Complaint: [redacted] y I am rejecting this response because: Regardless of their policy there should Always be exceptions when it comes to NECESSARY dental workBasically I feel Aetna has put their policy before my Health and safetyWas I just supposed to wait for their year deadline as my teeth rot out ? I appealed through Aetna and they rejected that appeal and I just wanted to give them ample chance to repair the situation before going to less preferable means and causing negative publicity and cost much more in the long run but if that's that it takes to get them to do the right thing so be it Sincerely, [redacted] ***
Complaint: [redacted] I am rejecting this response because:I dont have the cards in hand Once I receive the cards, I will review them to ensure they have the correct information and I will be in touch.I will not close the case until 100% certain the cards are correc**Revdex.com, can you fix my name on your website?Thanks 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 youUpon receipt of the complaint, we contacted our Customer Service department to review your concernsWe have confirmed that the name change was completed on May 4, A new medical id card was sent by mail on May 5, We have also reviewed your claim history and found that there are no claim denials due to this errorWe apologize for the inconvenience this has caused youWe 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, LaShonda CComplaint and Appeal Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: The claim presented was not for the procedure (9/11), it was for the consultation (dated 9/3) The executive team has not responded back with any concerns or questions, and have not reached out to any of the providers as well Sincerely, [redacted] ###-###-####
Dear Ms***, Please see our response to complaint # [redacted] for [redacted] that was received by us on July 15, We contacted our Medicare department and asked them to review Mr [redacted] concernsThey advised that the claim submitted by Dr [redacted] for March 25, 2015, was processed correctlyDr [redacted] billed the claim with a nonparticipating tax identification number (TIN), which does not accept the Aetna Medicare PPO planDr [redacted] is participating under a different TIN than the one used on the claimHowever, we cannot tell providers how to bill their claimsThe Medicare department sent Mr [redacted] a letter on August 04, 2015, which includes a detailed explanation of their review and his next steps 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 [redacted] concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Regards, [redacted] Executive Resolution Team
I did receive the advertised gift card weeks after receiving the insurance packet I also received a second identical insurance packet from Aetna I would highly recommend that Aetna include the gift card in the insurance packet, or at least a note stating when it should arrive Otherwise customers are left with the impression that the card was forgotten
Complaint: [redacted] I am rejecting this response because: 1) If my health care policy had been "terminated" after I received policy information and been had issued ID cards then why did AETNA not so notify me?2) How come I was still paying for it?3) The first time I contacted AETNA customer service in February of I was told that the policy was effective for myself, but not my wife.....which was opposite of the way it should have been Sincerely, [redacted]
From: [redacted] Sent: Thursday, May 05, 9:PMTo: [email protected]: My Complaint vAetna Insurance CoNo [redacted] Thank you for finally getting someone at Aetna Insurance Company to respondDespite the information provided in my complaint, Aetna claimed it needed more I provided it.Then Aetna next said that it needed a signed Authorization from my client in order to communicate with me I provided it.An authorization is not necessary, as I am the attorney for the beneficiary under an Aetna Life Insurance Co I have been requesting payment from Aetna since February All documentation has been provided to Aetna (birth certificate of the beneficiary, who is the son of the decedent, the death certificate, and other documents verifying the familial relationship) According to one Aetna representative, Aetna completed its review in October However, Aetna never paid the benefits I have been making numerous telephone calls to Aetna for the past year I have been promised return telephone calls, but no return calls are EVER made Then on March 21, 2016, I received an email from an Aetna adjuster, Angela P [redacted] , who is handling this matter, stating that payment would be made She asked "where to send the check" and I provided the mailing address However, no payment was made I sent a follow up email requesting the status to MsP [redacted] , but she ignored my inquiry After I filed a complaint with you, I did receive a request for more information and an Authorization as stated above I provided the Authorization, even though I am counsel for the beneficiary and I have provided Aetna with all of my client's documents I expected a response from Aetna, but there has been none I find it unconscionable for Aetna to withhold the payment of benefits when its policy states, in black and white, that payment will be made "within days" upon proof If Aetna completed its review in October 2015, payment should have been made then Instead Aetna waited five (5) months to even communicate its acceptance of the obligation to pay, and even further, Aetna has still refused to make its payment to the beneficiary The failure of Aetna to respond to my inquiries, and its neglectful handling of my client's claim, is simply outrageous I hope that there is a remedy, not only for my client, one that will penalize Aetna for its sub-standard business practice Aetna should pay my client the policy amount, plus attorney's fees and costs, and damages If not, I will be filing a claim for bad faith Thank you, [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 youUpon the receipt of your complaint, we reached out to the [redacted] on May 19, to discuss his concerns and we have decided to work with the member directly to resolve his issuesWe 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 [email protected] you, Tanika KComplaint and Appeal Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: This is not the information that [redacted] in the pre-certification department [redacted] gave me when she did the pre-certification I have tried to contact [redacted] multiple times and have yet to received a call backI contacted Aetna because I couldn't find anyone in my area that was covered for the food allergy services I needed [redacted] found this person and sent me to them I only did what Aetna told me to doEvery time I call Aetna I get a different story When [redacted] filed the appeal she told me that [redacted] didn't do the leg work correctly when she did the pre-certification I have been told the pre-certification was not working because the doctor that was billing was [redacted] versus [redacted] *** Then the next person told me they couldn't even see that [redacted] was the one billing I haven't been able to get any consistent answers from anyone at member services.This is the worst customer service I have ever experienced I just want this to be taken care of I have been dealing with this for over months now I have been trying to get this resolved on my own and I feel like I have no other choice than to do it this way Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because:I now have sets of cards, both with the incorrect name.This is such a BS game your playing PLEASE SEND ME CARDS WITH MY NAME ON THEMAnd Revdex.com, please fix my name your just as bad as Aetna is! When this form populates, it does not include *** Please fix Sincerely, [redacted]
Thank you for your rejection notice received on 09/14/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 for the inconvenience and difficulty this situation has caused youAetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processes We regret that your experience was not a positive oneWe 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 provide Upon further review, all claims on file have been processed and finalized timely 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 allowable If there is a specific date of service in question that the member feels was not processed correctly or disagrees with the payment, the member may file an appeal in writing to: Aetna- CRT Member Appeals [redacted] The request should include: Name, Aetna ID, date of birth, claim information (including date of service, billed amount, provider name), and your contact information We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
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 meI must add however that I called [redacted] today and they stated that a payment for $was made on May 25th and not earlier as Aetna saidThe provider also told me that a payment is still pending and Aetna's payment is about $short but I will not be responsible for this as I already paid my coinsurance in Overall, I think I will no longer be billed because I am only responsible for the coinsurance Sincerely, [redacted] [redacted]
Dear [redacted] ***Please see our response to complaint # [redacted] for [redacted] that was received by us on November 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 Marketing department to address [redacted] concernsWe confirmed that the card was shipped on 11/2/and it takes about 5-business days to receivePlease note that the card arrives in a plain white envelope from our vendorWe 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,LaShonda C.Complaint and Appeal Consultant Executive Resolution Team
From: [redacted] Sent: Friday, May 20, 1:PMTo: Revdex.com Subject: Re: You have a New Message from Revdex.com Serving Connecticut Regarding Complaint # [redacted] Please be advised that the check was sent; however, there was no apology.Nor was there additional compensation for the year-long wait my client had to go throughNor has Aetna offered to pay for all of the attorney's fees generated by Aetna's failure to promptly pay.This company deserves an "F." [redacted]
Dear Ms [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on December 14, Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the provider’s complaint I reached out to them directly to obtain additional informationAfter speaking with the provider, I confirmed they received a call from Aetna’s Recovery department who was able to resolve their concernsThe provider had no additional concerns at this time 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 concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Kim BComplaint and Appeals Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for Roy FreeseOur 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 request a review of the member’s policy on fileWe were advised by the member's employer, [redacted] , to terminate the policyThe member would need to follow up with their Human Resources department regarding this issue, as Aetna is only an administrator of the plan and does not control termination requestsI apologize for the inconvenience and difficulty this situation has caused the member We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] 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
[redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on January 10, 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 and Premium department to have the member’s concerns reviewedWe were advised that a termination file was received from the Marketplace on December 13, to terminate the policy with a date of December 27, The request for termination was completed on December 14, 2016, to reflect the term date of December 27, The member was refunded the prorated difference of $on December 16, We verified our call history on file since the member stated he called to terminate the policy for the effective date of November 30, 2016, and was told by a representative that he did not have to take any action, but there are no calls on file related to this complaintIf the call was with the Marketplace, we do not have recordings for those calls, only the Marketplace would have a recording Unfortunately, the policy does not qualify to be terminated effective November 30, 2016, because the file received from the Marketplace was received with a termination date of December 27, If the member is still disputing the termination date, the member would need to reach out to the Marketplace appeals department a [redacted] to request the November 30, 2016, termination dateOnly if the Marketplace appeals department approves the requested termination date would we be able to complete the full refund for the December premium 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 there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, [redacted] ***
Complaint: [redacted] I am rejecting this response because:There is still no way for me to know who the so called provider us on the claim forms.They refused to provide provider information (hospital clinic medical group) for the persons name in the provider column on there forms.I have to spend hours trying to guess and find out who they work for to verify if each claim is legitimateThey have resently deleted the claim I caught but the time I need to spend verifying 100's of claims by the end of the year will bealot of wadted time on my part because they refuse to let me know who the provider is.This is not personel information as they told meWhat clinic name or hospital or medical group they work at should not be considered personnel infomation they cannot provide on there formsThe clinics and hospitals provide the info to Aetna it's Aetna that refuses to put that on there claimsOnly other option is to send Aetna all the names on the claim forms and request special permision to find out the address of the persons billing addressThen I would [redacted] the address to find out what building is there and maybe find out who it isI then have to message my kids at collage to see if they went there for something on that dateCollage kids have short memoriesWhen I asked them ladt time they only remebered half of the claims Sincerely, [redacted] ***
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 have the calls pulled related to the pregnancy coverage prior to services being renderedThe records indicate only general pregnancy benefits were provided during the call from the memberThe claims in question were processed correctly in accordance to the member’s plan benefits When the child is born and is added to the policy as an individual, the facility is able to bill separately for both mom and child for any charges related to the pregnancyThe submitted charges were sent for both the mom and child; which triggered the individual copaysWhile we understand your concerns and recognize this is not the resolution you sought, our decision remains unchangedOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants 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
Complaint: [redacted] y I am rejecting this response because: Regardless of their policy there should Always be exceptions when it comes to NECESSARY dental workBasically I feel Aetna has put their policy before my Health and safetyWas I just supposed to wait for their year deadline as my teeth rot out ? I appealed through Aetna and they rejected that appeal and I just wanted to give them ample chance to repair the situation before going to less preferable means and causing negative publicity and cost much more in the long run but if that's that it takes to get them to do the right thing so be it Sincerely, [redacted] ***
Complaint: [redacted] I am rejecting this response because:I dont have the cards in hand Once I receive the cards, I will review them to ensure they have the correct information and I will be in touch.I will not close the case until 100% certain the cards are correc**Revdex.com, can you fix my name on your website?Thanks 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 youUpon receipt of the complaint, we contacted our Customer Service department to review your concernsWe have confirmed that the name change was completed on May 4, A new medical id card was sent by mail on May 5, We have also reviewed your claim history and found that there are no claim denials due to this errorWe apologize for the inconvenience this has caused youWe 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, LaShonda CComplaint and Appeal Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: The claim presented was not for the procedure (9/11), it was for the consultation (dated 9/3) The executive team has not responded back with any concerns or questions, and have not reached out to any of the providers as well Sincerely, [redacted] ###-###-####
Dear Ms***, Please see our response to complaint # [redacted] for [redacted] that was received by us on July 15, We contacted our Medicare department and asked them to review Mr [redacted] concernsThey advised that the claim submitted by Dr [redacted] for March 25, 2015, was processed correctlyDr [redacted] billed the claim with a nonparticipating tax identification number (TIN), which does not accept the Aetna Medicare PPO planDr [redacted] is participating under a different TIN than the one used on the claimHowever, we cannot tell providers how to bill their claimsThe Medicare department sent Mr [redacted] a letter on August 04, 2015, which includes a detailed explanation of their review and his next steps 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 [redacted] concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Regards, [redacted] Executive Resolution Team
I did receive the advertised gift card weeks after receiving the insurance packet I also received a second identical insurance packet from Aetna I would highly recommend that Aetna include the gift card in the insurance packet, or at least a note stating when it should arrive Otherwise customers are left with the impression that the card was forgotten
Complaint: [redacted] I am rejecting this response because: 1) If my health care policy had been "terminated" after I received policy information and been had issued ID cards then why did AETNA not so notify me?2) How come I was still paying for it?3) The first time I contacted AETNA customer service in February of I was told that the policy was effective for myself, but not my wife.....which was opposite of the way it should have been Sincerely, [redacted]
From: [redacted] Sent: Thursday, May 05, 9:PMTo: [email protected]: My Complaint vAetna Insurance CoNo [redacted] Thank you for finally getting someone at Aetna Insurance Company to respondDespite the information provided in my complaint, Aetna claimed it needed more I provided it.Then Aetna next said that it needed a signed Authorization from my client in order to communicate with me I provided it.An authorization is not necessary, as I am the attorney for the beneficiary under an Aetna Life Insurance Co I have been requesting payment from Aetna since February All documentation has been provided to Aetna (birth certificate of the beneficiary, who is the son of the decedent, the death certificate, and other documents verifying the familial relationship) According to one Aetna representative, Aetna completed its review in October However, Aetna never paid the benefits I have been making numerous telephone calls to Aetna for the past year I have been promised return telephone calls, but no return calls are EVER made Then on March 21, 2016, I received an email from an Aetna adjuster, Angela P [redacted] , who is handling this matter, stating that payment would be made She asked "where to send the check" and I provided the mailing address However, no payment was made I sent a follow up email requesting the status to MsP [redacted] , but she ignored my inquiry After I filed a complaint with you, I did receive a request for more information and an Authorization as stated above I provided the Authorization, even though I am counsel for the beneficiary and I have provided Aetna with all of my client's documents I expected a response from Aetna, but there has been none I find it unconscionable for Aetna to withhold the payment of benefits when its policy states, in black and white, that payment will be made "within days" upon proof If Aetna completed its review in October 2015, payment should have been made then Instead Aetna waited five (5) months to even communicate its acceptance of the obligation to pay, and even further, Aetna has still refused to make its payment to the beneficiary The failure of Aetna to respond to my inquiries, and its neglectful handling of my client's claim, is simply outrageous I hope that there is a remedy, not only for my client, one that will penalize Aetna for its sub-standard business practice Aetna should pay my client the policy amount, plus attorney's fees and costs, and damages If not, I will be filing a claim for bad faith Thank you, [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 youUpon the receipt of your complaint, we reached out to the [redacted] on May 19, to discuss his concerns and we have decided to work with the member directly to resolve his issuesWe 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 [email protected] you, Tanika KComplaint and Appeal Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: This is not the information that [redacted] in the pre-certification department [redacted] gave me when she did the pre-certification I have tried to contact [redacted] multiple times and have yet to received a call backI contacted Aetna because I couldn't find anyone in my area that was covered for the food allergy services I needed [redacted] found this person and sent me to them I only did what Aetna told me to doEvery time I call Aetna I get a different story When [redacted] filed the appeal she told me that [redacted] didn't do the leg work correctly when she did the pre-certification I have been told the pre-certification was not working because the doctor that was billing was [redacted] versus [redacted] *** Then the next person told me they couldn't even see that [redacted] was the one billing I haven't been able to get any consistent answers from anyone at member services.This is the worst customer service I have ever experienced I just want this to be taken care of I have been dealing with this for over months now I have been trying to get this resolved on my own and I feel like I have no other choice than to do it this way Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because:I now have sets of cards, both with the incorrect name.This is such a BS game your playing PLEASE SEND ME CARDS WITH MY NAME ON THEMAnd Revdex.com, please fix my name your just as bad as Aetna is! When this form populates, it does not include *** Please fix Sincerely, [redacted]
Thank you for your rejection notice received on 09/14/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 for the inconvenience and difficulty this situation has caused youAetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processes We regret that your experience was not a positive oneWe 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 provide Upon further review, all claims on file have been processed and finalized timely 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 allowable If there is a specific date of service in question that the member feels was not processed correctly or disagrees with the payment, the member may file an appeal in writing to: Aetna- CRT Member Appeals [redacted] The request should include: Name, Aetna ID, date of birth, claim information (including date of service, billed amount, provider name), and your contact information We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
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 meI must add however that I called [redacted] today and they stated that a payment for $was made on May 25th and not earlier as Aetna saidThe provider also told me that a payment is still pending and Aetna's payment is about $short but I will not be responsible for this as I already paid my coinsurance in Overall, I think I will no longer be billed because I am only responsible for the coinsurance Sincerely, [redacted] [redacted]
Dear [redacted] ***Please see our response to complaint # [redacted] for [redacted] that was received by us on November 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 Marketing department to address [redacted] concernsWe confirmed that the card was shipped on 11/2/and it takes about 5-business days to receivePlease note that the card arrives in a plain white envelope from our vendorWe 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,LaShonda C.Complaint and Appeal Consultant Executive Resolution Team
From: [redacted] Sent: Friday, May 20, 1:PMTo: Revdex.com Subject: Re: You have a New Message from Revdex.com Serving Connecticut Regarding Complaint # [redacted] Please be advised that the check was sent; however, there was no apology.Nor was there additional compensation for the year-long wait my client had to go throughNor has Aetna offered to pay for all of the attorney's fees generated by Aetna's failure to promptly pay.This company deserves an "F." [redacted]
Dear Ms [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on December 14, Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the provider’s complaint I reached out to them directly to obtain additional informationAfter speaking with the provider, I confirmed they received a call from Aetna’s Recovery department who was able to resolve their concernsThe provider had no additional concerns at this time 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 concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Kim BComplaint and Appeals Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for Roy FreeseOur 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 request a review of the member’s policy on fileWe were advised by the member's employer, [redacted] , to terminate the policyThe member would need to follow up with their Human Resources department regarding this issue, as Aetna is only an administrator of the plan and does not control termination requestsI apologize for the inconvenience and difficulty this situation has caused the member We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] 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
[redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on January 10, 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 and Premium department to have the member’s concerns reviewedWe were advised that a termination file was received from the Marketplace on December 13, to terminate the policy with a date of December 27, The request for termination was completed on December 14, 2016, to reflect the term date of December 27, The member was refunded the prorated difference of $on December 16, We verified our call history on file since the member stated he called to terminate the policy for the effective date of November 30, 2016, and was told by a representative that he did not have to take any action, but there are no calls on file related to this complaintIf the call was with the Marketplace, we do not have recordings for those calls, only the Marketplace would have a recording Unfortunately, the policy does not qualify to be terminated effective November 30, 2016, because the file received from the Marketplace was received with a termination date of December 27, If the member is still disputing the termination date, the member would need to reach out to the Marketplace appeals department a [redacted] to request the November 30, 2016, termination dateOnly if the Marketplace appeals department approves the requested termination date would we be able to complete the full refund for the December premium 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 there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, [redacted] ***
Complaint: [redacted] I am rejecting this response because:There is still no way for me to know who the so called provider us on the claim forms.They refused to provide provider information (hospital clinic medical group) for the persons name in the provider column on there forms.I have to spend hours trying to guess and find out who they work for to verify if each claim is legitimateThey have resently deleted the claim I caught but the time I need to spend verifying 100's of claims by the end of the year will bealot of wadted time on my part because they refuse to let me know who the provider is.This is not personel information as they told meWhat clinic name or hospital or medical group they work at should not be considered personnel infomation they cannot provide on there formsThe clinics and hospitals provide the info to Aetna it's Aetna that refuses to put that on there claimsOnly other option is to send Aetna all the names on the claim forms and request special permision to find out the address of the persons billing addressThen I would [redacted] the address to find out what building is there and maybe find out who it isI then have to message my kids at collage to see if they went there for something on that dateCollage kids have short memoriesWhen I asked them ladt time they only remebered half of the claims Sincerely, [redacted] ***
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 have the calls pulled related to the pregnancy coverage prior to services being renderedThe records indicate only general pregnancy benefits were provided during the call from the memberThe claims in question were processed correctly in accordance to the member’s plan benefits When the child is born and is added to the policy as an individual, the facility is able to bill separately for both mom and child for any charges related to the pregnancyThe submitted charges were sent for both the mom and child; which triggered the individual copaysWhile we understand your concerns and recognize this is not the resolution you sought, our decision remains unchangedOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants 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