursue the appeal the denial of the *** and *** claim 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

*** *** *** *** Please see our response to complaint #1*** *** *** *** that was received by us on October 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 Enrollment and Eligibility department to have the member’s concerns reviewedWe were advised that the member added the dependent effective June 02, 2016, which caused a rate change in the premium effective the first of JulyThe member paid the old premium rate for the July premium which caused the dependent to be terminated from the policy and the premium was refunded The member made a payment on October 10, 2016, and the account was reinstatedThe payment was made one day prior to our automatic dunning process (termination process) for the current period which was September 01, to September 30, Due to the payment being received but not posted to the account at the time of the dunning process, the account was terminated again in errorWe sincerely apologize for the incorrect handling of the policy The account was reinstated on October 28, 2016, with no lapse in coverageThe member will have to make the premium payment for November by November 30, 2016, at the latest to avoid a terminationAny claim that may have been occurred during the time of adjusting the plan can be resubmitted for consideration since there was not a lapse in coverage We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrHaner’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Sincerely, *** ** Complaint 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 Claims department to
verify if the claims were processed correctlyWe were advised that they were processed correctly according to the plan benefitsUnfortunately, we are unable to advise a provider how to bill the services that were renderedAetna would only be able to reprocess the services rendered if the provider wishes to rebill the servicesOutpatient surgery can be completed in an office or a hospitalYour benefits state the following for outpatient surgery:
Outpatient Surgery ***:
Performed at a Hospital Outpatient Facility:
aIN- NETWORK: $per visit copay after Calendar Year deductible then the plan pays 90%
bOUT-OF-NETWORK 60% per visit/surgical procedure after Calendar Year deductible
Performed at any other Facility:
aIN- NETWORK: 90% per visit/surgical procedure after Calendar Year deductible
bOUT-OF-NETWORK: 60% per visit/surgical procedure after Calendar Year deductible
While we understand your concerns and recognize this is not the resolution you sought, our decision remains unchanged as the claims are processed correctlyOur 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*** 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:
State of CA Department of Insurance is investigating issuing a new case +HCB-February 16, 2016.I will standby while the Department investigates the issues in complaint
Sincerely,
Robert Whiteside

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 immediately reached out to our Dental Claims department to have
the member’s concerns reviewedWe were advised that the daughter’s claim was correctly denied under the dental plan due to plan provisionsThe benefits that were set up by the employer states that if a member is enrolled in a medical plan, and that medical plan denies a claim for impactions (wisdom teeth removal) only then Aetna will cover the services under the dental plan, otherwise they are not coveredSince the daughter’s services were allowed and applied to the medical deductible, not denied, Aetna will not be covering the services rendered per the plan provisionsWe paid the son’s claim in error and will be requesting an overpayment from the provider for those services renderedThe claim will need to be sent to the medical plan for consideration as the primary payeeI understand your concerns and recognize this is not the outcome you desiredHowever, we must make coverage decisions in accordance with your plan of benefitsWe 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 SComplaint and Appeal Consultant Executive Resolution Team

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 Billing department to determine how the member was enrolled with AutopayBased on our review, it indicates that the member enrolled her information on April 26, at 04:39pmAetna did not set up this member's AutopayWe did receive the $payment on July 9, It was applied to the member's May invoice because it was short paid since her premium due for May was $Unfortunately, we can not refund the payment. We apologize for the inconvenience however the member would need to contact the Marketplace to dispute the loss of APTC which increased her premium rates.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 CComplaint and Appeal Consultant Executive Resolution Team

Dear *** *** ***: Please see our response to complaint #*** for *** ** *** *** that was received by us on June 01, 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 provider’s complaint, we reached out to our Credentialing department to have their concerns reviewedWe confirmed that Aetna’s Credentialing department reached out to *** *** with *** ** *** *** on June 04, The Credentialing representative confirmed that *** *** was requesting a group contract since the providers were already enrolled In reviewing the concerns, the Credentialing representative reached out to *** *** again on June 05, 2018, to confirm she was submitting their paperwork to the correct fax number, which she wasThe Credentialing representative received the documents and forwarded them to Aetna’s Contracting department for reviewA contracting representative will reach out to *** *** directly to assist with setting up the contracts I sincerely apologize for the inconvenience and difficulty this situation has causedI want the provider’s office to know that Aetna values their businessAetna strives for excellence and is constantly monitoring our service to try to provide better service to our health care providers 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, Michael H. SrComplaint and Appeal Analyst Executive Resolution Team

Dear *** *** *** Please see our response to complaint #*** fo* *** *** that was received by us on October 14, 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
Credentialing department to address the provider’s concerns. We confirmed that our office has contacted this providerA contract has been sent and we will work directly with his office once we received the signed copy We 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 ***
Sincerely, *** ** 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 Dental department to verify
the member’s benefits and claim historyOur records indicate that the member is enrolled in a Dental Maintenance Organization (DMO) planWhen enrolled in this plan the member is required to pick a primary care dentist (PCD) within the network for himself and his family to be assigned toTo receive in-network benefits, you must have your services performed or arranged by your selected PCDIf your PCD cannot perform a service, he or she will give you a referral to an in-network specialist to perform the servicesWhen the member goes out of the network for the DMO plan, they are required to pay a $deductible before the plan will pay at a set fee scheduled amount for services rendered
The claim on file is processed correctly and no additional payments will be made towards the servicesYour dental plan allows for pediatric specialist referrals to age six with a written referral form from your PCDOur records show that your son's referral was provided by his orthodontist who is invalid; this has to come from the PCDFurthermore, your child is over the pediatric referral age limit and requires a special authorization on file to be seen when over the age of six
The flyer information that you have is correct but that is only if the services are done by the in-network assigned PCD or a referred oral surgeon, then the uncomplicated extractions are covered at 100% with no cost to youBut since this was done by an out-of-network dentist, the fee schedule amount that is allowed is $a tooth and applies to the member’s annual $deductible
Our records also indicate that we have not received any calls from the member to discuss the benefits, only internet inquiresThere also were not any calls prior to services being rendered to verify coverage and benefits by either the member or the provider
We assure you that it is not our intent to mislead or misrepresent any benefit that may or may not be available under your health planWhile we understand your concerns and recognize this is not the resolution you sought, our decision remains unchangedOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants
We are not able to cancel the policy or issue any premium refunds for the plan without permission from the employerThe member must contact his HR department to request this be done
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
This policy was purchased on the Marketplace Exchange; therefore any refund request must be made with the MarketplaceAetna does not have permission to issue a refund or retro-actively terminate an exchange policy, per the member’s request, without the Marketplace’s approvalThe member must contact the Marketplace and request a review of the refund request
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 #*** *** *** ***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 back
out to our *** department to have the POA’s concerns reviewedWe were
advised that they have sent the POA a new letter today, February 23, 2016, that
addresses all of her concerns
Please know that all the information shared in our last
response is private and your complaint is not available for public viewAll
member names, addresses, complaint numbers, Drnames, claim IDs etcare
starred out by the Revdex.com if they make it available for public viewThey also
block complaint numbers from the public viewOnly the analyst who is assigned
the complaint and the member or their representative can view the HIPAA
information provided in a resolution by clicking on the link supplied in an
email separately to Aetna and the member/representative with a log in and
passwordWe verified on the Aetna Revdex.com website that your complaint is not
available for any public view
We sincerely apologize if you were not happy with our initial
response to you, as this was not our intentWe are here to assist our members
and if you have any further questions or concerns about the plan please feel
free to contact the number listed on the *** resolution letter mailed
today, or you can email the address below
We take customer complaints very seriously and appreciate
you taking the time to contact us and giving us the opportunity to address Ms
*** 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:Basically this was a necessary procedure to fix my Dental onlays so my teeth don't rot out of my mouth. That is like saying that you have a bullet wound but need to wait to have it removed because your insurance wont kick in until next monthThis is a MAJOR safety and health concern that it is not something that could wait until October. I find it Extremely unethical to reject a claim based on something procedural where safety and ones health is concernedAnd again this was just trying the ethical approach before calling Aetna out on Social and mass media for caring more about their policy regulations than my health and safety of my teeth. It is in Aetna's best interest to pay the claim that they should have covered because my teeth are more important than some rider in a unfair policy. Several contacts Media outlets expressed interest in the story and will consult a legal advisor on the best course of action to pursue nextExactly how much business are the willing to loose over this issue ?
Sincerely,
*** ***

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 reviewed our records to see if the member did
call prior to being admitted to the hospital to verify if the facility was participating with the planOur records indicate that neither the provider nor member called Aetna to verify this information prior to being admittedThe only call we have on record was from the facility the day the member was being discharged requesting benefit information and to be transferred to our pre-certification department to have the inpatient stay reviewed
There currently is an open appeal for the member under case number *** that is reviewing all medical documentation to support whether the decision will be to uphold or overturn the claimThe member will receive a resolution letter with the decision and the rationale
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** 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