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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

1,334 total complaints in the last 3 years.
468 complaints closed in the last 12 months.

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Submit a Complaint

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:03/04/2025
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.
On 02/10/2025 Aetna Medicare sent me a letter(attached) stating that they are required to supply me with a temporary 30-day supply of one of my medications(*************). My next refill date is March 6, so I called them today(03/04/2025) and asked the lady, a senior facilitator, for my 30-day supply. I was told that they had already given me my 30-day supply on 02/06/2025. However, since I HAD YET TO RECEIVE THE LETTER on 02/06 and WASN'T EVEN AWARE they would provide me with a temporary supply, I paid for the 02/06 prescription out of my own pocket. I then asked her if I could get it instead on 03/06(my next refill date). She refused to do that.
Business Response
Date: 03/10/2025
Dear *** ******* *********:

Please see our response to follow-up on complaint
# ******** for *** ****** **** which was received
by us on March 4, 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 that the issue pertains to
reimbursement for a prescription.

The member is enrolled in Aetna Medicare Platinum PPO
Plan which became effective on January 1, 2025.

The plan allows a one-time, temporary, “transition
fill,” of a medication when switching to a new plan. A transition fill is
provided to allow the prescriber time to submit a coverage determination
request.

As of April 1, 2025, the member will no longer be
eligible for the transition fill of medication and have it covered by the plan
without an approved prior authorization on file.

As of writing this resolution, we do not have a claim
on file for the transition fill. We have provided a prescription claim form
with this resolution. If the member has made an out-of-pocket payment for a
medication that may be covered by the plan, they can submit this form along
with the pharmacy receipt. Pharmacy receipts are usually attached to the bag
with the prescription or can be obtained from the pharmacy if you need another
copy.

Mail the form and the receipt/s to the address at the
top of the form. The plan will review the claim and benefits to determine if a
reimbursement is allowable. Reimbursement amounts are determined by the cost of
the drug and your cost share outlined in the plan benefits.

If the claim is processed and the member receives
reimbursement for the prescription on February 6, 2025, that will be considered
their one-time transition fill. Please note that he will not be eligible for
another transition fill.

We have received a coverage determination request on
December 6, 2024, for this prescription. It was denied due to the prescriber
not providing the requested information.
On December 16, 2024, a redetermination was then
initiated. It was denied as criteria was not met since we did not receive the
information above from the prescriber. This case has now been forwarded to C2C
Innovative Solutions, Inc., a Medicare Part D Independent Reviewing Entity. The
member will receive their decision in the mail and information about the next
steps.

According to the plan documents, there is no deductible
for Aetna Medicare Platinum (PPO). You begin in the Initial Coverage Stage when
you fill your first prescription of the year. See Section 5 in the Evidence of
Coverage (EOC) for information about your coverage in the Initial Coverage
Stage.

During the Initial Coverage Stage, the plan pays its
share of the cost of your covered prescription drugs, and you pay your share
(your copayment or coinsurance amount). Your share of the cost will vary
depending on the drug and where you fill your prescription.

The plan has 5 cost-sharing
tiers. Every drug on the plan’s Drug
List is in one of 5 cost-sharing tiers. In general, the higher
the cost-sharing tier number, the higher your cost for the drug.

The
member will receive a detailed 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: 03/14/2025
I have submitted my prescription receipt to Aetna for reimbursement on Tuesday 03/11.
When they reimburse me as promised, I will close the case.
Thank you for your assistance.
Initial Complaint
Date:02/28/2025
Type:Customer Service 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 over 20 claims at this point on my insurance that are not me. I have contacted Aetna multiple times through different avenues since September of 2024 and have yet to receive any help. This is a HIPAA violation so I don't understand why they do not care to help fix this situation. They are willingly paying $1000's for someone who is not insured through them because I can't get anyone to HELP ME.
Business Response
Date: 03/07/2025
**** ******* **********

Please
see our response to complaint #******** for ******** ***** that was received by us on February 28, 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 immediately reached out internally to further research the member’s
concerns. We confirmed that one of our client advocates made outreach and has
been in communication with Ms. ***** regarding this matter. Please know, Ms.
***** emailed a list of the claims in question and upon review, we found that
the member’s name and date of birth matched, but the address is different. All
claims have been sent back for rework to be voided out. Unfortunately, due to policy,
the member identification number cannot be changed. However, the client
advocate is working with the member to have a restriction placed on her account,
and a special handling alert for claim processing will be added to her file. As
a courtesy, we have also contacted all the providers’ billing offices and
explained the situation to them. In addition, we have submitted this matter to
our special investigations unit (SIU) for a thorough investigation. For continued
assistance regarding this concern, the client advocate provided Ms. ***** with
her direct 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. ******* concerns. If there are any additional
questions regarding this particular matter, please contact the Executive
Resolution Team at *******************************.

Sincerely,

Shay G.
Analyst,
Executive Resolution
Executive
Resolution Team
Customer Answer
Date: 03/07/2025

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:02/26/2025
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 had a dental cleaning and xrays from a dentist **** ****** who is included in the Aetna Dental network. The work was all covered by the policy. After the visit, I was told that there was a problem with my insurance card and that I had to pay with my credit card until the issue could be straightened out. I did pay, and had the dental visit submitted to Aetna for payment coverage.
I have called multiple times, with each call lasting 20-60 minutes. The last time I called (in December I believe) I was told the claim was successfully processed and a check was mailed, yet I have not been reimbursed. I am submitting this complaint because it is more painful than a root canal to deal with this insanely slow customer service process.
The dental visit was 3/8/2024 at **** ****** DDS at **** ******* ******** ***** **** *** *****
Please pay me the $320 that I had to pay for this visit.
Business Response
Date: 02/28/2025
Dear ******* *********:
Please see our
response to complaint # ******** for ***** ****** that was received by us on
February 26, 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 dentist **** ****** was paid in error. The payment
should have gone to the member. The claim was reprocessed to allow the $177.00
to be paid to the member, the claim can take up to 30 days to process and
finalize for payment. The member will be sent a new Explanation of Benefits
(EOB) after the claim has processed and paid correctly. Outreach was made to
the provider office, and they were advised that they were paid in error and
that they owe the member $143.00. The office is closed until March 3, 2025,
another outreach attempt will be made at that time. A detailed resolution letter
was mailed to the member today February 28, 2025, the member should allow 7-10
business days for the letter to be received.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address Ms. ******’s 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
Business Response
Date: 02/28/2025
Dear ******* *********:
Please see our
response to complaint # ******** for ***** ****** that was received by us on
February 26, 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 dentist **** ****** was paid in error. The payment
should have gone to the member. The claim was reprocessed to allow the $177.00
to be paid to the member, the claim can take up to 30 days to process and
finalize for payment. The member will be sent a new Explanation of Benefits
(EOB) after the claim has processed and paid correctly. Outreach was made to
the provider office, and they were advised that they were paid in error and
that they owe the member $143.00. The office is closed until March 3, 2025,
another outreach attempt will be made at that time. A detailed resolution letter
was mailed to the member today February 28, 2025, the member should allow 7-10
business days for the letter to be received.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address Ms. ******’s 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
Customer Answer
Date: 02/28/2025

Complaint: ********

I am rejecting this response because:
This issue cannot be considered closed until I receive reimbursement for the payment I made in March 2024.
I hope that this matter can truly be closed and do appreciate the timely response to this complaint, after eleven months of calls to Aetna.

Sincerely,

***** ******
Customer Answer
Date: 02/28/2025

Complaint: ********

I am rejecting this response because:
This issue cannot be considered closed until I receive reimbursement for the payment I made in March 2024.
I hope that this matter can truly be closed and do appreciate the timely response to this complaint, after eleven months of calls to Aetna.

Sincerely,

***** ******
Business Response
Date: 03/07/2025
Dear Mr. ******* *********:

Please see our
response to complaint #******** for ***** ****** that was received by us
on February 28,
2025. Our Executive
Resolution Team researched your 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 have Ms. ******’s concerns reviewed. We have
confirmed that the claim from the date of March 08, 2024, for Dr. **** ******
has been reprocessed to pay the member $177.00. The member would need to allow
5-7 business days for the arrival of the check.

***** at *** ******** office was contacted on
March 05, 2025. It was explained to ***** that since they are an Aetna PPO provider, they are held to the Aetna
PPO negotiated rate of $177.00. Per the Aetna PPO negotiated rate, the provider’s
office would owe the member back $143.00 since they charge the member $320.00
on the date of service. ***** has
agreed to refund the member the $143.00.

We take customer complaints very seriously and
appreciate you taking the time to contact us and giving us the opportunity to address Ms. ******’s concerns. If there are any additional
questions regarding this particular matter, please contact the Executive
Resolution Team at *******************************.

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive
Resolution Team
Business Response
Date: 03/07/2025
Dear Mr. ******* *********:

Please see our
response to complaint #******** for ***** ****** that was received by us
on February 28,
2025. Our Executive
Resolution Team researched your 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 have Ms. ******’s concerns reviewed. We have
confirmed that the claim from the date of March 08, 2024, for Dr. **** ******
has been reprocessed to pay the member $177.00. The member would need to allow
5-7 business days for the arrival of the check.

***** at *** ******** office was contacted on
March 05, 2025. It was explained to ***** that since they are an Aetna PPO provider, they are held to the Aetna
PPO negotiated rate of $177.00. Per the Aetna PPO negotiated rate, the provider’s
office would owe the member back $143.00 since they charge the member $320.00
on the date of service. ***** has
agreed to refund the member the $143.00.

We take customer complaints very seriously and
appreciate you taking the time to contact us and giving us the opportunity to address Ms. ******’s concerns. If there are any additional
questions regarding this particular matter, please contact the Executive
Resolution Team at *******************************.

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive
Resolution Team
Initial Complaint
Date:02/26/2025
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.
Failure to pay a valid claim of $1,200 for physical activity reimbursement for 2024
Business Response
Date: 02/28/2025
**** *** ******* **********

Please see our response to
follow-up on complaint # ******** for *** ****** ***** which was received by us
on February 26, 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 his concern relates to the delay in processing a fitness
reimbursement.

The member is currently enrolled
in Aetna Medicare Gold Advantage (HMO-POS) plan that became effective on April
1, 2024.

According to the Evidence of
Coverage (EOC), your plan, has a fitness allowance. The direct member
reimbursement (DMR) allowance was $1,200 for 2024.

The EOC provides instructions for
submitting reimbursement requests:

1. Complete
the reimbursement form
2.
Make copies of your documents.
3. Submit
the completed fitness reimbursement request and receipt.

Ensure
that all required fields on the form are filled out completely, as incomplete
submissions will not be processed. Once all the information is received, it may
take up to 45 days to process the reimbursement. Once approved, a check will be
mailed for repayment of the covered services up to your benefit amount.

Additionally, the fitness
reimbursement form consists of five pages. All submissions must include the
first and fifth pages, as well as the page corresponding to the goods or
services for which they are seeking reimbursement.

The form requires members to
submit an itemized receipt, which must include the date of purchase, name of
the retailer, location of the retailer, description of the item, and the amount
that was paid.

We have identified a fitness
reimbursement claim submitted on December 31, 2024. Unfortunately, this claim
was processed but denied due to missing information.
Specifically, the submission
lacked the first and fifth pages of the reimbursement form. Additionally, only
six out of the thirty-nine provided receipts were itemized, while the remainder
only listed the paid amount.

Please note that one of the
receipts dated January 1, 2024, is ineligible for reimbursement, since the plan
was not effective until April 1, 2024.

The member may send the missing
documents to the address listed on their member ID card or fax them to ###-###-####.
The member should ensure they include the current claim number on any documents
submitted, so they will be applied to the existing claim.

The member will receive the full
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: 03/04/2025
Thank you for your quick action. Aetna stated that the claim was denied due to the lack of missing pages in the claim form. Today, i faxed all five pages of the claim form with signatures on all five pages (page one and page 5 have nothing to do with the claim, only provide instructions. A detailed explanation was also provided providing information about my wife's claim which was paid using the same golf receipts as I provided. The claims agent stated that they wanted itemized receipts which do not exist. I saved each and every receipt for golf fitness activities that were provided by the golf courses. There is nothing to itemize when the only service sold was to play golf.
The signed documents and supporting letter were faxed to ###-###-#### per the Aetna agent in claims. This is the fax for claims that have been appealed. The letter from Aetna states that I will receive a response within seven to ten business days. Please keep this complaint open until I receive a response / resolution and full payment for the claim.
Regards,
*** *****
Business Response
Date: 03/12/2025
Dear Mr. Stewart Henderson:

Please see our response to complaint # ******** for *** ****** *****, which we received on March 5, 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 claims history. We found a fitness reimbursement claim for dates of service January 10, 2024, through September 28, 2024. The claim denied due to missing/incomplete information. The previous grievance resolution provided details of the denial.
Our members are required to follow these steps to get reimbursed for the covered fitness
services or products you receive:
1. Complete the reimbursement form.
2. Make copies of your documents.
3. Submit the completed fitness reimbursement request and receipt. We ask that members be sure to complete all of the required fields on the form
because incomplete forms will not be processed.

Members have the right to appeal plan decisions.
Members must request the appeal within 60 days of the Explanation of Benefits notice date. We can give you more time if you have good reason for missing the deadline. For additional information on appeal rights, the member can review their Evidence of Coverage booklet.

We received the member’s appeal request on, February 21, 2025. We have confirmed that the Appeals team has received the additional information faxed to us on, March 5, 2025. The Appeals Team made the decision to overturn the original denial based on the information provided. The member's fitness reimbursement request for $1200 has been approved. The check has been issued on March 12, 2025. Please allow up to 45 days to receive the payment by mail.

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
Initial Complaint
Date:02/26/2025
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.
Since Feb 1st we have contacted Aetna in regards to our health insurance plan. They have yet to activate this plan even after numerous attempts. We have stated to them it's an emergency as my husband has multiple health issues. 4 times we sat on the phone with them and marketplace only for them to say they were submitting the info and that they would put a rush on it. We have asked for supervisors to which we have been denied. They keep lying when we call and saying they are submitting a ticket. We have tried every avenue to get this corrected with no results. I had paid two months and my insurance should have been activated.
Business Response
Date: 03/06/2025
Dear ******* *********:

Please see our response to complaint
#******** for ****** ***** that was received by us on February 26, 2025. Our Executive Resolution Team
researched your concerns, and I would like to share the results of the review
with you.

Upon receipt of the member’s concerns we immediately reached out to
investigate. We found the member is currently enrolled in a partially
subsidized On-Exchange Aetna Gold 4 plan through *****. Initially, we received
a file from the Marketplace for the member’s plan, effective January 01, 2025.
Subsequently, we received a request from the Marketplace to terminate the
coverage prior to activating. Following this, we received a new file from the
Marketplace to activate the member’s plan, effective February 01, 2025, however
this was delayed due to an isolated error. When the error was discovered the
policy was corrected and now shows active in all syste*** The member was
contacted and advised, and assistance was provided regarding all the member’s
questions.

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,

William B.
Analyst, Executive Resolution
Executive
Resolution Team
Customer Answer
Date: 03/10/2025
No account was not taken care of as stated. I had prepaid for all of Feb and all of March. I do not believe that money has yet been applied to the account as they stated they would do so.
Business Response
Date: 03/13/2025
Dear ******* *********:
Please see our
response to complaint # ******** for ****** ***** 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 your request, we immediately reached out internally to further
research the concerns. After
further review it was determined that the member is enrolled in a partially subsidized On-Exchange
Aetna Gold 4 plan through *****. The member’s policy was active from March 1,
2024, to October 31, 2024, the plan was then terminated for nonpayment. Aetna
received the enrollment file from the Marketplace for a 2025 plan with the
effective date of January 1, 2025, Marketplace then sent a termination of this
plan on December 14, 2024, which caused the January 1, 2025, span to terminate.
Marketplace then sent another enrollment file with the effective date of
February 1, 2025, this enrollment file was updated in all systems as of
February 26, 2025. The delay was caused by an isolated incident with the vendor
partner ********. The member’s policy is now active in all systems with the effective
date of February 1, 2025, with a paid through date of March 31, 2025. For the
2025 plan the member has made payments on February 1, 2025, and February 26,
2025. The Enrollment and Billing team (EEB) confirmed that part of the new
payments (made in 2025) went to satisfy her balance for the plan year 2024.
Member has a paid through date of March 31, 2025, with her bill for April
coverage reflecting $42.63. The outreach that was made to the member to discuss
this was unsuccessful, a voicemail was left for the member with the Plan
Liaison direct contact information for a return phone call. An email was also
sent to the member with the direct contact information included.
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,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Initial Complaint
Date:02/25/2025
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.
from June 2024Silver Sneakers, $800.00 total amount due me. Received check on 11/27/2024 for $165.00 not able to receive balance of $645.00. no check to date 2/24/2024. Total amount was paid to ** ******* by credit card. I contacted aetna a number of times, help me resolve this. Thank you
Business Response
Date: 03/07/2025
Dear *** ******* *********:

Please see our response to complaint # ******** for *** **** *********, which we received on February 26, 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 Fitness Reimbursement Benefit. In 2024 members received a direct member reimbursement (DMR) allowance of $800 each year. You can be reimbursed toward:
-Fees paid to a qualified physical health/and or fitness club that does not participate with **************
-Aerobic/fitness activity fees paid (including those paid for personal training, lessons, coaching, or exercise equipment).
-Activity fees such as pickleball fees, golf green fees, ski/lift passes and fees, bowling, yoga, stretching, dance classes, and fees associated with extra features at ************** facilities.
-Weights and fitness supplies such as exercise peddlers, yoga mats, exercise bands.
-Wearable items such as tracking devices.

Allowance exclusions:
-Fees or dues for social clubs, country clubs, gun clubs, and shooting ranges
-Fees for National and State Parks
-Activity supplies such camping tents, hiking poles, and fishing rods
-Athletic clothing and shoes
-Edible items such as protein shakes, bars, and supplements
-Bicycle maintenance and repair
-Services covered by Original Medicare, including but not limited to, physical therapy, chiropractic, acupuncture, or massage therapy services.

We received multiple fitness reimbursement requests for the 2024 plan year. The claim details are provided below:
Date of Service: January 8, 2024
Claim ID: *********
Billed Amount: $75.66
Amount Paid: $75.66
Received January 12, 2024
Claim Processed Date: January 23, 2024

Date of Service: 6/3/2024
Claim ID: *********
Billed Amount: $166.00
Amount Paid: $166.00
Receipt Date: February 14, 2025
Claim Processed Date: March 6, 2025

Date of Service: July 2, 2024
Claim ID: *********
Billed Amount: $165.00
Amount Paid: $165.00
Receipt Date: February 14, 2025
Claim Processed Date: March 6, 2025

Date of Service: August 1, 2024
Claim ID: *********
Billed Amount: $165.00
Amount Paid: $63.34
Receipt Date: August 9, 2024
Claim Processed Date: March 6, 2025

Date of Service: October 1, 2024
Claim ID: *********
Billed Amount: $165.00
Amount Paid: $165.00
Receipt Date: November 20, 2024
Claim Processed Date: February 18, 2025

Date of Service: November 4, 2024
Claim ID: *********
Billed Amount: $165.00
Amount Paid: $165.00
Receipt Date: November 11, 2024
Claim Processed Date: November 25, 2024

Claims *********, *********, and ********* were originally denied because we did not have enough information about what the member bought. We received this information on, March 4, 2025. The claims were updated to approved. Payments were processed on March 6, 2024. The payment for claim ID ********* was processed on February 18, 2025. A check for $166.38 was mailed to the member on, February 19, 2025. This amount includes an interest payment for $1.38. Please allow up to 45 days to receive the payment by mail.

Members have the right to appeal plan decisions.
How to ask for an appeal with Aetna Medicare
Step 1: Member, member representative, or the member’s doctor must ask us for an appeal. The written request must include:
-Member name
-Address
-Member number
-Reasons for appealing

Step 2: Mail, fax, or deliver your appeal.
Aetna Medicare Grievance & Appeal Unit,
**** *** ****** ********** ** *****
**** **************
Deliver: **** ***** ******* ***** **** ***** ** *****
Online: Aetnamedicare.com
For a Fast Appeal: Phone: **************
Fax: ************

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 Mr. *********’s concerns.

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution
Customer Answer
Date: 03/08/2025
I will wait for the written resolution letter, 7to 10 business days.
Initial Complaint
Date:02/25/2025
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 am filing a formal complaint against Aetna and ********** for unfair billing practices, failure to cancel services, and violations of the Americans with Disabilities Act (ADA). Since March 2024, I have made multiple attempts to cancel my Aetna Dental policy, which is administered by **********.

I submitted cancellation requests via email on March 16, April 12, and May 11, 2024, and via Aetna’s secure contact form. Despite these efforts, Aetna has denied any record of my emails and continues to charge me $123 per month. **********, which Aetna claims is responsible for cancellations, has also failed to respond to my emails, and their customer support phone line is non-responsive.

I have had new dental insurance through ******** since February 15, 2024, which Aetna can see in their records. Aetna continues to charge me $123 per month even though I have never filed a claim and have been actively trying to cancel the policy for months. These ongoing charges constitute unauthorized billing and deceptive business practices.

I am deaf and unable to communicate by phone. Aetna and ********** have failed to provide an alternative method for me to cancel my policy, continuously directing me to call their support line.
This violates the Americans with Disabilities Act (ADA) by denying me equal access to customer support. The only alternative method provided (email) has been completely unresponsive.

I am requesting the following corrective actions:

- Immediate cancellation of my Aetna Dental policy, effective as of my first cancellation request in March 2024.
- A full refund for all charges paid from March 2024, to the present, as I have not used nor needed this coverage.This is retrospective to my initial contact attempt.

Aetna and **********’s refusal to address this matter through accessible communication channels has caused me financial harm and undue stress. If this issue is not addressed promptly, I am prepared to pursue further legal action against both entities.
Business Response
Date: 02/27/2025
**** *** **********

Please
see our response to complaint #******** for ******* ******** that was received
by us on February 25, 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. The billing administrator for Aetna individual plans, **********, confirmed that the member’s dental insurance policy has been
terminated as of March 01, 2024. A refund request in the amount of
$1,115.46 was processed and will be issued to the member’s credit card. We confirmed that ********** representatives and members have access to the TTY:711
service for the hearing impaired Telecommunications Relay Services (TRS) and members are instructed to request their policy termination to be sent in
writing by email or mail. Members can also contact Aetna at *************** ******* from 9 am to 5 pm Eastern Time, Monday through Friday. For hearing or
speech disabilities, they can call 711 to utilize TRS.

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 Mr. ********’s concerns. If there are any additional questions
regarding this particular matter, please contact the Executive Resolution Team
at: *******************************.

Sincerely,

Lisa B.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:02/25/2025
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.
I was denied coverage by Aetna to use ******** they rather me try there preferred. I have a message for these geniuses. If they look at my medical records they can see I tried everything else. They can also see that I am on the highest dose of ********. Who are insurances companies to tell people who and what to take? I know what agrees with my body I think it is ******** to keep getting ore authorizations everytime you change insurance companies they can see what the patient us taking and they want to play God and think they dsn bully people well I'm willing to fight and that's why I'm writing the BBB for justice. I need my medication I'm paying these people lots of money.., they would pay for reassigned surgery to ******** but no cover a medicine a person needs… this is unjust
Business Response
Date: 03/06/2025
**** ******* **********

Please see our
response to complaint # ******** for ******* ********* that was received by us
on February 25, 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 is currently enrolled in On Exchange Aetna
Silver S plan through *****, the members provider *** ***** ******* ** sent in
a prior authorization, and it was denied because the member had not tried other
formulary medications, step therapy. The member stated that he has tried all
the diabetic medications and the ******** ********* ******** is the only one
that has worked for him. The Pharmacy department advised that the ******** ********* ******** is not covered under the On Exchange Aetna Silver S plan. The
prior authorization was denied on February 24, 2025. The provider did not
provide enough information that the member has tried other medications such as
(*********, ***********, and *******). Outreach was made to the provider office
staff, and they advised they spoke with the member on February 28, 2025, and told
the member they must follow Aetna’s appeal process. The member requested assistance
with getting his medication for this month, a conference call was made between
the member, Aetna, and the pharmacy requesting a one-time override, the
pharmacy advised they could not because the member had a denial on file. The
member was given a list of resources that may assist him with paying for his
medication until Aetna receives all the documents from his provider. All the
member’s concerns were addressed.
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. 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
Business Response
Date: 03/06/2025
**** ******* **********

Please see our
response to complaint # ******** for ******* ********* that was received by us
on February 25, 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 is currently enrolled in On Exchange Aetna
Silver S plan through *****, the members provider *** ***** ******* ** sent in
a prior authorization, and it was denied because the member had not tried other
formulary medications, step therapy. The member stated that he has tried all
the diabetic medications and the ******** ********* ******** is the only one
that has worked for him. The Pharmacy department advised that the ******** ********* ******** is not covered under the On Exchange Aetna Silver S plan. The
prior authorization was denied on February 24, 2025. The provider did not
provide enough information that the member has tried other medications such as
(*********, ***********, and *******). Outreach was made to the provider office
staff, and they advised they spoke with the member on February 28, 2025, and told
the member they must follow Aetna’s appeal process. The member requested assistance
with getting his medication for this month, a conference call was made between
the member, Aetna, and the pharmacy requesting a one-time override, the
pharmacy advised they could not because the member had a denial on file. The
member was given a list of resources that may assist him with paying for his
medication until Aetna receives all the documents from his provider. All the
member’s concerns were addressed.
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. 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:02/24/2025
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.
On 09/11/24 I was billed a second time from the dental company (***** *********) for completion of a dental procedure and had to cover the expesneses out of pocket and have been waiting of a reimbursement from Aetna in the amount of $768.60. I have been in contact with Aetna 19 times without any progress in receiving any reimbursement. Aetna is aware of the issue but keeps telling me it is beeing reviewed and to wait 30 days. After the 30 days they tell me the claim is denied but then admit to the issue (that they do owe me the $768.60) and start another review. This is showing that Aetna is committing insurance fraud. My goal in filing the complaint with BBB is to retrieved the money owed and also make others aware of the fraud that Aetna is commiting. The last Dommuent number i received from Aetna is #************ and the Case#*********.
Business Response
Date: 02/27/2025
**** *** ******* **********

Please see our response to
follow-up on complaint #******** for *** ***** ****** which was received by us
on February 24, 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 that the member’s
concern is regarding a reimbursement for dental services.

After
reviewing the account, we found a claim with ID, Claim ********* that was
submitted by the dentist’s office on August 29, 2024. This claim contained an itemized
receipt detailing the procedure codes. The service date for the procedures was August
21, 2024.

Additionally,
the submission included proof of payment showing that you paid $768.60. The
overall claim amount was $1,708, which had a courtesy fee of $170.80 waived
from the balance.

The
total cost for the procedure amounted to $1537.20. The plan processed and
reimbursed the member, $768.60 on August 30, 2024.

On September
11, 2024, the member paid the outstanding balance of $768.60. However, September
11, 2024, was not an actual billable service date, which led to some confusion.

Some
dental services are considered multi-stage procedures. These multistage dental
services are generally invoiced collectively under a single billable service
date.

We
located the itemized receipt the member submitted to the plan on October 16,
2024, which includes confirmation of their second payment totaling $768.60.

For
future reference, if the member is submitting multiple receipts related to a
single claim, they should ensure that the claim number is included on all
subsequent receipts submitted to the plan.

Furthermore,
it has come to our attention that several grievances were incorrectly resolved. We have communicated this
issue to management, who will be providing coaching sessions to the analysts
involved.

We
also confirmed that the plan has issued a second reimbursement for the member’s
payment made on September 11, 2024. A check was mailed on February 26, 2025, in
the amount of $768. 60. The member should allow up to 45 days for the check to
arrive.

The
member will receive the Medicare response letter 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 Mr. ******** concern.

Sincerely,
Jennifer
Analyst
Medicare
Executive Resolutions
Initial Complaint
Date:02/24/2025
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.
First call and transaction was on 7/13/24. I phoned to set up health insurance plan for my daughter ******* ******. She had been under my ****** insurance for work and as of 11/1/24 when she turned 26 years old she would no longer be covered. ********** ******** Insurance promised that ******* would continue her ****** coverage, the same as coverage she had. We were to be charge a fee of $292.85 for payment and enrollment fee. This was the only time we were told we would be charged due to *******'s income being low and her after that being eligible for state subsidized enrollment. This is what we were told. ******* was pregant at the time. When she went in for her November 14th prenatal appointment at ****** *******, she showed them her ********** ******** ****** insurance card. ****** said that this insurance would not work, and this was not at all accepted by ******. She left the appointment in tears, not being seen this day. We called ********** ********. I was so upset. They apologized and said "I don't know who promised you this, but we can't cover ****** needs at all". I asked for a refund and for this policy to be cancelled. They assured they would immediately cancel the policy. It wasn't until January 2025 my husband noticed on my credit card statement that ********** ****** ******** had charged my ******** Credit card every month since July 2024, 242.25 taken out on 13th of the month for August - December 2024. I was so upset and told them I cancelled this. They then assured me they would cancel immediately the policy so as not to charge me on 1/13/25. I have been charged for January and February 2025. I have called so many times. They continue to fraudulently charge my card. I have asked for phone #'s and emails to file a complaint, always given emails that did not work. This is a scam. I have been working with my credit card to dispute all of these charges. I would like a complete refund. Thank you, ****** ******
Business Response
Date: 03/05/2025
**** ******* **********
Please see our
response to complaint # ******** for ****** ****** on behalf of daughter *******
****** that was received by us on February 24, 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 ******* ****** had an ********** ******** plan the concerns
from the complainant would need to be addressed directly to ********** ********.
An inquiry was submitted to ********** ******** for them to respond/resolved
the issue, we were advised that ********** ******** will respond directly to
the member or complainant regarding her concerns.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address Ms. ******’s 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
Business Response
Date: 03/05/2025
**** ******* **********
Please see our
response to complaint # ******** for ****** ****** on behalf of daughter *******
****** that was received by us on February 24, 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 ******* ****** had an ********** ******** plan the concerns
from the complainant would need to be addressed directly to ********** ********.
An inquiry was submitted to ********** ******** for them to respond/resolved
the issue, we were advised that ********** ******** will respond directly to
the member or complainant regarding her concerns.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address Ms. ******’s 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

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