Chevron USA, Inc.

Dear *** *** *** Please see our response to complaint #*** for *** *** that was received by us on April 18, 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 immediately reached out to our Eligibility, Claims and Overpayment departments to have the member’s concerns reviewedWe confirmed with the Eligibility department that the member was actively covered at the time the services were rendered with no break in coverageWe were able to take the confirmation from the Eligibility department and send this to our Overpayment department for review We worked with the Overpayment department to have all pended overpayments stopped and letters mailed to the providers that we are no longer pursuing the monies, since the member was active during the date of servicesAny monies that were recouped prior to our involvement were sent to our Claims department for review Our Claims department had all claims where money was recouped from the provider’s reprocessed and reissued the payments that were originally paidThe providers will receive the new payments and explanation of benefits within 7-business days Please accept my apology for incorrectly requesting overpayments from the member’s providers for services that were rendered when the member was active with AetaUnfortunately, 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 reoccurringFeedback has been provided to numerous areas as a result of this complaintPlease have the member contact the email address listed below if she is contacted by a provider who is billing her so we can confirm they have had payments reissued to them 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, Ashley WComplaint 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 reviewed the call history to verify if the provider
was able to confirm the member’s coverage and benefitsOn July 14, 2015, Dr*** office called to verify the member’s coverage and the office was advised that this plan is handled by an Aetna affiliate called Strategic Resource Company (SRC) who is able to discuss the eligibility and benefitsThe provider was given the phone number to call but our records indicate that the provider never called the SRCThe provider will be able to check the member’s benefits by calling *** and choosing option
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

Hello,
Thank you for your inquiry, regarding complaint # for Jessica P***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
someone contact the facility to have all of their concerns addressedOur department advised us that they spoke with the facility and advised that they have successfully added the associate as well as update the facility in our Aetna Better Health (ABH)We were also advised that the facility was provided a direct contact for any further questions or concerns
Please accept my apologies for the difficulties you have encountered with AetnaOur goal is immediately resolve issues when they do occurClearly, in your case, we fell short of that goalWe regret that your experience with Aetna was less than satisfactory and hope that we can better assist you in the futureI 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 MsP***’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

Complaint: ***
I am rejecting this response because: I only sent out a bill I received from *** *** last Monday along with a page letter explaining why I'm not paying this billOnly when I stop receiving bills can I truly say this issue is resolvedOn my own end I have been in contact with Aetna and keep being told that the overpayment team is evaluatingIt is way past when they told me this would be resolvedI don't know for certain if they processed the Anesthesia bill correctly so that I have a zero balance.
Sincerely,
*** ***

D*** *** *** *** Please see our response to complaint #*** *** *** *** that was received by us on November 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 Claims department to have the member’s concerns reviewedWe were advised that the original delay was based upon the claim reimbursement not being fully completeAt the time there were no procedure codes, no diagnosis codes and no Tax ID Number (TIN) for the provider given on the form to process a claimA letter should have gone out to the member to inform him the claim form was incomplete and what was needed to complete the requestWe have addressed this mishandling with the representatives manager for education to prevent any future mishandlings We were able to have the claim reprocessed based on the authorization on file and the new Claim ID for the member’s records is *** This reimbursement was sent to the member on November 04, 2016, and a corrected explanation of benefits (EOB) was sent to the member as wellPlease allow 7-business days to receive both the EOB and the reimbursement check Please accept my apology that we did not provide the level of service that the member rightfully expects and deserves, and my assurance that his concerns are getting the highest level of attention at AetnaI would also like to thank him for sharing his experience with usIt is feedback like this 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 Mr*** 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,
Please see our response regarding complaint #*** for *** *** that was received by us on July 15,
Upon receipt of your complaint, we contacted our Eligibility department and confirmed that the cancelation has taken effect within the timeframeThis member’s coverage
is in arrears and she requested the cancellation on June 30, The member has to allow time for the request to transmit to CVS Health which occurred July 1, 2015. The deduction taken July 10, 2015, paid for coverage through July 4, 2015, which is one pay cycle beyond the cancellation date and falls within the time frame.
We apologize for any inconvenience this has caused the memberHowever, a refund is not due based on the coverage guidelines
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 ***
*** **
Complaint and Appeal Consultant Executive Resolution Team

Dear Ms*** ***: Please see our response to complaint #*** for *** *** that was received by us on December 15, 2017. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Based upon our review
of the member’s complaint we reached out to our Claims department to have the member’s concerns reviewedI confirmed that we incorrectly had *** *** *** *** listed as the members other carrier which caused the claim to pend for the primary insurances Explanation of Benefit (EOB)The record was updated and the account now shows there is no other coverage for the member After the member’s record was update we had the claims reviewed. We have reprocessed the claim for *** *** *** and issued an additional payment to the providerThe member is only responsible for her coinsurance 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 *** ***’s 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

Dear *** *** ***
* Please see our response to complaint #*** *** *** *** that was received by us on October 17, 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 Eligibility departments to have the member’s concerns reviewedWe were advised that the member’s request for a Certificate of Coverage (COC) would not provide the termination date that the member is looking for to get other coverage with another insurance companyWe spoke with the member on October 19, 2016, and confirmed with the member that he had received via email, the termination letter that will show this informationThe member advised us on the call that this was the information he needed We also confirmed the member that he does not owe the $and the plan is currently terminated in our systemHe received a refund for $which was sent out on October 13, I apologize for the frustrations and difficulties the member encountered while attempting to resolve this issue and regret that this matter required much of his time in order to facilitate a resolutionPlease accept my apology that we did not provide the level of service that the member rightfully expects and deserves, and my assurance that his concerns are getting the highest level of attentionI would also like to thank him for sharing the experience with usIt is feedback like this 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 *** *** concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team ** *** Sincerely, Ashley WComplaint and Appeals Consultant Executive Resolution Team

Dear *** *** *** Please see our response to complaint # *** for *** *** that was received by us on June 21, 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 the Customer Service department and asked them to review *** ***’s concernsThe records show that the order was processed on May 25, 2017, and the *** gift card was sent via *** *** on June 1, They advised that if *** *** has not received the gift card by June 30th, she should contact Member Services so they can file a lost card claim and send her a replacement cardWe apologize for any inconvenience and difficulties 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 *** ***’s concernsIf there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***Sincerely, Mickey S.SrComplaint and Appeal Analyst Executive Resolution Team

Dear *** *** Please see our response to complaint #*** for Karyn Johnson that was received by us on 08/23/2016. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of your complaint, we
contacted our Dental department and confirmed the member’s cleaning and periodontal maintenance benefitsA complete review of the member’s claim history determined that a claim for services performed on 10/15/was not handled properlyWe have reprocessed the claim and payment in the amount of $has been issued to the provider on 08/29/ The member will receive an explanation of benefits statement within 7-business daysWe 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 Ms*** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** L*** ** Complaint and Appeal Consultant Executive Resolution Team

Dear Ms*** ***: Please see our response to complaint #*** for *** *** that was received by us on December 21, 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 Pharmacy Mail Order Delivery (MOD) department to have the member’s concerns reviewedWe were advised that the member’s exclusive checking account was charged $for order #*** in errorThis order is for a dependent on the account and the order was shipped on December 16, The member notified MOD on December 21, 2016, of the error and was refunded that same day as an issued electronic check refund of $back to *** *** accountThe payment confirmation number for this transaction is ***It may take several days for the funds to appear back in the member's accountThe average timeframe is 2-days An alert has been added to the profile advising the pharmacy the member’s checking account is to be used for his orders onlyCoaching has been provided to the Accounting Representative responsible for the errorWe sincerely apologize for any inconvenience 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 Mr***’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

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 your complaint, we reached out to our claims department to address the members concernsWe were advised that the claim for *** *** laboratory services performed on May 14, have been processed correctly toward the member’s plan deductible under his laboratory benefits, as these services are not considered to be routine or preventative servicesWhile 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 *** *** 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

Thank you for your inquiry received on 07/16/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 Pharmacy Management department
(APM) for assistance, and found that when the member was trying to get her prescription filled, she used her old identification number in errorAPM is currently working to have this claim transferred from the member’s old identification number to her new identification numberOnce completed, the member will be mailed a $balance letter 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 Ms*** 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
Aetna does set the overall price to the government; however, it is the responsibility of the government to decide the portion that they will pay and what the member will payThis is listed in every brochure, under the “Rates” sectionAetna does not collect premium or eligibility directly from individual members and is not able to refund any premium amounts
We make every attempt to alert members of premium increases, along with notifying members of their choice to change into the correct enrollment code based on the address that we have on file
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

Dear MsMadelyn Sola: Please see our response to complaint *** for Jill Watts that was received by us on August 05, 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 department to have the member’s concerns reviewedWe were advised the member was originally termed January 31, 2016, on January 15, On July 09, 2016, the system reenrolled the member under a new IDWe are still researching this issue as priority to prevent this from happening again We have refunded the premium of $back into the bank account on filePlease allow 1-business days (depending on the bank and how they handle electronic fund transfer requests) for this refund to be completedPlease accept my apologies for the difficulties the member has encountered with Aetna 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 *** 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 ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***

Thank you for your rejection notice 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
After further review, our records indicate that neither the provider nor the member called Aetna prior to being admitted into a nonparticipating facilityThe 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 precertification department to have the inpatient stay reviewed
Furthermore, the member’s concerns are currently being reviewed under appeal number ***The member 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 Ms*** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

thank you very much for addressing this promptly

Complaint: ***
I am rejecting this response because Aetna should make good on its representation to my wife and reimburse us the remaining $which Aetna acknowledged was attributable to customer service representation error:
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 the member to confirm which date of
service he was requesting be reviewedWe had the claim reviewed by our Claims department and they advised that the CPT code that was submitted to Aetna was not a preventative routine careWe were able to review the member’s specific plan benefits and confirmed that we were able to make an exception and cover the procedure under associated chargesWe have reprocessed and finalized the claim under claim ID *** at the in network benefit level, set to pay the provider within the next weekThe member will not have any responsibility for the September date of service
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