Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on April 11, 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 that we previously handled a grievance for this issue and the member’s enrollment call was listened to and it was verified that she received the correct information during enrollmentBelow is a timeline of what occurred and also the details of her enrollment call • [redacted] enrolled in the Aetna [redacted] Plan [redacted] effective January 01, 2017, and disenrolled effective September 30, [redacted] transitioned from Disability Eligible to Age Eligible for [redacted] • On July 28, 2017, [redacted] submitted an enrollment application to enroll in Aetna [redacted] Plan ( [redacted] with an effective date of October 01, At the time of [redacted] ’s enrollment, neither we nor our enrolling agents would not have known what her premiums or deductible would be in • We conducted an agent investigation against the enrolling agent regarding [redacted] ’s allegationsUpon review of the enrollment call, [redacted] contacted our Sales department looking for a standalone drug planShe explained to the agent that she is turning in [redacted] [redacted] opted to enroll in the Aetna [redacted] [redacted] asked will the plan start in OctoberThe agent verified that her plan will start October 01, 2017, as she is in her special election to enroll in a plan due to turning The agent provided her with the correct copayment, coinsurance, premium, formulary, and pharmacy information for the contract yearThe agent explained that she will receive her new I.Dcard and membership materials to be used for her new plan effective October 01, The agent clearly explained that her plan with Aetna [redacted] Plan [redacted] will terminate September 30, The agent explained that she will receive a new membership I.D number as she was changing plans [redacted] agreed to the enrollment and accepted all terms and conditions of the enrollment Effective October 01, 2017, [redacted] ’s monthly premium was $per month through December 31, Our Aetna [redacted] *** Plan ( [redacted] ) did not have a deductible in On September 05, 2017, a Summary of Benefits was mailed to [redacted] regarding her benefitsWe advised the monthly premium for will be $and advised of the deductible for as $This deductible does not apply for Tier One or Tier Two medications The agent would have not had the benefits for the contract year as the enrollment was completed on July 28, 2017, and the following year information is not released until early OctoberBased on review of the available information and the agent’s call recording, the findings in this case are unfounded and unsubstantiatedWe will not waive or change the member’s deductible for this plan The member’s deductible is processing correctly and she was notified about the deductible for and did not change plans when she had the opportunity to do so [redacted] is a Tier Three medicationHer tiering exception request was deniedThe member or her provider can file an appeal by calling ###-###-#### There are programs available for [redacted] members on fixed or limited incomesThese programs may help with your plan copays and monthly premiumsTo see if you qualify for any of these state or federal programs, you can call [redacted] at ###-###-####She can also contact: [redacted] We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Ashley W Complaint and Appeals Consultant Executive Resolution Team
Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on April 11, Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you We reached back out to our Claims department to have the member’s additional concerns reviewedWe reprocessed the claim for date of service October 17, 2016, to pay an additional $to providerThe payment was released to the provider as an electronic fund transfer today, April 20, We paid the provider directly to take the member out of the middle of the billing since the collection company stated to her that her debt was paid in full and owed nothing more for the services rendered Please accept my apology for the delay in processing the member’s claims correctly, and that it required multiple attempts on her 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 this 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 [redacted] ’s 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
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 contacted our Dental Claims department to confirm the member's orthodontic benefit. The total fee billed by the provider was $3716.00. Based on the dental plan benefit, it is to allow 50% which is $1858.00. Based on previous claims, we have already paid a total of $1644.87. The remaining balance due was $213.13. A check for this amount was mailed to your provider on April 22, 2016.Please accept my apology for the delay in processing the claim correctly, and the multiple attempts on your part to resolve your issue. We have provided feedback regarding your customer service concerns. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, LaShonda C.Complaint and Appeal Consultant Executive Resolution Team
Dear Ms [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on August 02, 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 date of service reviewedWe were advised that the claim was originally billed with a modifier and then was corrected to show no modifierWe have confirmed with the provider’s office that a modifier was not supposed to be billed with the claim so we were able to have this corrected and finalized for the member and the provider The new claim ID for the member’s records is [redacted] with a responsibility of $that applied toward the member’s deductibleThe corrected explanation of benefits (EOB) will be available to both the member and the provider within hoursOnce the provider EOB is available we will contact the office to clarify what the member’s out of pocket responsibility should be for this date of service Please accept my apology for the delay in processing the claim correctly, and that it required multiple attempts on the member’s part to resolve the issueOur goal is to provide accurate and reliable information when the member needs it and to immediately resolve issues when they do occurClearly, in this case, we fell short of that goalWe regret that the member’s experience with Aetna was less than satisfactory and hope that we can better assist the member in the future We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MsXiao’s 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
Dear MsM [redacted] Please see our response to complaint # [redacted] for J [redacted] that was received by us on July 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’s employer submitted the coverage request for [redacted] ***s and his wife on June 28, 2016, and requested that the coverage’s effective date be May 01, Since we did not receive the request until the end of June that is why there was a delay in receiving ID cards; which were mailed to the member on July 08, We did confirm that the employer requested the plan be terminated effective July 31, If the member and his wife had services rendered within that timeframe the policy was effective they can have their providers submit claims for consideration under the planThe member is also able to request an itemized bill and bill the insurance directly if any payments were made out of pocket Unfortunately, Aetna is only an administrator of the plan and has no control over the plan, when it is created and/or terminated, and what the premium is that is being billed to the memberThe member will need to contact the Human Resource department of the employer and request the refund of the premiums and discuss why he and his wife were enrolled without their permissionWe do not have access at Aetna to any of this information to assist the member any further 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] Sincerely, Ashley WComplaint and Appeals Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: I went to the doctor and asked for a preventative care yearly physicalI was told that all tests done were common tests done for preventative care and nothing more.Aetna claims "The benefit states that for diagnostic services billed at a participating lab, 100% is allowed after a $deductible is metThe member is responsible for $64.44," but that is simply not true Preventative care is 100% covered (I've included an attachment which is highlighted to show this), not 100% - $64.44.Check the tests done vs all common preventative care tests and you will see that nothing out of the ordinary was doneThis is insulting that I go for my free 100% covered preventative care annual physical and come out having to pay extra for it even though this is what I pay every paycheck to receive.If everything is not 100% covered in an annual preventative care yearly physical, then we should be notified of this upfront, not after we go to the doctor and have it doneThis seems like a bait and switch practice to trick us into getting Aetna insurance only to later find out we are not getting what was promised to usHad I known I would have to pay out of pocket on top of my regular payments, I would have gone to another providerMake this right and give what was promised.Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: I did call and talk to the market place and they said that I had to go through AetnaI called both places three times and no one called me back and let me know what was going onAnd each time nobody could tell me anythingPassing the buck to each otherAs far as autopay I never set up Autopay with Aetnaso why did they Autopay my accountPlus I payed them $on July 1stWhat happened to that moneyAnd when I talked to Aetna last month they stated that they could not found out anything because my Account was closed for the time in question Aetna need to straighten this outAnd yes I did turn in all of my paper workAnd no I don't have Autopay with Aetna set upThey took that apond themself and set that up themselfAetna needs to fix this, not the market placeThis is Aetna's problem Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: Unfortunately, I have not received a full complete resolutionAshley is correct, the doctor and myself has received approval for the requested procedures but the final piece has not been completed Following my conversation with Ashley yesterday, I spoke with the doctors office whom advised me that they had not received a follfrom Aetna in a week regarding the negotiationsI do not want to be one of those cases that get to the finish line and the insurance company doesn't see there part to completionThis has been a very complicated processI am hoping to receive an adequate resolution ASAP Sincerely, [redacted] ***
Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on May 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 member’s concerns, we immediately reached out to a Teladoc representativeThey researched this issue and have provided a responseThe member stated that they felt like the Aetna Teladoc services charged her a service fee for no service providedThe member said that all the Teladoc provider did was tell them to go to urgent care and the member said that she could hear child noises in the back ground In reviewing these concerns, the Teladoc representative conducted a thorough review of the case and determined that the treatment was medically appropriateThe member did receive advice from the physicianWe are sorry he was unhappy with his Teladoc consultMember satisfaction is very important to Teladoc, and to us, and we strive to provide the best care and best experience to all our membersTeladoc approved a refund of the member's consult feeA refund has been processed in the original form of payment 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] concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Michael HSrComplaint and Appeal Analyst 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 [redacted] department to have the complaint reviewed as priorityOur records indicate that the original appeal was received on August 18, 2015, and was being handled as an expedited appeal requestWe were requesting a power of attorney from the member’s son; due to [redacted] guidelines we must obtain this to discuss any appeal informationOn August 19, 2015, we received a request from the member’s doctor to complete a peer to peerThe member’s medical records were reviewed again by a medical director who overturned the appeal on August 20, 2015, and allowed the member to be transferred to the rehabilitation center Please accept my apologies for the difficulties the member has encountered with AetnaI’m sorry that our representatives were not able to assist the member when his son or he calledOur goal is to provide quality service and satisfaction to our members, and I sincerely regret that the member did not receive the service he should rightfully expect and deserveHis concerns have been forwarded to our management team for improvement opportunitiesI hope that going forward we will be able to regain the member’s confidence in us We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] If 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
From: [redacted] [mailto: [redacted] Sent: Saturday, June 25, 1:AMTo: [email protected]: Complaint # [redacted] To whom it may concern:I realize that my complaint is still being worked on, but today I just received a notice in the mail that Aetna sent me to collections for the amount I disputed and contacted you guys about I am so sick about it, and my anxiety is causing me a lot of painI am sick and really scared they are going to destroy my credit, which up until now has been very good I have never not paid a bill and always pay on timeI don't know what to do, mentally, I cannot handle dealing with Aetna anymoreI can't sleep, and my nerves are a messI don't know what I did to deserve this messIt is almost the end of June now, and I have been trying to get this mess resolved for almost half a year nowSomebody please help me! [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 me please note - although the monies I paid out of pocket have been reimbursed, it took several weeks to do soAlso, please advise Aetna to check their recordsYes, my son is shown to have been added but due to a 'glitch' in their system it was not being shown properly, therefore causing the doctors office to charge me as if I had no insurance coverageI was told this by multiple representatives upon calling AetnaI hope this will not happen again, as this has caused unnecessary stress Sincerely, E [redacted]
RevDex.com: Although Aetna's description of events in not nearly adequate, and is inaccurate. My broker and I have the supporting documents to prove it.The check did arrive today and therefore my overpaid premium funds have been restored. Aetna has yet to address their horrible handling of the situation, their positioning of the phone system so that customer reps are not available to be reached and their unfettered access to grab whatever money they want out of customer's bank accounts. It is definitely unethical and should be illegal. Customers should have the right to pay by check or ***. At this time, since my money has been returned, (complaint ID [redacted] ), this situation has been resolved. Sincerely, [redacted]
Dear Ms. [redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on June 22, 2016. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. Upon receipt of the... complaint we immediately reached out to the Claims department to have the member’s concerns reviewed. We are currently in the process of reviewing and correcting any claims on file for the member. We have contacted the member directly to let him know we are working to rectify the situation and will contact him directly once the claims review has been completed. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Cohen’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Ashley W. 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 to our Dental Claims... department to have the member's concerns reviewed. We were advised that they were able to have the claim corrected and the provider is to be paid the additional money due for services rendered this week. The provider and the member will receive a corrected explanation of benefits (EOB) within 7-10 business days or on our Aetna Navigator in 72 hours. Please accept my apology for the delay in processing your claim correctly, and that it required multiple attempts on your part to resolve your issue. Unfortunately, in some instances, errors do occur. When 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. Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur. I sincerely apologize for the frustrations and difficulties you experienced and that we did not provide the level of service that you rightfully expect and deserve. These actions are not consistent with Aetna's service standards and we appreciate you notifying us of your experience. We have addressed your customer service concerns directly with the representatives who handled your calls. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns. If 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
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] I am still disappointed that my coverage was changed from what I had under [redacted] I was told by the person who called me that it was the same, but when I protested that I had had *** surgery in the past I did not pay a $co-pay When he researched it he admitted I was right I was happy they resolved the medication compensation and he told me there had been an error in calculating my other co-pay and that it would be adjusted I am still waiting to hear about that I appreciate that they contacted me and made an effort to address my complaint
Can you please request either the member’s ID number or Date of Birth to be able to start an investigation for this complaint? We are not able to locate him with just his name and zip code searchThank you,Ashley
Thank you for your inquiry, regarding complaint # [redacted] received on 08/24/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 Vision department and verified the spelling of the member’s nameA card was mailed to the member on the 8/21/The [redacted] system can confirm when a card was sent but cannot provide an image of the card from that mailingSince [redacted] cannot verify the image of the card mailed out with [redacted] included, we decided to reissue a second card You should receive within 7-days 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] Thank you, LaShonda C 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 your complaint, we contacted our Claims department and confirmed that the claim was reprocessed correctly based on our reviewThe member is responsible for 10% coinsurance based on the plan benefitsThe claim was reconsidered for an additional payment of $The customer service representative did not consider the plan benefit which allows 90% of the allowed chargesThe member’s portion was 10% of this amount so no additional payment is due for this claim We apologize for any difficulties and inconvenience this has caused the member We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] LaShonda C Complaint and Appeal Consultant Executive Resolution Team
Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on April 11, 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 that we previously handled a grievance for this issue and the member’s enrollment call was listened to and it was verified that she received the correct information during enrollmentBelow is a timeline of what occurred and also the details of her enrollment call • [redacted] enrolled in the Aetna [redacted] Plan [redacted] effective January 01, 2017, and disenrolled effective September 30, [redacted] transitioned from Disability Eligible to Age Eligible for [redacted] • On July 28, 2017, [redacted] submitted an enrollment application to enroll in Aetna [redacted] Plan ( [redacted] with an effective date of October 01, At the time of [redacted] ’s enrollment, neither we nor our enrolling agents would not have known what her premiums or deductible would be in • We conducted an agent investigation against the enrolling agent regarding [redacted] ’s allegationsUpon review of the enrollment call, [redacted] contacted our Sales department looking for a standalone drug planShe explained to the agent that she is turning in [redacted] [redacted] opted to enroll in the Aetna [redacted] [redacted] asked will the plan start in OctoberThe agent verified that her plan will start October 01, 2017, as she is in her special election to enroll in a plan due to turning The agent provided her with the correct copayment, coinsurance, premium, formulary, and pharmacy information for the contract yearThe agent explained that she will receive her new I.Dcard and membership materials to be used for her new plan effective October 01, The agent clearly explained that her plan with Aetna [redacted] Plan [redacted] will terminate September 30, The agent explained that she will receive a new membership I.D number as she was changing plans [redacted] agreed to the enrollment and accepted all terms and conditions of the enrollment Effective October 01, 2017, [redacted] ’s monthly premium was $per month through December 31, Our Aetna [redacted] *** Plan ( [redacted] ) did not have a deductible in On September 05, 2017, a Summary of Benefits was mailed to [redacted] regarding her benefitsWe advised the monthly premium for will be $and advised of the deductible for as $This deductible does not apply for Tier One or Tier Two medications The agent would have not had the benefits for the contract year as the enrollment was completed on July 28, 2017, and the following year information is not released until early OctoberBased on review of the available information and the agent’s call recording, the findings in this case are unfounded and unsubstantiatedWe will not waive or change the member’s deductible for this plan The member’s deductible is processing correctly and she was notified about the deductible for and did not change plans when she had the opportunity to do so [redacted] is a Tier Three medicationHer tiering exception request was deniedThe member or her provider can file an appeal by calling ###-###-#### There are programs available for [redacted] members on fixed or limited incomesThese programs may help with your plan copays and monthly premiumsTo see if you qualify for any of these state or federal programs, you can call [redacted] at ###-###-####She can also contact: [redacted] We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Ashley W Complaint and Appeals Consultant Executive Resolution Team
Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on April 11, Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you We reached back out to our Claims department to have the member’s additional concerns reviewedWe reprocessed the claim for date of service October 17, 2016, to pay an additional $to providerThe payment was released to the provider as an electronic fund transfer today, April 20, We paid the provider directly to take the member out of the middle of the billing since the collection company stated to her that her debt was paid in full and owed nothing more for the services rendered Please accept my apology for the delay in processing the member’s claims correctly, and that it required multiple attempts on her 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 this 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 [redacted] ’s 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
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 contacted our Dental Claims department to confirm the member's orthodontic benefit. The total fee billed by the provider was $3716.00. Based on the dental plan benefit, it is to allow 50% which is $1858.00. Based on previous claims, we have already paid a total of $1644.87. The remaining balance due was $213.13. A check for this amount was mailed to your provider on April 22, 2016.Please accept my apology for the delay in processing the claim correctly, and the multiple attempts on your part to resolve your issue. We have provided feedback regarding your customer service concerns. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, LaShonda C.Complaint and Appeal Consultant Executive Resolution Team
Dear Ms [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on August 02, 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 date of service reviewedWe were advised that the claim was originally billed with a modifier and then was corrected to show no modifierWe have confirmed with the provider’s office that a modifier was not supposed to be billed with the claim so we were able to have this corrected and finalized for the member and the provider The new claim ID for the member’s records is [redacted] with a responsibility of $that applied toward the member’s deductibleThe corrected explanation of benefits (EOB) will be available to both the member and the provider within hoursOnce the provider EOB is available we will contact the office to clarify what the member’s out of pocket responsibility should be for this date of service Please accept my apology for the delay in processing the claim correctly, and that it required multiple attempts on the member’s part to resolve the issueOur goal is to provide accurate and reliable information when the member needs it and to immediately resolve issues when they do occurClearly, in this case, we fell short of that goalWe regret that the member’s experience with Aetna was less than satisfactory and hope that we can better assist the member in the future We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MsXiao’s 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
Dear MsM [redacted] Please see our response to complaint # [redacted] for J [redacted] that was received by us on July 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’s employer submitted the coverage request for [redacted] ***s and his wife on June 28, 2016, and requested that the coverage’s effective date be May 01, Since we did not receive the request until the end of June that is why there was a delay in receiving ID cards; which were mailed to the member on July 08, We did confirm that the employer requested the plan be terminated effective July 31, If the member and his wife had services rendered within that timeframe the policy was effective they can have their providers submit claims for consideration under the planThe member is also able to request an itemized bill and bill the insurance directly if any payments were made out of pocket Unfortunately, Aetna is only an administrator of the plan and has no control over the plan, when it is created and/or terminated, and what the premium is that is being billed to the memberThe member will need to contact the Human Resource department of the employer and request the refund of the premiums and discuss why he and his wife were enrolled without their permissionWe do not have access at Aetna to any of this information to assist the member any further 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] Sincerely, Ashley WComplaint and Appeals Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: I went to the doctor and asked for a preventative care yearly physicalI was told that all tests done were common tests done for preventative care and nothing more.Aetna claims "The benefit states that for diagnostic services billed at a participating lab, 100% is allowed after a $deductible is metThe member is responsible for $64.44," but that is simply not true Preventative care is 100% covered (I've included an attachment which is highlighted to show this), not 100% - $64.44.Check the tests done vs all common preventative care tests and you will see that nothing out of the ordinary was doneThis is insulting that I go for my free 100% covered preventative care annual physical and come out having to pay extra for it even though this is what I pay every paycheck to receive.If everything is not 100% covered in an annual preventative care yearly physical, then we should be notified of this upfront, not after we go to the doctor and have it doneThis seems like a bait and switch practice to trick us into getting Aetna insurance only to later find out we are not getting what was promised to usHad I known I would have to pay out of pocket on top of my regular payments, I would have gone to another providerMake this right and give what was promised.Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: I did call and talk to the market place and they said that I had to go through AetnaI called both places three times and no one called me back and let me know what was going onAnd each time nobody could tell me anythingPassing the buck to each otherAs far as autopay I never set up Autopay with Aetnaso why did they Autopay my accountPlus I payed them $on July 1stWhat happened to that moneyAnd when I talked to Aetna last month they stated that they could not found out anything because my Account was closed for the time in question Aetna need to straighten this outAnd yes I did turn in all of my paper workAnd no I don't have Autopay with Aetna set upThey took that apond themself and set that up themselfAetna needs to fix this, not the market placeThis is Aetna's problem Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: Unfortunately, I have not received a full complete resolutionAshley is correct, the doctor and myself has received approval for the requested procedures but the final piece has not been completed Following my conversation with Ashley yesterday, I spoke with the doctors office whom advised me that they had not received a follfrom Aetna in a week regarding the negotiationsI do not want to be one of those cases that get to the finish line and the insurance company doesn't see there part to completionThis has been a very complicated processI am hoping to receive an adequate resolution ASAP Sincerely, [redacted] ***
Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on May 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 member’s concerns, we immediately reached out to a Teladoc representativeThey researched this issue and have provided a responseThe member stated that they felt like the Aetna Teladoc services charged her a service fee for no service providedThe member said that all the Teladoc provider did was tell them to go to urgent care and the member said that she could hear child noises in the back ground In reviewing these concerns, the Teladoc representative conducted a thorough review of the case and determined that the treatment was medically appropriateThe member did receive advice from the physicianWe are sorry he was unhappy with his Teladoc consultMember satisfaction is very important to Teladoc, and to us, and we strive to provide the best care and best experience to all our membersTeladoc approved a refund of the member's consult feeA refund has been processed in the original form of payment 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] concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Michael HSrComplaint and Appeal Analyst 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 [redacted] department to have the complaint reviewed as priorityOur records indicate that the original appeal was received on August 18, 2015, and was being handled as an expedited appeal requestWe were requesting a power of attorney from the member’s son; due to [redacted] guidelines we must obtain this to discuss any appeal informationOn August 19, 2015, we received a request from the member’s doctor to complete a peer to peerThe member’s medical records were reviewed again by a medical director who overturned the appeal on August 20, 2015, and allowed the member to be transferred to the rehabilitation center Please accept my apologies for the difficulties the member has encountered with AetnaI’m sorry that our representatives were not able to assist the member when his son or he calledOur goal is to provide quality service and satisfaction to our members, and I sincerely regret that the member did not receive the service he should rightfully expect and deserveHis concerns have been forwarded to our management team for improvement opportunitiesI hope that going forward we will be able to regain the member’s confidence in us We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] If 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
From: [redacted] [mailto: [redacted] Sent: Saturday, June 25, 1:AMTo: [email protected]: Complaint # [redacted] To whom it may concern:I realize that my complaint is still being worked on, but today I just received a notice in the mail that Aetna sent me to collections for the amount I disputed and contacted you guys about I am so sick about it, and my anxiety is causing me a lot of painI am sick and really scared they are going to destroy my credit, which up until now has been very good I have never not paid a bill and always pay on timeI don't know what to do, mentally, I cannot handle dealing with Aetna anymoreI can't sleep, and my nerves are a messI don't know what I did to deserve this messIt is almost the end of June now, and I have been trying to get this mess resolved for almost half a year nowSomebody please help me! [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 me please note - although the monies I paid out of pocket have been reimbursed, it took several weeks to do soAlso, please advise Aetna to check their recordsYes, my son is shown to have been added but due to a 'glitch' in their system it was not being shown properly, therefore causing the doctors office to charge me as if I had no insurance coverageI was told this by multiple representatives upon calling AetnaI hope this will not happen again, as this has caused unnecessary stress Sincerely, E [redacted]
RevDex.com: Although Aetna's description of events in not nearly adequate, and is inaccurate. My broker and I have the supporting documents to prove it.The check did arrive today and therefore my overpaid premium funds have been restored. Aetna has yet to address their horrible handling of the situation, their positioning of the phone system so that customer reps are not available to be reached and their unfettered access to grab whatever money they want out of customer's bank accounts. It is definitely unethical and should be illegal. Customers should have the right to pay by check or ***. At this time, since my money has been returned, (complaint ID [redacted] ), this situation has been resolved. Sincerely, [redacted]
Dear Ms. [redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on June 22, 2016. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. Upon receipt of the... complaint we immediately reached out to the Claims department to have the member’s concerns reviewed. We are currently in the process of reviewing and correcting any claims on file for the member. We have contacted the member directly to let him know we are working to rectify the situation and will contact him directly once the claims review has been completed. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Cohen’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, Ashley W. Complaint and Appeals Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: 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 Dental Claims... department to have the member's concerns reviewed. We were advised that they were able to have the claim corrected and the provider is to be paid the additional money due for services rendered this week. The provider and the member will receive a corrected explanation of benefits (EOB) within 7-10 business days or on our Aetna Navigator in 72 hours. Please accept my apology for the delay in processing your claim correctly, and that it required multiple attempts on your part to resolve your issue. Unfortunately, in some instances, errors do occur. When 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. Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur. I sincerely apologize for the frustrations and difficulties you experienced and that we did not provide the level of service that you rightfully expect and deserve. These actions are not consistent with Aetna's service standards and we appreciate you notifying us of your experience. We have addressed your customer service concerns directly with the representatives who handled your calls. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns. If 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
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] I am still disappointed that my coverage was changed from what I had under [redacted] I was told by the person who called me that it was the same, but when I protested that I had had *** surgery in the past I did not pay a $co-pay When he researched it he admitted I was right I was happy they resolved the medication compensation and he told me there had been an error in calculating my other co-pay and that it would be adjusted I am still waiting to hear about that I appreciate that they contacted me and made an effort to address my complaint
Can you please request either the member’s ID number or Date of Birth to be able to start an investigation for this complaint? We are not able to locate him with just his name and zip code searchThank you,Ashley
Thank you for your inquiry, regarding complaint # [redacted] received on 08/24/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 Vision department and verified the spelling of the member’s nameA card was mailed to the member on the 8/21/The [redacted] system can confirm when a card was sent but cannot provide an image of the card from that mailingSince [redacted] cannot verify the image of the card mailed out with [redacted] included, we decided to reissue a second card You should receive within 7-days 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] Thank you, LaShonda C 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 your complaint, we contacted our Claims department and confirmed that the claim was reprocessed correctly based on our reviewThe member is responsible for 10% coinsurance based on the plan benefitsThe claim was reconsidered for an additional payment of $The customer service representative did not consider the plan benefit which allows 90% of the allowed chargesThe member’s portion was 10% of this amount so no additional payment is due for this claim We apologize for any difficulties and inconvenience this has caused the member We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] LaShonda C Complaint and Appeal Consultant Executive Resolution Team