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Insurance Companies

Aetna Inc.

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Complaints

This profile includes complaints for Aetna Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

1,333 total complaints in the last 3 years.
467 complaints closed in the last 12 months.

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The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:03/18/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
On 11/01/2024 Aetna authorized a tooth extraction, a surgery to place a metal post in my jaw, an extension on the post and a crown. These authorizations were valid from 11/01/2024-4/30/2025. On 11/12/2024 my front tooth was extracted and the metal post was surgically placed in my jaw. For medical reasons, a certain amount of healing must take place, so the remainder of the procedure, which is the extension on the metal post in jaw and the crown could not be finished before the end of the calendar year therefore my dentist could not bill Aetna in full. On 2/14/2025 Aetna sent a letter denying authorization to finish the rest of the work which is the extension of the metal post and the crown. The reason is they (not I, my policy rolled over) changed the policy and it no longer covers this procedure. Open enrollment started 10/15/2024 so at that time Aetna knew they would be changing the policy. However, they sent a letter on 11/01/2024 authorizing all stated services from 11/01/2024-04/30/2025. I have called Aetna repeatedly, and on 3/12025 an Aetna CSR confirmed my dentist would not have been able to bill for the procedures that had yet to be done. My dentist office filed an appeal yet Aetna is continuing to refuse to finish my previously authorized procedure .
Business Response
Date: 03/21/2025
**** *** ******* **********

Please
see our response to complaint #******** for Ms. ***** ***** that was received
by us on March 18, 2025. Our Executive Resolution Team researched the concerns,
and we would like to share the results of the review with you below.

Upon
receipt of the complaint, we immediately reviewed the member’s account. We
confirmed on September 23, 2024, the members 2025 Annual Notice of Changes was
mailed to her address on file as: **** ** ****** *** ***** ******** ** *****.
The ANOC was delivered as there is no returned mail located on the member’s
account.
The
ANOC states: You are currently enrolled as a member of Aetna Medicare Assure
Plus (HMO D SNP). Next year, there will be changes to the plan’s costs and
benefits. On January 1, 2025, our plan name will change from Aetna Medicare
Assure Plus (HMO D SNP) to Aetna Medicare FL Dual Select (HMO D SNP).

This
document tells members about the upcoming changes to their plan for 2025. The
members are instructed to review the ANOC document and decide whether they want
to change their plan. They are advised that if they don’t join another plan by
December 7, 2024, they will stay in Aetna Medicare ** Dual Select (HMO D SNP)
and to change to a different plan, they can switch plans between October 15 and
December 7. They are also advised if they choose to stay their new coverage
will start on January 1, 2025, with the changes in this document.

We
show on page 9 of the 2025 ANOC it explains the changes to the members dental
benefit for 2025. As of the 2025 plan year dental implants services are not
covered.

According
to the member’s 2025 Evidence of Coverage plan booklet, the member has a $0 copay
for covered dental services. The plan has an annual benefit amount (allowance)
of $3,000 for additional (non-Medicare covered) preventive dental services and
additional (non-Medicare covered) comprehensive dental services combined. The
member is responsible for any costs over this amount.

Covered
services include oral exams, cleanings, fillings, extractions, crowns,
dentures, and more. We have teamed up with ******* ****** to provide the
members dental coverage.

Preventive
dental services (non‑Medicare covered):
•
Oral exams: $0 copay
•
X‑rays: $0 copay
•
Other diagnostic dental services: $0 copay
•
Cleanings: $0 copay
•
Fluoride treatments: $0 copay
•
Other preventive dental services: $0 copay

Comprehensive
dental services (non‑Medicare covered):
•
Restorative services: $0 copay
•
Endodontics: $0 copay
•
Periodontics: $0 copay
•
Prosthodontics, removable: $0 copay
•
Maxillofacial prosthetics: Not covered
•
Implant services: Not covered
•
Prosthodontics, fixed: $0 copay
•
Oral and maxillofacial surgery: $0 copay
•
Orthodontics: $0 copay
•
Adjunctive general services: $0 copay

This
benefit uses the ******* ****** network, which is different from the member’s
medical network. If the member chooses a provider outside of the ******* ******
network, services will not be covered. Note: Implants are not covered.

As
the member’s dental coverage is with ******* ******, we escalated the members
concern directly to ******* ******. We asked them to review the member’s
concern of the implant dental services being previously authorized effective
November 1, 2024, through April 30, 2025, and the plan refusing to cover the
previous authorized dental implants. Please know, Medicare plan benefits are
based on January, through December calendar year. In the calendar year 2024,
the member's policy covered 2 implants. We understand, the process of placing
an implant involves several steps and the complete process can take up to six
months. At the time, the member requested the implant it was a covered benefit.
Health plan benefits are based on the calendar year which runs from January to
December. Plan benefits can change year over year, which is why the health plan
notifies members of plan changes in via Annual Notice of Change mailings
(ANOC). It was confirmed the health plan mailed an ANOC notifying member that
implants will not be covered in plan year 2025. At the time, the prior
authorization was issued for services November 1, 2024, through April 30, 2025,
implants were a covered benefit, prior authorizations are contingent on plan
year covered benefits, and dental providers can only bill for completed
services. The ******* ****** market discussed the concern and agreed to uphold
the appeal.

We
take our customer concerns very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Ms. ***** *****’s concerns.
We do apologize for the inconvenience this may have caused her as our valued
member.
Customer Answer
Date: 03/21/2025

Complaint: ********

I am rejecting this response because: according to their response they sent (online and at that time I was only communicating by mail so I never received such a letter) was sent on September 23rd 2024,the letter approving my services was sent on November 1st 2024 approving the completion of my procedure through April 30th 2025 so clearly they knew the policy would be changing when they approved my procedure. Normally the approval letter sent in November would override the letter sent in September.This is definitely unethical if not bad faith

Sincerely,

***** *****
Business Response
Date: 03/26/2025
**** *** ******* **********

Please see our response to complaint #******** for Ms. ***** ***** that was received by us on March 21, 2025. Our Executive Resolution Team researched the concerns, and we would like to share the results of the review with you below.

Upon receipt of the complaint, we immediately reviewed the member’s account. Upon receipt of the complaint, we immediately reviewed the member’s account. We confirmed on September 23, 2024, the 2025 Annual Notice of Changes was mailed to the member’s address on file as: **** ** ****** *** ***** ******** ** *****. The ANOC was delivered, as there is no returned mail located on the account.

This ANOC document tells about the upcoming changes to the plan for 2025. We encourage the member to review the ANOC document and decide whether she want to change her plan. The document does advise that if you don’t join another plan by December 7, 2024, the member will stay in Aetna Medicare ** Dual Select (HMO D SNP) and to change to a different plan, the member can switch plans between October 15 and December 7. It also states if the member chooses to stay, the new coverage will start on January 1, 2025, with the changes in this document.

The member can also make a change to another plan between January 1, 2025, to March 31, 2025, and the plan will change the first of the following month.

We show on page 9 of the 2025 ANOC it explains the changes to the member’s dental benefit for 2025, and states as of the 2025 plan year dental implants services are not covered.

We reviewed a call from October 25, 2024. The member contacted us asking a question about a change being made that she saw in the Annual Notice of Changes. The member had also asked about getting an authorization for dental procedures, but was not specific to the representative about needing implants. The Annual Notice of Changes was received before the authorization request was made.

Please be advised that the letters that are created for authorizations have a general authorization period of 6 months and are not able to be changed if the calendar year ends.

The member will receive a detailed Medicare Resolution Letter within 7-10 business days.

We take our customer concerns very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *****’s concerns. We do apologize for the inconvenience this may have caused her as our valued member.

Sincerely,
Cindi D
Analyst
Medicare Executive Resolutions
Customer Answer
Date: 03/29/2025

Complaint: ********

I am rejecting this response because: this company clearly,( and has admitted to) entered into this contract knowing they wouldn't cover the rest of the claim after the end of the year, this is misrepresentation. Since the company did know this would be changing when the approval letter was sent I should be grandfathered in and my procedure finished as per their contract

Sincerely,

***** *****
Business Response
Date: 04/09/2025
**** *** ******* **********

Please see
our response to follow-up on the rejection of complaint ## ******** for Ms. *****
***** which was received by us on March 31, 2025. After receiving the
complaint, we promptly conducted internal research.
Our
Executive Resolution Team has finalized the research, and I would like to share
the results of the review with you.

We have
confirmed in the member’s account, that her complaint pertains to coverage for
dental implants.

The dental
benefits are outlined in the Evidence of Coverage and covered services are
listed in the dental schedule of benefits.

Please note
that some services require clinical review for pre-authorization prior to treatment. If
the prior authorization is denied, the service will not be covered, and the
member will be responsible for all associated costs. Dental procedures for
cosmetic or aesthetic reasons are not covered. Coverage is limited to the
services listed in the Schedule of Benefits. If a service is not listed, it is
not included and is not covered.

Additionally, prior authorization also
called predetermination, is a pre-service utilization management review to
confirm clinical necessity as defined by the health plan. Authorization
is not a guarantee of payment, nor does it ensure that the health plan will
cover the cost of a service.

The
2025 Annual Notice of Change (ANOC) was sent to the member’s address on file in
September 2024. It informed the member that Maxillofacial prosthetic and
Implant services are not covered. We recommend that the member review the ANOC
for any additional changes related to her 2025 plan.

It
also informed the member of their rights to change plans from October 15
through December 7. The ANOC stated: to stay in our plan, you do not need to do
anything. If you do not sign up for a different plan or change to Original
Medicare by December 7, you will automatically be enrolled in our Aetna
Medicare ** Dual Select (HMO D-SNP).

Currently,
there are no predetermination requests or claim denials on file for 2025.
Providers are welcome to submit predetermination requests for any services, and
the member has the right to file a preservice appeal for any denials related to
those services.

We want to assure you that we are committed to delivering
exceptional customer service and have established procedures to address any
service delivery issues. In cases where service shortcomings are identified, we
conduct a comprehensive review of inbound calls.

After our review, we found no errors in the calls the
member had with our member services team.

The member
will receive the detailed Medicare response in the mail within seven to ten
business days.

We take
customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Ms. *****’s concern.

Sincerely,
Jennifer
Analyst
Medicare
Executive Resolutions
Initial Complaint
Date:03/17/2025
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have Aetna Freedom PPO for years, this year Aetna came out with ********* OTC debit card that is supposed to be $30/month, I used it once in February and spent $29. I tried to use it again on 03/12/2023, but only had cents for a balance. Undoubtedly Aetna has changed the rules in the middle of the game. This is pathetic and not what is in the 2025 Aetna Freedom Plan PPO
Business Response
Date: 03/19/2025
**** *** ******* **********

Please see our response to complaint # ******** for *** ****** ****** that was received by us on March 17, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the complaint, we reached out internally to view the member’s concerns. The OTC Benefit changed from $120 quarterly in 2024 to a $30 quarterly in 2025. This can be found in the Annual Notice of Changes (ANOC) which was sent to the member through email on August 16, 2024. The ANOC is sent so the member can see what changes happen from year to year and make informed decisions to keep your current plan or look for other plans in the member’s area.

The quarterly benefit amount will be available on the Aetna Medicare Extra Benefits Card the first day of each calendar quarter. Calendar quarters begin in January, April, July, and October. Be sure to use the full benefit amount each quarter, because any unused benefit amount will not roll over into the next quarter nor will it roll over into the next plan year. There are no exceptions to request additional or unused funds to be added to the card.
The member will receive a detailed Medicare Resolution Letter within 7-10 business days.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. ******’s concerns.
Sincerely,
Cindi D
Analyst
Medicare Executive Resolutions
Initial Complaint
Date:03/17/2025
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
On March 14th I tried to contact Aetna insurance about getting a travel log so I can be reimbursed for gas money. I talked to someone from their customer service department 2 weeks ago and they were supposed to send it right out so I could get my money which I desperately need I have stage 4 cancer and cannot work. Every time I contact their customer service department it turns into a circus the first time I called about this issue I was given some guy that didn't even understand English then as I said I finally spoke to someone that did understand English I thought I had everything worked out then on the 14 th when I tried to call and find out what happened to the travel logs they were supposed to send me they try to tell me I have never had insurance with their company. I've had Aetna insurance for over 6 years but I wont be dealing with their company anymore unless this issue is resolved quickly. I know if I have problems in the future I'm going to have this problem again people that don't know what they're doing telling me a bunch of ********.
Customer Answer
Date: 03/17/2025
I have emailed them and the person I have been corresponding with tells me the same thing after I sent her my full legal name the Id number off of my card my address the hospital that I had my treatments even sending them a picture of my insurance card with there company name my name and if number on it. I even sent them the reservation numbers that I got from one of their customer service reps . The funny thing the second time I had called to get the information I needed the lady had no problem putting up my account with the id number I gave her. So I guess that calling their customer service department does no good all they tell you is what they want to hear to get the person off the phone. The person I spoke to this morning keeps telling me the same thing no account and then tells me to call their customer service department they must be crazy . I wouldn't be going through this if their customer service department really worked but apparently it doesn't
Business Response
Date: 03/24/2025
**** ******* **********
Please see our
response to complaint # ******** for **** ******** that was received by us on
March 17, 2025. Our Executive Resolution Team researched the concerns, and I
would like to share the results of the review with you.
Upon
receipt of your request, we immediately reached out internally to further
research the concerns. After
further review it was determined
that the member’s Aetna Better Health of ******** plan was terminated on February
28, 2025, this was also confirmed by the eligibility team. The member would
have received a letter from the ********** ** ***** ******** *****/ State to
inform them they had termed. Outreach was made to the member by our Care Management
team, and they received the member’s voicemail, a detailed voice message was
left with the call back number, an email was also sent by the Care Management
team. Outreach was made to ********* which is the transportation vendor, and
the member’s most recent trip was on March 5, 2025, which is outside of the
members coverage with Aetna Better Health of ********. Two more outreach attempts
were made to the member to get clarification on what month he needs the travel
logs for, we cannot assume it is for February when the member had coverage, or March
when the member no longer had coverage through Aetna Better Health of ********.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address *** ********** concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Initial Complaint
Date:03/14/2025
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have recently received calls as well as mail for Medical services. Aetna is my current insurance provider. Ive never authorized a third party to have access to my medical records nor my personal information. Also, I never was informed about a third party having access to my information. I feel very violated. Also the fact that my co-pays has went up without being informed is even more ballistic. I don't feel that my privacy rights have been upheld. I also feel that them not informing me of a co-pays increase prevented me the opportunity to seek an insurance company that would be in my best interest.
Business Response
Date: 03/24/2025
**** *** ******* *********:

Please see our response to complaint # ******** for *** ******* ********* that was received by us on March 14, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the complaint, we reached out internally to view the member’s concerns. Evicore is a vendor that Aetna utilizes for enhanced clinical information. We are required to use them for certain procedures to be reviewed and approved. Per Aetnamedicare****, there is a document that advises Aetna is allowed to use the member’s information for preventative health, disease, case management, and care coordination.

The notification of the change of the member’s copays can be found in your Annual Notice of Change (ANOC) that was sent out on September 10, 2024 to the member's email on file. The ANOC is sent out in September so that the member can weigh her options of keeping the plan or changing a different plan in her area. Open Enrollment Period which runs October 15th to December 7th yearly. The document is emailed yearly so our members can better plan financially for the upcoming year.

Annual Enrollment runs from January 1, 2025, until March 31, 2025, where the member can make a onetime plan change that would start the 1st of the following month. The member can go to Aetnamedicare**** to view plans in your area. To see what plans are offered by other carriers in her area you can go to Medicare.gov or by calling Medicare at ###-###-####. The member can always contact her ***** ****** ********* ********** ******* ****** at ###-###-####.
The member will receive a detailed Medicare Resolution Letter within 7-10 business days.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *********** concerns.
Sincerely,
Cindi D
Analyst
Medicare Executive Resolutions
Initial Complaint
Date:03/11/2025
Type:Product Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I had to get an MRI done. Date of service was 11/4/2024. My pre-paid card would not work in the Service Providers machine, so I had to pay with my credit card. So I went to Aetna to get re-imbursed for the $120 I had to pay the Service Provider. My claim was denied. I then appealed and and won on my payment claim 2/5/25. So I never got the reimbursement payment and called them again and they told me I only had to 3/1/25 to file a claim. I told them I didn't have to file a claim. I already had filed it previously. I had to call them several times (they won't call you back). So I finally got a manager in the Hartford CT Headquarter office named David. He reviewed it and said I had to file more paperwork if I want to get paid. I explained to him that I had sent documentation 2 or 3 times already. And he said, there's nothing else he could do. The phone number on my called ID from him was ###-###-####. So I tried to call him back at that number and it said I had to call the # that was on the back of my Medicare ID card. So I called Aetna again today to try and get his last name and contact info, but they said they are not allowed to give that out. There have been numerous phone calls made to them since 11/2024 through today with no satisfaction. Perhaps, there is also an agency that regulates insurance companies that I could report them.
Business Response
Date: 03/24/2025
**** *** ******* **********

Please see our response to complaint # ******** for *** ***** ******, which we received on March 11, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the concern, we immediately reviewed the member’s 2024 plan details. The member was enrolled in Aetna Medicare Advantra Silver (HMO-POS) for the 2024 plan year. With this plan, members received an Aetna Medicare Payment Card. The benefit includes a $100 quarterly benefit amount (allowance) member can use to pay for cost share expenses for medical plan covered services such as physician visits, lab work, and vision and hearing exams. It may also be used to pay for additional visits for a plan covered service that has a visit limit.

We located the claim for date of service, November 4, 2024. The claim was accepted with a copay responsibility of, $120. We understand that the member had issues with his ******* card on the date of service. We contacted ******* (now *******) to address the member’s concerns. Unfortunately, the ******* benefit details for 2024 are no longer available. ******* advised that they did receive a reimbursement request for $120 on November 15, 2024. $120.00. On November 19, 2024, ******* sent a request for additional information. ******* asked the member to send the claim with the insurance Explanation of Benefits statement or an itemized bill. According to *******, the member called on December 20, 2024. The ******* Rep explained what information was needed for reimbursement. The member called ******* again on March 6, 2025. He advised that he submitted the requested information. At that time, the benefit for the 2024 plan year expired. The representative advised to re-submit the documents and it could be sent as an appeal. The member requested to speak to a supervisor. A supervisor was not available at the time. The representative offered a call back.

We received an appeal on December 30, 2024. The Appeals team reviewed the member’s request and decided to overturn the original claim decision. On February 5, 2025, the claim was sent back to the Claims Department to be reprocessed. Unfortunately, the request to reprocess and remove the copay was not clear. We have sent feedback to Appeals team for service improvement. The claim for date of service, November 4, 2024, has been reprocessed as of March 24, 2025. We have adjusted the cost share for this date of service. The claim details are below.
Date of Service: November 4, 2024
Claim: *********
Provider: *** ****** ************* ***
Billed Amount: $4,502
New Paid Amount $682.28
Copay $0

Previous Claim
Claim: *********
Provider: *** ****** ************* ***
Billed Amount: $4,502
Paid Amount: $564.69
Copay: $120

The plan will send an updated Explanation of Benefits statement to the member and his provider within 30 days. *** ****** can contact his provider to be refunded.

The member will receive a written resolution letter within 7-10 business days.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ******’s concerns.

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution

Business Response
Date: 03/24/2025
**** *** ******* **********

Please see our response to complaint # ******** for *** ***** ******, which we received on March 11, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the concern, we immediately reviewed the member’s 2024 plan details. The member was enrolled in Aetna Medicare Advantra Silver (HMO-POS) for the 2024 plan year. With this plan, members received an Aetna Medicare Payment Card. The benefit includes a $100 quarterly benefit amount (allowance) member can use to pay for cost share expenses for medical plan covered services such as physician visits, lab work, and vision and hearing exams. It may also be used to pay for additional visits for a plan covered service that has a visit limit.

We located the claim for date of service, November 4, 2024. The claim was accepted with a copay responsibility of, $120. We understand that the member had issues with his ******* card on the date of service. We contacted ******* (now *******) to address the member’s concerns. Unfortunately, the ******* benefit details for 2024 are no longer available. ******* advised that they did receive a reimbursement request for $120 on November 15, 2024. $120.00. On November 19, 2024, ******* sent a request for additional information. ******* asked the member to send the claim with the insurance Explanation of Benefits statement or an itemized bill. According to *******, the member called on December 20, 2024. The ******* Rep explained what information was needed for reimbursement. The member called ******* again on March 6, 2025. He advised that he submitted the requested information. At that time, the benefit for the 2024 plan year expired. The representative advised to re-submit the documents and it could be sent as an appeal. The member requested to speak to a supervisor. A supervisor was not available at the time. The representative offered a call back.

We received an appeal on December 30, 2024. The Appeals team reviewed the member’s request and decided to overturn the original claim decision. On February 5, 2025, the claim was sent back to the Claims Department to be reprocessed. Unfortunately, the request to reprocess and remove the copay was not clear. We have sent feedback to Appeals team for service improvement. The claim for date of service, November 4, 2024, has been reprocessed as of March 24, 2025. We have adjusted the cost share for this date of service. The claim details are below.
Date of Service: November 4, 2024
Claim: *********
Provider: *** ****** ************* ***
Billed Amount: $4,502
New Paid Amount $682.28
Copay $0

Previous Claim
Claim: *********
Provider: *** ****** ************* ***
Billed Amount: $4,502
Paid Amount: $564.69
Copay: $120

The plan will send an updated Explanation of Benefits statement to the member and his provider within 30 days. *** ****** can contact his provider to be refunded.

The member will receive a written resolution letter within 7-10 business days.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ******’s concerns.

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution

Customer Answer
Date: 03/25/2025

Complaint: ********

I am rejecting this response because: I have submitted the documentation 2 or 3 times in the mail to Aetna already. I had contacted Aetna on 3/19/25 Case# ********* and was told a check would be processed to me in 30-45 days. On a previous call to Aetna on 3/11/25 and I was told they sent a payment from Aetna for $569 (which supposedly the $120 was included with that payment). I followed up with *** and they said they never received a wire from Aetna. The only other information was that the address for this wired payment on 3/14/25. Going back to the 11/4/24 letter, it said I won the appeal, but I still never got the money. Since Aetna made the payment to AHN, they were at fault, so I think they should debit *** for the $120 and send me the payment (that's if the payment went through. that *** denied getting). So why is it that they screwed up and they want me to jump through hoops to get the $120. Bottom line is they should send me a payment for $120 and they need to go back to *** and debit them $120 to them. Thank you.

Sincerely,

***** ******
Customer Answer
Date: 03/25/2025

Complaint: ********

I am rejecting this response because: I have submitted the documentation 2 or 3 times in the mail to Aetna already. I had contacted Aetna on 3/19/25 Case# ********* and was told a check would be processed to me in 30-45 days. On a previous call to Aetna on 3/11/25 and I was told they sent a payment from Aetna for $569 (which supposedly the $120 was included with that payment). I followed up with *** and they said they never received a wire from Aetna. The only other information was that the address for this wired payment on 3/14/25. Going back to the 11/4/24 letter, it said I won the appeal, but I still never got the money. Since Aetna made the payment to AHN, they were at fault, so I think they should debit *** for the $120 and send me the payment (that's if the payment went through. that *** denied getting). So why is it that they screwed up and they want me to jump through hoops to get the $120. Bottom line is they should send me a payment for $120 and they need to go back to *** and debit them $120 to them. Thank you.

Sincerely,

***** ******
Business Response
Date: 04/15/2025
Dear
Mr. Stewart Henderson:

Please
see our response to follow-up on complaint # ******** for *** ***** ****** which
was received by us on March 26, 2025. After receiving this rejection, we
promptly conducted internal research.
Our
Executive Resolution Team has finalized the research, and I would like to share
the results of the review with you.
We
have confirmed in the member’s account, the claim for the services
the member received on on November 4, 2024, at *** has been reprocessed. There
was an error found in a previous appeal and the claim was reprocessed to remove
the member’s cost share of $120.

We
have received notification from *** that a refund of $120 was processed back to
the credit card, which was used as the original method of payment on April 11,
2025. They recommend allowing 5-7 business days for the refund to appear in the
member’s account.

According
to the 2024, Evidence of Coverage, the member’s benefit for their emergency
care was as follows:

Emergency care refers to services that are:
•
Furnished by a provider qualified to furnish emergency services, and
• Needed to evaluate or stabilize an
emergency medical condition.

Cost sharing for necessary emergency services furnished out-of-network is
the same as for such services furnished in-network. The 2024 cost share was a $120
copay. Cost sharing is waived if they are admitted to the hospital within 24 hours.

The
member also had the Aetna Medicare Payment Card. The Medical Expense Wallet
provided a $100 quarterly benefit amount (allowance) that could be used to pay
for cost share expenses for medical plan covered services such as physician
visits, lab work, and vision and hearing exams.

The
payment could not be processed through ******* as the copay amount exceeded the
$100 allowance.

The
member will receive the detailed Medicare response in the mail within seven to ten business days.

We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ******’s concern.

Sincerely,
Jennifer
Analyst
Medicare Executive
Resolutions

Business Response
Date: 04/15/2025
Dear
Mr. Stewart Henderson:

Please
see our response to follow-up on complaint # ******** for *** ***** ****** which
was received by us on March 26, 2025. After receiving this rejection, we
promptly conducted internal research.
Our
Executive Resolution Team has finalized the research, and I would like to share
the results of the review with you.
We
have confirmed in the member’s account, the claim for the services
the member received on on November 4, 2024, at *** has been reprocessed. There
was an error found in a previous appeal and the claim was reprocessed to remove
the member’s cost share of $120.

We
have received notification from *** that a refund of $120 was processed back to
the credit card, which was used as the original method of payment on April 11,
2025. They recommend allowing 5-7 business days for the refund to appear in the
member’s account.

According
to the 2024, Evidence of Coverage, the member’s benefit for their emergency
care was as follows:

Emergency care refers to services that are:
•
Furnished by a provider qualified to furnish emergency services, and
• Needed to evaluate or stabilize an
emergency medical condition.

Cost sharing for necessary emergency services furnished out-of-network is
the same as for such services furnished in-network. The 2024 cost share was a $120
copay. Cost sharing is waived if they are admitted to the hospital within 24 hours.

The
member also had the Aetna Medicare Payment Card. The Medical Expense Wallet
provided a $100 quarterly benefit amount (allowance) that could be used to pay
for cost share expenses for medical plan covered services such as physician
visits, lab work, and vision and hearing exams.

The
payment could not be processed through ******* as the copay amount exceeded the
$100 allowance.

The
member will receive the detailed Medicare response in the mail within seven to ten business days.

We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ******’s concern.

Sincerely,
Jennifer
Analyst
Medicare Executive
Resolutions

Customer Answer
Date: 04/15/2025
I checked my charge card, but as of today at 4:40PM EST, it is ,not there. I will continue to check and advise if/when I recieve the payment. Thank you.
Customer Answer
Date: 04/15/2025
I checked my charge card, but as of today at 4:40PM EST, it is ,not there. I will continue to check and advise if/when I recieve the payment. Thank you.
Customer Answer
Date: 04/17/2025

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. I did see the credit on my credit card today. Thank you.

Sincerely,

***** ******
Customer Answer
Date: 04/17/2025

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. I did see the credit on my credit card today. Thank you.

Sincerely,

***** ******
Initial Complaint
Date:03/11/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I’ve had Silverscript for years. All of a sudden *** ******** raised my drug prices by a factor of about 10. It’s unconscionable. There is no legitimate reason to increase prices so dramatically. As soon as the next opening occurs, we will look for other options! Very dissappointed in ***!
Business Response
Date: 03/12/2025
**** *** ******* **********

Please see our response to complaint # # ******** for Mr. ***** ****** that was received by us on March 11, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the complaint, we reached out internally to view the member’s concerns. The inflation reduction act made many enhancements to Part D coverages such as $0 cost-sharing during the catastrophic phase, elimination of the coverage gap and limiting the Rx OOP threshold to $2,000. These enhancements to the basic Part D plan will benefit many if not most Medicare beneficiaries but reduces the ability to design products with meaningful differentiation. Consequently, a decision was made to consolidate SmartSaver and Plus with our Choice PDP.

One of the changes in the member’s plan for 2025 is the deductible phase of Coverage. In 2024, the deductible of $280 only applied to Tier 2 through 5. In 2025, the deductible of $590 is for Tiers 1 through 5, except for covered insulin products and most adult Part D vaccines.

The notification of the change of the name can be found in the Annual Notice of Change (ANOC) that was sent out in September. The ANOC is sent out in September so that the member can weigh his your options of keeping the plan or changing a different prescription drug plan in his area. Open Enrollment Period which runs October 15th to December 7th yearly. The document is emailed yearly so our members can better plan financially for the upcoming year.

The member may apply for Extra Help which is federal funded by using one of these options should you need financial assistance:
1. Fill out the online application at **************************************
2. Call Social Security at <###-###-####, 8 a.m. to 7 p.m. Local Time, Monday-Friday>.
The member may apply for state assistance through State pharmaceutical assistance program (SPAP) at **************** member will receive a detailed Medicare Resolution Letter within 7-10 business days.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ******** concerns.
Sincerely,
Cindi D
Analyst
Medicare Executive Resolutions
Initial Complaint
Date:03/09/2025
Type:Delivery Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have been trying for over a year to resolve an issue with receiving my EOB’s from ********/Silverscript in the mail. I have filled out the go paperless information on my profile in my online account. Also made many phone calls. Also spoke with their technical support staff and most recently with their member service support team. Every time I get of the phone I’m told “you’re all set you should no longer receive your EOB’s in the mail”. However I just received another one this past Friday. I called in on Monday to talk to members service support team, had to leave my name and number for a call back. Two days later still no call. I sent an email to the person I had communications with in December and January. The response I got was my survey was closed that I needed to call in.
This has become extremely frustrating. I have been very patient trying to resolve this through the normal channels with no success. I’m hoping you can move this up to the next level as I’m starting to feel like they are not taking this issue seriously.
Their is so much identify theft going on and this document has some information about me that I would rather not be left in my mailbox that could alternately be delivered electronically.
Business Response
Date: 03/20/2025
Dear *** ******* *********:

Please see our response to complaint # ******** for *** ******* *****, which we received on March 10, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the concern, we immediately reviewed the member’s communications preference. We confirmed that the member’s communications preference is set to paperless. We found that *** ***** has contacted the Customer Service team to express concerns about his Explanations of Benefits statements. The Customer Service team has set the preference correctly. The member’s email address and communications preferences are showing as accurate in our system.

The member’s concerns were sent to our Digital Communications team to be escalated. The Digital Communications team advised that the email notifications were flagged as undeliverable. The Centers for Medicare and Medicaid (CMS) requires the plan to send a paper copy of the Explanation of Benefits statement if the digital copy is undeliverable. The Digital Communications team contacted our print vendor for further assistance. The plan print vendor has advised that there was a system delay in retrieving the member’s email address from the plan. We have worked with the print vendor to fix this issue. The email address has been successfully updated with the print vendor. The member’s Explanation of Benefits statement notification will now be sent to you by email.

The member will receive a written resolution letter within 7-10 business days.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *****’s concerns.

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution

Customer Answer
Date: 03/21/2025

Better Business Bureau:

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

Sincerely,

******* *****
Initial Complaint
Date:03/07/2025
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Basically, my Aetna policy is being violated. Aetna has refused to honor the benefit package that I have, despite my repeated attempts to straighten things out. I don't want to try and determine what causes them the confusion, but they do not have a good system going...especially for senior citizens. I have never dealt with anything like this before.
My policy is the ***** ******** (PPO) # *********. The Vision Care benefit I have is this: one free routine eye exam/year and $150 eyeglasses reimbursement/year. I went to an in-network eye doctor (***** *****) for the exam this year on 1-2-2025. I also purchased through a two-for one offer four pair of glasses...first on 1-2-25, then again on 1-17-25. Again, all "in-network". My out-of-pocket expenses totaled $189: $39 for the exam and $150 for the glasses. This is what I am entitled to under my Aetna policy. (My glasses actually ran over the $150 limit, but by policy, that's my cost.)
Aetna has wrongly interpreted my benefit package, and also wrongly labeled my purchases as "out-of-network". So, what can I do about it? I have tried calling their service number (1-833-570-6670) many times, I have sent them e-mail messages online to no avail, and even returned to the stores to attempt to resubmit using the Aetna card. Nothing has worked. Since 2022 I have never had a problem paying and then submitting to Aetna for reimbursement. This was how my insurance rep had directed me to handle vision care.
My cost invested as stated is $189. Aetna has paid a total of $100.63 by means of three checks (see below). Their people have admitted I am entitled to the free exam and $150 for glasses, but that's as far as it goes. The $88.37 I'm rightfully owed doesn't begin to cover my time, gas, and headache this has caused. Seems to me that this is the Aetna way: to underpay on benefits and then try to discourage people from collecting. Please help??
Business Response
Date: 03/17/2025
**** ** *** *********** *** ******* **********

Please see our response to complaint
# ******** for *** ******* ****** that was received by us on March 7,
2025. Our Executive Resolution Team
researched the concerns, and I would like to share the results of the review with
you.

Upon receipt of the complaint, we
reached out internally to view the member’s concerns. The member’s plan
allows for one routine eye exam per year at a $0 copay. The member had his eye exam on January 2,
2025, and the provider had the member pay for the routine eye exam up front. The provider is in network with Eyemed, and a
claim was submitted by the provider and paid for by Aetna on March 4,
2025. We contacted the provider to
inquire that the member should not have been charged for your eye exam. The provider
advised us that they contacted the member on March 13, 2025, and he will be reimbursed
for the eye exam.

We contacted the Claims’ Department to find out why the
member was not reimbursed the full $150 for your glasses and were only reimbursed
$89. The second request for the eyewear reimbursement
was denied because only one pair of frames were covered.

The member has a right to appeal. Appeal *********** was overturned on March 13,
2025. The claim is being reworked so the
member will get the additional $61 eyewear reimbursement. The member will receive a detailed Medicare Resolution Letter
within 7-10 business days.
We take customer complaints very
seriously and appreciate you taking the time to contact us and giving us the
opportunity to address Mr. ******** concerns.
Sincerely,
Cindi D
Analyst
Medicare
Executive Resolutions
Initial Complaint
Date:03/06/2025
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Late last year while reviewing my medical insurance with Aetna I noticed I had a benefit of $600. I could use to purchase health related equipment . Then in November I received a letter in regard to an Aetna Extra Benefits card that I would not be able to use after 12/31/2024. I contacted Aetna and was told I had been receiving an extra $45. Each month uploaded to a card that I had not received. I explained to multiple representatives that I had not received this money and did not have a card. They agreed to send me a card for December with $45. On it that I must use by 12/31/2024. Representatives explained they would check with supervisors about sending me the remainder of the money I should have been receiving, total of $495. And I should hear from someone in a couple weeks. During this conversation I asked about the $600. Benefit for health equipment. The representative explained that I could purchase things like a bicycle, smart watch, etc. So I asked specifically, if I buy a smart watch I can be reimbursed? Yes, she replied and went on to explain it would take about 30 days to be reimbursed and I would have to complete a form on line and upload receipt. I purchased an ***** watch on 12/30/2024, completed the online form and uploaded the receipt. The form indicated it had received it and listed it as pending. After many calls with representatives telling me to give it awhile longer, give it till the end of Feb. Etc. Most recently 3/5/2025 I was told I would need to submit another form that would be mailed to me. This is just another stall tactic; they do not intend to reimburse me. According to my records they owe me $495.money I should have received in 2024 plus the 353.68 for the smart watch reimbursement $848.68. Seems like after *** bought Aetna everything fell apart.
Business Response
Date: 03/11/2025
**** *** ******* **********

Please see our response to complaint # ********for *** **** **** that was received by us on March 6, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the complaint, we reached out internally to view the member’s concerns. The ******* ******* Extra Benefit program for 2024, can be found on page 11 of the Annual Notice of Changes that was mailed out on August 17, 2023.

We do apologize that the member was not able to utilize her full ******* *******s Funds, but the program with ******* *******s as of December 31, 2024, and we are unable to obtain any missed funds that was not used.

The member has a yearly or quarterly allowance and will pay upfront for qualified fitness activities and fitness equipment for the sole use by the member. The member will need to submit for reimbursement. The member can use this benefit to be reimbursed for a range of eligible fitness-related services, activities, and equipment. Wearable tracking device examples but not limited to:

1. ***** Watch (All models)
2. ******* Watch (All models)
3. ****** ***** Watch
4. ****** (All Models)
5. ****** Fitness Tracker
6. ***** **** *** Pro Outdoor Watch
7. Step Counter
8. ******* Watch
9. ******** smartwatch

Wearable heart rate monitor used for tracking heart rate during exercise or monitoring fitness activity levels during the day is covered.

With a reimbursement allowance, the member will pay upfront and send the required information to us to get paid back. The member will need to complete a fitness reimbursement claim form for each item and include an itemized receipt. Additional information may be required. See the fitness reimbursement form for details. The member must use the fitness reimbursement form. The member can find this online at *****************/reimburse to print. It will arrive in 7-10 days. The Fitness DMR form is also available on *****************, *********************************** and ***************.

Once the member completes the fitness claim form, she can mail to the medical claims address listed on the back of your ID card or you can fax it to ###-###-####. Be sure to make copies of what is sent to us.

Submit the reimbursement request within 60 days of the purchase date. While the member can request reimbursement at any time during the plan year, we encourage the member to file right away. All receipts must be submitted by the end of the plan year.

Once all required information is received and the request is approved, it may take up to 45 days to send payment via check.

If something has been denied, the member is able to submit a written appeal if she believes it should have been covered.

Per further research, the submitted your receipt for the fitness reimbursement to ******* *******s and not to Aetna. We were able to upload the receipt, but in order for Aetna to process your reimbursement, the member will need to fill out the claim form. The member will receive a detailed Medicare Resolution Letter within 7-10 business days.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ****** concerns.
Sincerely,
Cindi D
Analyst
Medicare Executive Resolutions
Customer Answer
Date: 03/11/2025

Complaint: ********

I am rejecting this response because: I did pay upfront for my ***** watch, I completed the online form, attached my receipt and have been told since January that they did receive it and it is still pending. Asking me to complete another form is just another stall tactic. What has happened to this company? The other funds that were never used should also be paid. What a horrible way to treat seniors! My guess is they will not even send me this new form they mentioned. I am not letting this go. Not sure what my next step is...maybe I need to contact ******** ******** office. Based on all the other complaints I have read perhaps there should be a class action law suit. At any rate I am so disappointed with Aetna and I will pursue this claim.

Sincerely,

**** ****
Business Response
Date: 03/12/2025
**** *** ******* **********

Please
see our response to the rejection of our previous response to complaint #********
for *** **** **** that was received by us on March 12, 2025. Our Executive
Resolution Team took a second look of the members concerns, and we would like
to share the results of the review with you.

Upon
receipt of the rejection, we confirmed in the *****************************
website the online form that the member mentions that she already filled out, for
her ***** Watch fitness reimbursement request was to ***************.
*************** was our vendor in 2024, for the extra benefits card.

The fitness allowance benefit is a direct member
reimbursement through the Aetna plan, not through the vendor, ***************.
The member would need to submit the fitness reimbursement form that is required
by the plan. Once all required information is received and the request is approved,
it may take up to 45 days to send payment via check. If the reimbursement claim
would happen to be denied, the member is able to submit a written appeal. We
have attached a copy of the fitness reimbursement form for the member’s convenience.
We ask that she please complete and return the fitness reimbursement form as
instructed on the form.

In 2025, Aetna no longer uses the vendor *************** for
the extra benefit allowance. All the
extra benefit cards through *************** were deactivated at the end of the
calendar year, December 31, 2024.

After further review, we show the member requested a
rollover of her extra benefits allowance on December 17, 2024, due to not being
aware of her extra benefit card monthly allowance of $45 and not using the
benefits January through November of 2024. *************** completed a review
on their end on December 18, 2024, and closed her request as follows:

The ******* ******* Extra Benefit program information for
2024, was provided to the member in the Annual Notice of Changes for 2024. We have
confirmed was mailed to the member on August 17, 2023, to her address on file
as **** ********* *** ******* **** *****. The member’s plan included a $45
monthly benefit amount.

We confirmed the member was mailed an extra benefits card
ending in 4441 on December 21, 2023. The member did not report the card lost or
stolen until December 4, 2024. We confirmed a new extra benefits card ending in
**** was shipped to the member on December 6, 2024. We show the member
activated the new extra benefit card on December 17, 2024.

The 2024 plan benefits state that the monthly benefit amount
will be available on the card the first day of each month. Be sure to use the
benefit amount each month, because any unused benefit amount will not roll over
into the next month. Important: Plan not responsible for lost or stolen cards
or for fees associated with late utilities, rent, or mortgage payments.

*************** does not grant requests for fund rollovers
for lost or stolen cards, or members forgetting/unable to use their card. When
members stating they never received the extra benefits card is not a valid
reason to ask for rollovers, as cards are mailed to the mailing address on
file. The request for rollovers can only be granted if Aetna is at fault for
the member not being able to use their funds. The members request for a
rollover of the $45 allowance, for the months of January through November of
2024, has been denied.

Please know, the member will receive a formal detailed
Medicare Resolution Letter within 7-10 business days with this response.

We take
customer complaints very seriously and appreciate you taking the time to contact
us and giving us the opportunity to address *** **** ****** concerns. We do apologize for
the inconvenience this may have caused her as our valued member.

Sincerely,
Marilyn
Analyst, Medicare Executive Resolution
Customer Answer
Date: 03/16/2025

Complaint: ********

I am rejecting this response because:The card I received in December 2024 was for $45.00. I did receive and use this card. ******* *******s checked and the benefit of $45.00 for Jan. 24 thru Nov.24 was not used. If I had been aware of this money I would have used it. Please reconsider this decision as that money was part of my 2024 benefit package with Aetna.
I will complete another form for reimbursement for the ***** watch. Where do I get this form?

Sincerely,

**** ****
Business Response
Date: 03/28/2025
**** *** ******* *********:

Please see our response to follow-up on complaint # ******** for
*** **** **** which was received by us on March 17, 2025. After receiving the
complaint, we promptly conducted internal research.

Our Executive Resolution Team has finalized the research, and I
would like to share the results of the review with you.

We have confirmed in the member’s account, that September 2023,
the plan emailed a notification that the member’s 2024 Annual Notice of Change (ANOC)
was ready to view.

The
ANOC informed the member about the Extra Benefits Card coverage for 2024. It
reads:

If
the member is diagnosed with a chronic medical condition, they may be eligible
for this benefit. See the Evidence of Coverage for more information and
eligibility requirements. Extra Supports Wallet amount $45 monthly benefit
amount (allowance).

Additionally,
the plan mailed the Extra Benefits Card in December 2023. Unused funds do not
roll over into the next month, nor the next year.

Regarding
the Fitness Benefit, we found that according to page 53 in the 2024 Evidence of
Coverage (EOC), the Fitness Reimbursement includes important information. The receipt
and documentation must be submitted before the end of each year to be eligible
for reimbursement. If the member needs assistance with the reimbursement
process, they were directed to can call the Member Services phone number listed
on the Aetna Member ID card.

The
item the member purchased on December 30, 2024, was not submitted to the plan
for reimbursement until March 7, 2025. This has been denied for timely filing
and is not reimbursable. The member can file an appeal if you disagree with the
claim status.

The member will receive the detailed Medicare response in the mail
within seven to ten business days.

We take customer complaints very seriously and appreciate you
taking the time to contact us and giving us the opportunity to address
********* concern.

Sincerely,
Jennifer
Analyst
Medicare
Executive Resolutions
Initial Complaint
Date:03/05/2025
Type:Order Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
My policy was paid current and claim was processed incorrectly not processing my medication refill to the deductible and max out of pocket for my claim in January. I have spent several hours on the phone and been told multiple times I will receive call backs and escalations that have not been processed, not allowing me to fill my medication at the corrected amount and the correct out of pocket and deductible expenses to show on the app, website, or pharmacy.
Business Response
Date: 03/14/2025
Dear *** *********:

Please see our response to complaint #******** for ******* ******** that was received by us on March 5, 2025. Our Executive Resolution Team researched the
member’s concerns, and I would like to share the results of the review with
you.

Upon receipt of the complaint, we reached out
internally to have the member's concerns reviewed. We
confirmed that all Aetna individual family plan members have a 31-day grace
period during which prescription claims will process at 100 percent member
responsibility. Once the grace period expires, the member’s account is reviewed
to determine how claims will process going forward. Please know, the grace
period for *** ********’s plan ended on March 6, 2024. Since *** ********’s
account is showing paid to date, all impacted claims between dates of service
January 10, 2025, and March 6, 2025, were reprocessed to show the correct
deductible and out of pocket amounts. All updates should now be visible on the
Aetna member website, and *** ******** should receive a reimbursement of
$279.78 in the mail within 7-10 business days. Additionally, the member’s call history
is being reviewed and the necessary feedback will be provided.
We apologize for any difficulties and inconvenience this situation has
caused. We take customer complaints very seriously and appreciate you taking
the time to contact us and giving us the opportunity to address *** ********’s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at: *******************************.

Sincerely,
Herman M.
Analyst, Executive Resolution
Executive Resolution Team

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