Chevron USA, Inc.

Complaint: ***
I am rejecting this response because:Aetna is completely falsifying their statement I did call to get my member ID and Aetna COULD NOT provide it to meI was advised to proceed to urgent care and submit my claim for reimbursement I did exactly what I was supposed to do and Aetna did not I did not go for an office visit( the office is not open on Saturdays or Sunday's) which is when I went.....a SaturdayUrgent care hours are from 10am - pm on SaturdayTo the other point, if it was processed correctly than why was I told repeatedly that my check was in the mail??? I paid over $10,in premium payments and used the insurance twice - the first time I paid in full out of pocket and the 2nd time Aetna admittedly filed claim incorrectly but did rectify that situation They are completely incompetent (in my experience) and wondering if they are doing this to me out of discrimination
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because: I am working with the doctor's office to confirm they received this request for additional informationI am still waiting for their response. I am not about to accept this as a settled complaint. There still has not been a resolve to the two claims. Thank you for being patient with me while I research this and hear back from the doctor's office. I will communicate my findings with Revdex.com
Sincerely,
*** ***

Thank you for your inquiry received on 09/15/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 the Individual Plan’s department, and
the member is not due a refund. According to the member’s record, the Marketplace stated he was not eligible for a tax credit for the month of January 2015, so he was billed the full premium of $239.83. Aetna does not control or determine eligibility of tax credits for Marketplace members, and cannot make any changes without permission from the Marketplace A refund of $was processed in error on 01/23/2015, and sent back to the member’s credit card A plan change and premium change was received from the Marketplace on 01/12/2015, and was made effective 02/01/2015. The February bill then produced the charge back of the $that was refunded in error and the new rate of $23.83. If the member is disputing that he should have a tax credit for the month of January, then he needs to contact the Marketplace at ###-###-####
Furthermore, the ebilling system was down previously, but the issue is now resolved and the member should now be able to access his accountWe apologize for any inconvenience this may have 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***’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

Dear *** ***: Please see our response below to the additional concerns reported in complaint # *** for *** *** that were received by us on May 7, We regret any misunderstanding from our initial response. While it may not have been clear in that response, the claims for May 6, 2017, and June 25, 2017, were reprocessed as a result of that review. The October 8, 2017, claim was mentioned in the initial response as it had been affected by the same issue that was occurring with the May and June claims, but had been corrected previously. Additional review has been done and it was confirmed that the Explanation of Benefits and payments for the May and June visits were sent to *** on May 10, 2018. We have attached copies of the EOBs to this response. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrsSerrao-ahuna’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Sincerely, Chris BComplaint and Appeals Consultant Executive Resolution Team

Complaint: ***
I am rejecting this response because what the Aetna rep said is not true, I am very frustrated after so many exchanges Aetna still did not resolve the matter and got the facts wrongAttached are two Pre-approval letters dated January and July 2015, clearly on the January one, it says *** is covered, let me quote on Page reads "hours per week ABA has been authorized from 1/15/2015-7/15/2015, inclusive of the following procedure code 0364T, ***, 0366T, 0367T etc to 0374T"But now Aetna rep is saying *** is not added until 7/16? This simply is wrong, wrong and wrong.As a matter of fact, *** *** *** has been providing services for us since late and following same procedures, never had problems billing using *** and previous claims have been paid in full, how come only these two claims #***and #*** are denied based on "educational services are not covered"?
Sincerely,
*** **

Complaint: ***
I am rejecting this response because: Aetna has, as yet, not reworked the claim which they have as yet failed to admit was mishandled by AetnaThe amounts on the claim have thus far not been reallocated vis a vis in network versus out of networkMy zero balance is irrelevant at this pointIt remains in Aetna's hands, SERIOUSLY.
Sincerely,
*** ***

From: *** *** *** *** Sent: Thursday, January 11, 7:PM To: *** Subject: [SPAM?] My complaint I apologize, but I complained too early Aetna Insurance only gave me a phone number for me to give the provider when I picked up
my prescription The pharmacy technician was directed to a website where she was able to get all of my information and lowered my cost The only complaint now is that I never used to pay anything for my prescriptions, but now I do I want Aetna to explain why I’m being charged Please have Aetna call me to explain why I have to pay when I didn’t have to on my old insurance plan *** *** *** that my company switched me from without telling me 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 contacted our Customer
Service department to review the phone calls requestedWe reviewed the call
dated January 20, 2016, where the customer service representative explained the
plan benefits and advised the member that her $deductible would need to
be met prior to Aetna paying for the service
We also located a call that was placed on February 23,
2016. The representative did misquote
the member responsibility at the beginning of the callDuring the call, the
representative placed the call on hold and contacted the facilityThe CSR
confirmed the procedure and billing informationThe CSR then apologized and
provided the correct benefits that would apply based on the provider’s billing
methodWe assure you that it is not our intent to mislead or misrepresent any
benefit that may or may not be available under the member's health planThe
claim for services performed on January 22, has been reviewedIt was
processed correctly according to her plan benefits
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,
LaShonda C
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
As addressed in our previous response the ID cards were
mailed prior to us receiving the retro-termination request of the policy by the
employerWe did not receive the request from the employer until December 30,
2015, which is after the ID cards were issuedAetna is strictly an administrator
of the plan and has no control over termination requests made by employersIt is
the employer’s responsibility to notify the member of any terminations, not
Aetna
Aetna also has no control over premium deductions that are
made for the policyAetna is never advised the premium rate of a member as it
is private information between the member and the employerAgain to reiterate,
the member will have to follow up with the Human Resources (HR) department with
these questionsAetna will not be able to assistance why the member is paying
for a medical policy that is terminated
There is a pharmacy policy only, not a medical plan, that is
effective for the member only, not his spouseThis is under a Medicare ID and
is sponsored by TX PDP. The member used these benefits in the month of April and this may be why the member is being deducted money for
a policyThe medical plan that was through the *** ** ***, is correctly terminated per the employerTo recap the member will need to follow up with the HR
department to have his questions/concerns addressed
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 [email protected]
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 youUpon receipt of the complaint, we contacted our Benefits department and verified the maternity coverageWe also listened to the recorded callsThe calls indicate only general maternity benefits were provided during the phone callThe claims in question were processed correctly in accordance to the member’s plan benefitsWhen the child is born and is added to the policy as an individual, the facility is able to bill separately for both mom and child for any charges related to the pregnancyThe submitted charges were sent for both the mom and child; which triggered the individual copaysWhile 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 participantsWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concerns.I attempted to contact the member to discuss the
outcome of our reviewI left a message and have not received a return
call. If 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

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 contacted our Claims department and found that the
claim was processed out of network as this lab is not apart of Aetna's networkWe made an exception to reconsider the charges because this member did not have a choice in selecting this laboratoryThe claim has been reprocessed and a check will be sent to this provider within 7-days
We apologize for any 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 Ms***'s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Thank you
LaShonda C
Complaint and Appeals Consultant
Executive Resolution Team

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,
*** ***

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,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meI am looking forward to receiving all of the explanation of benefits showing the correct payments being made If there are further issues related to coverage provided by Aetna for this situation, I will reach out to the Revdex.com again
Sincerely,
Rajat Jain

Thank you for your inquiry received on 08/06/regarding complaint #*** for *** ***. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
The member’s concerns are currently being
reviewed under appeal numbers *** and ***The member's will receive a resolution letter with an explanation under separate cover
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 complaint we immediately reached out to the Disability department to
review the member’s requestWe were advised that the claim was denied as the medical information did not support the member’s disabilityA letter was mailed to the member on December 11, 2015, that explains the decision in detailAt this time the disability claim is deniedThe member may submit additional information for review and may also file an appeal by following the instructions in the decision letterThe letter states to appeal within days and send the appeal to:
Aetna Life Insurance Company
*** *** *** *** ** *** *** *** ** ***
Fax: ###-###-####
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

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 claims on file reviewed for
accuracyWe were advised that the claims for the date of service in question were
not processed correctlyWe have had the claims all combined into one claim, the
new claim ID ***, and had it reprocessed per the benefits to pay the
provider directlyThe provider and member should receive a corrected
explanation of benefits within 7-business days, as well as the provider
receiving payment for the services renderedThe member does have a copay responsibility
which will be listed on the explanation of benefits
Please accept my apologies for the inconvenience and
difficulties you experienced while trying to obtain payment for your
claims. Our goal is to pay claims timely
and accurately, and to promptly resolve issues when they do occurI would also
like to thank you for sharing your experience with us. It 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
Chang’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

Dear
MsShea,
Please see our response to complaint
#*** for *** *** that was received by us on February 24,
Upon receipt of the complaint we
immediately reached out directly to the provider’s office to address the
member’s concernsWe spoke with Dawn, at the New Berlin office on February 29,
at 03:50pm EST, who advised that Mr*** showed a $balance on
their records and the payment had been posted
I apologize for any difficulties or
confusion this may have caused Mr***We take customer complaints very
seriously and appreciate you taking the time to contact us and giving us the
opportunity to address Mr***’s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at ***
Regards,
Julian Cano
Executive Resolution Team

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,
*** ***

Complaint: ***
I am rejecting this response because: I have yet to receive a resolution even though I was suppose to receive one a while agoTheir response to this complaint does not resolve anything
Sincerely,
*** ***