Complaint: [redacted] I am rejecting this response because:Dear Revdex.com,As you can clearly see from the response from Aetna, they can not even get my name correct in the correspondence about correcting my name!!! Please see the red areas below for my comments.While I will agree that the term "medical" may have been a poor choice for a description, what I was referring too in my complaint is my Aetna Vision cards Ashley is correct that Aetna carries my Dental coverage, but she is incorrect when she states that is all Aetna carries my vision as well Please see the attached pictures On my dental information, my name is listed correctly, on my vision information, it is listed two different ways on the same piece of paper, and both are incorrect And as far as contacting my employer for corrected cards, they do not issue the cards, they only provide information to the carriers who distribute the cards to the members When I signed up for the insurance, I filled out the paperwork correctly and with my full legal name.Bottom line is that I need my legal name reflected on my vision cards and other pertinent information related to insurance coverage.And to the Revdex.com, your system doesn't have my name listed correctly either If I have a complaint about the Revdex.com, who do I send that too.I have attached some pictures for your viewing pleasure I look forward to a response and mitigation of this matter [redacted] ** Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 had our files reviewed to verify that we had the member’s name correct in our systemOur records indicate we have the member’s name in our system just as it shows in the Revdex.com complain [redacted] Our records also indicate that we do not carry this employer’s medical benefits, only dental benefitsThe employer’s medical benefits are with any of the following carriers: [redacted] , [redacted] and [redacted] ***Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those recordsPlease contact your medical carrier to request a corrected medical ID cardWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] [redacted] **
Dear [redacted] Please see our response to complaint # [redacted] fo [redacted] 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 [redacted] concernsIf there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, [redacted] Complaint and Appeal Consultant Executive Resolution Team
Hello, Please see our response regarding complaint # [redacted] for [redacted] 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, 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 [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] [redacted] Complaint and Appeal Consultant Executive Resolution Team
Dear MsMadelyn Sola: Please see our response to complaint [redacted] for Jill Watts that was received by us on August 05, 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 [redacted] concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Ashley WComplaint and Appeals Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: Your advertising and marketing of this plan is misleading and deceptive Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: I received an email stating "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 [redacted] and was paid to the member on July 30, 2015." This is untrueWe still have not received payment and were certainly not paid on July It's August 5thThis has been exactly the kind of thing that has been frustrating during the whole process Sincerely, [redacted]
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 [redacted] 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 issueUnfortunately, 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 [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, [redacted] Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
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, [redacted]
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 records to see what type of dental discount policy the member is enrolled inWe found that the member is enrolled in a Vital Savings plan purchased through http://www[redacted] .comAetna is strictly an administrator of this plan; Aetna does not control the enrollment or the billing All enrollments are handled through a Third Party Administrator (***) and the Billing is handled by the ***, not by AetnaThe participant makes the payments directly to the ***; there is no pay roll deductionAnyone requesting a refund of premiums or a cancellation of the plan must contact the [redacted] directlyYou can call ###-###-#### or go online to the website listed above Please be aware that this plan is strictly a discount plan and is not insuranceThere are no claim submissions of any kind and the member is responsible for paying the discounted price directly to the dentistAetna would have no way of verifying if the plan was not used by the memberAlso any renewal information would come from the [redacted] directly to the member; Aetna is not responsible for any communications to the member We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address ** [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] .com Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Complaint: [redacted] 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, [redacted] ***
Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on March 20, 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 Customer Service department to have the member’s concerns reviewedOur Customer Service department was aware of the member’s request and were working to reissue the checkWe completed the request and overnighted the check to the memberThe [redacted] tracking number was [redacted] This was delivered to the member’s confirmed address on March 27, 2018, at 10:14amPlease relay my apologies for the difficulties the complainant has encountered with AetnaI’m sorry that our representatives were not able to assist her when she calledOur goal is to provide quality service and satisfaction to our members, and I sincerely regret that [redacted] did not receive the service she should rightfully expect and deserveHer concerns have been forwarded to our management team for improvement opportunitiesI hope that going forward we will be able to regain [redacted] ’s confidence in usRegarding her request for reimbursement for her time, we are unable to provide compensation to any complainant.We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely,William B.Complaint and Appeals ConsultantExecutive Resolution Team
[redacted] Please see our response to complaint #[redacted] that was received by us on October 27, 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 [redacted] Sincerely, [redacted] Complaint and Appeals Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 directly to the provider’s office to address the member’s concernsWe spoke with Dawn, at the New Berlin office, and we explained the situation that the claim was sent to us as performed at the [redacted] officeIn our discussion with Dawn, we provided the payment ID and confirmed the address the payment was sent to and we were advised the payment went to their main office for Forward Dental, per the way the claim was submitted to Aetna by the provider We faxed the explanation of benefits to Dawn’s attention for review on Friday February 05, We called today, February 09, 2016, and spoke with Dawn and she advised that the main office submitted the claim incorrectly to Aetna, listing the wrong office, but that she was working internally within their offices to have the money applied to the member’s account The office was provided with my direct number for any future questions or concerns surrounding the claimUnfortunately, we are not able to change the claim on file to show the correct office, the provider’s office would be required to submit a corrected claim for Aetna to be able to make any adjustments We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Dear Ms***, Please see our response to complaint # [redacted] for [redacted] that was received by us on October 08, The records indicate that Mr***’s original effective date is October 1, 2014, with a month waiting periodSince this criterion was not met, benefits are not eligible under the plan for the service performed on June 3, We had the claim verified with our Dental department to review if there was any way any exceptions could be made; we also reviewed the original appeal informationHowever, our decision remains the sameBased on the guidelines of Mr***’s policy that were provided in our previous response, the plan has a month waiting period for type C servicesThe service performed June 3, was a type C serviceTherefore, an exception could not be madeOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants I apologize for any difficulties this situation has 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 concernsIf there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Regards, Julian C [redacted] Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint [redacted] 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 Claims department to verify if the claim was processed correctly according to the member’s benefitsWe were advised that according to the benefits for hospital emergency room services the claim was processed correctlyHospital emergency room services are covered 85% after the deductible is metThe level of care was not a factor when considering the amount the member owes, it is strictly based upon the 15% due of the contracted rate of the provider’s billed charges We also had the calls pulled prior to the member purchasing the breast pump to see if incorrect information was provided to the memberThe member was advised that a breast pump would only be covered under the plan if it was medically necessary, meaning there has to be an issue with feeding before it will be coveredShe was advised that a letter would have to be submitted by the provider stating the reason for medical necessity and the customer service representative (CSR) again reiterated that it must be medically necessaryWe also listened to the calls after the purchase of the breast pump and again the member was advised that it would only be covered under the plan if medically necessaryThe member requested what would qualify as medically necessary and the CSR provided an example of if the child was born with a cleft palate or if the mother was discharged prior to the baby being dischargedThe member stated she understood the benefits on both callsI empathize with your situation and regret that our decision could not be more favorable While 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 take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Thank you for your inquiry received on 09/15/regarding complaint # [redacted] for [redacted] 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 $ 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/ The February bill then produced the charge back of the $that was refunded in error and the new rate of $ 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 [redacted] ’s concerns If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
Dear MsShea, Please see our response to complaint # for Robert Whiteside that was received by us on February 17, We would like to advise that the specific supporting information MrWhiteside submitted was received from a Department of Insurance inquiry on February 16, and a response will be provided by March 08, after the received information is reviewed I would also like to again advise that Aetna did not attempt to intimidate, threaten, delay or deceive MrWhiteside, nor did it attempt to discourage submission of claimsIn fact, where Aetna made reference to its legal department or compliance area reviewing the matter, we were only indicating that they were providing a higher level review of MrWhiteside’s issues to determine if Aetna had appropriately handled his claimsIt was not Aetna’s intention to infer that MrWhiteside was being investigated; only that Aetna’s handling of his claims and concerns was being investigated I apologize for any difficulties or confusion this may have caused MrWhiteside We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrWhiteside’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected] Regards, Julian Cano Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 Customer Service department to have the calls pulled prior to services rendered to see if the member was advised incorrect informationWe located only one call on file prior to services being rendered related to the procedure on January 20, 2016, where the customer service representative (CSR) advised the member would have to meet her $deductible prior to Aetna paying for the service We did locate a call that took place after the services were rendered where the CSR did incorrectly quote the out of pocket responsibility for the member, but after calling the facility and confirming how they bill this service and where it would take place, the CSR corrected the amount the member would be responsible forThe CSR apologized and did state the member would be responsible for meeting her deductible and she was going to be responsible for more than what she originally quoted at the beginning of the callWe assure you that it is not our intent to mislead or misrepresent any benefit that may or may not be available under your health plan The claims in question were processed correctly in accordance to your plan benefitsWhile 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 participantsI realize that understanding your benefits can be challenging, and regret that you had difficulty when you tried to obtain information It is our goal to be there for you when you need us, and I apologize that the assistance you received from our customer service representatives did not meet your needs Be assured that your concerns are getting the highest level of attention at Aetna I 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 [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 department to have the member’s concerns reviewedWe were advised by our Aetna Rx Home Delivery department that on August 21, 2014, the member’s physician called in three new prescriptions for the memberThe order diverted to a member outreach to obtain a payment method for the orderOn August 26, 2014, a call was made to the member to obtain a payment method for the order; the member was not available and a message was leftOn September 03, 2014, the member had not returned the call and the order was released and charged to the credit card on file, which had been used for a previous orderThe order shipped the same day via *** On September 04, 2014, the member contacted Customer Care regarding the order to advise that the order was charged to her credit card without her approvalThe member requested to have the credit card removed from her account and a note added stating not to fill orders until she calls to request themThe note was added to the account per the member’s request and on September 20, 2014, the credit card charge was refunded in the amount of $Due to this refund, the member then owed the charges incurred for the August 21, 2014, prescriptions On December 30, 2014, the member contacted Customer Care and requested to have a prescription refilledA request was sent to the pharmacy to fill the prescription and the order diverted for a member outreach to obtain a method of paymentOn December 31, 2014, and January 02, 2015, outreaches were made to the member to obtain a payment methodThe member returned the call to the account receivable team on January 05, 2015, and provided a method of payment for the orderShe was also advised that the order would be released as a courtesy and she is responsible for the past due balance of $The member requested to speak to a supervisor and was transferred to a supervisor The member advised the supervisor that she called to cancel the August prescription order and was assured that the order would be cancelledThe supervisor said that she would have the call reviewed to verify if the member was told the order would be cancelled and would call her back The supervisor called the member back on January 08, 2015, to advise her of the call review results but the member was not available and a message was leftThe call review confirmed that the member was advised that the order could not be cancelled but that a return label could be sent to return the prescription and the member stated not to worry about sending the return label, that she would dispute the charge with her bank We did not hear back from the member and on April 24, 2015, a new prescription was received via fax from the physicianThe order diverted to the account receivable team for a member outreach to obtain a payment method for the order and to resolve the outstanding balance of $Three separate outreaches were made to the member on May 01, 2015, May 07, 2015, and May 08, and messages were left On August 21, 2015, the member requested two prescriptions via the Aetna websiteThe order diverted for a member outreach because the outstanding balance had to be resolved prior to the order being shippedAn outreach was made to the member to obtain payment for the past due balance on August 25, and a message was left for the member to call backAs a second courtesy to the member, the prescriptions were released on August 26, 2015, without member contact for the outstanding balanceThe orders shipped the same day and were charged to the credit card on file On March 02, 2016, a prescription was received electronically from the physician and on March 03, 2016, the prescription was diverted for a member outreach because of the $past due on the fileOn March 07, 2016, an outreach was made to the member to obtain a method of payment for the prescription order and a message was left for the member to call backThe member called Customer Care back the same day regarding the balance and declined to pay the outstanding balance of $She was transferred to the account receivable department to assist with the paymentThe member again declined to pay the balance and requested that the prescription order be releasedThe member stated that she would call back regarding the past due balance As a last and final courtesy for the member, the balance of $has been written off due to the situationThe prescription has been release and the $copay has been charged to the credit card on fileDue to the previous chargebacks to the credit card going forward the member will be required to send money orders for any future prescriptions We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms Keith’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because:Dear Revdex.com,As you can clearly see from the response from Aetna, they can not even get my name correct in the correspondence about correcting my name!!! Please see the red areas below for my comments.While I will agree that the term "medical" may have been a poor choice for a description, what I was referring too in my complaint is my Aetna Vision cards Ashley is correct that Aetna carries my Dental coverage, but she is incorrect when she states that is all Aetna carries my vision as well Please see the attached pictures On my dental information, my name is listed correctly, on my vision information, it is listed two different ways on the same piece of paper, and both are incorrect And as far as contacting my employer for corrected cards, they do not issue the cards, they only provide information to the carriers who distribute the cards to the members When I signed up for the insurance, I filled out the paperwork correctly and with my full legal name.Bottom line is that I need my legal name reflected on my vision cards and other pertinent information related to insurance coverage.And to the Revdex.com, your system doesn't have my name listed correctly either If I have a complaint about the Revdex.com, who do I send that too.I have attached some pictures for your viewing pleasure I look forward to a response and mitigation of this matter [redacted] ** Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 had our files reviewed to verify that we had the member’s name correct in our systemOur records indicate we have the member’s name in our system just as it shows in the Revdex.com complain [redacted] Our records also indicate that we do not carry this employer’s medical benefits, only dental benefitsThe employer’s medical benefits are with any of the following carriers: [redacted] , [redacted] and [redacted] ***Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those recordsPlease contact your medical carrier to request a corrected medical ID cardWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] [redacted] **
Dear [redacted] Please see our response to complaint # [redacted] fo [redacted] 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 [redacted] concernsIf there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, [redacted] Complaint and Appeal Consultant Executive Resolution Team
Hello, Please see our response regarding complaint # [redacted] for [redacted] 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, 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 [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] [redacted] Complaint and Appeal Consultant Executive Resolution Team
Dear MsMadelyn Sola: Please see our response to complaint [redacted] for Jill Watts that was received by us on August 05, 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 [redacted] concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Ashley WComplaint and Appeals Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: Your advertising and marketing of this plan is misleading and deceptive Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: I received an email stating "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 [redacted] and was paid to the member on July 30, 2015." This is untrueWe still have not received payment and were certainly not paid on July It's August 5thThis has been exactly the kind of thing that has been frustrating during the whole process Sincerely, [redacted]
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 [redacted] 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 issueUnfortunately, 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 [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, [redacted] Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
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, [redacted]
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 records to see what type of dental discount policy the member is enrolled inWe found that the member is enrolled in a Vital Savings plan purchased through http://www[redacted] .comAetna is strictly an administrator of this plan; Aetna does not control the enrollment or the billing All enrollments are handled through a Third Party Administrator (***) and the Billing is handled by the ***, not by AetnaThe participant makes the payments directly to the ***; there is no pay roll deductionAnyone requesting a refund of premiums or a cancellation of the plan must contact the [redacted] directlyYou can call ###-###-#### or go online to the website listed above Please be aware that this plan is strictly a discount plan and is not insuranceThere are no claim submissions of any kind and the member is responsible for paying the discounted price directly to the dentistAetna would have no way of verifying if the plan was not used by the memberAlso any renewal information would come from the [redacted] directly to the member; Aetna is not responsible for any communications to the member We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address ** [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] .com Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Complaint: [redacted] 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, [redacted] ***
Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on March 20, 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 Customer Service department to have the member’s concerns reviewedOur Customer Service department was aware of the member’s request and were working to reissue the checkWe completed the request and overnighted the check to the memberThe [redacted] tracking number was [redacted] This was delivered to the member’s confirmed address on March 27, 2018, at 10:14amPlease relay my apologies for the difficulties the complainant has encountered with AetnaI’m sorry that our representatives were not able to assist her when she calledOur goal is to provide quality service and satisfaction to our members, and I sincerely regret that [redacted] did not receive the service she should rightfully expect and deserveHer concerns have been forwarded to our management team for improvement opportunitiesI hope that going forward we will be able to regain [redacted] ’s confidence in usRegarding her request for reimbursement for her time, we are unable to provide compensation to any complainant.We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely,William B.Complaint and Appeals ConsultantExecutive Resolution Team
[redacted] Please see our response to complaint #[redacted] that was received by us on October 27, 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 [redacted] Sincerely, [redacted] Complaint and Appeals Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 directly to the provider’s office to address the member’s concernsWe spoke with Dawn, at the New Berlin office, and we explained the situation that the claim was sent to us as performed at the [redacted] officeIn our discussion with Dawn, we provided the payment ID and confirmed the address the payment was sent to and we were advised the payment went to their main office for Forward Dental, per the way the claim was submitted to Aetna by the provider We faxed the explanation of benefits to Dawn’s attention for review on Friday February 05, We called today, February 09, 2016, and spoke with Dawn and she advised that the main office submitted the claim incorrectly to Aetna, listing the wrong office, but that she was working internally within their offices to have the money applied to the member’s account The office was provided with my direct number for any future questions or concerns surrounding the claimUnfortunately, we are not able to change the claim on file to show the correct office, the provider’s office would be required to submit a corrected claim for Aetna to be able to make any adjustments We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Dear Ms***, Please see our response to complaint # [redacted] for [redacted] that was received by us on October 08, The records indicate that Mr***’s original effective date is October 1, 2014, with a month waiting periodSince this criterion was not met, benefits are not eligible under the plan for the service performed on June 3, We had the claim verified with our Dental department to review if there was any way any exceptions could be made; we also reviewed the original appeal informationHowever, our decision remains the sameBased on the guidelines of Mr***’s policy that were provided in our previous response, the plan has a month waiting period for type C servicesThe service performed June 3, was a type C serviceTherefore, an exception could not be madeOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants I apologize for any difficulties this situation has 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 concernsIf there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Regards, Julian C [redacted] Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint [redacted] 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 Claims department to verify if the claim was processed correctly according to the member’s benefitsWe were advised that according to the benefits for hospital emergency room services the claim was processed correctlyHospital emergency room services are covered 85% after the deductible is metThe level of care was not a factor when considering the amount the member owes, it is strictly based upon the 15% due of the contracted rate of the provider’s billed charges We also had the calls pulled prior to the member purchasing the breast pump to see if incorrect information was provided to the memberThe member was advised that a breast pump would only be covered under the plan if it was medically necessary, meaning there has to be an issue with feeding before it will be coveredShe was advised that a letter would have to be submitted by the provider stating the reason for medical necessity and the customer service representative (CSR) again reiterated that it must be medically necessaryWe also listened to the calls after the purchase of the breast pump and again the member was advised that it would only be covered under the plan if medically necessaryThe member requested what would qualify as medically necessary and the CSR provided an example of if the child was born with a cleft palate or if the mother was discharged prior to the baby being dischargedThe member stated she understood the benefits on both callsI empathize with your situation and regret that our decision could not be more favorable While 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 take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Thank you for your inquiry received on 09/15/regarding complaint # [redacted] for [redacted] 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 $ 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/ The February bill then produced the charge back of the $that was refunded in error and the new rate of $ 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 [redacted] ’s concerns If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
Dear MsShea, Please see our response to complaint # for Robert Whiteside that was received by us on February 17, We would like to advise that the specific supporting information MrWhiteside submitted was received from a Department of Insurance inquiry on February 16, and a response will be provided by March 08, after the received information is reviewed I would also like to again advise that Aetna did not attempt to intimidate, threaten, delay or deceive MrWhiteside, nor did it attempt to discourage submission of claimsIn fact, where Aetna made reference to its legal department or compliance area reviewing the matter, we were only indicating that they were providing a higher level review of MrWhiteside’s issues to determine if Aetna had appropriately handled his claimsIt was not Aetna’s intention to infer that MrWhiteside was being investigated; only that Aetna’s handling of his claims and concerns was being investigated I apologize for any difficulties or confusion this may have caused MrWhiteside We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrWhiteside’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected] Regards, Julian Cano Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 Customer Service department to have the calls pulled prior to services rendered to see if the member was advised incorrect informationWe located only one call on file prior to services being rendered related to the procedure on January 20, 2016, where the customer service representative (CSR) advised the member would have to meet her $deductible prior to Aetna paying for the service We did locate a call that took place after the services were rendered where the CSR did incorrectly quote the out of pocket responsibility for the member, but after calling the facility and confirming how they bill this service and where it would take place, the CSR corrected the amount the member would be responsible forThe CSR apologized and did state the member would be responsible for meeting her deductible and she was going to be responsible for more than what she originally quoted at the beginning of the callWe assure you that it is not our intent to mislead or misrepresent any benefit that may or may not be available under your health plan The claims in question were processed correctly in accordance to your plan benefitsWhile 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 participantsI realize that understanding your benefits can be challenging, and regret that you had difficulty when you tried to obtain information It is our goal to be there for you when you need us, and I apologize that the assistance you received from our customer service representatives did not meet your needs Be assured that your concerns are getting the highest level of attention at Aetna I 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 [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] 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 department to have the member’s concerns reviewedWe were advised by our Aetna Rx Home Delivery department that on August 21, 2014, the member’s physician called in three new prescriptions for the memberThe order diverted to a member outreach to obtain a payment method for the orderOn August 26, 2014, a call was made to the member to obtain a payment method for the order; the member was not available and a message was leftOn September 03, 2014, the member had not returned the call and the order was released and charged to the credit card on file, which had been used for a previous orderThe order shipped the same day via *** On September 04, 2014, the member contacted Customer Care regarding the order to advise that the order was charged to her credit card without her approvalThe member requested to have the credit card removed from her account and a note added stating not to fill orders until she calls to request themThe note was added to the account per the member’s request and on September 20, 2014, the credit card charge was refunded in the amount of $Due to this refund, the member then owed the charges incurred for the August 21, 2014, prescriptions On December 30, 2014, the member contacted Customer Care and requested to have a prescription refilledA request was sent to the pharmacy to fill the prescription and the order diverted for a member outreach to obtain a method of paymentOn December 31, 2014, and January 02, 2015, outreaches were made to the member to obtain a payment methodThe member returned the call to the account receivable team on January 05, 2015, and provided a method of payment for the orderShe was also advised that the order would be released as a courtesy and she is responsible for the past due balance of $The member requested to speak to a supervisor and was transferred to a supervisor The member advised the supervisor that she called to cancel the August prescription order and was assured that the order would be cancelledThe supervisor said that she would have the call reviewed to verify if the member was told the order would be cancelled and would call her back The supervisor called the member back on January 08, 2015, to advise her of the call review results but the member was not available and a message was leftThe call review confirmed that the member was advised that the order could not be cancelled but that a return label could be sent to return the prescription and the member stated not to worry about sending the return label, that she would dispute the charge with her bank We did not hear back from the member and on April 24, 2015, a new prescription was received via fax from the physicianThe order diverted to the account receivable team for a member outreach to obtain a payment method for the order and to resolve the outstanding balance of $Three separate outreaches were made to the member on May 01, 2015, May 07, 2015, and May 08, and messages were left On August 21, 2015, the member requested two prescriptions via the Aetna websiteThe order diverted for a member outreach because the outstanding balance had to be resolved prior to the order being shippedAn outreach was made to the member to obtain payment for the past due balance on August 25, and a message was left for the member to call backAs a second courtesy to the member, the prescriptions were released on August 26, 2015, without member contact for the outstanding balanceThe orders shipped the same day and were charged to the credit card on file On March 02, 2016, a prescription was received electronically from the physician and on March 03, 2016, the prescription was diverted for a member outreach because of the $past due on the fileOn March 07, 2016, an outreach was made to the member to obtain a method of payment for the prescription order and a message was left for the member to call backThe member called Customer Care back the same day regarding the balance and declined to pay the outstanding balance of $She was transferred to the account receivable department to assist with the paymentThe member again declined to pay the balance and requested that the prescription order be releasedThe member stated that she would call back regarding the past due balance As a last and final courtesy for the member, the balance of $has been written off due to the situationThe prescription has been release and the $copay has been charged to the credit card on fileDue to the previous chargebacks to the credit card going forward the member will be required to send money orders for any future prescriptions We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms Keith’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team