DELTA AIRLINES

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 contacted our Benefits department and verified the maternity coverage. We also listened to the recorded calls. The calls indicate only general maternity benefits were provided during the phone call. The claims in question were processed correctly in accordance to the member’s plan benefits. When the child is born and is added to the policy as an individual, the facility is able to bill separately for both mom and child for any charges related to the pregnancy. The submitted charges were sent for both the mom and child; which triggered the individual copays. 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.I attempted to contact the member to discuss the
outcome of our review. I left a message and have not received a return
call. 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 # 10744957 for Jessica P[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...

someone contact the facility to have all of their concerns addressed. Our department advised us that they spoke with the facility and advised that they have successfully added the associate as well as update the facility in our Aetna Better Health (ABH). We were also advised that the facility was provided a direct contact for any further questions or concerns.
Please accept my apologies for the difficulties you have encountered with Aetna. Our goal is 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 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. P[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

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 Eligibility department to...

confirm what date the member should have on file as a termination date. We confirmed that we had the incorrect information on file for the member. We have since updated the policy to show terminated as of December 31, 2015. We also sent the member’s dental claim back for same day reprocessing and it was completed yesterday, January 25, 2016. The provider will receive the payment and a corrected explanation of benefits within 7-10 business days.
Please accept my apology for the delay in processing the member’s claim correctly. Unfortunately, in some instances, procedural 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 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,
[redacted]
Complaint and Appeal Consultant
Executive Resolution Team

[redacted] Please see our response to complaint [redacted] for [redacted] that was received by us on June 12, 2017. 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 Customer Service department and determined that some problems occurred during the member’s initial request for the PCP selection. We confirmed that our systems reflect that [redacted] has been selected as PCP effective June 2, 2017. We also contacted the member and confirmed that the medical ID cards have been received.  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 there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely,[redacted]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 attempted to find the member’s ID number and plan...

information but were unsuccessful. We reached out to the Revdex.com to have them request more information from you. To assist you will you please advise of your member ID number and also confirm in writing that you wish to terminate your policy and which date you are requesting termination. If you do not wish to cancel this policy, we would be more than happy to assist in resolving your first issue by finding you a doctor since you said you were having difficulty finding one.
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

Complaint: [redacted]
I am rejecting this response because:what Aetna said all my claims are re-processed, simply it's not trueI logged into my account, as now the claim #[redacted]( part 2), #[redacted], #[redacted]  are still wrongly rejected based on educational charges not covered, even thoughwe are covered and received the pre-certification letter in advanceand claim # [redacted], #[redacted], # [redacted] are all partially denied saying provider's charges are over the agreed rate.  The insurance need pay the agreed part, as before, such as pay ($100 out of $150 billed) as processed correctly before, instead of simply denied the whole charge.and what Aetna said they will start to process my claims correctly, this is also not true, a new claim on 9/17/15 just shows up and got denied againI called the provider - [redacted], she told me that she was still was owed about $6000 from Aetna for the wrongly rejected claims and she is going to stop the service if she continue not to be able to get paidIn summary, what the Aetna said is simply not true and seriously damage our son's chance to get service and recovery.
Sincerely,
[redacted]

Complaint: 11096310
  State of CA Department of Insurance is investigating issuing a  new case +HCB-7050107 February 16, 2016.I will standby while the Department investigates the issues in complaint.
Sincerely,
Robert Whiteside

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 Claims department and found that the...

claim was processed out of network as this lab is not apart of Aetna's network. We made an exception to reconsider the charges because this member did not have a choice in selecting this laboratory. The claim has been reprocessed and a check will be sent to this provider within 7-10 days.
 
We apologize for any 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 Ms. [redacted]'s 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 Appeals Consultant
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:
I know I called before I was admitted the call could have not been recorded or just been deleted on your part. I am going to research my call records from January and submit them. I know I called before I was admitted and was told the hospital was in network that is the only reason I was sent there.
Sincerely,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted] I do hope Aetna will make the needed service and technology improvements. 
Sincerely,
[redacted]

[redacted]   Please see our response to complaint #1[redacted] that was received by us on October 27, 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 Enrollment and Eligibility department to have the member’s concerns reviewed. We were advised that the member added the dependent effective June 02, 2016, which caused a rate change in the premium effective the first of July. The member paid the old premium rate for the July premium which caused the dependent to be terminated from the policy and the premium was refunded.   The member made a payment on October 10, 2016, and the account was reinstated. The payment was made one day prior to our automatic dunning process (termination process) for the current period which was September 01, 2016 to September 30, 2016. Due to the payment being received but not posted to the account at the time of the dunning process, the account was terminated again in error. We sincerely apologize for the incorrect handling of the policy.   The account was reinstated on October 28, 2016, with no lapse in coverage. The member will have to make the premium payment for November by November 30, 2016, at the latest to avoid a termination. Any claim that may have been occurred during the time of adjusting the plan can be resubmitted for consideration since there was not a lapse in coverage.   We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Haner’s concerns.  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

Thank you for your inquiry received on 05/26/15 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.
 
An Aetna client advocate investigated the situation...

with Dr. [redacted] being listed in the [redacted]. Unfortunately, Dr. [redacted] is still listed under a location on [redacted] that he no longer practices in and is not contracted under the practice the member went to for services.  The practice is not contracted at all with Aetna.  We apologize for any inconvenience this may have caused the member and his wife. The member does have the option to appeal if they so choose. The member can submit an appeal in writing to:
 
Aetna- CRT Member Appeals
[redacted]
 
The request should include:
• Name, date of birth, Member ID, and address
• Any other claim documents or records or other facts they would like us to consider.
 
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]

Dear
Ms. Shea,
Please
see our response to complaint #11096310
for Robert
Whiteside that was received by us on February 17, 2016.
We
would like to advise that the specific supporting information Mr. Whiteside
submitted was received from a Department of Insurance inquiry on February 16,
2016 and a response will be provided by March 08, 2016 after the received
information is reviewed. 
I
would also like to again advise that Aetna did not attempt to intimidate,
threaten, delay or deceive Mr. Whiteside, nor did it attempt to discourage
submission of claims. In fact, where Aetna made reference to its legal
department or compliance area reviewing the matter, we were only indicating
that they were providing a higher level review of Mr. Whiteside’s issues to
determine if Aetna had appropriately handled his claims. It was not Aetna’s
intention to infer that Mr. Whiteside was being investigated; only that Aetna’s
handling of his claims and concerns was being investigated. 
I
apologize for any difficulties or confusion this may have caused Mr. Whiteside.
We take customer complaints very seriously and appreciate you taking the time
to contact us and giving us the opportunity to address Mr. Whiteside’s concerns. 
If there are any additional questions regarding this particular matter, please
contact the Executive Resolution Team at [email protected].
Regards,
Julian
Cano
Executive
Resolution Team

Hello, Thank you for your inquiry, regarding complaint #[redacted] for Jared G[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 Eligibility department to verify the policy. Our records indicate the policy was effective on November 10, 2014, and terminated on January 01, 2015. We received a retro-termination request from the employer to back date the termination to January 01, 2015. Any termination requests are forwarded to [redacted] from the employer.[redacted] cannot refund premium payments. If the member is seeking a refund for the policy he must contact his Human Resources department to request.  I apologize for the frustrations and difficulties you encountered while attempting to resolve this issue. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. G[redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].com. Thank you, LaShonda C.Complaint 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 Aetna Student Health (ASH)...

Claims department to have the member’s concern addressed. We were advised that the member’s plan has a $250 annual deductible. The visit on July 07, 2015, was for an urgent care visit (sick visit) and was applied to the 2014/2015 plan year deductible in the amount of $224.58. The member would be responsible for this amount. The visit on December 07, 2015, was also an office visit (sick visit) and was applied to the 2015/2016 plan year deductible in the amount of $218.30. The member would be responsible for this amount as well.
The plan renewal date is based on the academic year, not a calendar year. The plan renews on September 01, 2015, therefore the member’s deductible is renewed as well.
The member did have two other claims on file that were paid in March of 2015, but those visits were preventative visits, and under Health Care Reform, are not subject to the deductible and are paid at 100%.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. Tran’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 contacted our Customer
Service department to review the phone calls requested. We reviewed the call
dated January 20, 2016, where the customer service representative explained the
plan benefits and advised the member that her $6000.00 deductible would need to
be met prior to Aetna paying for the service.
We also located a call that was placed on February 23,
2016.  The representative did misquote
the member responsibility at the beginning of the call. During the call, the
representative placed the call on hold and contacted the facility. The CSR
confirmed the procedure and billing information. The CSR then apologized and
provided the correct benefits that would apply based on the provider’s billing
method. 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 plan. The
claim for services performed on January 22, 2016 has been reviewed. It was
processed correctly according to her plan benefits.
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 complaint we immediately contacted our Life Insurance department to verify...

what information was needed to complete Ms. [redacted] request. We were advised that we had the incorrect information on file for Ms. [redacted] and we had a consultant reach out directly to Ms. [redacted] to discuss the error and have it corrected. As a courtesy we have obtained an invoice for payment of the death certificate(s) she obtained and sent to us and we are going to reimburse her. I would like to express my sincere condolences on the passing of your son. I’m genuinely sorry if this situation caused you any additional stress during an already difficult time in your life.
 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,
[redacted]
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 on file reviewed for
accuracy. We were advised that the claims for the date of service in question were
not processed correctly. We have had the claims all combined into one claim, the
new claim ID [redacted], and had it reprocessed per the benefits to pay the
provider directly. The provider and member should receive a corrected
explanation of benefits within 7-10 business days, as well as the provider
receiving payment for the services rendered. The member does have a copay responsibility
which will be listed on the explanation of benefits.
Please accept my apologies for the inconvenience and
difficulties you experienced while trying to obtain payment for your
claims.  Our goal is to pay claims timely
and accurately, and to promptly resolve issues when they do occur. 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.
Chang’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 Aetna Pharmacy Management...

team (APM) to verify if they had any records of reimbursements that were sent to Ms. [redacted] and if we had received any reimbursement requests that had not been paid out yet. To prevent any private health information being released for public view I have attached the medications that have been reimbursed to Ms. [redacted], which includes claim numbers, paid amount and the paid date. If you do not receive these checks within 30 business days we will be able to place a stop pay on the checks and reissue them.
Please let us know if there are any other medications that you have submitted to us that are not listed so we may better assist you. Please provide us with a copy of the reimbursement request so that we may have that reprocessed as quickly as possible for you. I have also attached for reference, the claim form that needs to be mailed with reimbursement requests and the correct address that it should be mailed to. Please keep in mind to reimburse pharmacy claims we will need the attached form as well as the pharmacy receipt that is stapled to the top of your prescription when you pick up your medication. This shows Aetna how many are being filled, the refill amount left, and amount paid.
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. Unfortunately, in some instances, procedural 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 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,
[redacted]
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: 11411231
I am rejecting this response because: This claim is absolutely without doubt is preventative laboratory testing for the reasons already mentioned. I was told by the phone representative of Aetna that they do consider situations like mine to be covered as a deviation of routine preventative. I will not accept that this claim is not covered.
Sincerely,
[redacted]