Business Profile

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.
467 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:06/18/2025
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.
Aetna stopped their contract with ********** ** ** hospital / clinic june 1st 2025. Right in a middle of a year i cant see my doctors anymore and i can t even use out of network benefits as there is non.. you cant do that to people your solution is to switch to a different hospital or clinic? Well i ** ****** *** because it is not as easy. I will nver choose you aetna and will switch as soon as i can
Business Response
Date: 06/20/2025
**** ******* **********
Please see our response to complaint
# ******** for *****
****** that was received by us on June 18, 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 complaint, we immediately reached out internally to further
research the member’s concerns. We confirmed that as
of June 1, 2025, ********** ** ********** **** ******* *****r providers and facilities are no longer a part of our
Commercial and Medicare Advantage health plan networks. However, we are
continuing our contract discussions in hopes of reaching an agreement that will
bring them back into our health plan network. Should negotiations be successful
in securing a new contract, a notification will be sent to our members.
If the member was
receiving an active course of treatment that continued past May 31, 2025, they
should work with their care team to request transition of care (TOC) coverage.
The request can be initiated by following the instructions on the attached form
or they may contact member services by dialing the phone number on the back of
their member identification card. Additionally, they can assist the member
with locating participating providers in their area. Please know, TOC coverage
requests are subject to approval by Aetna.
An active course of
treatment means that the member has begun a program of planned services with their
doctor to correct or treat a diagnosed condition. To be considered for TOC coverage,
treatment must have started before the date their doctor or facility left the
health plan’s network or before the date a doctor or facility’s network status
changed.?If the member is not
receiving an active course of treatment, they still may submit a request for TOC
coverage or if applicable, they can submit a network deficiency request (gap
exception). However, we cannot guarantee that either request will be approved.
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 [email protected].
Sincerely,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Customer Answer
Date: 06/24/2025

Complaint: ********

I am rejecting this response because:

Sincerely,

***** ******
Customer Answer
Date: 06/24/2025
I am not able to see my doctors and get procedures done i basically pay for insurance that i cant use. I am not happy with aetnas response. This shouldnt have happened in a middle of a year.
Initial Complaint
Date:06/17/2025
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.
Patient ********* ******* was seen on April 1, 2025, at our office. He received his twice-monthly ******** injection (for asthma) along with his allergy injections (for allergic rhinitis). Aetna denied the allergy injections stating they were part of the patient's ******** injection. These services are two separate procedures for two separate conditions. Every two weeks, the patient has both services done on the same day, and every time we send in the claim, Aetna denies the allergy injections. We have to appeal these every two weeks with medical records substantiating the billing of the two separate services. Most of those appeals are subsequently paid. This claim, however, was denied in a 'final appeal' denial letter received by our office. It is apparent that the 'complaint and appeal analyst, Christine B' did not review our appeal with the provided medical records before denying our appeal. Aetna needs to be held responsible for these erroneous denials and subsequent waste of provider office's time in getting these claims properly processed/paid.
Business Response
Date: 06/24/2025
**** ******* **********
Please see our
response to complaint # ******** for ******* ******* on behalf of provider
***** ***** that was received by us on June 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 appeal was reviewed incorrectly. The nurse upheld the
denial but the provider disputes these claims every two weeks to receive payment
for procedure code *****. Each time the claims are reprocessed and allowed for
payment. The appeal under case number ************* was overturned to be approved.
A corrected letter was sent to the provider and the claim was sent back for reprocessing
to allow the payment of procedure code *****. The provider will receive a new
Explanation of Benefits (EOB) once the claim has been reprocessed and
finalized. The provider should allow up to 7-10 business days for the claim to be
finalized for payment.
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

Customer Answer
Date: 06/24/2025

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:06/16/2025
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 am filing this complaint against Aetna regarding the wrongful denial and lack of response to my Critical Illness claim, specifically related to a medically documented stroke I suffered in 2024.
In February 2025, I submitted a full claim (************) package under my Critical Illness policy with supporting documentation from my MRI, neurologist, cardiologist, primary care physician, and psychologist. Despite clear medical evidence, including a confirmed ischemic stroke with lasting cognitive and emotional impairments, my claim was denied in April 2025 on the grounds that it did not meet the definition of “critical illness.”

This denial is unjustified, as the Aetna policy states that stroke benefits are payable if neurological deficits persist for more than 24 hours, which my medical records clearly support. My stroke was confirmed by MRI and further supported by multiple provider letters and records, including ongoing therapy and treatment.

On May 15, 2025, I submitted an appeal package via **** (tracking #**********************), which included:
My only copy of the MRI

A detailed appeal letter

Updated provider letters: Neurologist, Cardiologist, Family doctor, and hospital discharge

Documentation of an upcoming heart procedure to close a PFO, believed to have caused my stroke

As of today, June 16, 2025, Aetna has not acknowledged or responded to the appeal package. This is the second time I’ve provided extensive documentation, and I feel Aetna has been delaying and mishandling my case since the beginning of the year. This ongoing situation has caused significant emotional and financial stress, especially as I continue medical treatment and therapy related to the stroke.

I respectfully request that Aetna: Reverse the denial and pay the benefit outlined in my policy
Business Response
Date: 06/23/2025
**** *** ******* **********

Please see our response
to complaint #******** for *** ******** that was received by us on June 16, 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 *** **********
concerns reviewed. Based on the review it has been confirmed that the critical illness claim for the stroke benefit has been reviewed and approved. The claim
************ has been processed to pay $10,000. The payment will be issued via direct deposit to the member’s account on file.

We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Ms.
Castillo’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
Customer Answer
Date: 06/24/2025

Complaint: ********

Dear Executive Resolution Team,

Thank you for your recent response via the Better Business Bureau confirming the approval and payment of my critical illness claim (#************) for a stroke diagnosis dated May 24, 2024.

However, after reviewing my policy details, I believe there has been an underpayment. As shown on my Aetna member dashboard, my Critical Illness coverage for 2024/2025 includes a $15,000 benefit. Since stroke is a covered condition under Critical Illness, I was expecting the full $15,000 payment. To date, I have only received $10,000 via direct deposit.

I respectfully request clarification on why the full benefit was not paid, and I kindly ask that the remaining $5,000 be issued as per the policy terms.

I have attached a screenshot showing my policy coverage clearly indicating the $15,000 amount.

Thank you for your prompt attention to this matter. Please confirm receipt of this message and let me know how this will be resolved.

Sincerely,
*** ********
***** ********** **
*********** ** *****

Business Response
Date: 07/02/2025
**** ******* **********
Please see our response
to complaint # ******** for *** ******** that was received by us on June 24, 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 complaint, we immediately
reached out internally to further research the member’s concerns. We confirmed
that *** ********** date of diagnosis was May 24, 2024. During the 2024
coverage year, *** ******** had the $10,000 policy. Although *** ********
submitted the claim in 2025, the benefit amount is based on the year of
diagnosis. It is not based on the date of claim submission. Also, the critical illness
screenshot that *** ******** submitted as evidence has a start date of January
1, 2025. Thus, *** ********** claim of $10,000 was processed correctly.
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,

Brittany
F.
Analyst,
Executive Resolution
Executive
Resolution Team
Initial Complaint
Date:06/16/2025
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 writing on behalf of my elderly mother, ****** *****, pursuant to the POA that will be included with this complaint. We recently detected an ACH withdrawal from her bank account on 5/28/25 in the amount of $19.32 paid to “Aetna Life Insurance Company.” My mother lacks the capacity to have knowingly agreed to any such arrangement, which we fear was procured by deceptive and coercive sales tactics and under extreme duress. We demand an immediate refund and cancellation of any policy related to this charge. We have received no paperwork related to this transaction or any policy and therefore have no additional details to provide.

For reference in investigating this matter, her address is:
**** ********** *******
**** ****
******** ***** ** *****
Business Response
Date: 06/23/2025
**** *** ******* **********

Please see our response to follow-up on complaint
# ******** for Ms. ****** ***** that was received by us on June 16, 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 Ms. ***** concerns. We have confirmed on
April 23, 2025, there were two Aetna Life Insurance policy applications
received and two policies active for Ms. *****. The policy number **********,
which is a Cancer, Heart Attack, Stroke policy included a cost of $19.32. The
policy number **********, which is a Cancer only policy, included a cost of
$15.31. Both policies were effective May 23, 2025. The policies are in the free
look period. The free look period is the required time period in which a new
life insurance policy owner can terminate the policy without any penalties,
such as surrender charges. A free look period often lasts 10 or more days
depending on the insurer and state law. As requested, we have cancelled both
policies as of the effective date, May 23, 2025. A full refund of $19.32 for
the policy number ********** and $15.31 for policy number ********** and has
been issued to Ms. *****. Please know, Ms. ***** will receive a refund check in
the mail and a letter confirming the cancellation of both of these policies. If
the family has any additional questions, they can contact the Aetna Continental
Life Insurance Company directly at ###-###-####.

The beneficiary will receive a detailed Medicare
Resolution Letter within 7-10 business days with this response, from us, as
well.

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

Sincerely,
Marilyn G.
Analyst, Medicare Enterprise Resolution
Initial Complaint
Date:06/11/2025
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.
To Whom It May Concern,

After attempting to formally appeal directly with Aetna, I am writing this to dispute the denial of in-network coverage for medical services provided on March 11, 2025, by *** **** ********* at ********* *******, related to a colonoscopy and biopsy.

The reason for denial states that the provider is not in-network with my Aetna plan. However, I have attached documentation showing that both *** ********* and ********* ******* were listed as in-network at the time I scheduled and received the procedure, as well as currently still showing as in-network. These listings were verified through Aetna’s provider directory, accessed through my member portal.

If there has been a change in network status, I request a clear explanation including the exact dates during which the provider was considered out-of-network.

Given that I relied in good faith on the information provided by Aetna, I request that this claim be reprocessed as in-network. If further documentation is needed, I am happy to provide it.

Thank you for your attention to this matter. I look forward to a prompt and fair resolution.

Sincerely,
******** *****
Aetna Member ID *************
Claim Number *********
Business Response
Date: 06/20/2025
**** *** ******* **********

Please see our response
to complaint #******** for ******** ***** that was received by us on June 11, 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 ***
*****’s concerns reviewed. Based on the review it has been confirmed that the
claim from the date of service has been reprocess per the member’s in-network
benefits. The member has a responsibility of $862.92 that applied to the coinsurance.

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,

Marshell H.
Analyst, Executive Resolution
Executive
Resolution Team
Initial Complaint
Date:06/11/2025
Type:Billing 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.
December 20, 2024 i called number that was suppose to be Aetna health. When they answered i ask if they were an Aetna agent and he said yes. He sold me a Medicare supplement that was supposed to be a Medicare Advantage plan covering dental, vision, hearing, and prescription drug coverage. No premiums monthly, no co-pays, no deductibles. I only was to pay $706 one time for my self and husband. As time passed I received no card so I called Aetna and they said I had no such plan with them. So upon investigation I found they lied to me on so many fronts. I decided to cancel so I called to cancel and was told they had charged me an additional $706 in January. I told them I cancelled the policy but they did not cancel it when I ask them to. Now I wait for reimbursement of the charges. They keep saying 7 - 10 Days everytime i call and still no reimbursement. This company lies and is deceptive! I need my money put back in my account immediately! Please help.
Business Response
Date: 06/19/2025
Dear Stewart Henderson:
Please see our response
to complaint # ******** for ***** ****** that was received by us on June 11, 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 complaint, we immediately reached out internally to further research Ms.
******’ concerns. We confirmed that Ms. ****** had
an ******* Medicare Supplement Plan G policy effective July 1, 2022. On
December 20, 2024, Ms. ****** contacted us to cancel her ******* policy, so we
canceled the policy, and a cancellation notice dated December 23, 2024, was
mailed to the address on file. In January 2025, Ms. ****** applied for the *****
Medicare Supplement Plan N policy which went into effect on February 1, 2025,
and is still active.

Please know, the
plan contacted Ms. ****** to obtain clarification regarding this concern because
we do not have any record of withdrawing $1,400 from her account. Ms. ******
informed us that the $1,400 charge was with another company, and she has been
refunded. Ms. ****** did not have any additional questions for us regarding
this matter.
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: 06/27/2025
This has been resolved, they finally sent me the reimbursement I was waiting for. Please close this case.
Thank you,

***** ******
Initial Complaint
Date:06/09/2025
Type:Billing 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.
In September 2021, a previous dental practice, ***** **** ********* *** ****** ********** sent Aetna Inc. an Estimate of Service (EoS) for Root Scaling. I had two dental insurances Aetna (Primary) and *** **** (Secondary) ******* Paid $235 on 8/8/23. Around Nov/Dec 2023 I realized Aetna did not pay anything the remaining balance of $357.80.
In March of 2025 I called Aetna and spoke with Janice W****, she needed to work with a manager to get the requested information on the resubmitted claim which was denied again
In March/April Janice actually followed up with me and stated she needed the invoice from the dental office showing what was due and paid and she would contact the dental office was able to provide this information. Janice called and let me know she contacted the Dental office and they didn’t have me as a patient and that there was conflicting information in my story. She stated she needed to know what the secondary insurance paid and the dates I had the insurance, etc. I provided this information to Janice W**** on April 16 via email. On April 16 responded via, Janice wrote “ this wasn’t going to work because she because it has to be itemized showing each procedure code and the date for which visit it applies to” I contacted my dental office and sent the requested information on April 24 to the Janice W****.
I never heard back from Janice, but I called Aetna in May 2025 after seeing Aetna was waiting for information from my primary insurance to process the claim. After informing Aetna they were the primary I then had to direct the representative to resubmit the claims. I still have an outstanding bill from my visit on 2/13/25 for a 2 resin composite for $171.06. While on the phone I inquired about the original claim for a root scaling, and the representative didn’t see the information, but told me to hold while she spoke with a manager. While on hold I was disconnected and the representative never called me back.

Attachment has total problem
Business Response
Date: 06/13/2025
**** *** ******* **********

Please see our response
to complaint #******** for ****** ****** that was received by us on June 09, 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. Based on the review it has been confirmed that the
claim from the dates of service May 08, 2023, and June 14, 2023, for the
scaling and root planning was processed with a payment of $616.00 to the
provider. The claim from the dates of service February 13, 2025, was processed
with a payment of $112.00. The payments were sent to the office of Dr. Matthew
Garbin. I have included copies of the Explanation of Benefits (EOBs) for these
claims. We have confirmed that the
claims were pending for the EOBs from the primary insurance carrier MetLife.

We
have confirmed that the claim for *** **** **** ****** from the date of service
July 15, 2021, has been voided and the provider has paid back the funds as of
November 17, 2021.

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: 06/13/2025
**** *** ******* **********

Please see our response
to complaint #******** for ****** ****** that was received by us on June 09, 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. Based on the review it has been confirmed that the
claim from the dates of service May 08, 2023, and June 14, 2023, for the
scaling and root planning was processed with a payment of $616.00 to the
provider. The claim from the dates of service February 13, 2025, was processed
with a payment of $112.00. The payments were sent to the office of Dr. Matthew
Garbin. I have included copies of the Explanation of Benefits (EOBs) for these
claims. We have confirmed that the
claims were pending for the EOBs from the primary insurance carrier MetLife.

We
have confirmed that the claim for *** **** **** ****** from the date of service
July 15, 2021, has been voided and the provider has paid back the funds as of
November 17, 2021.

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
Customer Answer
Date: 06/16/2025

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,

****** ******
Customer Answer
Date: 06/16/2025

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:06/09/2025
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 have Medicare Healthcare Insurance through the ****** ******** ************** Office in my area. I'm getting notices from Aetna, and bills, stating I owe a monthly bill. I pay the *** $185.00 monthly. Aetna is fraudulently sending me letters trying to get money from me. The address on the bills are: Aetna, **** *** ****** *********** ** **********, and AETNA, **** *** ******** ******** ** *********** Aetna listed a Member ID ************. The telephone # ###-###-####. I don't understand why Aetna's trying to extort money from me. Aetna has been placed on my insurance profile as if they're my health insurance provider. I don't know if ******************** * ****** ********* listed Aetna and placed on my insurance coverage profile, but I won't Aetna taken off immediately.
Business Response
Date: 06/19/2025
**** *** ******* **********

Please see our response to complaint # ******** for *** **** ********, which we received on June 9, 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 enrollment history. The member was enrolled in the Aetna Medicare Premier (HMO) plan effective January 1, 2025. We confirmed that *** ******** applied to be enrolled in the Aetna Medicare Premier (HMO) plan by phone on, December 6, 2024. The monthly plan premium for the plan is $0. We encourage the member to feel free to let us know if she did not agree to be enrolled in the Aetna Medicare Premier (HMO) on December 6, 2024. There was enrollment confirmation letters sent to the address on file. However, we have received returned mail from the ****** ****** ****** *******. The member can contact the plan to update her mailing address.

There was a Late Enrollment Penalty (LEP) added to the member’s monthly premium because she did not have creditable prescription drug coverage for 63 days or more in a row after she was eligible for Medicare drug coverage. This is Medicare prescription drug coverage or other drug coverage that meets Medicare's minimum standards. Medicare told us, the member did not have creditable coverage for 32 months. There was an LEP of, $11.80 added to the member’s monthly premium. If the member disagrees with the LEP, she can ask Medicare to reconsider or review its decision if certain circumstances apply to her. The member can ask for an appeal online at Web Portal Address: ****************************************. I have attached the Part D Later Enrollment Penalty (LEP Reconsideration Request Form. We are here to assist if the member has questions about the Late Enrollment Penalty. The member can call us at ###-###-#### Monday through Friday 8:00 a.m. to 5:00 p.m. local time.

There is a premium balance of $82.60 on the member’s account. There are multiple ways members can pay their plan premium.
-Members can pay by check. Please make check or money order payable to:
AETNA
**** *** *******
******** ** **********
-Members can pay by phone. Call ###-###-#### for one-time or automatic payments by card or bank account.
-Members can pay online at *************************
-Members can pay by electronic funds transfer (EFT).
-Members can have the plan premium taken out of your monthly ****** ******** check
-Pay bill at CVS Pharmacy. Take the premium invoice to any CVS Pharmacy to pay with cash, credit card or debit card.

The member advised that she wants to disenroll from the Aetna Medicare Premier (HMO) plan. Requests to disenroll must be sent in writing. I have attached the plan's Disenrollment Request form for *** ******** to review.

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: 06/20/2025
Aetna is not my medicare provider. My Medicare provide is the ****** ******** ************** where I pay $185.00 monthly for my medicare healthcare plan with the ***. I have the paperwork. Aetna is a fraud. I am not paying Aetna zero. I would like to know who falsely indicated on my insurance profile that Aetna and **** were my insurance providers. Did ******************** tell this lie? Did ********** ********* tell this lie and placed these two fraudulent insurance companies on my healthcare plan profile? I would like to know, because I owe Aetna $0.00 dollars. Again, Aetna is not my provider. Aetna is a FRAUD.
Business Response
Date: 07/02/2025
**** *** ******* **********

Please
see our response to follow-up to the rejection of complaint #******** for ***
**** ******** that was received by us on June 20, 2025.

Upon
receipt of the rejection of our previous response, we immediately took a second
look at the member’s account. We have confirmed the member’s enrollment was
an unassisted self-enrollment completed online, as an online application
submitted on December 6, 2024. Below are the details of the unassisted
self-enrollment website the application was received from:

IP Address: ************

URL: ***************************************

We confirmed *** ******** is enrolled into an Aetna Medicare
Premier (HMO) plan effective January 1, 2025, and is currently still active.
The Aetna Medicare Premier (HMO) plan has a $0 monthly plan premium.

We were notified by Medicare that *** ******** didn’t have
Medicare prescription drug coverage or other drug coverage that met Medicare’s
minimum standards (creditable coverage) for 32 months. Medicare advised us that
she has a Late Enrolment Penalty (LEP) amount of $11.80 added to her plan
premium effective January 1, 2025. We show the plan has not received any
payments from her January, through July, at $11.80 each month. We confirmed ***
******** has a LEP premium balance due of $82.60 due on her account.

As we previously have advised, if *** ******** disagrees
with the LEP amount, she can ask Medicare to reconsider or review its decision
if certain circumstances apply to her, by utilizing the Late Enrollment Penalty
Reconsideration request form that we provided in our previous response.

Please know, according to Medicare guidelines, the rules
state that members may change or end their membership in our plan only during
certain times of the year, known as enrollment periods. The enrollment periods
set by original Medicare are as follows:

Annual Enrollment Period (AEP):
The AEP is a set time each fall when members can change
their health or drug plans or switch to Original Medicare. The Annual
Enrollment Period is from October 15 until December 7. If members do not make
any changes, the member will remain in the same plan with any changes that were
contained in the ANOC becoming effective January 1st.

Open Enrollment Period (OEP):
The OEP is a set time each year when members in a Medicare
Advantage plan can cancel their plan enrollment and switch to another Medicare
Advantage plan or obtain coverage through Original Medicare. If members choose
to switch to Original Medicare during this period, members can also join a
separate Medicare prescription drug plan at that time. The Medicare Advantage
Open Enrollment Period is from January 1 until March 31, and is also available
for a 3-month period after an individual is first eligible for Medicare.

Special Enrollment Period (SEP):
The SEP is a set time when members can change their health
or drug plan or return to Original Medicare. Situations in which members may be
eligible for a Special Enrollment Period include: if members move outside the
service area, if members are getting “Extra Help” with their prescription drug
costs, if members move into a nursing home, or if we violate our contract with
the member. Our members can find out if they are eligible for a Special Enrollment
Period, by directly calling Medicare at ************** *****************

If *** ******** has any questions or would like more
information on when she can change or end her membership with the plan, she can
contact her State Health Insurance Assistance Program (SHIP). The State Health
Insurance Assistance Program (SHIP) is an independent government program with
trained counselors in every state. It is a state program that gets money from
the Federal government to give free local health insurance counseling to people
with Medicare. SHIP counselors can help members with their Medicare questions
or proble*** They can help members understand their Medicare plan choices and
answer questions about switching plans. *** ********’s SHIP can be contacted at
###-###-####. She can also visit their website:
****************.

In regard to *** ******** stating that she pays $185 to the
****** ******** ************** (***) for her Medicare healthcare plan with the
***, we do not have any information on why she is paying that amount to ***. She
would need to clarify that by contacting her local ****** ******** office, or
call ****** ******** at ###-###-####, 8am to 7pm, Monday through Friday.

The
member will receive a detailed Medicare Resolution Letter within 7-10 business
days with this response, from us, as well.

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,
Marilyn
G.
Analyst, Medicare
Enterprise Resolution
Customer Answer
Date: 07/02/2025

Complaint: ********

I am rejecting this response because, I was enrolled only in ****** ******** ************** Medicare Healthcare Plan, and I pay $185.00 per month to the ****** ******** ************** ONLY.
I do not owe Aetna. I am NOT interested in Aetna's HMO plan. I have not spoken with a representative from Aetna. I just know they are trying to extort money from me for a healthcare plan I do not know anything about. Aetna is a FRAUD. **** HMO is a FRAUD. Neither one of these providers are my healthcare plan.
I would like to know who lied and said Aetna and **** were my medicare plans? Please provide this information to me, because I need to know if it was ********************, ********** *********, Aetna or ****. I'm filing a complaint with the *** Fraud Office to report Aetna & **** as frauds. I NEED THESE TWO FRAUDULENT COMPANIES TO TAKE THEIR NAMES OFF OF MY PERSONAL INSURANCE PROFILE, IMMEDIATELY.
Sincerely,

**** ** ********* ***** ****
Business Response
Date: 07/03/2025
**** *** ******* **********
Please see our response to the BBB Rejection Complaint #
******** – Medicare Enrollment Dispute, for *** **** ********, which was
received by us on July 2, 2025. Our Executive Resolution Team researched the
concerns, and I would like to share the results of the review with you.

Concern Regarding Unauthorized Enrollment
We have initiated an internal review to investigate *** ****
********’s concern about the unauthorized association of our Aetna Medicare
plan with the member’s insurance profile. We understand that *** ******** is
enrolled only in the ****** ******** ************** (***) Medicare Healthcare
Plan and has not authorized any additional coverage.

Please note that Aetna does not have access to ****’s
systems or personal account information. If *** ******** has received any
correspondence or billing statements from ****, we recommend contacting their
customer service directly using the contact information provided in their
communication.

Your Enrollment Details
After reviewing *** ********’s account, we confirmed that
the enrollment in the Aetna Medicare Premier (HMO) plan was completed through
an unassisted online application on December 6, 2024. No agent was involved in
this process.
Enrollment *******:

Plan: Aetna Medicare Premier (HMO)
Application Date: December 6, 2024
Submission Method: Online
IP Address: ************
Website: ***************************
Effective Date: January 1, 2025
Monthly Premium: $0

Late Enrollment Penalty (LEP)
Medicare has informed us that *** ******** did not have
creditable prescription drug coverage for 32 months prior to your enrollment.
As a result, a Late Enrollment Penalty (LEP) of $11.80 per month was
applied, effective January 1, 2025.

As of today, no LEP payments have been received for January
through July, resulting in a total balance of $82.60.

How to Appeal the LEP
If *** ******** believes this penalty was applied in error
or if creditable coverage was active during this period in question, ***
******** may request a reconsideration through Medicare.
*** ******** can use the Late Enrollment Penalty
Reconsideration Request Form we previously provided. For further
assistance, contact Medicare at ************** (**************).

Medicare Enrollment Periods
Medicare allows plan changes only during specific times of
the year:

Annual Enrollment Period (AEP): October 15 – December 7
Switch plans or return to Original Medicare.
Open Enrollment Period (OEP): January 1 – March 31

Switch Medicare Advantage plans or return to Original
Medicare and join a drug plan.
Special Enrollment Period (SEP): Available under
specific conditions (e.g., moving, entering a nursing home, qualifying for
Extra Help).

To check eligibility, contact Medicare or your
local State Health Insurance Assistance Program (SHIP).

Additional Support
For free, unbiased help understanding your Medicare options,
contact SHIP:

Phone: ###-###-####
Website: ****************

*** Premium Payment
Regarding your $185 payment to the ****** ********
Administration (***), please note that Aetna does not have access to ***
billing records. For clarification, contact *** directly
at ###-###-####, Monday through Friday, 8 a.m. to 7 p.m.

Final Remarks
We sincerely regret any confusion or inconvenience this
situation may have caused the member. We are committed to transparency and
member satisfaction and will continue to support the member in resolving this
matter through the appropriate channels.
Please let us know if any additional information is
required.

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,

Meli*** R.
Analyst, Medicare Executive Resolution
Medicare Complaint Team
Initial Complaint
Date:06/09/2025
Type:Sales and Advertising 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.
Please stop calling me and asking me to call you back. I have not been a member for many years. Please remove me completely. This happens every couple of years or so. Tired of it. Know who is a member and who isn't. That's part of your job.
Business Response
Date: 06/18/2025
**** *** ******* **********

Please see our response to complaint # ********, for *** **** ***, which was received by us on June 9, 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 account. We confirmed that *** *** sent a fax to Aetna requesting information on Monday February 26, 2024.

*** *** stated in the fax, “Just because she requested information does not mean you need to again start sending me explanation of benefits in the mail and emails about coverage I have not had for years. I am tired of requesting this to stop. I request, it stops for a bit then starts up again.

Please stop sending me member information when I am not a member. Kindly have someone email me to let me know this has been received and addressed.”

NOTE: “Aetna has submitted the request to stop the calls; it can take up to 30 days to become effective.

We want to let the member know the Do Not Call request is good for 5 years. The request only applies to automated calls (Robocalls/IVR), telemarketing calls, and texts. This does not apply to wellness and health-related live manual calls.”

Also, if a provider submits a claim for additional information or correction, then we are required by law and the Centers for Medicare & Medicaid Services (CMS) to provide you and the provider with an updated explanation of benefits.

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,

Melissa R.

Analyst, Medicare Executive Resolution

Medicare Complaint Team
Customer Answer
Date: 06/18/2025

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.
However, it should be noted that February 26, 2024 to today, is far more than 30 days.

Sincerely,

**** ***
Initial Complaint
Date:06/06/2025
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'm an Aetna member with major depressive disorder. Seeing as I was at the end of my rope, I began looking into doing IOP care again. There are only two mental health IOP facilities in my area. Neither are in-network.

Called to report a network deficiency, as the only options were online and I do not respond well to online therapy (and tend to instead have negative reactions). Got told I need the CPT, ICD, and NPI data for the provider.

How would I have that without already seeing the provider? IOP services are hundreds of dollars - am I supposed to go to the doctor KNOWING there's a chance I'll be on the hook for all of it?

*** ********. I'm trying to get help. Instead, Aetna bounced me back and forth between departments. What kind of insurance puts the onus on the patient to initiate a single case agreement request? I've worked for three insurance companies - every single one, when a network deficiency was identified, the provider relations team was notified so THEY could see about getting an appropriate provider brought into their network. THEY did the research and outreach. That Aetna just blatantly does not care is devastating.

My plan has good in-network mental health benefits. Aetna just can't be bothered to fix their inadequate network.
Business Response
Date: 06/11/2025
Dear ******* *********:
Please see our response
to complaint # ******** for ****** ******* that was
received by us on June 6, 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 complaint, we immediately
reached out internally to further research the member’s concerns. We could not
locate any participating intensive outpatient program (IOP) providers who could
perform the requested services in the member’s area. Also, we do not have access to out-of-network (OON) providers, so essentially the
member can go to one of the OON providers that she mentioned and get assessed. Please
keep in mind that the OON provider must be willing to work with Aetna. Regarding
an IOP network deficiency, *** ******* is not the one who would call in for the
precertification. If *** ******* has a specific program that she wants to
attend, the OON provider will complete an assessment then contact us to go
through the network deficiency process. If the provider is an in-network IOP,
then no precertification is required.
Furthermore, our clinical staff contacted the member and assessed her
for safety. During the call, *** ******* did not report suicidal ideation, and
she stated she is not in need for emergent care. If *** ******* feels that she is
suicidal, we recommend that she goes to the nearest emergency room and/or
consider an inpatient level of care.
Please know, the member has been assigned a case manager who will assist
with this process and work with her directly. The case manager called *** *******
on June 9, 2025, and emailed her their direct contact information. In addition,
the member’s call history is currently being reviewed and if necessary,
feedback will be provided. We sincerely apologize for the
inconvenience and difficulty this situation may have caused.
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,

Shay
G.
Analyst,
Executive Resolution
Executive
Resolution Team

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