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Aetna Inc.This business is NOT BBB Accredited.
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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.
If you've experienced an issue
Submit a ComplaintThe 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:06/06/2025
Type:Customer Service IssuesStatus: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 two unresolved claims with Aetna for 12/23/24 for ** ****** and ********** ****** Surgery Center. I was promised multiple times the claims would be paid and still have no result. I have provided all requested information and claims related to this event before and after were paid with no issues. Its just the two claims. I have exhausted all I have with the insurance company with no result. I also filed a internal complaint with them and review with no result.Business Response
Date: 06/13/2025
**** ******* **********
Please see our
response to complaint # ******** for ***** ****** that was received by us on
June 6, 2025. Our Executive Resolution Team researched the concerns, and I
would like to share the results of the review with you.Upon
receipt of your request, we immediately reached out internally to further
research the concerns. After
further review it
was determined that the claim from the facility is pending as of May 30, 2025,
the claim is pending for a description of the procedure codes billed. This was
sent to the facility for them to send us additional information for the
procedure codes billed on the claim. Once we receive the additional information
the claim can be reprocessed. The claim from the provider has been processed
and paid as of June 9, 2025.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 TeamCustomer Answer
Date: 06/13/2025
Complaint: ********
I am rejecting this response because: the one bill that is still pending I completed a three way call with ********** ****** and the insurance and they have recorded medical records and they paid the doctor now from the procedure makes no sense why they need more than medical records
Sincerely,
***** ******Business Response
Date: 06/20/2025
**** *** ******* **********
Please see our response
to complaint #******** for ***** ****** that was received by us on June 13, 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 Mr. ******’
concerns reviewed. Based on the review it has been confirmed that the claim
from the date of service December 23, 2024, has been reprocessed for the services
rendered. There is a member responsibility of $150.00 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 Mr.
******’ 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 TeamCustomer Answer
Date: 07/02/2025
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:06/06/2025
Type:Order IssuesStatus: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.
Aetna Voluntary Claims Dept ** *** *****, ************ ********** (Ph *** *** ****, Fax *** *** ****) On 4/29/24, I filed a claim with Aetna Voluntary Insurance under claim #************, it closed without my knowledge due to accident not meeting the definition. That was incorrect, I tripped and fell resulting to injury to my left ankle (both r and l sides), right knee, and hamstring strain. On 5/30/25, Aetna rep agreed the decision was incorrectly denied for not meeting the definition of an accident, and sent it back for review. After multiple calls, Aetna opened claim #************ to address injury DOS 7/22/24 but failed to transfer the original claim docs submitted under claim ending in ****. Upon submitting my claim documents I reported the claim via their online claims portal and submitted documents and bills. There were a small amount of bills that I didn't physically have, and I was told previously that Aetna could pull them from their website, and that all I needed to do was indicate the dates of service (DOS) in my reporting.. On 5/30/25, I called and spoke to a rep at Aetna who opened up the denied claim (claim#************) and reviewed the docs and stated the claim was incorrectly denied and said she would send it to the claims dept to be processed with high priority. I called again on 6/2/25 and a supervisor wasn't available and the person I spoke with again escalated the claim to the claims dept for priority review and processing. On 6/4/25, I finally received a call from a Quality Assurance Sup, Michele (ID# *******) stated, claims had opened up claim #************, to address the injury related to DOS 7/22/24. I expld I saw that on the portal however they were only addressing a small portion of the reimbursements that are afforded under my accident policy. In total my benefit reimbursement should have been approx $3700. Aetna claims denied & closed my claim without proper review. They have the docs to correctly process and refuses to review them.Business Response
Date: 06/10/2025
Dear *** ******* *********:
Please see our response
to complaint #******** for ******* **** that was received by us on June 06, 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.
****** concerns reviewed. Based on the review it has been confirmed that the original
claim ************ paid the following benefits:
Initial visit: $240.00
X-ray: $240.00 (1 per accident)
Follow up visit #1: $80.00
Follow up visit #2: $80.00
Surgery with repair: $400.00
Total payments paid: $1,040.00.
Additional
benefits were allowed per the reprocessed claim ************ as followed:
Follow up visit #3: $80.00
Follow up visit #4: $80.00
Follow up visit #5: $80.00
Follow up visit #6: $80.00 (6 follow up visit are allowed per accident)
Magnetic Resonance Imaging (MRI): $400.00 (1 allowed per accident)
Physical Therapy #1: $80.00
Physical Therapy #2: $80.00
Physical Therapy #3: $80.00
Physical Therapy #4: $80.00
Physical Therapy #5: $80.00
Physical Therapy #6: $80.00
Physical Therapy #7: $80.00
Physical Therapy #8: $80.00
Physical Therapy #9: $80.00
Physical Therapy #10: $80.00 (10 physical therapy visits are allowed per accident)
The total payment of $2,620 will be direct deposited into the member’s account on file.
Ms.
****** coverage shows terminated as of February 28, 2025, therefore the
benefits for the epidural from March 04, 2025, and the minor appliance from
March 17, 2025, are not payable.
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,
Marshell H.
Analyst, Executive Resolution
Executive
Resolution TeamCustomer Answer
Date: 06/11/2025
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:06/05/2025
Type:Customer Service IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
My doctor provided a prescription. Aetna/cvs want a cheaper formulary. My doctor says no. Aetna/processed for the cheaper medicine despite doctors orders and denied the doctors prescription. They took 16 days to make that determination. I’m paying premiums for that?Business Response
Date: 06/11/2025
Dear ******* *********:
Please see our response
to complaint # ******** for ****** ***** that was received by us on June 5, 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 the member’s requested prescription is not covered since it is a non-formulary medication. To be considered for coverage, a member may
submit a request for an exception. Along with the submission, a prescriber must
submit documentation to prove medical necessity and show that the member cannot
take any of the covered alternatives for the requested medication to be
approved. Please know, the request for an exception was already submitted, and
a determination has been made.On the criteria form that the prescriber filled out and submitted to
Aetna, the prescriber marked that it is okay to switch to the formulary drug.
Because the prescriber indicated the member can be switched from the requested
medication to its alternative (the formulary drug), we were able to approve the
formulary drug on May 29, 2025.
Furthermore, we confirmed that there were no delays in the determination
process. A precertification request typically takes up to 72 business hours for
completion. However, the member’s request was processed within one business day.
Should Mr. ***** have any additional questions regarding his medication, he may
contact the pharmacy team at ###-###-####.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 TeamInitial Complaint
Date:06/04/2025
Type:Billing IssuesStatus: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.
Myself and my wife both received separately the next monthly bill mid December for January 2025. The amount went from around $13 a month to over $48 a month after the early December time to change. We both called within 10 days or so to complain and cancel the enrollment with them. We were both told don't worry and it would automatically cancel after 90 days with no problems. They are still sending notices and now say we owe $96.60 which appears they charged 2 months even though we made multiple calls cancelling. First, they should not be able to increase premium 300% and notify after cutoff date to drop. They said they notified several months earlier and my wife and I did not see anything. Something like that should be Highlighted in bold on the 1st page where no one can miss it. One of the people I spoke to said they had a lot of complaints regarding the recent price increase. This is unacceptable especially when I found out the penalty they kept trying to scare us with, was only around $0.40 a month which would take years to even approach 2 months of their increase.Business Response
Date: 06/17/2025
**** *** ******* *********:
Please see our response to follow-up on complaint
# ******** for *** *** ***** which was received
by us on June 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 in the member’s account, that
the concern pertains to the changes of the SilverScript Prescription
Drug Plan (PDP).
The member was enrolled in the SilverScript PDP which became
effective September 1, 2021, and terminated on February 28, 2025.
This concern was also resolved under complaint numbers,
*********** and ***********.
We requested an Appointment of Representative Form to review
the wife's account; however, this form was never received. As mentioned in our
email, in the absence of that form, we were only able to investigate *** ****’s
account.
We consolidated our plans in alignment with the Inflation Reduction
Act. It has impacted Medicare Part
D by introducing a $2,000 annual out-of-pocket cap on prescription drug costs,
essentially eliminating the "donut hole" coverage gap.
The Centers for Medicare and Medicaid Services (CMS) does not consider
plan consolidation as termination or non-renewal of a plan. Therefore,
individuals impacted by a plan consolidation do not qualify for a Special
Enrollment Period (SEP) that allows them to re-enroll in a different plan.
These plan
changes were communicated via the Annual Notice of Change (ANOC). An email
notification was sent on September 13, 2025, informing the member that the ANOC
was available for viewing.
Additionally,
the email said that the member could find their ANOC and other Plan Benefit
Documents within their secure ************ account by navigating to “Plan &
Benefits” then selecting “Plan Benefit Documents.”
The ANOC also included the change in the monthly premium
amount from $13.30 in
2024 to $48.30 in
2025. The plan adheres to Medicare guidelines and the monthly premiums will
remain unchanged after January 1.
The member’s plan was terminated as of February 28, 2025,
for failure to pay his premiums. Members are responsible for the premium
payments for the months in which they had active coverage.
The member may qualify for help paying for prescription
drugs. People with limited incomes may qualify for “Extra Help” to pay for
their prescription drug costs. If the member qualifies, Medicare could pay up
to 75% or more of the drug costs including monthly prescription drug premiums,
yearly deductibles, and coinsurance. Additionally, those who qualify will not
have a late enrollment penalty. To see if the member qualifies, they should
call:
o ************** (###-###-####).
TTY users should call ###-###-####, 24 hours a day, 7 days a week.
o The ****** ******** ****** at
###-###-#### between 8 a.m. and 7 p.m., Monday through Friday for a
representative. Automated messages are available 24 hours a day. TTY users
should call, ###-###-####.
o Your State Medicaid Office.
The member can also reach out to their State Health
Insurance Assistance Program (SHIP).
We want to assure you that we
strive for excellence in customer service and have procedures in place to
address any lapses in service delivery. In cases where poor service is
identified, we thoroughly review inbound calls and provide coaching feedback to
the representative involved as needed. Our supervisors actively engage with the
representative to work towards service improvement goals.
We have identified a call in which the representative did
not deliver the level of courtesy service expected and was unable to resolve the
member’s issue. This representative is no longer affiliated with the company.
The
member will receive our detailed Medicare response in the mail within seven to
ten business days.
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ****** concern.
Sincerely,
Jennifer
Analyst
Medicare Executive
ResolutionsInitial Complaint
Date:06/02/2025
Type:Billing IssuesStatus: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.
9/4/2024 I called Aetna insurance to determine what the prices for my allergy shots (immunotherapy) would cost. I was informed by the representative that it would be entirely covered. At that point in 2024, I had reached my maximum out of pocket, so everything was covered by insurance. I asked the agent in 2025, would the prices be changed & would I have to pay anything including a copay once the plan reset. The agent said no it would be fully covered.
I have been charged for copays weekly when I visit & additional fees for testing & vial mixes in 2025. On 04/23/2024 I called Aetna to dispute this and described the aforementioned situation. I was assured by that agent it would be resolved in 10 business days & my doctor was willing to wait for insurance to resolved it. After the period of 10 business days, nothing was resolved & I received no additional callback. I called again 05/28/2025 where again the agent said they would follow up & call me in 24-48 hours with a status update. I received no call back. I called again on 6/1/2025, the agent is trying to reach out to everyone, but there is still no resolution.
I want the transcript from the original call to determine what was exactly said by myself & the agent. If the agent claimed everything was covered after the year reset, I would like Aetna to cover my immunotherapy shots & treatment plan until it is complete. I would not have begun this if I had known the prices I would be expected to pay.Business Response
Date: 06/11/2025
Dear ******* *********:
Please see our
response to complaint # ******** for ******* ****** that was received by us on
June 2, 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 made an initial call on August 19, 2024, on that
call the member wanted to confirm his coverage for allergy injections. The
representative checked to see if the provider was participating with the member’s
plan. The representative confirmed the provider was in network with the plan
and proceeded to quote the member benefits for the 2024 calendar year plan.
Member was quoted that the allergy injections would be covered at 100% no
deductible, after a $50.00 copay. The member then asked the representative what
his coverage would be for the 2025 calendar year, again the representative
quoted the allergy injections would be covered at 100% no deductible, after a
$50.00 copay. The member was advised that he had satisfied his out of pocket
(OOP) for the 2024 calendar year, so no copays applied for the rest of the 2024
calendar plan year. That representative did not give the member any
misinformation. On April 23, 2025, the member called and stated that he was
advised on his August 2024 phone call that he would not be responsible for the
copays. The representative reviewed claims submitted from January 9, 2025,
through February 27, 2025, and again the representative quoted the member the
same benefits but since he had not met his OOP, yet the member would be
responsible for the copays until the $4500.00 OOP was satisfied. Representative
then advised they would send the August 2024 call for review to make sure the
member was not quoted incorrectly. Another call was made by the member on May
28, 2025, member was following up from the call from April 23, 2025, the
representative again advised the member of his benefits and that he was
responsible for the copay as the plan’s OOP resets in January because he has a
calendar year plan, and as of April 23, 2025, the member had not satisfied his deductible
so the copays would apply. Nothing further was discussed on this call and the
representative did not give any incorrect information. The last call was on
June 1, 2025, the member again advised he needed the transcript from the August
2024 call as he believes he was given incorrect information. The representative
again quoted the member plan benefits and advised that his claims for the 2025
calendar year are processing per his benefits correctly as he is responsible for
the copays until he meets his OOP. The member requested that the call from
August 2024 be sent to him, the representative advised that the call can only
be sent if Aetna has a subpoena to release the call transcript to the member.
After reviewing all the calls, the member made no incorrect information was
given at any time. The member was quoted his benefits for the 2024 and 2025 calendar
year correctly. The member is responsible for the copays until he reaches his
OOP.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 TeamInitial Complaint
Date:06/02/2025
Type:Billing IssuesStatus: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.
The "co-pay" is for wound care that should be included in the surgery. It is not "durable medical equipment" The collagen pads dissolve into my cells regenerating tissue growth thus closing my wound with skin. This should be covered with the surgery.Business Response
Date: 06/13/2025
**** *** ******* **********
Please see our response to complaint # ******** for *** ***** ******, which we received on May 27, 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 claim history. We located a claim for date of service, February 28, 2025. The claim is requesting payment for wound dressing and collagen pads. The member’s provider has requested payment for these services separate from any outpatient surgery. Wound dressing and collagen pads are considered durable medical equipment. I have provided the claim details below.
Date of Service: February 28, 2025
Claim ID: *********
Provider: ********** ***** *
Billed Amount: $5,615.40
Allowed Amount: $4,644.99
Paid Amount: $3,828.41
Member Responsibility: $738.45
Durable medical equipment (DME) and related supplies are covered by the plan. There is a 20% coinsurance for each Medicare******;covered durable medical equipment (DME) item.
The member has the right to ask the plan for an appeal. The member must request the appeal within 60 days of the Explanation of Benefits notice date. We can give more time if there is good reason for missing the deadline.
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.
***** ******** ********* * ****** *****
**** *** ****** ********** ** *****
**** **************
******** **** ***** ******* ***** **** ***** ** *****
******* *****************
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 ResolutionInitial Complaint
Date:05/28/2025
Type:Billing IssuesStatus: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 due to two unresolved issues with Aetna that have caused significant stress during my pregnancy.
Issue 1: Improper Prenatal Billing
I have been incorrectly charged co-pays for multiple prenatal visits, starting with my first appointment on 2/4/25. Under my plan, routine prenatal care should be fully covered without co-pays. Despite repeated calls and attempts to resolve this over the past few months, these charges remain uncorrected.
Issue 2: Transition of Care Form for Chiropractor
I submitted a Transition of Care form for my chiropractor, which was approved from February through May 1, 2025. I then submitted an extension request to cover the remainder of my pregnancy (due 9/8/25). My husband has called Aetna several times and has been told the extension was approved, yet we have not received anything in writing to confirm this. Without written proof, my chiropractor cannot treat me, and I’ve now gone over a month without care. I am in severe pain and limping as a result.
I have spent countless hours trying to resolve these issues, and Aetna’s lack of transparency and follow-through has negatively affected both my health and peace of mind. I am requesting immediate correction of the billing errors and prompt delivery of written confirmation of the Transition of Care approval.Business Response
Date: 06/06/2025
**** ******* **********
Please see our response
to complaint # ******** for ****** ********* that was received by us on May 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 the complaint, we immediately
reached out internally to further research the member’s concerns. We reviewed Ms. *********’s claim history and found that none of the
claims had a copay for global prenatal procedure codes as they are covered at
100 percent. However, there were several billed charges
for labs and ultrasounds that correctly generated a copay per the plan
benefits. The lab charges required a copay because they were not performed at an
independent facility. Also, the ultrasounds required a copay because, per the
member’s benefits, a specialist copay of $20 applies to each visit.We also reviewed Ms. *********’s Transition of Care (TOC) form and
confirmed that the request was denied. With approved
TOC coverage, members can continue receiving treatment for a limited time at
the highest level of benefits provided by the plan. Typically, this coverage
lasts for a duration of 90 days. Per the denial letter dated May 30, 2025, we
are administratively denying the service request as previous TOC service
coverage was approved completing 90 days benefit coverage from February 1,
2025-May 1, 2025. On May 30, 2025, Ms. *********
was contacted by Raven who explained why her request was denied. Furthermore, Ms. *********’s call history was reviewed, and the necessary feedback has been
provided. Please know, Ms. ********* will
receive a separate resolution letter detailing our response.In reading Ms. *********’s concerns, we can
certainly understand her frustration. Our goal is to provide exceptional
service to our customers, and immediately resolve issues when they do occur. We
apologize for the difficulties Ms. ********* experienced and that we did not
provide the level of service that she rightfully expects and deserves. These
actions are not consistent with Aetna’s service standards, and we appreciate Ms.
********* notifying us of her experience.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,
Brittany
F.
Analyst,
Executive Resolution
Executive
Resolution TeamCustomer Answer
Date: 06/16/2025
This is incorrect, I have attached what I have been sent in regards to my insurance coverage for pregnancy. I should not have to pay for any prenatal appointments besides the initial one that establishes pregnancy. I am most likely going to have to be induced in 9 weeks and I have 2 appointments per week for the remainder of my pregnancy due to complications. Please help me to resolve this before I have to give birth. It’s been many months and this has completely destroyed my mental health and ability to enjoy my last pregnancy. Please advise on how to proceed.
Thank you,
****** *********
Customer Answer
Date: 06/16/2025
This is incorrect, I have attached what I have been sent in regards to my insurance coverage for pregnancy. I should not have to pay for any prenatal appointments besides the initial one that establishes pregnancy. I am most likely going to have to be induced in 9 weeks and I have 2 appointments per week for the remainder of my pregnancy due to complications. Please help me to resolve this before I have to give birth. It’s been many months and this has completely destroyed my mental health and ability to enjoy my last pregnancy. Please advise on how to proceed.
Thank you,
****** *********
Business Response
Date: 06/20/2025
**** ******* **********
Please see our
response to complaint # ******** for ****** ********* 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 your request, we immediately reached out internally to further
research the concerns. After
further review it
was determined that the Account Team and Plan Liaison have been made aware of
the member’s concerns. A deviation request was placed to have the plan updated
on June 17, 2025, this request can take up to 60 days for a decision. If
approved the claims will be sent for reprocessing.We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address Mrs. *********’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 TeamInitial Complaint
Date:05/27/2025
Type:Product IssuesStatus: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 a dental service from *** *********, **** * who is out of network on March 6, 2025. The bill is $3,096.00. I have paid all the amount and faxed and mailed all required paperwork to Aetna.
According to my Aetna Plan Medicare PPO I have to be reimbursed 50%. I have called Aetna Dental customer service over 15 times. The number one problem is customer service outsourced to the *********** and they cannot speak English. They do not have a number to speak to someone in the dental reimbursement group to discuss the issue. Please help.Business Response
Date: 06/04/2025
**** *** ******* **********
Please see our response to complaint #******** for *** ****** ************ that was received by us on May 27, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.
Upon receipt of the complaint, we reached out internally to view the member’s concerns. We were able to find the claim that was on file and denied. We contacted the Claims’ Department, and claim ********* was reprocessed on May 28, 2025, and the member will be receiving a reimbursement for $2096. The check number is ******** and was processed on May 29, 2025. Please allow 7 to 10 business days.
We reviewed the calls. The representative gave correct information about the claims’ process and the appeals’ process. The member will receive a detailed Medicare Resolution Letter within 7-10 business days.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ************’s concerns.
Sincerely,
Cindi D
Analyst
Medicare Executive ResolutionsCustomer Answer
Date: 06/04/2025
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.Thank you very much for your help.
Sincerely,
****** ************Initial Complaint
Date:05/27/2025
Type:Billing IssuesStatus: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.
In late fall 2024/early 2025, while my wife and I were traveling, our secondary health insurance [whom we have been with since 01/2001] provided Silver Script Insurance Company with our personal data [without our knowledge nor our permission] - to manage a prescription drug plan with Aetna Medicare RX.
Upon our return from our travels, it took quite a while for us to determine what had occurred. In addition, to OPT OUT, Silver Script required the date when our health insurance began. Because Federal agencies and the workforce were being hit with closures and layoffs, the specific date which our health insurance began [01/2001] took quite a bit of time to obtain.
My wife and I OPTED OUT of Silver Script as soon as possible.
Nevertheless, Silver Script continues to bill both my wife and me for two months of “service.” Silver Script Insurance justified the billing as a “late enrollment penalty” for Medicare Plan D.”
When my wife and I enrolled in Medicare, we chose NOT to select Plan D. Medicare Plan D is NOT MANDATORY!
I have sent Silver Script four letters stating that we DID NOT sign up for this plan – my wife and I have refused to pay the amount billed. I have informed Silver Script Insurance that:
1. We DID NOT voluntarily enroll in their program!
2. It is NOT MANDATORY to have Medicare Plan D!
3. We are NOT paying this bogus bill!
4. We find their AGGRESSIVE MARKETING STRATEGY to be DECEITFUL AND MISLEADING – verging on SENIOR HARRASMENT AND FRAUD!
We want Silver Script Insurance Company to STOP BILLING both of us for a service we DID NOT request nor consent to.Business Response
Date: 06/08/2025
**** *** ******* **********
Please see our response to complaint # ******** for *** ****** ********, which we received on May 27, 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 Rx offered by SilverScript (****) from January 1, 2025, through February 28, 2025. On December 13, 2024, a letter was sent to the address on file to confirm the enrollment into Aetna Medicare Rx offered by SilverScript. The letter advised that the plan would begin on January 1, 2025. The letter advised that the member’s retiree drug coverage sponsored by ******* is an employer sponsored (****) Medicare Prescription Drug Plan (PDP) or Medicare Part D Plan, administered through our partnership with SilverScript. The member was enrolled on behalf of ******* and should have been provided a time period by ******* to opt out.
On February 11, 2025, we sent the member a letter to notify him that a gap in his prescription drug coverage that has resulted in a Part D Late Enrollment Penalty. The Late Enrollment Penalty (***) is an amount added to members monthly Medicare drug plan (Part D) premium for as long as they have Medicare prescription drug coverage. *** is an extra charge added to the member’s monthly premium for Medicare Part D prescription drug coverage if they have a continuous period of 63 days or more after their Initial Enrollment Period where they are eligible for Part D but are not enrolled and do not have other creditable prescription drug coverage. The Late Enrollment Penalty of $29.40 was applied to your premium.
We received the member’s disenrollment request on, February 26, 2025. The request was approved, and the plan terminated on March 1, 2025. The plan continued to bill the premium of $29.40 for the months of January and February. On May 23, 2025, we were notified that the *** has been removed from the member’s Medicare account. On, May 27, 2025, the *** was deleted from the member’s account. The remaining balance has been adjusted to $0. The member will not receive any premium invoices from the plan.
The member mentioned that his wife had the same issue. I tried contacting the member by phone to obtain his wife's information to resolve her concerns. I was unable to reach the member by phone. I left a voicemail with my contact information. If the member’s wife is still receiving premium invoices, she can contact the plan for assistance.
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 *** ********’ concerns.
Sincerely,
Jasmine W.
Analyst
Medicare Enterprise ResolutionInitial Complaint
Date:05/27/2025
Type:Billing IssuesStatus: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 seen at ******** ****** **** Urgent Care in ********* ** on 5/20/25. Per my insurance card and messages I have saved from Aetna representatives, my copay is $25. I was seen by ********** ******** NP. She went by Katie during the visit. I was then charged $40. I checked my Aetna member portal and see a "******* ********" was who I was billed under. After messaging with Aetna, they admit they see on the claim I was seen by a ********* ******* and agree my copay should be $25 as they can see the location is an urgent care. When I ask them how to fix it, they then changed their messaging that I was seen by a ******* ******** at a primary care office. I still have my discharge paperwork and can show proof, as well as have messages from the Aetna rep they also can see the medical claim is from an urgent care and from a different provider. They are not willing to work with me to refund the copay difference.Business Response
Date: 05/29/2025
Dear ******* *********:
Please see our
response to complaint # ******** for ****** **** that was received by us on May
27, 2025. Our Executive Resolution Team researched the concerns, and I would
like to share the results of the review with you.Upon
receipt of your request, we immediately reached out internally to further
research the concerns. After
further review it
was determined that the member’s claim was received and processed correctly.
The provider submitted an electronic claim, on the claim they billed a place of
service of ** which is an office not an Urgent Care. The rendering provider is
listed as *******, ********, and the referring provider is listed as *********
Leonard. Since the provider billed an office visit place of service code and
billed procedure code ***** (office visit) the $40.00 copay will apply. The
member is mistaking the Hospital Corporation of America (HCA) Urgent Care
Facility $25.00 copay, with the standard Primary Care Physician (PCP) copay of
$40.00. The member would only pay a $25.00 copay when she is seen at a HCA
Urgent Care Facility. The facility the member was seen at is not HCA affiliated,
therefore, the $25.00 copay would not apply. If the provider would have billed
the claim as Urgent Care the member would have been responsible for a $50.00 copay.
So, if the provider was to send in a corrected claim the member would owe the
$50.00 copay instead. The messages between the member and the member portal
were correct. The member was advised that the provider specialty is Family
Practice not an Urgent Care specialty, and the member is referring to the HCA
copayment when she referred to the copay on the insurance card. Attached to
this email is the message the member wrote through the member portal and the
reply. If the member does not agree with the claim decision she can appeal
through member services.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 TeamCustomer Answer
Date: 05/29/2025
Complaint: ********
I am rejecting this response because:
The chat history attached from ShaCarra is a very small piece that does not include further discussion with the Aetna representative. I did include where they noted there were errors. I can also provide additional chat history where the agent reported within 3 days they would reach out to Prompt Care to figure out who Dr. ******** is. I have not heard back.I have attached my visit summary where it states the provider I saw at ******** ****** **** Urgent Care was ********* ******* NP, not ******* ********. As defined,
"1. Rendering Provider:
The rendering provider refers to the healthcare professional who directly performs or provides medical services to patients. A physician or nurse practitioner, along with any licensed healthcare professional who delivers direct care and treatment, serves as the rendering provider. The rendering provider appears on the claim form to show who provided the medical service, especially when multiple providers work at a single practice."So, what I will not accept is- who is this ******* ********? Nobody wants to answer who this man is. He does not work for Prompt Care, not even Piedmont Health. Why am I being billed by him? This is all very suspicious and I continually get "beat around the bush" answers on who this man could be.
The rendering provider is the provider who directly provided services. I did not see a ******* ********, nor was I referred to one. I was referred to *** *** ****, where I unfortunately did not go due to lack of appointment availability. Furthermore, I have attached the practice address for a Dr. ******* ********. It does not match the practice I was seen at, nor does his profile indicate he is even an employee at ******** **********. There is a Dr. **** ******** who works for ******** ********** in their provider directory.
Sincerely,
****** ****Business Response
Date: 06/03/2025
Dear ******* *********:
Please see our response
to complaint # ******** for ****** **** that was received by us on May 30, 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 made
multiple phone calls to ******** ****** **** to inquire about who Bozeman
******** is, but we could not reach a representative. We suggest that *** ****
contacts ******** ****** **** to determine why ******* ******** was listed as
the rendering provider.We confirmed that the member’s claim was submitted with
an office visit procedure code under ******** ************ ******** (an
internal medicine provider type). According to *** ****** benefits, the
standard copay for a primary care physician (pcp) office visit is $40 and since
the provider was listed as an internal medicine provider, urgent care copays
would not apply. In addition, the facility where Ms. **** received services is
not owned by Hospital Corporation of America (HCA). On the back of *** ******
insurance card at the bottom right side, the middle line has “HCA Healthcare
Affiliates” before it lists the urgent care copay. The copay that’s listed is
only for facilities that are owned by HCA. If the facility is not owned by HCA,
then the standard $50 copay would apply for in-network urgent care facilities.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
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