Dear [redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on June 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 Claims department for clarification on why the claim was processed correctly according to the member’s benefitsWe were advised that the physician billed a routine physical procedure code, which falls under the routine office visit benefitsThe claim was paid at 100% for the office visit The bloodwork was billed as an outpatient diagnostic lab by a different provider who performed the testsBased on how the claim was billed to Aetna, it falls under the benefit of participating lab benefitsPage five of the member’s Schedule of Benefits shows that the member’s in-network, outpatient diagnostic lab is covered at 100% after Calendar Year deductible was metThe member’s deductible had not been met so the member’s responsibility correctly applied to the deductible We assure you that it is not our intent to mislead or misrepresent any benefit that may or may not be available under the member’s health planI understand the member’s concerns and recognize this is not the outcome that was desiredHowever, we must make coverage decisions in accordance with the member’s planThe member does have the right to appeal the claims if the member still disagrees with our decisionPlease send the appeal request to: Appeals Resolution Team [redacted] 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, Ashley WComplaint and Appeals Consultant Executive Resolution Team
From: [redacted] Sent: Sunday, June 03, 10:PM To: Revdex.com Subject: Re: You have a New Message from Revdex.com Serving Connecticut Regarding Complaint # [redacted] Yes, I already responded to this emailI am completely satisfied with AETNA solutionI was contacted by AETNA & they solve my problemThank you to AETNA & the Revdex.com
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 the complaint, we contacted our Customer Service department to review your concernsWe have requested that all non-required letters and correspondence be stopped from both the medical and prescription portions of [redacted] policyThe member will continue to receive any pertinent correspondence for his current prescription and medical coverageIn regards to the request of having months of premiums waived, we would need to receive proof of denial of access to medical or prescriptions coverage in order to justify premium waiverThat premium waiver would require home office exceptionWe apologize for any frustrations and difficulties the member has experienced with this matterWe 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 s [redacted] Thank you, Tanika KComplaint 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 Disability department to have the member’s concerns addressedWe were advised that the claim was finalized on February 17, 2016, and the case manager reached out to him the same day to advise of the claim decision 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
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]
[redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on August 31, Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reached out to our Pharmacy department to have the member’s concerns reviewedWe were advised that on August 29, the member’s pharmacy submitted the prescription and it rejected due to his ageA pre-certification was required by the plan and on August 31, 2016, the pre-certification request was received and approved the same day for a one year period for both strengths An override was entered effective for a one year period: August 31, 2016, through August 31, 2017, and it included both strengths of the medicationOn August 31, 2016, the pharmacy submitted two claims, one for each medication strengthBoth were paid and the member is being charged the generic $copay per strength dispensed, which is correct - a copay per dispense is the contracted benefitOur Social Media Resolution Team contacted the member on September 01, 2016, to notify of him directly of the resolution Aetna takes seriously the responsibility to ensure that pharmaceuticals are dispensed timely and accurately, realizing that a member’s health and well-being can be dependent on their medication We strive to provide the highest level of service and satisfaction for our members, and I sincerely regret that the member did not receive the service he should rightfully expect and deserve We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr [redacted] If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, [redacted] Complaint and Appeals Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: [redacted] stated in their response that the policy was "terminated" Jan 1, Why then have I been paying them for this coverage all of 2015? They just made my case for me Thank you I want a return of my premiums for a policy that I am paying for that was cancelled, Jan 2015, according to the response from *** Also ***s response indicates that they do not keep accurate and/or comprehensive records of EVERY call from their members I called Atena at least times about this issue Including a call on or the day before I filled this complaint with the Revdex.com I have a record of that call and I received a call back from a manager out of their South Carolina office ***s response doesn't indicate a record of those calls to and from [redacted] therefore they CLEARLY are not capturing records of EVERY calls which explains why they may not have a record of my call with my request to cancel their coverage or confirmation that was given my wife and I My wife was on the cancellation request call me & the recent calls aforementioned and can attest to the validatity of my complaint & dealings with [redacted] regarding this matter Based on ***s response and unwillingness to resolve this I am inclined to fill further complaints with the attorney general(s) office of the various states where they conduct this part of their business I may also consider legal action for fraud [redacted] can resolve this with me directly or I will pursue additional action Sincerely, Jared G [redacted]
Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on January 11, 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 Dental department to address the member’s concernsWe reviewed the member’s current [redacted] Dental benefits effective July 01, We found that they are based on a list of dental procedures determined and agreed upon by your employerUnfortunately, it does not include orthodontic treatment as an expense eligible for reimbursementThe member’s prior [redacted] Dental plan effective from November 1, through June 30, had coverage for orthodontic coverageThe member changed the plan during mid treatment, which means it changed the coverageWe determined that the claim was processed correctly, according to the information we received, and no benefits are available for this serviceWe 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 CComplaint 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 youUpon receipt of the complaint, we contacted Aetna Student Health (ASH) Claims department to review her claimsWe confirmed that the member’s plan has a $annual deductible per plan yearThe plan renewal date is based on the academic year, not a calendar yearThe plan renews on September 01, 2015, therefore the member’s deductible is renewed as wellThe visit on July 07, 2015, was for an urgent care visit (sick visit) and was applied to the 2014/plan year deductible in the amount of $The visit on December 07, 2015, was also an office visit (sick visit) and was applied to the 2015/plan year deductible in the amount of $The member would be responsible for these amounts because her deductible had not been metWe apologize for the inconvenience this has caused [redacted] 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] LaShonda C.Complaint and Appeals 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 have the call pulled to verify the information that was provided to the memberOur records indicate that the member advised the customer service representative that this procedure would take place in the provider’s own facility, with the doctor’s name and procedure codeBased upon that description the general benefits were provided to the member Information provided through member services is not a guarantee of benefits under the planThe claim that was submitted to Aetna did not list the services rendered as being taken place in the office setting, instead in an ambulatory surgical center as outpatient surgeryDue to the way the claim was billed it triggered the deductible instead of an office visit copayThe claims in question were processed correctly in accordance to your plan benefits I realize that understanding your benefits can be challengingIt is our goal to be there for you when you need us, and I apologize that the assistance you received from our customer service representatives did not meet your needs We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # 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 member’s concerns addressedWe were advised that the member’s concerns were reviewed and that a resolution letter is being mailed to the member explaining their findingsIf the member has any additional concerns after reviewing the resolution letter, there is a contact number and address he can send future concerns to We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reached out to our Claims department to have the member’s concerns reviewedWe were advised that the claims are processed correctly per the benefits Prenatal benefits are for routine care prenatal care which is billed as a global fee by the physicianThese tests are not part of routine care based on policy and therefore covered under the medical benefit not the prenatal benefit The Maternity benefit includes: • All prenatal and postpartum visits, including the 6-week postpartum che • Routine urinalysis • Delivery Per policy all prenatal tests billed separately from the global fee are to be covered the same as any other medical test to diagnosis or treat a diseasePlease refer to your plan booklet, which states: “PRENATAL TESTS: Pay expenses for covered prenatal tests on the same basis as tests to diagnose or treat disease.” I understand your concerns and recognize this is not the outcome you desiredI want to assure you we reviewed all the documents and available information before issuing this responseOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Dear [redacted] *** Please see our response to complaint # [redacted] for [redacted] that was received by us on October 23, 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 concerns reviewedWe were advised that all claims on file, including the treating physicians’ claim, are processed as participating for services rendered on September 04, The physician claim [redacted] shows a member responsibility of $towards the percent coinsurance that was due and $was paid to the provider on September 19, Please have the member contact us directly at the email listed below if she is being balance billed any additional money outside the $that applied to the coinsurance 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 compliant we immediately reached out to our Health Savings Account (HSA) department to have the member’s concerns addressedWe were advised that prior to receiving this complaint the member’s account was already updated with the contribution for December We confirmed the member’s money was deposited on January 13, 2016, and an email was sent to the member on January 14, 2016, advising her of the deposit Please accept my apology that we did not provide the level of service that you rightfully expect and deserve, and my assurance that your concerns are getting the highest level of attention at AetnaI would also like to thank you for sharing your experience with usIt is feedback like yours that helps us address issues and prevent them from reoccurring We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MsStiles’ concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint [redacted] for [redacted] ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reached out to our Network department to have the member’s concerns reviewedWe were advised that both providers listed in the compliant are participating with the member’s plan, and that our list of surgeons the member is locating online is up to date and correctWe called and spoke with [redacted] at [redacted] office and advised her that she was given incorrect information from our provider service center and that the member was within the network if they wish to continue their member/provider relationshipOur Network department will reach out to the provider’s office to educate them on their contracts and plans they participate with Our goal is to provide accurate and reliable information when you need it and to immediately resolve issues when they do occurClearly, in your case, we fell short of that goalWe regret that your experience with Aetna was less than satisfactory and hope that we can better assist you in the futureI would like to assure you that we have taken the appropriate actions to address the customer service issues the member and the provider have experienced 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] ***s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, XE "Type Name"Ashley S Complaint and Appeal Consultant Executive Resolution Team XE "Title/Business Area"
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reached out to our Claims department to have the date of service reviewedWe were advised that the member is not responsible for the billed charges because the facility failed to call the Pre-certification department in a timely mannerWe confirmed that both the member and the provider’s explanation of benefits (EOB) state that the member is not responsible for the billed charges The provider did not call our pre-certification office within one day of discharge, so it will be their responsibility to file an appeal, not the member’s responsibilityWe called the facility and left a voicemail with the billing department explaining that they should refer to their EOB which states they are to not balance bill the memberIt also went on to explain that claim was denied due to failure to follow Aetna contractual notification requirementsWe advised of the address they could send the appeal request to and left a call back number for any questions/concernsWe have also mailed another copy of the explanation of benefits to the provider for their records We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] .com 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]
Complaint: [redacted] I am rejecting this response because: I did not complain about correspondence regarding policy options, as this dishonest "response" claimsI complained about the advertising junk mail they refuse to stop harassing me with, and I am prepared to Take further action if forced, and if they continue in their refusal to cease and desist [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 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 had our files reviewed to verify that we had the member’s name correct in our systemOur records indicate we have the member’s name in our system just as it shows in the Revdex.com complaintOur records also indicate that we do not carry this employer’s medical benefits, only dental benefitsThe employer’s medical benefits are with any of the following carriers: [redacted] , [redacted] and [redacted] ***Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those recordsPlease contact your medical carrier to request a corrected medical ID card 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] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Dear [redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on June 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 Claims department for clarification on why the claim was processed correctly according to the member’s benefitsWe were advised that the physician billed a routine physical procedure code, which falls under the routine office visit benefitsThe claim was paid at 100% for the office visit The bloodwork was billed as an outpatient diagnostic lab by a different provider who performed the testsBased on how the claim was billed to Aetna, it falls under the benefit of participating lab benefitsPage five of the member’s Schedule of Benefits shows that the member’s in-network, outpatient diagnostic lab is covered at 100% after Calendar Year deductible was metThe member’s deductible had not been met so the member’s responsibility correctly applied to the deductible We assure you that it is not our intent to mislead or misrepresent any benefit that may or may not be available under the member’s health planI understand the member’s concerns and recognize this is not the outcome that was desiredHowever, we must make coverage decisions in accordance with the member’s planThe member does have the right to appeal the claims if the member still disagrees with our decisionPlease send the appeal request to: Appeals Resolution Team [redacted] 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, Ashley WComplaint and Appeals Consultant Executive Resolution Team
From: [redacted] Sent: Sunday, June 03, 10:PM To: Revdex.com Subject: Re: You have a New Message from Revdex.com Serving Connecticut Regarding Complaint # [redacted] Yes, I already responded to this emailI am completely satisfied with AETNA solutionI was contacted by AETNA & they solve my problemThank you to AETNA & the Revdex.com
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 the complaint, we contacted our Customer Service department to review your concernsWe have requested that all non-required letters and correspondence be stopped from both the medical and prescription portions of [redacted] policyThe member will continue to receive any pertinent correspondence for his current prescription and medical coverageIn regards to the request of having months of premiums waived, we would need to receive proof of denial of access to medical or prescriptions coverage in order to justify premium waiverThat premium waiver would require home office exceptionWe apologize for any frustrations and difficulties the member has experienced with this matterWe 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 s [redacted] Thank you, Tanika KComplaint 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 Disability department to have the member’s concerns addressedWe were advised that the claim was finalized on February 17, 2016, and the case manager reached out to him the same day to advise of the claim decision 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
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]
[redacted] Please see our response to complaint # [redacted] for [redacted] that was received by us on August 31, Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reached out to our Pharmacy department to have the member’s concerns reviewedWe were advised that on August 29, the member’s pharmacy submitted the prescription and it rejected due to his ageA pre-certification was required by the plan and on August 31, 2016, the pre-certification request was received and approved the same day for a one year period for both strengths An override was entered effective for a one year period: August 31, 2016, through August 31, 2017, and it included both strengths of the medicationOn August 31, 2016, the pharmacy submitted two claims, one for each medication strengthBoth were paid and the member is being charged the generic $copay per strength dispensed, which is correct - a copay per dispense is the contracted benefitOur Social Media Resolution Team contacted the member on September 01, 2016, to notify of him directly of the resolution Aetna takes seriously the responsibility to ensure that pharmaceuticals are dispensed timely and accurately, realizing that a member’s health and well-being can be dependent on their medication We strive to provide the highest level of service and satisfaction for our members, and I sincerely regret that the member did not receive the service he should rightfully expect and deserve We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr [redacted] If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, [redacted] Complaint and Appeals Consultant Executive Resolution Team
Complaint: [redacted] I am rejecting this response because: [redacted] stated in their response that the policy was "terminated" Jan 1, Why then have I been paying them for this coverage all of 2015? They just made my case for me Thank you I want a return of my premiums for a policy that I am paying for that was cancelled, Jan 2015, according to the response from *** Also ***s response indicates that they do not keep accurate and/or comprehensive records of EVERY call from their members I called Atena at least times about this issue Including a call on or the day before I filled this complaint with the Revdex.com I have a record of that call and I received a call back from a manager out of their South Carolina office ***s response doesn't indicate a record of those calls to and from [redacted] therefore they CLEARLY are not capturing records of EVERY calls which explains why they may not have a record of my call with my request to cancel their coverage or confirmation that was given my wife and I My wife was on the cancellation request call me & the recent calls aforementioned and can attest to the validatity of my complaint & dealings with [redacted] regarding this matter Based on ***s response and unwillingness to resolve this I am inclined to fill further complaints with the attorney general(s) office of the various states where they conduct this part of their business I may also consider legal action for fraud [redacted] can resolve this with me directly or I will pursue additional action Sincerely, Jared G [redacted]
Dear [redacted] ***: Please see our response to complaint # [redacted] for [redacted] that was received by us on January 11, 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 Dental department to address the member’s concernsWe reviewed the member’s current [redacted] Dental benefits effective July 01, We found that they are based on a list of dental procedures determined and agreed upon by your employerUnfortunately, it does not include orthodontic treatment as an expense eligible for reimbursementThe member’s prior [redacted] Dental plan effective from November 1, through June 30, had coverage for orthodontic coverageThe member changed the plan during mid treatment, which means it changed the coverageWe determined that the claim was processed correctly, according to the information we received, and no benefits are available for this serviceWe 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 CComplaint 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 youUpon receipt of the complaint, we contacted Aetna Student Health (ASH) Claims department to review her claimsWe confirmed that the member’s plan has a $annual deductible per plan yearThe plan renewal date is based on the academic year, not a calendar yearThe plan renews on September 01, 2015, therefore the member’s deductible is renewed as wellThe visit on July 07, 2015, was for an urgent care visit (sick visit) and was applied to the 2014/plan year deductible in the amount of $The visit on December 07, 2015, was also an office visit (sick visit) and was applied to the 2015/plan year deductible in the amount of $The member would be responsible for these amounts because her deductible had not been metWe apologize for the inconvenience this has caused [redacted] 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] LaShonda C.Complaint and Appeals 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 have the call pulled to verify the information that was provided to the memberOur records indicate that the member advised the customer service representative that this procedure would take place in the provider’s own facility, with the doctor’s name and procedure codeBased upon that description the general benefits were provided to the member Information provided through member services is not a guarantee of benefits under the planThe claim that was submitted to Aetna did not list the services rendered as being taken place in the office setting, instead in an ambulatory surgical center as outpatient surgeryDue to the way the claim was billed it triggered the deductible instead of an office visit copayThe claims in question were processed correctly in accordance to your plan benefits I realize that understanding your benefits can be challengingIt is our goal to be there for you when you need us, and I apologize that the assistance you received from our customer service representatives did not meet your needs We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # 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 member’s concerns addressedWe were advised that the member’s concerns were reviewed and that a resolution letter is being mailed to the member explaining their findingsIf the member has any additional concerns after reviewing the resolution letter, there is a contact number and address he can send future concerns to We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reached out to our Claims department to have the member’s concerns reviewedWe were advised that the claims are processed correctly per the benefits Prenatal benefits are for routine care prenatal care which is billed as a global fee by the physicianThese tests are not part of routine care based on policy and therefore covered under the medical benefit not the prenatal benefit The Maternity benefit includes: • All prenatal and postpartum visits, including the 6-week postpartum che • Routine urinalysis • Delivery Per policy all prenatal tests billed separately from the global fee are to be covered the same as any other medical test to diagnosis or treat a diseasePlease refer to your plan booklet, which states: “PRENATAL TESTS: Pay expenses for covered prenatal tests on the same basis as tests to diagnose or treat disease.” I understand your concerns and recognize this is not the outcome you desiredI want to assure you we reviewed all the documents and available information before issuing this responseOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Dear [redacted] *** Please see our response to complaint # [redacted] for [redacted] that was received by us on October 23, 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 concerns reviewedWe were advised that all claims on file, including the treating physicians’ claim, are processed as participating for services rendered on September 04, The physician claim [redacted] shows a member responsibility of $towards the percent coinsurance that was due and $was paid to the provider on September 19, Please have the member contact us directly at the email listed below if she is being balance billed any additional money outside the $that applied to the coinsurance 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 compliant we immediately reached out to our Health Savings Account (HSA) department to have the member’s concerns addressedWe were advised that prior to receiving this complaint the member’s account was already updated with the contribution for December We confirmed the member’s money was deposited on January 13, 2016, and an email was sent to the member on January 14, 2016, advising her of the deposit Please accept my apology that we did not provide the level of service that you rightfully expect and deserve, and my assurance that your concerns are getting the highest level of attention at AetnaI would also like to thank you for sharing your experience with usIt is feedback like yours that helps us address issues and prevent them from reoccurring We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MsStiles’ concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
Hello, Thank you for your inquiry, regarding complaint [redacted] for [redacted] ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reached out to our Network department to have the member’s concerns reviewedWe were advised that both providers listed in the compliant are participating with the member’s plan, and that our list of surgeons the member is locating online is up to date and correctWe called and spoke with [redacted] at [redacted] office and advised her that she was given incorrect information from our provider service center and that the member was within the network if they wish to continue their member/provider relationshipOur Network department will reach out to the provider’s office to educate them on their contracts and plans they participate with Our goal is to provide accurate and reliable information when you need it and to immediately resolve issues when they do occurClearly, in your case, we fell short of that goalWe regret that your experience with Aetna was less than satisfactory and hope that we can better assist you in the futureI would like to assure you that we have taken the appropriate actions to address the customer service issues the member and the provider have experienced 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] ***s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, XE "Type Name"Ashley S Complaint and Appeal Consultant Executive Resolution Team XE "Title/Business Area"
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reached out to our Claims department to have the date of service reviewedWe were advised that the member is not responsible for the billed charges because the facility failed to call the Pre-certification department in a timely mannerWe confirmed that both the member and the provider’s explanation of benefits (EOB) state that the member is not responsible for the billed charges The provider did not call our pre-certification office within one day of discharge, so it will be their responsibility to file an appeal, not the member’s responsibilityWe called the facility and left a voicemail with the billing department explaining that they should refer to their EOB which states they are to not balance bill the memberIt also went on to explain that claim was denied due to failure to follow Aetna contractual notification requirementsWe advised of the address they could send the appeal request to and left a call back number for any questions/concernsWe have also mailed another copy of the explanation of benefits to the provider for their records We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] .com 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]
Complaint: [redacted] I am rejecting this response because: I did not complain about correspondence regarding policy options, as this dishonest "response" claimsI complained about the advertising junk mail they refuse to stop harassing me with, and I am prepared to Take further action if forced, and if they continue in their refusal to cease and desist [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 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 had our files reviewed to verify that we had the member’s name correct in our systemOur records indicate we have the member’s name in our system just as it shows in the Revdex.com complaintOur records also indicate that we do not carry this employer’s medical benefits, only dental benefitsThe employer’s medical benefits are with any of the following carriers: [redacted] , [redacted] and [redacted] ***Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those recordsPlease contact your medical carrier to request a corrected medical ID card 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] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team