DELTA AIRLINES

Complaint: [redacted]
I am rejecting this response because:
Supposedly the money was sent. If this is actually the case, then it will be accepted. I am taking all precautions since from day one, including submissions here, there have been inaccurate commitments.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: I went to the doctor and asked for a preventative care yearly physical. I 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 $5000.00 deductible is met. The 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 done. This 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 done. This 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 us. Had I known I would have to pay out of pocket on top of my regular payments, I would have gone to another provider. Make this right and give what was promised.Sincerely,
[redacted]

Thank you for your inquiry received on [redacted] 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 the Flexible Spending Account (FSA)...

department, and the member’s check for $20.00 has been reissued as of [redacted]. We apologize for any inconvenience this may have caused.
 
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].

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

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 addressed. We were advised that prior to receiving this complaint the member’s account was already updated with the contribution for December 2015. 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 Aetna. I would also like to thank you for sharing your experience with us. It 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 Ms. Stiles’ 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 reached out to the Eligibility and Billing...

department for the member’s employer to verify why there was an increase in premiums. We were advised that this member has the [redacted] plan. Aetna does send out notifications each year of the benefit changes and rates. Federal members have a choice; it is a passive enrollment, meaning if they do nothing, they will stay in the same plan. This letter is sent to all members and is mandatory from Office of Personnel Management (OPM). The member needs to refer to her Human Resources department in regards to the premium amounts, as Aetna has no control in the premium rate changes, Aetna is strictly an administrator in the plan benefits.
This member has been receiving this letter each October since she has been a member with Aetna. The address that we have on file is [redacted], **, [redacted].
Also, the member is still in the old enrollment code. We continue to send her letters to switch her enrollment code to the correct one for her area. I have attached a copy of this year’s letter that has already went out to members.
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 Ms. Madelyn Sola:   Please see our response to complaint [redacted] for Jill Watts that was received by us on August 05, 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 our Billing department to have the member’s concerns reviewed. We were advised the member was originally termed January 31, 2016, on January 15, 2016. On July 09, 2016, the system reenrolled the member under a new ID. We are still researching this issue as priority to prevent this from happening again.   We have refunded the premium of $213.72 back into the bank account on file. Please allow 1-3 business days (depending on the bank and how they handle electronic fund transfer requests) for this refund to be completed. Please accept my apologies for the difficulties the member has encountered with Aetna.   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 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:
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 January 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 reached out to our Eligibility and Premium department to have the member’s concerns reviewed. We were advised that a termination file was received from the Marketplace on December 13, 2016 to terminate the policy with a date of December 27, 2016. The request for termination was completed on December 14, 2016, to reflect the term date of December 27, 2016. The member was refunded the prorated difference of $16.68 on December 16, 2016.   We verified our call history on file since the member stated he called to terminate the policy for the effective date of November 30, 2016, and was told by a representative that he did not have to take any action, but there are no calls on file related to this complaint. If the call was with the Marketplace, we do not have recordings for those calls, only the Marketplace would have a recording.   Unfortunately, the policy does not qualify to be terminated effective November 30, 2016, because the file received from the Marketplace was received with a termination date of December 27, 2016. If the member is still disputing the termination date, the member would need to reach out to the Marketplace appeals department a[redacted] to request the November 30, 2016, termination date. Only if the Marketplace appeals department approves the requested termination date would we be able to complete the full refund for the December premium.   We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   Sincerely,   [redacted]
[redacted]
[redacted]

Dear Ms. [redacted]:   Please see our response to complaint #[redacted] for [redacted] that was received by us on December 20, 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 our Precertification department to have the member’s concerns reviewed. We requested that the Precertification department review the member’s request as soon as possible due to the delay the member was experiencing surrounding the request. We were advised that on Thursday December 22, 2016, our Precertification department spoke with the provider’s office and confirmed that the codes that were being requested did not require a precertification request and apologized that the request was not handled sooner.   The provider confirmed the member was aware she was using her out-of-network benefits and again apologized for the inconvenience the office and the member experienced. We have provided additional training and feedback to those involved in the handling of this request. The provider will contact the member to set up having the services rendered.   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,   Ashley W. Complaint and Appeals Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:There is still no way for me to know who the so called provider us on the claim forms.They refused to provide provider information (hospital clinic medical group) for the persons name in the provider column on there forms.I have to spend hours trying to guess and find out who they work for to verify if each claim is legitimate. They have resently deleted the false claim I caught but the time I need to spend verifying 100's of claims by the end of the year will bealot of wadted time on my part because they refuse to let me know who the provider is.This is not personel information as they told me. What clinic name or hospital or medical group they work at should not be considered personnel infomation they cannot provide on there forms. The clinics and hospitals provide the info to Aetna it's Aetna that refuses to put that on  there claims. Only other option is to send Aetna all the names on the claim forms and request special permision to find out the address of the persons billing address. Then I would [redacted] the address to find out what building is there and maybe find out who it is. I then have to message my kids at collage to see if they went there for something on that date. Collage kids have short memories. When I asked them ladt time they only remebered half of the claims.
Sincerely,
[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] I have sent an email to Aetna as suggested. I'm hoping this can be resolved without further detriment to my credit. Thank you for your assistance in this matter.

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 reached out to our Dental
department to have the...

member’s concerns reviewed. We were advised that the
information the member received from the Aetna response team was correct, Aetna
no longer provides dental ID cards, so we are unable to honor the member’s
request. We sincerely apologize for any inconvenience this has caused the
member.
With the member’s Aetna Dental plan, all the dentist office will
need is the member ID number or SSN and our provider call center phone number.
We can then provide them with the eligibility and benefit information. Dental
ID cards are not required by providers and the offices are aware that Aetna no
longer issues ID cards. They rely on rosters or online patient eligibility and
benefit information to verify member’s coverage. The member is on a DMO plan,
which requires a Primary Care Dentist (PCD) to be assigned to. The office which
he is assigned to receives a roster each month with his name showing he is
assigned to the office. Please have the dental office refer to page two of
their roster, where the member’s plan information is located.
Also, members can still access their dental ID card on Aetna
Navigator and the Mobile App. When printing the ID card from Aetna Navigator,
the member may want to adjust the window margins in the printing options to
have the ID card fit to his approval. The member can also download the Aetna Mobile
App onto any mobile device, where there will be easy access to pull up an ID
card and present it to the dental office.
We take customer complaints very seriously and appreciate
you taking the time to contact us and giving us the opportunity to address Mr.
Edmund’s concerns. If 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

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 reviewed. We 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 correct. We 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 relationship. Our 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 occur. Clearly, in your case, we fell short of that goal. We
regret that your experience with Aetna was less than satisfactory and hope that
we can better assist you in the future. I 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 processes. I want you to know
that we appreciate your feedback because it gives us the opportunity to listen
to our customers and make any improvements to our processes and the service we
provide. Your 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 concerns. If 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 had our files reviewed to verify that we had...

the member’s name correct in our system. Our records indicate we have the member’s name in our system just as it shows in the Revdex.com complaint. Our records also indicate that we do not carry this employer’s medical benefits, only dental benefits. The employer’s medical benefits are with any of the following carriers: [redacted] and [redacted]. Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those records. Please 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 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 #11432250 for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. As previously stated we have stopped all mailings as per the request of [redacted]. The Aetna mailings are not meant as harassment and we take all complaints seriously that come from our members. We will only consider reimbursing a premium if the member was unable to use the benefits under the policy. At this time there is no proof the member was not able to use his plan benefits, so we will not being reimbursing the member the four months that is being requested because of the member receiving Aetna mailings. 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

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.
As addressed in our previous response the ID cards were
mailed prior to us receiving the retro-termination request of the policy by the
employer. We did not receive the request from the employer until December 30,
2015, which is after the ID cards were issued. Aetna is strictly an administrator
of the plan and has no control over termination requests made by employers. It is
the employer’s responsibility to notify the member of any terminations, not
Aetna.
Aetna also has no control over premium deductions that are
made for the policy. Aetna is never advised the premium rate of a member as it
is private information between the member and the employer. Again to reiterate,
the member will have to follow up with the Human Resources (HR) department with
these questions. Aetna will not be able to assistance why the member is paying
for a medical policy that is terminated.
There is a pharmacy policy only, not a medical plan, that is
effective for the member only, not his spouse. This is under a Medicare ID and
is sponsored by TX PDP. The member used these benefits in the month of April and this may be why the member is being deducted money for
a 2016 policy. The medical plan that was through the [redacted], is correctly terminated per the employer. To recap the member will need to follow up with the HR
department to have his questions/concerns addressed.
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 [email protected].
 
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:Clearly we won't mutually agree ever on this point.  Unless you plan to resolve your billing process I still believe I am correct.
Sincerely,
[redacted]

Hello,
Thank you for your inquiry, regarding complaint [redacted] Our Executive Resolution Team researched your concerns,
and I would like to share the results of the review with you.
Upon receipt of the complaint we immediately reached out to
our Claims department to...

have the member’s concerns reviewed. We were advised
that the claim was processed correctly according to the out of network
benefits. The member’s benefit when seen at an out of network urgent care
facility is reimbursed at 50% after the deductible is met.
Our records indicate that the
member did visit an urgent care facility in September but it was a different facility
than the one the member visited for the November date of service, which is why
the claims processed differently. It is ultimately the member’s responsibility
to verify the participation status of the provider. We did not locate a call on
file from either the member or provider prior to services being rendered to confirm
the coverage; therefore we are not able to make any exceptions for this claim.
The member will be responsible for any billed amount from the provider. 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 [redacted] concerns. If 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 directly to the provider’s office to address the member’s concerns. We spoke with Dawn, at the New Berlin office, and we explained the situation that the claim was sent to us as performed at the [redacted] office. In our discussion with Dawn, we provided the payment ID and confirmed the address the payment was sent to and we were advised the payment went to their main office for Forward Dental, per the way the claim was submitted to Aetna by the provider.
We faxed the explanation of benefits to Dawn’s attention for review on Friday February 05, 2016. We called today, February 09, 2016, and spoke with Dawn and she advised that the main office submitted the claim incorrectly to Aetna, listing the wrong office, but that she was working internally within their offices to have the money applied to the member’s account.
The office was provided with my direct number for any future questions or concerns surrounding the claim. Unfortunately, we are not able to change the claim on file to show the correct office, the provider’s office would be required to submit a corrected claim for Aetna to be able to make any adjustments.
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 [redacted]
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team