DELTA AIRLINES

Hello,
Thank you for your inquiry, regarding complaint #*** for *** ***. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
We apologize if our previous response was misunderstood or upset the member in any way, we assure you that it is not our intent to mislead or misrepresent any information that was relayed to the member regarding the payment. We mailed a check to the member on July 30, 2015, to the home address on file. Our records indicate that this check was received and was cashed on August 13, 2015.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mrs. *** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
 
Thank you,
*** **
Complaint and Appeal Consultant
Executive Resolution Team

Thank you for your inquiry received on 06/30/2015 regarding complaint #[redacted] for [redacted].  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
 
We reached out to Aetna’s Eligibility department...

for assistance, and the member was on a low deductible plan from 04/01/2013 to 03/25/2015. Then, transferred to a [redacted] plan effective 03/22/2014, until 03/25/2015, and was on the correct plan. The member was only on the high deductible plan from 04/01/2015 to 04/30/2015.  There is only one outstanding claim for both Mr. and Mrs. [redacted], which have been sent for reconsideration. A new Explanation of Benefit (EOB) will be mailed under separate cover within 7-10 days.
 
 
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Dear Ms. [redacted]:   Please see our response to complaint #[redacted] for [redacted] that was received by us on November 10, 2017.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.   Upon receipt of the...

complaint we immediately reviewed the member’s file to have the member’s concerns addressed. I requested that a Supervisor who handles this member’s account through the employer contact her directly to attempt to resolve. At this time we discovered that the doctor that referred her son referred them to [redacted]. The member went to the center in [redacted] and the sign read [redacted] and also [redacted]. It appears that the services were actually performed by [redacted] which does the billing through [redacted] Hospital. The member understands that we quoted her the correct rate for [redacted] and that the issue lies with the bill that was received from [redacted] Hospital not [redacted].   The member asked to the Supervisor to contact [redacted] to clarify the billing and to follow up with her on the findings. We did advise the member that in order for us to make any changes to this billing we would have to have a corrected bill from [redacted]. The Supervisor spoke to a representative at [redacted]. She advised that if an [redacted] provider refers the patient to them it is then billed as an [redacted] provider [redacted] Hospital. If a non [redacted] provider refers the patient to them it is billed by [redacted]. The representative also advised there are signs within the facility to warn the patients. However, she was going to escalate the issue to her manager and will follow up with the Supervisor the week of November 27, 2017. The Supervisor followed up with [redacted] and shared the above information with her and advised her we would follow up with her the same week after talking to the facility. We will continue to work directly with this member in an attempt to resolve this to the member’s satisfaction.      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 W. Complaint and Appeals Consultant Executive Resolution Team

Revdex.com res sent 05/15/17 @ 05:12pmDear [redacted]: Please see our response to complaint #[redacted] for [redacted] that was received by us on May 09, 2017. 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 Overpayment department to address the member’s concerns. We have confirmed that all pended overpayments have been stopped. We are no longer pursuing funds from your providers, since the member was active during the date of services. We also verified that all claims where money was recouped from the provider’s, have been reprocessed and  payments reissued. Please allow time for payments to be processed and posted by each provider. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, LaShonda C.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.
We show that this complaint was already reviewed and responded to under previous Revdex.com case...

[redacted]. We had the complaint reviewed again to make sure the original determination was correct. We verified that our previous response was correct regarding the coverage for codes [redacted] and [redacted]. We mailed a check to the member on October 08, 2014 for $1,227.80 for code [redacted]. The procedure code [redacted] is not being denied at this point for medical necessity, the procedure is being considered incidental to code [redacted] so an additional payment of $210.00 will not be allowed. We have had this reviewed under appeal case [redacted], where a medical director agreed with this determination. When a code is incidental the charge for the service ([redacted]) is not payable because it is considered part of another procedure ([redacted]) performed on the same date and is included in that payment of [redacted].
While we understand your concerns and recognize this is not the resolution you sought, our decision remains unchanged. Our 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 Mr. [redacted]’ concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
 
Thank you,
[redacted]
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: [redacted]
I should get a full refund.  It's obvious your online billing system is filled with glitches.  It's not my fault that your system was unable to process my request.  It is downright criminal that you would erroneously bill me with your inefficient system and have the audacity to refuse to give me a refund.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:I dont have the cards in hand.  Once I receive the cards, I will review them to ensure they have the correct information and I will be in touch.I will not close the case until 100% certain the cards are correc**Revdex.com, can you fix my name on your website?Thanks
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: I did not complain about correspondence regarding policy options, as this dishonest "response" claims. I 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]

Thank you for your inquiry received on 06/01/2015 regarding complaint # [redacted] for [redacted].  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
 
We reached out to Aetna’s Pharmacy Management...

department (APM) for assistance, and our records indicate the member’s effective date of coverage is 01/26/2015. If the member purchased medications prior to that date before her employment started, then there was no active coverage and the medications are not eligible for reimbursement.     
 
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted] concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Thank you for your inquiry received on 06/01/2015 regarding complaint # [redacted] for [redacted].  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
 
We reached out to Aetna’s Pharmacy Management department (APM) for assistance, and were advised that the member tried to obtain a refill of [redacted] on 05/27/2015 at Public Pharmacy, and the claim was denied as being too early to refill. The member had filled a 60 day supply of [redacted] at Public Pharmacy last on 04/19/2015.The plan has a 75% utilization requirement. Therefore, a refill is not available on a 60 day supply until after 45 days has passed from the previous fill. In this case, the member would not have been eligible for a refill until on or after 06/03/2015. The member had enough medication to last through the termination date. The member’s termination date was 05/31/2015.
 
Additionally on 05/29/2015, the member contacted APM’s Customer Care and requested that he be provided with an early refill for vacation. The request was denied. The member was traveling domestically to an area where there are participating pharmacies. The plan will consider vacation supplies as a courtesy when the member is leaving the country and will not have access to a network of participating pharmacies.
The member then called a second time on 05/29/2015, and indicated that the medication was damaged or defective. Aetna’s standard is that replacement supplies for Lost/Stolen or Damaged Medications are excluded.
 
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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Hello,
Thank you for your inquiry, regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Upon receipt of this complaint our office had already received a letter from the member...

regarding the same complaint. The consultant reached out to speak with the member to let him know we would research the issue. The member was advised that his claim was processed correctly according to his coordination of benefits. There will be no additional payments made on the claim.
I understand your concerns and recognize this is not the outcome you desired. Our 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 Mr. [redacted]’s 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

Hello,
Thank you for your inquiry, regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Upon receipt of the complaint we immediately had the call pulled and listened to so we could...

verify what information was provided to Ms. [redacted]. We confirmed that she was provided incorrect information and due to the nature of the complaint we made a one-time exception and reprocessed the claim to pay the member. The member was mailed a check on May 12, 2015, to the home address on file. The claim was reprocessed to reflect this change under claim ID [redacted]. The member will receive a corrected explanation of benefits or it is available to view on our Aetna Navigator online.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
 
Thank you,
[redacted]
Complaint and Appeal Consultant
Executive Resolution Team

Dear Ms. [redacted]: Please see our response to complaint # [redacted] for [redacted] that was received by us on January 11, 2018. 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 [redacted] department to address the member’s concerns. We reviewed the member’s current plan benefits and found the member is enrolled in a [redacted] Plan. This plan does not include [redacted] prescription drug coverage.  The member’s pharmacy benefits are covered by [redacted]. The member can contact [redacted] Member Services at ###-###-####. [redacted] will be able to supply you with the information you need to get your prescriptions including the PCN and BIN numbers for their plan. They can also send you an [redacted] ID card. Aetna representatives aren’t able to give you the PCN and BIN numbers for an [redacted] plan because they’re a separate company. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. Gattermeyer’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected]. Sincerely, LaShonda C. Complaint and Appeal Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because: Aetna has not made any attempt to contact me as indicated in their response. I have not received any emails from them dated Nov. 6th or otherwise. I even checked my spam folder. They already have my tax ID on file. It has been submitted to them with each call that I made to them. Also, a W-9 has been sent more than once. This is just a small example of what I have been experiencing over the past 5 months. No resolution.
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 the claims for the [redacted] family reviewed. We were...

able to verify that there were a few claims on file that were delayed in processing due to not have diagnosis codes submitted with the claim. Once we received the diagnosis codes we were able to process the claims in a timely manner. At this time all claims on file have been processed and finalized.
Most of the family’s claims on file were processed and finalized within 10-15 business days of receipt. If the member sees an out of network provider the payment of the claim is going to be based upon a reasonable and customary rate, not determine by Aetna, and will pay the percentage of the allowable. If there is a particular date of service that the member feel was not processed correctly or disagrees with the payment, the member may file an appeal with our Customer Resolution Team.
Please accept my apology for the delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issue.  Our goal is to pay claims timely and accurately, and to promptly resolve issues when they do occur.  When issues do arise, we take them very seriously and do our best to understand how and why the errors occurred and determine what we can do to prevent a recurrence.  We continually use feedback like yours to improve our service and prevent issues from reoccurring.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’s 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

Dear [redacted]: Please see our response to complaint # [redacted] for [redacted] that was received by us on December 5, 2017. 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 Claims department to address the member’s concerns. We reviewed the October 16, 2017 claim and found that the claim originally processed under the incorrect contract for [redacted]. The claim initially allowed $189.00 and was applied to the member’s deductible. However, Aetna determined that an error was made and reprocessed the claim at the correct provider contract rate on December 2, 2017.  The correct allowed amount for the service should have been $283.50. This resulted in an increase of the member responsibility by $94.50.  The member is responsible for the $94.50 because his deductible was not met.We apologize for the inconvenience that 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]’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely,LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Dear [redacted]    Please see our response to complaint #[redacted] for [redacted] that was received by us on November 02, 2017.  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 reviewed. We were advised that the authorization on file had to be updated to correct how the claims were being processing under the member’s plan. We updated the authorization on file to have the claims processed at the full billed amount. We also had any claims on file that were not allowed at the full billed amount of $210.00, corrected. Additional payments will be released within 7-10 business days and a corrected explanation of benefits will also be sent to the member for her records. If the member has any other claims that process incorrectly in the future she can email me directly at the email address listed below and I will have them handled immediately.   Please accept my apology for the delay in processing the member’s claim correctly, and that it required multiple attempts on her part to resolve the 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 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 W. Complaint and Appeals Consultant Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint #[redacted]or [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Upon receipt of the complaint we immediately reached out to our Eligibility department to verify...

if the member should have active [redacted] coverage with Aetna. We confirmed that the member’s employer switch to a new health insurance carrier in the middle of 2015 and the member is no longer covered by Aetna. We were advised that a representative from the member’s Human Resources (HR) will be reaching out directly to the member to confirm that her coverage is with United Health Care. The member will need to contact either her HR or United Health Care with any benefit or eligibility questions. I apologize for any inconvenience this may have caused for the member.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team [redacted].
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: 11[redacted]
I am rejecting this response because: This does not change the fact that I had to go 2 days with out necessary medication and due to Aetna playing doctor (deciding that my age isn't appropriate for a medication) my life was put on the line. I do not accept Aetna's absurd procedures and disregard of human life. It's not just my life that is put on the line. Daily Aetna plays this game with several of their customers and the evidence is right on their [redacted] page. Hundreds of angry people who are tired of the same thing. I will continue to keep this case open for myself and all the others like me who have been toyed with just so that Aetna could play doctor the prescriptions.  
Sincerely,
[redacted]