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 youUpon receipt of your complaint, we contacted our Benefits department and determined that this
member is currently enrolled under the group, ADP Total SourceADP Total Source does not cover transgender reassignment servicesAetna, however, is a LGBT friendly company which means that Aetna supports the communityWe apologize for any inconvenience this has caused the memberHowever, we must make coverage decisions in accordance with the plan benefitsWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

Thank you for your inquiry received on 06/05/regarding complaint #*** for *** ***. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
As previously advised, since the claims in question were foreign claims, which did not have procedure codes on the claims, we reached out to Dr*** to verify the services that were renderedThe requested information has not been received from Dr*** who completed the dental work on Ms***We have sent a second request as of 06/11/to Dr*** for the information needed for processing of the claimsOnce this information is received, we will be able to review the claims accordingly
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’ concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

Complaint: ***
I am rejecting this response because: You are a joke......You don't have a clue do you?????? I believe NOTHING you sayDR*** wasn't even the doctor to call to Pre-Qualify me so Nice try......You wanna try for a 3rd Strike!!!!! I truly hope the Revdex.com is seeing my responses and your incompetence........It's fine you can continue to fleece hard working people out of their money with no consequences.....I guess you have no trouble sleeping at night doing it....IF you truly want to go over my case call me directly at ***....At least lie to me in person!!!!!!!!
Sincerely,
*** ***

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 youUpon receipt of your complaint, we contacted our Pharmacy department and found that the
plan pays 100% for drugs labeled as Smoking Cessation Aids. The product dispensed is a generic for *** SR which is labeled as an Antidepressant. The benefit would only apply to the generic to *** which is also ***. However, it has to be the product labeled as a smoking deterrent to be eligible for $cost shareWe have entered an exception and placed an override to allow for the dates of service submittedA check will be mailed within business days
Going forward, the member needs to obtain a prescription written for *** with substitution permissible in order to be eligible to obtain the generic to that product, *** 150mg SR, a $cost shareThe antidepressant product isn’t labeled by the FDA as a smoking cessation drug, only the actual generic for *** is
We apologize for any inconvenience this has caused the memberWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
*** **
Complaint and Appeal Consultant Executive Resolution Team

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
Upon receipt of the complaint we immediately had the email pulled that the member states she was provided incorrect information by a customer service representative (CSR)We confirmed that indeed Ms*** was given incorrect information regarding her ultrasound and stated we would cover it 100% after a copay was paidDue to this incorrect information being provided we made a one-time exception to pay the deductible amount owed by the member directly to the providerThis was completed today June 19, Going forward for any ultrasounds the member has she will be responsible for any amount that applies to her deductible
We also confirmed that we provided Ms*** the plan information in the email that verifies the information in our previous Revdex.com response which states there are exceptions to the prenatal coverageThat includes:
Routine prenatal care includes:- The initial and subsequent history- Physical exams- Monthly visits up to weeks gestation- Biweekly visits to weeks gestation- Weekly visits until delivery- Recording of weight- Blood pressures- Fetal heart tones- Routine chemical urinalysisServices that are not considered routine prenatal care include:- Office visit to confirm pregnancy- Ultrasounds- Certain Pregnancy diagnostic laboratory tests- High Risk Specialist Visits- Amniocentesis- Fetal Stress Tests- Inpatient admissions- Delivery including Anesthesia
In reference to the doctor’s visit that applied a $copay on May 14, 2015, the copay was applied to the fetal stress test that was completed on this dayAs listed above that service is not considered a prenatal service that is covered at 100%The member is responsible for a $copay for this date of service
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf 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

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this research is satisfactory to me
Sincerely,
*** ***

Thank you for your inquiry received on 05/18/regarding complaint #*** for *** ***. 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 Individual Plans department for
assistance, and were advised the member lost her tax credit through the Marketplace effective 04/01/This change was loaded into the system on 03/16/2015. Aetna is not privy to the reasoning and has no control over the plans or rates that the member is eligible for through the Marketplace. The member would have received a letter(s) from the Marketplace advising of the loss of tax credit and the reasoning behind the change. Aetna did not pull the auto draft for this member in April due the timing of the plan change and the issues with the billing cycle. April and May’s premium of $(total of $875.32) was auto drafted on 05/04/2015. The invoice was available online on 04/29/2015, as auto drafted members do not receive an invoice via mail.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

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
Upon receipt of the complaint we immediately went through the claims and totaled what was owed to each provider and how much was owedPlease see the attachment that explains what is owed for the member
In regards to the member being sent to collections, this information is not something that is provided to AetnaIf the member is requesting assistance with this please provide all documentation and we will assist as much as we can to resolve any collections the member owes
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf 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

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
Upon receipt of the complaint we immediately reached back out to the Revdex.com
on April 28, 2015, to verify some information we need to be able to research this issue furtherWe have yet to receive this information back from the Revdex.com as of May 05, To be able to further assist you please provide the following information and we will be happy to review it:
Father’s full name, date of birth and last address on file for him
Documented proof that you are the beneficiary for your father so we may speak with you in regards to the life insurance policy
A copy of the letter was received from Aetna stating there is an unclaimed life insurance policy
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’ concernsIf 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

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
Upon receipt of the complaint we had the member’s claims reviewed to see if they were processed correctly and if the member owed $We confirmed that the claims have been processed correctly and there were three procedures that were done that are not considered preventative services under the member’s planTherefor she is responsible for a total of $that applied to the member’s deductible
The member’s effective date per the file from the employer is January 26, We are not able to cover prescriptions prior to this dateIf the member paid for any medications out of pocket after this date please send in a completed claim form and attach the pharmacy receipt that is stapled to the medication when you pick up your prescription and we will be happy to review them for consideration of reimbursement
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf 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 05/01/regarding complaint #*** for *** ***. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
We reached out to our *** *** ***
*** department for assistance, and the member’s check in the amount of $1,issued on 04/13/(Claim# ***)The *** policy is to allow a minimum of business days for delivery, which would be on 04/24/The member called on 04/27/to request the check be reissuedThe stop payment/reissue process took business daysThe check was sent via *** under tracking # *** shows that the package was delivered on 05/01/
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me I hope to keep the complaint open until I receive the reimbursement from the company.
Sincerely,
*** ***

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 youUpon receipt of the complaint, we contacted our Claims department regarding the claim from April
23, from *** Vision CareWe confirmed that the plan does allow one routine vision exam every monthsBased on the plan benefits, the copay applies to a routine vision examThe total billed charge of $has been allowed at percentThe claim has been reprocessed to allow the all charges after a copay of $An explanation of benefits was mailed on June 15, which indicated the member responsibilityWe apologize for the inconvenience this has caused
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrChan’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Thank you,
*** **
Executive Resolution Team

Thank you for your inquiry received on 05/28/regarding complaint # *** for *** ***. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
We reached out to our Claims department, and had
the member’s claims reviewed The member’s claims have now been reprocessed and corrected with *** Part A onlyWe 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 Ms*** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

Spoke on May 20th to ***, and then again today to someone else 6/8/15. He couldn't confirm that the reprocessing was completed after spending minutes on hold waiting and took my cell phone and said *** would call me back. Therefore, I don't agree to the response statement until someone actually calls me to clarify what was reprocessed and how they come up with this new number Complaint: ***
I am rejecting this response because:
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because: This is BS....My doctor calling on Nov14th was them checking to see if I was covered and your guy gave them a confirmation # which I will get from them....Your guy said I had to do the Month program and then go back to the insurance,,,,,,SO YES YOU AETNA TOLD MY DOCTOR I HAD TO DO THIS MONTH PROGRAM WHICH COST ME $300.......HENCH WHY YOU HEARD BACK FROM MY DOCTOR IN MAY....HMMMM LETS DO THE MATHMONTHS LATER, WHAT A COINCIDENCE You can lie all you want but the truth will come out....why don't you release the call and transcript so we can see for our self what your representative told my doctor...because I tend to believe my doctor and when I called in and had someone review the transcript she had a different version of what it said I Will show this Pitiful excuse to my doctor and see what they have to say about it. I've also filed a complaint with the *** *** of *** and I've had a local News Station interested in my story.....So like I said before....Keep liying the truth will come outI don't even care about the Surgery anymore you crushed that hope but YOU OWE me the $I spent on the moth prerequisite program Your Representative told my doctor I needed to do for your company!!!!
Sincerely,
*** ***

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
Upon receipt of the rejection we were able to verify that the check was never received or cashedWe have since reissued a check on May 21, 2015, for the amount of $1,to the home address on fileI sincerely apologize that the check information was not verified in our previous responses
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 ***
Thank you,
*** **
Complaint and Appeal Consultant
Executive Resolution Team

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 youUpon receipt of the member’s response, we requested a second review. The November 19, phone call between Dr*** office and our provider customer service representative did not indicate any incorrect information was providedWhen we reviewed the call, the provider was advised that in order to determine if the surgery would be allowed, the office would need to send in a predeterminationWe provided the phone number to call and fax number to send Mr*** medical records for review to see if it qualified for medical necessityOur records indicate that this was not completed by the provider until May 07, Unfortunately, the plan does not cover this surgery and we are unable to make any exceptions to allow coverage at this timeYou are responsible for any copayments to the specialist office visitWe apologize for any inconvenience this has caused the memberHowever, we must make coverage decisions in accordance with your plan of benefits and our medical necessity guidelinesWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr*** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***.*** **Complaint and Appeal Consultant Executive Resolution Team

Thank you for your inquiry received on 05/11/regarding complaint #*** for *** **. 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 member and provider of service to
have the claims/itemized bills refaxed to Aetna, as the forms were not legibleOnce received, we were able to send to our Claims department for processingThe member should be expecting a reimbursement payment in the amount of $3,320.00, less her $copayment responsibility for each date of serviceWe apologize for any inconvenience or frustration 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 Ms*** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***