DELTA AIRLINES

Hello,
Thank you for your inquiry, regarding complaint #11103156 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 Accounting department to...

have the member’s concerns reviewed. We were advised by [redacted] that the claim needs to be submitted to [redacted] as they were given all the financial details and [redacted] will pay the claim.
The member did submit a claim that was received on December 31, 2015, but the claim was not processed until January 06, 2016. Per [redacted] will handle all Run Off and Grace Period processing. No further processing by will be completed by Aetna as of January 01, 2016.
We sent the request back to the member on January 06, 2016 and advised the member to resubmit to [redacted] since they are responsible for handling the Run Off and Grace Period. Please have the member send the information directly to [redacted] with their new account information. We apologize for any inconvenience this may have 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 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 claims reviewed. We were advised
that the services rendered require medical records to be submitted by the
provider. At this time we have yet to receive the medical records requested
from the provider so we are unable to process the claim. Once they are received
we will be able to process the claims for any benefits available under the
plan.
Our goal is to provide accurate
and reliable information when you need it and to immediately resolve issues
when they do occur. 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. Your concerns
have been forwarded to our management team for improvement opportunities.
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

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 your complaint, we contacted our Pharmacy department and confirmed that the prescription...

has been shipped and delivered to the member. We have spoken to the member and confirmed receipt of his medication. We apologize for any difficulties and inconvenience this has caused the member. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

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 call and talk to the market place and they said that I had to go through Aetna. I called both places three times and no one called me back and let me know what was going on. And each time nobody could tell me anything. Passing the buck to each other. As far as autopay I never set up Autopay with Aetna. so why did they Autopay my account. Plus I payed them $100.00 on July 1st. What happened to that money. And when I talked to Aetna last month they stated that they could not found out anything because my Account was closed for the time in question.  Aetna need to straighten this out. And yes I did turn in all of my paper work. And no I don't have Autopay with Aetna set up. They took that apond themself and set that up themself. Aetna needs to fix this, not the market place. This is Aetna's problem.
Sincerely,
[redacted]

this issue has been resolved. please close thx

During our review, we reached out to our Enrollment department to address [redacted]’* concerns. However, [redacted]’s information was not found in our system which required [redacted] to be contacted.An outbound call was placed to [redacted] by our Enrollment department so we could address [redacted]...

[redacted] concerns. However, there was no answer from [redacted], so a detailed voicemail was left including the nature of the call and a direct call back number ###-###-####. This way [redacted] may call our Enrollment department directly so her concerns may be addressed.I apologize for any difficulties or confusion this may have 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]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]Regards,Julian C[redacted]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 reviewed. We 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 physician. These 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 check-up
• 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 disease. Please 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 desired. I want to assure you we reviewed all the documents and available information before issuing this response. 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 [email protected].
Thank you,
Ashley S.
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 June 22, 2016. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.   Upon receipt of the...

complaint we immediately reached out to the Claims department to have the member’s concerns reviewed. We are currently in the process of reviewing and correcting any claims on file for the member. We have contacted the member directly to let him know we are working to rectify the situation and will contact him directly once the claims review has been completed.   We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Cohen’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
* Sincerely,   Ashley W. Complaint and Appeals Consultant Executive Resolution Team