Chevron USA, Inc.

Complaint:
I am rejecting this response because: This claim is absolutely without doubt is preventative laboratory testing for the reasons already mentionedI was told by the phone representative of Aetna that they do consider situations like mine to be covered as a deviation of routine preventativeI will not accept that this claim is not covered
Sincerely,
*** ***

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 reviewed the member’s claim historyOur
records indicate that the claim was reprocessed prior to the complaint being received, and the reprocessing was completed on January 06, The provider received the payment of $for the date of service on January 06, 2016, and the member is only responsible for a $copayWe have also updated the member’s coordination of benefits to reflect that Aetna is the primary insurance for medical claims and no other coverage exists
Please accept my apologies for the inconvenience and difficulties you experienced while trying to obtain payment for your claimsOur goal is to pay claims timely and accurately, and to promptly resolve issues when they do occur
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

Dear
*** *** ***
Please
see our response to complaint #*** for *** *** that was received by us on June 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 Clinical department to have the
member’s concerns reviewedWe were advised that the member’s MRI was approved
the same day the complaint was receivedWe were advised that the
authorization is good from June 22, through September 19, We
sincerely 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 *** *** concerns. If there are any additional questions
regarding this particular matter, please contact the Executive Resolution Team
at ***
*
Sincerely,
Ashley
W
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 Network department
to have the member’s concerns reviewedNetwork advised
that they contacted the provider’s office regarding the form the member had to
fill outThe doctor’s office advised that this form is completed by all their
patients before services are renderedThis form basically states that the
patient is responsible for any charges that are not covered by their insurance
if their office is quoted the incorrect benefit by an insurance representative
In addition, depending on the plan benefits, at times certain procedures done
at a *** *** may be considered cosmetic and may not be covered under the
planTherefore, this is a form to let the patient know they will be held responsible
for any services rendered
This form was not created because our insurance company has
bad billing practices but more to let the patient know they could be held
responsible for any services rendered that are not covered under the planThe
providers are able to request member’s fill out these forms prior to being seen
and the office stated they do it for every insurance company, not just Aetna
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 #*** 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 have the Summary of Benefits
Coverage (SBC), Summary of Benefits (SOB), and the Certificate of Coverage (COC) pulled for the planWe were advised that the SOB and the COC both had the correct information for 2015, but the SBC listed the incorrect responsibility for the specialist copayIt original reflected 0% coinsurance, when it should have stated a $copay responsibilityIf the member called in to verify the benefits, he would have been provided the correct benefits as our system reflected the $copay as well being able to reference the COC or SOB
Due to this error in the SBC, we have made a one-time exception to waive the copay on the two dates of services (04/28/and 10/22/2015) that were processed with a copay and have the $copay reimbursed directly to the memberDate of service 09/03/charged a deductible and all the correspondences had the correct deductible amounts and what they would apply to, so we are not able to make an exception for this claim
I apologize for the frustrations and difficulties you encountered while attempting to resolve this issue and regret that this matter required some of your time in order to facilitate a resolutionUnfortunately, we are unable to honor your request for compensationWe do appreciate your patience during the time involved in researching and resolving your issue
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 *** ***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 request
they reach out the provider and get the necessary network updates done for Dr***We were advised that the providers file has now been updated to reflect participating for the PIN/TIN and address combinationAll the member’s claims have been reprocessed and allowed as in networkI have attached a word document of the reimbursement information
Please accept my apology that we did not provide the level of service that the provider and member rightfully expect and deserve, and my assurance that their concerns are getting the highest level of attention at AetnaI would also like to thank the member for sharing their 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 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

Tell us why here...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 Claims department to review the
member’s concerns. We found that the lab charges billed from *** *** *** were processed correctlyThe charges billed were not a part of the preventative services and applied according to the medial benefit. The benefit states that for diagnostic services billed at a participating lab, 100% is allowed after a $deductible is metThe member is responsible for $64.44.We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Karran ‘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

Complaint: ***
I am rejecting this response because: I tried calling Aetna for a month and a half trying to get everything they needed for my claimEvery time I called they needed new documents which I providedMy doctor even sent everything they neededAlso when I called they kept telling me different thingsSo I went without pay for a month and a half because of this which also means my bills didn't get paid, myself and my daughter barely had food to eatI did everything I was suppose to and also my doctorThe denial I feel isn't accurate.
Sincerely,
*** ***

Tell us why hereHello, 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 concernsWhile we do understand that it can be an inconvenience to get letters regarding prescription options and plan changes, they are often pertinent to the member’s current prescription and medical coverageAll non-required letters and correspondence have been requested to be stopped from both the medical and prescription portions of *** *** *** policy.As for the member’s request to waive months of premiums, we would need to receive proof of denial of access to medical or prescriptions coverage for review 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 CComplaint and Appeal Consultant Executive Resolution Team

Thank you for your inquiry received on 07/21/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 Individual Plans and
Eligibility department for assistance, and the member was originally enrolled into the system on 12/05/2014, with an effective date of 01/01/2015. An invoice was generated on 01/09/2015, and sent to the member. The member was sent another invoice on 01/24/2015, advising that their payment needed to be made or they will be cancelled. The member did not pay their initial binder payment until 01/30/2015. We do not show any payments received for February or June. Delinquency letters were mailed to the member. According to our phone records, the member did contact Aetna and requested a list of Primary Care Physicians (PCP) and specialists to be mailed to her, but nothing pertaining to the missing/delinquent payments. The member did call on 05/15/about the payment and stated she would look into it. Then on 07/16/2015, the member called about the payments again and stated she would send us copies. Aetna cashes all payments received in any billing lockbox timely, and any unidentified funds would be moved to the correct account within days
We checked our system and do not show that we ever received any copies of the money orders for us to research. We also checked our system and do not show that we cancelled her coverage but her policy is delinquent. Our policy is that if a subsidized member is delinquent, their claims would be pended until all outstanding premiums are paidWithout copies of the money orders we have no way of tracking the payments
The member stated that she called to cancel her insurance plan on 07/16/2015, but we did advise that she has to go through the Marketplace to terminate her plan. As of today, her plan is cancelled effective 07/31/2015.
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 ***

Complaint: ***
I am rejecting this response because: there are still claims (approx 6) that are still listed as "not approved"I will need proof that ALL claims have been accepted and there EOB via postal mailI need this proof because Aetna can very easily change the status on their website; which I have personally seen those changesAetna between the dates of Feb through Oct 31, was the only health insurance that was active.
Sincerely,
*** ***

Hello,
Thank you for your inquiry, regarding complaint #*** for *** **Our Executive Resolution Team researched your concerns, and I would **ke to share the results of the review with you
Upon receipt of the complaint we immediately reached out to have the member’s claims reprocessed
per the approval on fileWe were advised that all the claims have been reprocessed and are currently in the process of being paid to the providerWe have also placed a special handling on the policy so that future claims will drop to a claims specialist for handling
Please accept my sincere apology for the delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issueUnfortunately, 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 **ke 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 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 *** ***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 Life Insurance department to have the complaint reviewedWe were advised that the claim was paid as of May 03, The delay in payment resulted from not having a valid address to send the paymentThe address details were received by Aetna’s Life Insurance department on April 22, to make the payment out to the attention of *** ***Concerning the customer service you 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 you experienced and that we did not provide the level of service that you rightfully expect and deserve. These actions are not consistent with Aetna’s service standards and we appreciate you notifying us of your experience. We have addressed your customer service concerns directly with the managers of the representatives who handled your calls. 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, Tanika KComplaint and Appeal Consultant Executive Resolution Team

Complaint: ***
The fact that Aetna repeatedly fails to address the basis of my complaint makes it clear that the company has no valid explanation for its actionsThe issue is not whether my current dental plan covers orthodontics, as the company continues to state, but that its policy of delaying payment of a bill should not absolve it of paying the billAnd, even more importantly, that the company does not disclose this policy or its repercussions to its customersThe closest the company came to addressing this issue was to say that it doesn't have to disclose its payment structure to the customer because it is an agreement between the insurer and provider, as if it were none of the customer's businessBut when the consequences of the company's payment structure greatly affect the customer, transferring several hundred dollars of its obligations to the customer, then the customer most certainly needs to be informed.As I've stated before, I wouldn't have switched to a lower-cost plan if I had any idea that Aetna would stop paying for a service that had been performed and billed for several months earlierBut now, unfortunately, it is too late to undo that decisionBecause the company withheld information that led to much greater cost to me, I think Aetna should pay the remainder of its share of the bill
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because the claim Aetna is referring to are not the ones I have filed a complaint forI have attached copies of two of the claim Aetna did not process or refusing to processPlease note one of the claims for $from *** *** *** is currently in collections and they are threatening to report to my credit bureau if not paid by Aug 6thI need Aetna to process these claims ASAPThank you,
Sincerely,
*** ***

*** *** *** *** Please see our response to complaint *** for *** *** that was received by us on June 12, 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 Customer Service department and determined that some problems occurred during the member’s initial request for the PCP selectionWe confirmed that our systems reflect that *** *** *** has been selected as PCP effective June 2, We also contacted the member and confirmed that the medical ID cards have been received. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** 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

Dear *** *** ***: Please see our response to complaint #*** for *** *** that was received by us on June 04, 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 representativeThey researched this issue and have provided a responseThe complaint is concerning a small business group ownerThe owner stated that we kept debiting their business account for the May 01, renewal date, even though they never renewed their contractThe owner said that they have been trying to get their money back with no success. In reviewing the owner’s concern, it shows that the owner called on May 22, to request a refund checkThe check was approved on May 30, 2018, and the owner should receive that check in seven to ten 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, Michael H. SrComplaint and Appeal Analyst 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,
*** ***

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
a comprehensive review of the member’s claims completedWe were advised that there were not any claims, as of now, that were not processed as primary during the period of dual coverageIf the member has a specific claim that needs reviewed please advise of the date of service and the provider and we would be happy to review
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

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 worked with the member throughout the process to review
the surgery and provider performing the surgeryWe have approved the surgery
as all criteria have been met and the member and provider have both been
informed of the approvalWe are now in negotiations with both the facility and
the provider to come to an agreement for the payment of the surgery
I will continue to be in touch with the member and the
provider’s office throughout the agreement until a decision is made and the
surgery date is setI spoke with the member again today to reassure that I
will continue to follow this case up until the surgery
We take customer complaints very seriously and appreciate
you taking the time to contact us and giving us the opportunity to address Ms
Head’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