DELTA AIRLINES

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 Eligibility department to verify if
the member should have [redacted] coverage with Aetna. We confirmed that the
member’s employer changed health insurance carriers to [redacted] in
2015.  We have no record of receiving any [redacted] information for medical coverage.  However
for 2016, this member has medical coverage with another employer: [redacted]
Her member ID is [redacted]. The member ID card has been mailed. Please
allow 7-10 business days. She can register for Aetna Navigator with the new ID number to get
a temporary ID card.
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[redacted]                                         ...⇄ Complaint and Appeal Consultant Executive Resolution Team

Thank you for your inquiry received on 05/05/2015 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 our Claims department for assistance,...

and found the claim was originally processed incorrectly. The amount of $182.04 has been added back into the member’s Aetna Healthfund. 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 Mr. [redacted] concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Thank you for your rejection notice received on 09/14/15 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. 
We apologize for the inconvenience and difficulty this situation has caused you. Aetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processes.  We regret that your experience was not a positive one. We 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.
Upon further review, all claims on file have been processed and finalized timely 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 specific date of service in question that the member feels was not processed correctly or disagrees with the payment, the member may file an appeal in writing to:
Aetna- CRT Member Appeals [redacted]
The request should include:
Name, Aetna ID, date of birth, claim information (including date of service, billed amount, provider name), and your contact information.
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].

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 am still disappointed that my coverage was changed from what I had under [redacted].  I was told by the person who called me that it was the same, but when I protested that I had had [redacted] surgery in the past I did not pay a $600 co-pay.  When he researched it he admitted I was right.  I was happy they resolved the medication compensation and he told me there had been an error in calculating my other co-pay and that it would be adjusted.  I am still waiting to hear about that.  I appreciate that they contacted me and made an effort to address my complaint.

Complaint: [redacted]
I am rejecting this response because: Aetna has, as yet, not reworked the claim which they have as yet failed to admit was mishandled by Aetna. The amounts on the claim have thus far not been reallocated vis a vis in network versus out of network. My zero balance is irrelevant at this point. It remains in Aetna's hands, SERIOUSLY. 
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 reviewed our records to verify if Mr. [redacted]...

called prior to services being rendered to confirm if his primary care physician (PCP) was participating. We had the only call on file pulled, prior to services being rendered, from December 13, 2013, and had it listened to. Mr. [redacted] requested information on how his policy would cover his routine checkup with his provider. He stated that he could not locate the provider online as in network and that the office stated he could submit a claim form and the receipt to be considered for reimbursement. The customer service representative (CSR) advised Mr. [redacted] that he did not carry out of network benefits and would be required to be seen by a participating provider to be able to be covered. The CSR asked for the doctor’s name and said that she would verify if the provider was participating with his plan. Mr. [redacted] advised the doctor was [redacted], and the CSR confirmed the doctor was not participating with his plan. The CSR again reiterated that he must go in network to be covered for a checkup visit.
We are not able to retro a PCP on file to cover a claim. It is the member’s responsibility to verify that everything on file is correct prior to being seen by the physician. Due to the information provided our original determination was correct in denying the date of service April 28, 2014. 
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 am rejecting this response because:they make false claims:1. the diagnosis codes were there at the first submission...All the forms and receipts were the same (the same receipt) every week. However, they chose to randomly deny claims and have me re-submit them.2. They paid what they claim to be "usual and customary provider rate". This is a lie. I have quotes from several providers of the same service, and all of them came up with higher quotes that the one I went with eventually. 
Sincerely,
[redacted]

Dear [redacted]
* Please see our response to complaint #[redacted] for [redacted] that was received by us on June 24, 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 Disability department to have the member’s concerns reviewed. We were advised that the member’s disability claim was approved and the approval has been communicated the member. The Disability department is also sending a letter with the details of the approval to the member.   I apologize for any difficulties the member encountered with the disability case manager.  It is our goal to provide the member with quality service and I regret any incidents that created the perception that we have not provided the member with adequate service.  These actions are not consistent with Aetna’s service standards and we appreciate you notifying us of the member’s experience.  I would like to assure the member that we have taken the appropriate actions to address the service issues the member experienced.   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 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

Thank you for your rejection notice received on 07/17/15 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.
 
We reached out to the Plan Sponsor Liaison contact for assistance, and were advised that our records show coverage for the period 05/24/15 through 07/04/15, which will be refunded. The refund amount of $109.62 will be included on this Friday’s (07/24/15) paycheck and no additional deductions have been taken.
 
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].

Complaint: [redacted]
I am rejecting this response because: I was Never contacted by Aetna regarding changing my code except when I first enrolled back in 2012. I was told to change the enrollment code from Ep1 to 221. Thereafter,  Aetna took it amongst themselves to change my code to JS1 a code that doesn't exist anywhere on aetnas website or brochure. My premium was raised by Aetna not my human resources office. This is ridiculous and robbery.  I would like my plan changed back and all overpayment returned to me.  I never signed nor agreed to change my plan to JS1. I was informed by Aetna that they were changing my plan without my permission.  I plan to take legal action an continue to report these unethical practices until it is rectified. 
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 contacted our Disability department and confirmed that his...

request for Short Term Disability was denied due to insufficient clinical information. His case manager called him on 04/11/16 to advise of this denial however there was no answer and no voicemail available. A letter was sent to [redacted] to explain the denial and provide his appeal rights. We contacted [redacted] on 04/18/16 to discuss his complaint. He understands what is needed to support disability and the lack of supporting information. We have advised him that we will determine if we can offer a peer to peer review even though the claim is denied or if he must file an appeal. We will contact him tomorrow, to advice of the next steps. He expressed appreciation with the call. 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 [redacted]’s 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

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 Eligibility department and...

requested the policy be terminated per the member’s request as of December 31, 2015. Our records indicate that the policy reflects terminated as of December 31, 2015, and we have also approved the premium refund. Please allow 2-3 business days for the $248.42 refund to be electronic deposited in the member’s bank account.
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 [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

[redacted]  Please see our response to complaint [redacted] for [redacted] that was received by us on September 14, 2016.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. Our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur. I sincerely apologize for the difficulties the member experienced. As previously stated, the member’s medication required precertification. This is not [redacted]s way of saying that the member did not need the medication or to cause any delays. Precertification is required for many different medications.  Again, the two day delay was due to our Precertification department not being contacted until August 31, 2016. The medication was denied at the pharmacy on August 29, 2016, due to the precertification requirement. The provider called two days later to request the precertification and it was approved on the same day. The member and the provider were notified of the approval and the member picked up the medication that same day.  Based on our records, we have addressed [redacted] concerns on previous complaints. Therefore, we consider this matter closed. 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.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
*Sincerely, As[redacted]Complaint and Appeals ConsultantExecutive Resolution Team

Complaint: [redacted]
I am rejecting this response because: You have record of my calling twice. Both instances I was only given one amount as my responsibility which was $500. What is the point of providing this service for individuals wishing to be proactive and properly budget if false and inaccurate information is going to be provided? My decisions, twice, were based off your customer service reps provided information. Twice, not once, was I told "it would only be $500" and confirmed there would be no surprises. One of the reps even confirmed I had no deductible and some other fee so it was only $500. If you call to order something and get one price and proceed with this purchase would you not protest when you suddenly get billed for double the amount? Now that my calls are re-discovered I would like to hear both recordings myself as I don't believe I gave any room to misinterpret my concerns when checking my benefits and co-pays. Had there been one individual who even slightly gave mention to an additional $500 copay I could understand your not wanting to resolve the issue. This simply was never the case otherwise, as you have stated in both recordings I would have went to my hospital and had the co-pay waived now saving $1000 as you're claiming. I have provided several ways to contact me. Feel free to use any method. 
Sincerely,
[redacted]

First it says my initial visit is covered which is not true I was charged a $50.00 copay. Second it says no limits but then in the next paragraph it states prenatal is limited to.... . They are contradicting themselves. Ultrasounds are routine to prenatal how can they not be covered? Meanwhile I have an email from another Aetna rep stating my ultrasounds are covered 100% and I am only responsible for a $50 copay. 
Complaint: [redacted]
I am rejecting this response because:
Sincerely,
[redacted]

Dear
[redacted]
Please
see our response to complaint #[redacted]
for [redacted] that was received by us on March 04, 2016.
During our review, we reached out to
our Dental department to address [redacted] concerns. It was determined that
the physical Dental identification cards are no longer available. I would like
to reiterate as advised in our previous response, that Dental ID cards are not required
to receive service.
However, as a onetime exception we have printed and laminated a copy of [redacted] dental ID card and mailed it on March 8, 2016.
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] concerns. 
If there are any additional questions regarding this particular matter, please
contact the Executive Resolution Team at [email protected].
Regards,
Julian
C[redacted]
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]

Thank you for your inquiry received on 05/01/15 regarding complaint #[redacted] for Dr. [redacted].  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
 
Dr. [redacted] concerns were reviewed under case...

number [redacted]. Based on review of the information submitted, the invoice was processed as a “one-time exception” under electronic payment number [redacted]. Funds were deposited in Dr. [redacted] bank account on Tuesday 05/05/2015.
 
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]

Complaint: [redacted]
I am rejecting this response because ::::::: I was able to make contact with AETNA and spoke with Ashley regarding my open complaint with AETNA. The case is still pending review. We are still in the process of working out the Medical Necessity and Need of Service. There has been a bit of back and forth on both Aetna and the referred physician. I would like to keep this claim open until a resolution is provided. I am confident when saying if Ashley would have been the "sales" rep that I spoke with at AETNA this complaint would not exist. She is truly helpful however; a resolution is what I need. I am paying AETNA $366.85 monthly for health services that are not catered to my immediate health or lifestyle. The prolonging of this complaint with no resolution has caused me loss of time at work, stress both mental and physical and financial hardship. I would like AETNA to make this right. This is becoming a complete nightmare. Please leave this case open. While this is truly private in nature, going public may be the best form of action to prevent false sales or lack of treatment/ assistant due to benefit deficiency.  Thanks for getting the ball rolling Revdex.com. As a Billion dollar corporation, AETNA should consider not outsourcing there business due to lack of training and development.
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. I will file additional complaints if the same "accidental" errors occur again in the future. 
Sincerely,
[redacted]