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 youUpon receipt of the complaint, we contacted our Disability department and confirmed that his request for Short Term Disability was denied due to insufficient clinical informationHis case manager called him on 04/11/to advise of this denial however there was no answer and no voicemail availableA letter was sent to [redacted] to explain the denial and provide his appeal rightsWe contacted [redacted] on 04/18/to discuss his complaintHe understands what is needed to support disability and the lack of supporting informationWe have advised him that we will determine if we can offer a peer to peer review even though the claim is denied or if he must file an appealWe will contact him tomorrow, to advice of the next stepsHe expressed appreciation with the callWe 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 [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] LaShonda CComplaint and Appeal Consultant Executive Resolution Team
They actually told me that if I did not receive the card in weeks to notify them, not until June as they told you that they told me, not true and I have the message from them stating soHowever, I have since received the giftcardWhy in the world would they not answer the phones and say what they responded to above? The is pitiful poor customer service! Thank you for your help Revdex.com! Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted]
Dear Ms [redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on October 7, 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 address the member’s concernsWe verified that all claims have been reviewed and reprocessed to show the correct rateWe also confirmed that the provider’s contracted rate is $for HMO productsThe $rate is for non-HMO products We apologize for the inconvenience in regards to the delay in processing the member’s claimWe have provided feedback to improve service and to prevent these issues from reoccurringWe appreciate the member’s comments and have submitted the recommendations to leadership for reviewWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [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, Thank you for your inquiry, regarding complaint # [redacted] for Jared G [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 contacted our Eligibility department to verify the policyOur records indicate the policy was effective on November 10, 2014, and terminated on January 01, We received a retro-termination request from the employer to back date the termination to January 01, Any termination requests are forwarded to [redacted] from the employer[redacted] cannot refund premium paymentsIf the member is seeking a refund for the policy he must contact his Human Resources department to request I apologize for the frustrations and difficulties you encountered while attempting to resolve this issueWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrG [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] @***.comThank you, LaShonda C.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 had the claims for the [redacted] family reviewedWe were able to verify that there were a few claims on file that were delayed in processing due to not have diagnosis codes submitted with the claimOnce we received the diagnosis codes we were able to process the claims in a timely mannerAt this time all claims on file have been processed and finalized Most of the family’s claims on file were processed and finalized within 10-business days of receiptIf the member sees an out of network provider the payment of the claim is going to be based upon a reasonable and customary rate, not determine by Aetna, and will pay the percentage of the allowableIf there is a particular date of service that the member feel was not processed correctly or disagrees with the payment, the member may file an appeal with our Customer Resolution Team Please accept my apology for the delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issue Our goal is to pay claims timely and accurately, and to promptly resolve issues when they do occur When issues do arise, 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 Ms***’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: I want to know the exact date they sent requested information to the medical provide Which provider, the doctor's name, and what address was this request for information sent to I have heard repeatedly they request information so it would be important of me, the patient, to follow up with the doctor to make sure they received this information and respond to Aetna I appreciate Revdex.com to go back to Aetna with this request for additional, more detailed information Sincerely, [redacted] ***
Hello, Thank you for your inquiry, regarding complaint # [redacted] received on 09/23/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 contacted our Provider Network department and confirmed that this provider is contracted with Aetna [redacted] applied for credentialing in [redacted] on 11/06/The provider was credentialed and approved on 12/26/A contract was not sent to this provider until 02/26/The provider countersigned on 03/02/Based on our review, we will approve the contract as of 01/01/to cover the multiple rejected claims on fileWe will submit a claims project to reprocess the claimsWe have contacted this provider to confirm our findingsWe will also terminate the [redacted] service location once we confirm with the provider 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 [redacted] Thank you, LaShonda CExecutive 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 This member’s claim was processed and finalized on September 5, The member’s explanation of benefits was also mailed to the home address on file that day and is available for review on their Aetna Navigator accountThe provider has been paid for the services and the member is only responsible for a copay 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
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 our [redacted] department to have the member’s concerns reviewedWe were advised by the [redacted] department, that The Annual Notice of Change (ANOC) and Explanation of Coverage (EOC) The Centers for [redacted] & [redacted] require us to send a combined ANOC and EOC mailing each yearThe ANOC describes the changes to the members plan for the upcoming plan yearThe EOC is the actual contract that provides the members plan benefits and guidelinesAll of our booklets and mailings are approved by [redacted] and are written according to [redacted] guidelines We reviewed the members ANOC/EOC and found the following: Page states: Hospice The member may receive care from any [redacted] -certified hospice programThe member is eligible for the hospice benefit when their doctor and the hospice medical director have given the member a terminal prognosis certifying that the member is terminally ill and has months or less to live if the members illness runs its courseThe member's hospice doctor can be a network provider or an out-of-network provider Covered services include: - Drugs for symptom control and pain relief - Short-term respite care - Home care For hospice services and for services that are covered by [redacted] Part A or B and are related to the members terminal prognosis: Original [redacted] (rather than our plan) will pay for hospice services and any Part A and Part B services related to the terminal prognosisWhile the member is in the hospice program, their hospice provider will bill Original [redacted] for the services that Original [redacted] pays for For services that are covered by [redacted] Part A or B and are not related to the terminal prognosis: If the member needs non-emergency, non-urgently needed services that are covered under [redacted] Part A or B and that are not related to the terminal prognosis, the cost for these services depends on whether the member uses a provider in our plan’s network: -If the member obtains the covered services from a network provider, the member will only pay the plan cost-sharing amount for in-network services -If the member obtains the covered services from an out-of-network provider, the member will pay the cost-sharing under Fee-for-Service [redacted] (Original [redacted] ) When a member enrolls in a [redacted] -certified hospice program, their hospice services and their Part A and Part B services related to their terminal condition are paid for by Original [redacted] , not Aetna [redacted] Select Plan (HMO) Hospice consultations are included as part of Inpatient hospital carePhysician service cost sharing may apply for outpatient consultations Aetna Compassionate Care Program This program offers case management and services to members and their families who are managing the complex and emotional issues involved in advanced illnessesA nurse case manager by the name of Sue Lwill be in contact with you We strive to provide the best customer service experience possible and we expect that in all of our departmentsWe have reviewed your concerns and verified the calls made into our Member ServicesWe forwarded the issue to the representative’s direct supervisor for education and/or re-training Aetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processesI want you to know that we appreciate your feedback because it gives us the opportunity to listen to our customers and make any improvements to our processes and the service we provideYour opinion is valued at Aetna, and I trust that you will not hesitate to contact us when you need assistance 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
I do not accept the response made by the business to resolve this complaint I did in fact send them copies of the money orders they stated they did not receive
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 compliant we immediately reached out to [redacted] to confirm the children were not active under the policyWe were able to confirm the children were never active on any other plan, making Aetna the primary payer for the claims on file After confirming that Aetna is the primary payer, we immediately reached out to our Claims department to have all the claims reprocessed and paid as primary to the providersPlease allow 7-business days for the providers to receive the payments as well as the corrected explanation of benefitsPlease accept my apology for the delay in processing the claims correctly, and that it required multiple attempts on the member’s part to resolve the 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 the member’s to improve our service and prevent issues from reoccurring Our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occurThese actions are not consistent with Aetna’s service standards and we appreciate you notifying us of the member’s experienceI would like to assure you that we have taken the appropriate actions to address the service issues the member experienced We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Dr Jain’s 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
Complaint: [redacted] I am rejecting this response because: This does not change the fact that I had to go days with out necessary medication and due to Aetna playing doctor (deciding that my age isn't appropriate for a medication) my life was put on the lineI do not accept Aetna's absurd procedures and disregard of human lifeIt's not just my life that is put on the lineDaily Aetna plays this game with several of their customers and the evidence is right on their [redacted] pageHundreds of angry people who are tired of the same thingI will continue to keep this case open for myself and all the others like me who have been toyed with just so that Aetna could play doctor the prescriptions Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: You have record of my calling twiceBoth instances I was only given one amount as my responsibility which was $What is the point of providing this service for individuals wishing to be proactive and properly budget if and inaccurate information is going to be provided? My decisions, twice, were based off your customer service reps provided informationTwice, not once, was I told "it would only be $500" and confirmed there would be no surprisesOne of the reps even confirmed I had no deductible and some other fee so it was only $If you call to order something and get one price and proceed with this purchase would you not protest when you suddenly get billed for double the amount? Now that my calls are re-discovered I would like to hear both recordings myself as I don't believe I gave any room to misinterpret my concerns when checking my benefits and co-paysHad there been one individual who even slightly gave mention to an additional $copay I could understand your not wanting to resolve the issueThis simply was never the case otherwise, as you have stated in both recordings I would have went to my hospital and had the co-pay waived now saving $as you're claimingI have provided several ways to contact meFeel free to use any method 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 [redacted] departmentOur [redacted] department attempted to reach the member on April 05, 2016, to find out more information regarding the complaint Unfortunately, our [redacted] department has yet to hear back from the member about the details surrounding this complaintOnce we receive more information and details about this complaint, whether it is related to benefits, customer service etcwe will be able to research furtherPlease have the member contact our [redacted] department if they wish to pursue the complaint further 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
Complaint: [redacted] I am rejecting this response because: I was Never contacted by Aetna regarding changing my code except when I first enrolled back in I was told to change the enrollment code from Epto Thereafter, Aetna took it amongst themselves to change my code to JSa code that doesn't exist anywhere on aetnas website or brochureMy premium was raised by Aetna not my human resources officeThis is ridiculous and robbery I would like my plan changed back and all overpayment returned to me I never signed nor agreed to change my plan to JSI was informed by Aetna that they were changing my plan without my permission I plan to take legal action an continue to report these unethical practices until it is rectified Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because:Our coverage is supposed to be effective January 1, I need this resolved ASAP Sincerely, [redacted]
Hello, Thank you for your inquiry, regarding complaint # [redacted] *or [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 Eligibility department to verify if the member should have active [redacted] coverage with AetnaWe confirmed that the member’s employer switch to a new health insurance carrier in the middle of and the member is no longer covered by AetnaWe were advised that a representative from the member’s Human Resources (HR) will be reaching out directly to the member to confirm that her coverage is with United Health CareThe member will need to contact either her HR or United Health Care with any benefit or eligibility questionsI apologize for any inconvenience this may have caused for 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] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Thank you for your inquiry received on 07/01/regarding complaint # [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 Aetna’s Student Health department for assistance, and for [redacted] , eligible students are automatically enrolled in the Aetna Student Health Plan, unless a completed Waiver Form has been received by [redacted] by the deadline date which would have been 08/01/for continuing students or 08/04/for new students We do have Ms [redacted] enrolled from 07/01/2014-06/30/2015, which means more than likely she did not submit a waiver which shows proof of other insuranceIf this is the case, then she is enrolled for the months and is responsible for the insurance premium We do have a Broker that handles all waiver and enrollment questions and issuesMs [redacted] (the student) will need to reach out to them directly if she has further questions or issuesMs [redacted] may contact HSA Consulting at [redacted] ; or online at: [redacted] 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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [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 We apologize if our previous response was misunderstood or upset the member in any way, we assure you that it is not our intent to mislead or misrepresent any information that was relayed to the member regarding the paymentWe mailed a check to the member on July 30, 2015, to the home address on fileOur records indicate that this check was received and was cashed on August 13, 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 Upon receipt of the complaint we immediately reviewed the prior authorization request and the appeal requestAccording to our records our pre-certification department was contacted by the provider on September 14, 2015, and the medical records were received by [redacted] on September 22, Our medical director reviewed the pre-certification request on September 22, and a determination was made that same dayWe mailed a letter to both the member and the provider advising of the resolution on September 22, 2015, and we verified that the address on file for the member was the address the letter was mailed to The appeal request was made on November 27, by the provider on the member’s behalfThe first page of the appeal request included the pre-certification denial letter dated September 22, 2015, and at the top of the page the provider wrote received on September 30, The provider’s office was waited almost a month to request the first level appealThe appeal was closed on December 07, 2015, in a timely manner and a resolution letter was mailed to the facility on the same day The member was advised of the resolution by a representative of [redacted] on December 10, 2015, and she also emailed the resolution letterI understand your concerns and recognize this is not the outcome you desiredHowever, we must make coverage decisions in accordance with your plan of benefits and our medical necessity guidelinesThe member and/or the provider can request another level of appeal by contacting our customer service department or sending a request in writing within calendar days Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occurI sincerely apologize for the frustrations and difficulties you experienced and that we did not provide the level of service that you rightfully expect and deserveThese actions are not consistent with ***’s service standards and we appreciate you notifying us of your experienceWe have addressed your customer service concerns directly with the representatives and supervisors who were involved 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 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
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 youUpon receipt of the complaint, we contacted our Disability department and confirmed that his request for Short Term Disability was denied due to insufficient clinical informationHis case manager called him on 04/11/to advise of this denial however there was no answer and no voicemail availableA letter was sent to [redacted] to explain the denial and provide his appeal rightsWe contacted [redacted] on 04/18/to discuss his complaintHe understands what is needed to support disability and the lack of supporting informationWe have advised him that we will determine if we can offer a peer to peer review even though the claim is denied or if he must file an appealWe will contact him tomorrow, to advice of the next stepsHe expressed appreciation with the callWe 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 [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] LaShonda CComplaint and Appeal Consultant Executive Resolution Team
They actually told me that if I did not receive the card in weeks to notify them, not until June as they told you that they told me, not true and I have the message from them stating soHowever, I have since received the giftcardWhy in the world would they not answer the phones and say what they responded to above? The is pitiful poor customer service! Thank you for your help Revdex.com! Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted]
Dear Ms [redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on October 7, 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 address the member’s concernsWe verified that all claims have been reviewed and reprocessed to show the correct rateWe also confirmed that the provider’s contracted rate is $for HMO productsThe $rate is for non-HMO products We apologize for the inconvenience in regards to the delay in processing the member’s claimWe have provided feedback to improve service and to prevent these issues from reoccurringWe appreciate the member’s comments and have submitted the recommendations to leadership for reviewWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [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, Thank you for your inquiry, regarding complaint # [redacted] for Jared G [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 contacted our Eligibility department to verify the policyOur records indicate the policy was effective on November 10, 2014, and terminated on January 01, We received a retro-termination request from the employer to back date the termination to January 01, Any termination requests are forwarded to [redacted] from the employer[redacted] cannot refund premium paymentsIf the member is seeking a refund for the policy he must contact his Human Resources department to request I apologize for the frustrations and difficulties you encountered while attempting to resolve this issueWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrG [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] @***.comThank you, LaShonda C.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 had the claims for the [redacted] family reviewedWe were able to verify that there were a few claims on file that were delayed in processing due to not have diagnosis codes submitted with the claimOnce we received the diagnosis codes we were able to process the claims in a timely mannerAt this time all claims on file have been processed and finalized Most of the family’s claims on file were processed and finalized within 10-business days of receiptIf the member sees an out of network provider the payment of the claim is going to be based upon a reasonable and customary rate, not determine by Aetna, and will pay the percentage of the allowableIf there is a particular date of service that the member feel was not processed correctly or disagrees with the payment, the member may file an appeal with our Customer Resolution Team Please accept my apology for the delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issue Our goal is to pay claims timely and accurately, and to promptly resolve issues when they do occur When issues do arise, 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 Ms***’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: I want to know the exact date they sent requested information to the medical provide Which provider, the doctor's name, and what address was this request for information sent to I have heard repeatedly they request information so it would be important of me, the patient, to follow up with the doctor to make sure they received this information and respond to Aetna I appreciate Revdex.com to go back to Aetna with this request for additional, more detailed information Sincerely, [redacted] ***
Hello, Thank you for your inquiry, regarding complaint # [redacted] received on 09/23/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 contacted our Provider Network department and confirmed that this provider is contracted with Aetna [redacted] applied for credentialing in [redacted] on 11/06/The provider was credentialed and approved on 12/26/A contract was not sent to this provider until 02/26/The provider countersigned on 03/02/Based on our review, we will approve the contract as of 01/01/to cover the multiple rejected claims on fileWe will submit a claims project to reprocess the claimsWe have contacted this provider to confirm our findingsWe will also terminate the [redacted] service location once we confirm with the provider 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 [redacted] Thank you, LaShonda CExecutive 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 This member’s claim was processed and finalized on September 5, The member’s explanation of benefits was also mailed to the home address on file that day and is available for review on their Aetna Navigator accountThe provider has been paid for the services and the member is only responsible for a copay 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
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 our [redacted] department to have the member’s concerns reviewedWe were advised by the [redacted] department, that The Annual Notice of Change (ANOC) and Explanation of Coverage (EOC) The Centers for [redacted] & [redacted] require us to send a combined ANOC and EOC mailing each yearThe ANOC describes the changes to the members plan for the upcoming plan yearThe EOC is the actual contract that provides the members plan benefits and guidelinesAll of our booklets and mailings are approved by [redacted] and are written according to [redacted] guidelines We reviewed the members ANOC/EOC and found the following: Page states: Hospice The member may receive care from any [redacted] -certified hospice programThe member is eligible for the hospice benefit when their doctor and the hospice medical director have given the member a terminal prognosis certifying that the member is terminally ill and has months or less to live if the members illness runs its courseThe member's hospice doctor can be a network provider or an out-of-network provider Covered services include: - Drugs for symptom control and pain relief - Short-term respite care - Home care For hospice services and for services that are covered by [redacted] Part A or B and are related to the members terminal prognosis: Original [redacted] (rather than our plan) will pay for hospice services and any Part A and Part B services related to the terminal prognosisWhile the member is in the hospice program, their hospice provider will bill Original [redacted] for the services that Original [redacted] pays for For services that are covered by [redacted] Part A or B and are not related to the terminal prognosis: If the member needs non-emergency, non-urgently needed services that are covered under [redacted] Part A or B and that are not related to the terminal prognosis, the cost for these services depends on whether the member uses a provider in our plan’s network: -If the member obtains the covered services from a network provider, the member will only pay the plan cost-sharing amount for in-network services -If the member obtains the covered services from an out-of-network provider, the member will pay the cost-sharing under Fee-for-Service [redacted] (Original [redacted] ) When a member enrolls in a [redacted] -certified hospice program, their hospice services and their Part A and Part B services related to their terminal condition are paid for by Original [redacted] , not Aetna [redacted] Select Plan (HMO) Hospice consultations are included as part of Inpatient hospital carePhysician service cost sharing may apply for outpatient consultations Aetna Compassionate Care Program This program offers case management and services to members and their families who are managing the complex and emotional issues involved in advanced illnessesA nurse case manager by the name of Sue Lwill be in contact with you We strive to provide the best customer service experience possible and we expect that in all of our departmentsWe have reviewed your concerns and verified the calls made into our Member ServicesWe forwarded the issue to the representative’s direct supervisor for education and/or re-training Aetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processesI want you to know that we appreciate your feedback because it gives us the opportunity to listen to our customers and make any improvements to our processes and the service we provideYour opinion is valued at Aetna, and I trust that you will not hesitate to contact us when you need assistance 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
I do not accept the response made by the business to resolve this complaint I did in fact send them copies of the money orders they stated they did not receive
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 compliant we immediately reached out to [redacted] to confirm the children were not active under the policyWe were able to confirm the children were never active on any other plan, making Aetna the primary payer for the claims on file After confirming that Aetna is the primary payer, we immediately reached out to our Claims department to have all the claims reprocessed and paid as primary to the providersPlease allow 7-business days for the providers to receive the payments as well as the corrected explanation of benefitsPlease accept my apology for the delay in processing the claims correctly, and that it required multiple attempts on the member’s part to resolve the 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 the member’s to improve our service and prevent issues from reoccurring Our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occurThese actions are not consistent with Aetna’s service standards and we appreciate you notifying us of the member’s experienceI would like to assure you that we have taken the appropriate actions to address the service issues the member experienced We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Dr Jain’s 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
Complaint: [redacted] I am rejecting this response because: This does not change the fact that I had to go days with out necessary medication and due to Aetna playing doctor (deciding that my age isn't appropriate for a medication) my life was put on the lineI do not accept Aetna's absurd procedures and disregard of human lifeIt's not just my life that is put on the lineDaily Aetna plays this game with several of their customers and the evidence is right on their [redacted] pageHundreds of angry people who are tired of the same thingI will continue to keep this case open for myself and all the others like me who have been toyed with just so that Aetna could play doctor the prescriptions Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: You have record of my calling twiceBoth instances I was only given one amount as my responsibility which was $What is the point of providing this service for individuals wishing to be proactive and properly budget if and inaccurate information is going to be provided? My decisions, twice, were based off your customer service reps provided informationTwice, not once, was I told "it would only be $500" and confirmed there would be no surprisesOne of the reps even confirmed I had no deductible and some other fee so it was only $If you call to order something and get one price and proceed with this purchase would you not protest when you suddenly get billed for double the amount? Now that my calls are re-discovered I would like to hear both recordings myself as I don't believe I gave any room to misinterpret my concerns when checking my benefits and co-paysHad there been one individual who even slightly gave mention to an additional $copay I could understand your not wanting to resolve the issueThis simply was never the case otherwise, as you have stated in both recordings I would have went to my hospital and had the co-pay waived now saving $as you're claimingI have provided several ways to contact meFeel free to use any method 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 [redacted] departmentOur [redacted] department attempted to reach the member on April 05, 2016, to find out more information regarding the complaint Unfortunately, our [redacted] department has yet to hear back from the member about the details surrounding this complaintOnce we receive more information and details about this complaint, whether it is related to benefits, customer service etcwe will be able to research furtherPlease have the member contact our [redacted] department if they wish to pursue the complaint further 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
Complaint: [redacted] I am rejecting this response because: I was Never contacted by Aetna regarding changing my code except when I first enrolled back in I was told to change the enrollment code from Epto Thereafter, Aetna took it amongst themselves to change my code to JSa code that doesn't exist anywhere on aetnas website or brochureMy premium was raised by Aetna not my human resources officeThis is ridiculous and robbery I would like my plan changed back and all overpayment returned to me I never signed nor agreed to change my plan to JSI was informed by Aetna that they were changing my plan without my permission I plan to take legal action an continue to report these unethical practices until it is rectified Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because:Our coverage is supposed to be effective January 1, I need this resolved ASAP Sincerely, [redacted]
Hello, Thank you for your inquiry, regarding complaint # [redacted] *or [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 Eligibility department to verify if the member should have active [redacted] coverage with AetnaWe confirmed that the member’s employer switch to a new health insurance carrier in the middle of and the member is no longer covered by AetnaWe were advised that a representative from the member’s Human Resources (HR) will be reaching out directly to the member to confirm that her coverage is with United Health CareThe member will need to contact either her HR or United Health Care with any benefit or eligibility questionsI apologize for any inconvenience this may have caused for 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] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Thank you for your inquiry received on 07/01/regarding complaint # [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 Aetna’s Student Health department for assistance, and for [redacted] , eligible students are automatically enrolled in the Aetna Student Health Plan, unless a completed Waiver Form has been received by [redacted] by the deadline date which would have been 08/01/for continuing students or 08/04/for new students We do have Ms [redacted] enrolled from 07/01/2014-06/30/2015, which means more than likely she did not submit a waiver which shows proof of other insuranceIf this is the case, then she is enrolled for the months and is responsible for the insurance premium We do have a Broker that handles all waiver and enrollment questions and issuesMs [redacted] (the student) will need to reach out to them directly if she has further questions or issuesMs [redacted] may contact HSA Consulting at [redacted] ; or online at: [redacted] 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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [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 We apologize if our previous response was misunderstood or upset the member in any way, we assure you that it is not our intent to mislead or misrepresent any information that was relayed to the member regarding the paymentWe mailed a check to the member on July 30, 2015, to the home address on fileOur records indicate that this check was received and was cashed on August 13, 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 Upon receipt of the complaint we immediately reviewed the prior authorization request and the appeal requestAccording to our records our pre-certification department was contacted by the provider on September 14, 2015, and the medical records were received by [redacted] on September 22, Our medical director reviewed the pre-certification request on September 22, and a determination was made that same dayWe mailed a letter to both the member and the provider advising of the resolution on September 22, 2015, and we verified that the address on file for the member was the address the letter was mailed to The appeal request was made on November 27, by the provider on the member’s behalfThe first page of the appeal request included the pre-certification denial letter dated September 22, 2015, and at the top of the page the provider wrote received on September 30, The provider’s office was waited almost a month to request the first level appealThe appeal was closed on December 07, 2015, in a timely manner and a resolution letter was mailed to the facility on the same day The member was advised of the resolution by a representative of [redacted] on December 10, 2015, and she also emailed the resolution letterI understand your concerns and recognize this is not the outcome you desiredHowever, we must make coverage decisions in accordance with your plan of benefits and our medical necessity guidelinesThe member and/or the provider can request another level of appeal by contacting our customer service department or sending a request in writing within calendar days Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occurI sincerely apologize for the frustrations and difficulties you experienced and that we did not provide the level of service that you rightfully expect and deserveThese actions are not consistent with ***’s service standards and we appreciate you notifying us of your experienceWe have addressed your customer service concerns directly with the representatives and supervisors who were involved 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 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