Complaints

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

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• 

  Aetna Inc.

  151 Farmington Ave Hartford, CT 06156-7003

• 

  Aetna Insurance

  7799 Leesburg Pike Ste 1100 Falls Church, VA 22043-2408

• 

  Aetna Insurance

  1301 Mccormick Dr Largo, MD 20774-5416

• 

  Aetna Inc.

  99 Park Ave Rm 3R New York, NY 10016-1601

• 

  Aetna Inc.

  12209 Shaffer Rd Swanton, OH 43558-9425

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:05/14/2025

  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.

  For all of 2024, Aetna has arbitrarily decided not to cover healthcare expenses for my 2 children. I have had a case open since November 2024 (Original case Ref #*********, updated case #*********). The children are on both my ex-spouse's policy and mine with Aetna being the secondary. For some reason they paid some bills beginning in October 2024, but pulled back all funds for anything else. They then feigned ignorance of the bills and EOBs which were sent by the provider. I have since provided them with a copy of the same and they were to have 30 days to respond and review from 4/9/24 and I have received absolutely no communication. I am owed for all of the payments that were already made, in accordance with Aetna's rate with the provider and without deduction as the deductible would have long since been covered. Reimbursement for payments already made to the provide should be sent directly to me, and payments for outstanding bills should be made to the provider.

  Business Response

  Date: 05/23/2025

  **** *** ******* **********
  
  Please
  see our response to complaint #******** for
  ***** ******* that was received by us on May 14, 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 Aetna did pay
  some of the children’s claim incorrectly. If we reworked the claims as
  secondary, we would be requesting that money back from the provider ($136.38
  for each visit) as we should not have paid those claims since the other insurance
  carrier is primary. If we did reprocess those claims negatively impact the me
  member.
  
  The coordination
  of benefits (COB) for this member’s self-insured plan is maintenance of benefits
  (MOB). This means that Aetna is secondary and will maintain the primary plan’s
  benefits unless our (Aetna) is higher than the primary plan. Typically, with
  MOB, secondary plan (Aetna) will not usually pay benefits until the out-of-pocket
  maximum is met for the year since the primary plan is already higher rate and paying
  more than Aetna would have if we were primary. After April 2024 dates of
  service, the remaining claims were processed as secondary correctly and
  applied to the plan’s coinsurance limit due to the type of COB the policy
  uses- MOB. Once the coinsurance limit was met, the Aetna plan made accurate
  small secondary payments according to the COB type.
  
  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,
  
  Marshell H.
  Analyst, Executive Resolution
  Executive
  Resolution Team

  Customer Answer

  Date: 05/27/2025

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:

   

  The attempts to paint the payments as having been made are wholly inaccurate. Those same payments were then PULLED, a.k.a. REVERSED when Aetna attempted to rectify their inaccurate billing. NO PAYMENTS were ever made back to the provider for the same services provided. Even today I received an EOB that asks for more information. This team referred to in Aetna's response is either disingenuous or flat out lies. Additionally the insurer claims not to have sufficient information to process the claims, but alleges to have processed the claims and paid them out. This is so convoluted, it smacks of attempts to cover up the matter. Please attend to the attached and provide contact information for someone that I can speak to directly. I would prefer to work this out amicably, thank you.
  
  
  
  Sincerely,
  
  
  
  ***** *******

• Initial Complaint

  Date:05/14/2025

  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.

  Aetna is not helping me to resolve an issue I have with an open bill. They are billing me out of network for an in network doctor and procedure and are billing me $10,046.74. I have been calling for months, conference calls with the doctor billing department and the insurance they are in network. I refuse to pay, ai keep calling asking for them to help fix this nothing is done. Everytime I call they review all the notes and do nothing. This is unqcceptable

  Business Response

  Date: 05/23/2025

  **** ******* **********

  Please see our response to complaint # ******** for ******** ***** that was received by us on May 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 the complaint, we immediately
  reached out internally to further research the member’s concerns. We reviewed
  the member’s call history and identified opportunities to provide feedback and
  coaching. Additionally, we confirmed that the claim in question was eligible
  for reprocessing. Thus, the claim was reworked on May 21, 2025, at the in-network
  benefit level. Please know, the new member
  responsibility is $492.28, and they should receive an updated Explanation of
  Benefits (EOB) within 7-10 business days. Should the member disagree with our
  decision, they have the right to appeal per the instructions provided in the EOB.
  If the member has any additional questions regarding our response, they may
  contact member services by dialing the phone number on the back of their member
  identification card.

  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,
  

  Shay
  G.
  Analyst,
  Executive Resolution
  Executive
  Resolution Team

  Customer Answer

  Date: 05/27/2025

  
  
  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:05/13/2025

  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.

  Complaint ID: ******** - I originally filed this complaint and it was closed without resolution. There was a question from the business, ****** ******, asking for the member id number. I was just now able to get it - *********. I would like to continue to pursue - the original complaint is below.
  
  My son and I were looking at health insurance options for him and his new wife. And we looked at the MN-state run individual health marketplace called ******. An "insurance agent" called him - and my son explained he needed an insurance plan and that he had Type1 Diabetes and regularly needed insulin and diabetic supplies. The agent indicated they had good "Aetna" plans. My son signed up for almost $600/month. When he got the insurance card, it did not say it was an Aetna plan, but rather had multiple names like - *********** powered by *** *** **; ****** ******, Group Name of ****** ******, ***** ****** ******* (Limited Benefit Plan) and ****** for the pharmacy benefit. None of which we had heard of before and find little/no information online about them. My son had his first claim for insulin and then we find out it is NOT an insurance plan but rather a private, limited benefit that only covers a few office visits and some lab work. It does not have the minimum essential health benefits - no catastrophic coverage, no hospitalization, no insulin, etc. This has been endless phone calls with even more unknown company names ******** ****** ********* as *** and **** ****** * **** for enrollment) and getting nowhere. It is like a Ponzi-scheme - no one is accountable or has answers. Very nervous he has provided his SSN and date of birth too. Asking for reimbursement of Jan-April, 2025 premiums and 2 years of identity theft protection.

  Business Response

  Date: 05/23/2025

  **** ******* **********

  Please know, the complainant's concerns were misdirected to
  our company because it does not involve an Aetna plan. However, as a courtesy,
  we reached out to our contacts at ***** ****** and confirmed that they must
  contact ****** ****** directly. We were also advised that the claim was
  received and is currently pending for funding from the stop loss carrier.
  

  Unfortunately, we were unable to obtain a direct contact number for Aither
  Health and we do not have any additional information regarding the concerns.
  Please see below for the legal contact information for ****** ******. If contacted, they
  should be able to further assist the complainant. 

  Mailing Address:

  ****** ****** ***
  **** ******* *****
  ********** ** *****
  ********** ***

  Email Addresses:

  **** ** * **********************
  ***** ** * ************************

  Thanks

  Shay G.
  Analyst, Executive
  Resolution
  Executive Resolution
  Team

• Initial Complaint

  Date:05/13/2025

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On 4/23/2025 I submitted an appeal for the coverage of a medication that was non-formulary after my initial request for a prior authorization was denied. The appeal was submitted through my Aetna Member Portal. It was not registered with appeals until 5/2/2025 at which point I contacted the phone line for expedited appeals. I then left a message stating my reason for an expedited appeal and offered to provide documentation substantiating the need for such appeal. To this date I have made multiple calls to member services and have been unable to get any information substantial to my appeal.

  Business Response

  Date: 05/22/2025

  **** ******* **********

  Please see our response
  to complaint # ******** for ******* ****** that was received by us on May 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 the complaint, we immediately
  reached out internally to further research the member’s concerns. We confirmed
  that there are certain criteria that has to be met for an expedited appeal. An
  expedited (rush) appeal is a request for review of a decision not to certify
  urgent or ongoing services when a delay in decision making might seriously
  jeopardize (put at risk) the life or health of the member or jeopardizes the
  member’s ability to regain maximum function. Based on this description, Mr.
  ******’s request did not meet our criteria for an expedited appeal. Please know,
  on April 25, 2025, we confirmed receipt of Mr. ******’s appeal via the Aetna
  member website and stated that it would be processed within 30-60 calendar days. The due date for Mr.
  ******’s appeal is July 1, 2025. If Mr. ****** would like updates, he can call
  the member services number on the back of his member identification card.

  Furthermore,
  Mr. ******’s call history was reviewed. We confirmed that all representatives
  advised correctly. Therefore, no feedback was necessary. We attempted to
  contact Mr. ****** on May 16, 2025, but was unsuccessful. Thus, a voicemail was
  left stating why his appeal was not expedited and that we had also inquired
  about medicine that was similar to his requested medication.

  Moreover, we also asked about alternatives to Mr.
  ******’s requested medication (in case his appeal is upheld). We found out that
  Mr. ******’s policy excludes all weight loss medications. Thus, there are no alternatives within the weight loss group that would be
  covered under the plan.

  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,
  
  Brittany
  F.
  Analyst,
  Executive Resolution
  Executive
  Resolution Team

  Customer Answer

  Date: 05/22/2025

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because: while they did contact me and leave a message, no contact information was left so I could follow up. Furthermore, they lack the needed information to make a decision as to the medical necessity and criticality. No documentation was requested to substantiate why the medication is needed, it's presumed that the medication is only being used for weightloss but that's not the case as medication can be prescribed by my provider for off label uses which they can authorize. To be clean my provider can off label prescribe by Aetna can not off label sell respectively. Lastly, the individual that reviewed my claim lacks the medical credentialing to make such decisions as to the criticality of my need. For example the Executive Resolutions Rep does not have credentials of any help profession that would allow them to make the decision of my need. I however am a Nurse and do have those credentials so I would like another call back from a QUALIFIED health care professional so I properly provid documents to support my claim. 
  
  
  
  Sincerely,
  
  
  
  ******* ******

  Business Response

  Date: 05/29/2025

  **** *** ******* **********  
  
  Please see our response
  to complaint #******** for ******* ****** that was received by us on May 22, 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.
  ******’s concerns reviewed. Based on the review, it has been confirmed that
  the member’s appeal was review by our pharmacy team. Our pharmacy team
  confirmed that the medication ******** 2.5/0.05ml subcutaneous pen injector is
  not a covered medication. Weight management treatment or drugs intended to
  decrease or increase body weight, control weight or treat obesity are
  contractually excluded.
  
  Per
  the plan document, under “General policy exclusions,” it states that, “the
  following are not covered services under your policy:
  
  Obesity
  (bariatric) surgery and services
  
  Weight
  management treatment or drugs intended to decrease or increase body weight,
  control weight, or treat obesity, including morbid obesity excepts as
  described in the Coverage and exclusions section, including preventive services
  for obesity screening and weight management interventions. This is regardless
  of the existence of other medical conditions.

  These are:
  Liposuction, banding, gastric stapling, gastric by-pass, and other forms of bariatric surgery
  Surgical procedures, medical treatments, and weight control/loss programs primarily intended to treat, or are related to the treatment of obesity, including morbid obesity.
  Drugs, stimulants, preparations, foods or diet supplements, dietary regimens and supplements, food supplements, appetite suppressants, and other medications.
  Hypnosis, or other forms of therapy.
  Exercise programs, exercise equipment, membership to health or fitness clubs, recreational therapy or other forms of activity or activity enhancement.”
  
  A copy of the appeal resolution letter has been included with this
  response. If Mr. ****** have any additional questions or concerns, he can
  contact Aetna 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 Mr.
  ******’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:05/13/2025

  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.

  Banner Aetna has provided health insurance for my wife and me since Jan 2024. My wife is pregnant and according to our insurance policy, all pre-natal health costs are covered 100%.
  However, since our pre-natal appointments and costs began in Jan 2025, none of our costs have been fully covered by Aetna. Each individual bill also contains the term 'pre-natal' and yet Aetna claims these are not coded correctly.
  
  My wife has been on several long phone calls and files several claims through Banner Aetna's support channels, only to receive conflicting answers and no follow ups as promised. Representatives have no explanations regarding the incorrect 'billing codes' nor attempted to correct the issues on their end, despite being told by the doctor's office that each claim was filed under the appropriate pre-natal codes.
  
  We spend nearly $600 per month for the privilege of such services, yet have not been adequately treated. We feel lied to by our insurance representatives and now exploring other options for recourse, including legal means. Hoping the BBB can help us resolve these issues, as we've had no luck going through the Banner Aetna support channels.
  
  Two insurance claims are from ****** ***** (for pre-natal blood work) and one from ****** (another pre-natal blood work), which total to $799.
  
  The following is the support claim reference number from Banner Aetna: *********
  The insurance is under my name, and my wife's name is *** ******.

  Business Response

  Date: 05/19/2025

  Dear *** *******
  *********:
  
  Please
  see our response to complaint #******** for
  ********* ****** that was received by us on May 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.
  ******’s concerns reviewed. Based on the review it has been confirmed that not
  all services provided prior to delivery are considered preventative prenatal
  care. Prenatal preventative services are limited to the basic office visit, which
  includes the standard weight check, blood pressure check, the baby heart
  monitoring and the applicable laboratory screening.  The standard laboratories include the anemia
  screening, blood typing; rhesus factor D (Rhd), the complete blood count (CBC),
  hematocrit or hemoglobin, glucose (Diabetes) screening, glucose tolerance
  testing, hepatic function panel, hepatitis C screening, obstetric panel
  (includes HIV testing), and the urine culture. Any additional services such as
  the ultrasounds and amniocentesis would be covered at the contract plan rate
  and the member’s cost share.
  
  The claim *********
  for the laboratory services was processed correctly per the member’s outpatient
  laboratory benefits. The claim ********* for the office visit for the initial testing
  was processed correctly. The claim is considered neither prenatal nor
  preventative. It was paid at the member’s in-network specialist office visit
  benefit. The claim ********* considered neither prenatal nor preventative care.
  This claim paid at the member’s laboratory benefits.
  
  
  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,
  
  Marshell H.
  Analyst, Executive Resolution
  Executive
  Resolution Team

  Customer Answer

  Date: 05/24/2025

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:
  

  Firstly, the Aetna Policy attached to this message explicitly outlines on page 27 the covered prenatal services. Both the ****** and ****** ***** blood work services fall under items in that prenatal category. ****** was a "Panorama Prenatal Screen" (which includes the covered STD screenings) and ****** ***** was a Rh incompatibility screening, as shown in their respective bills and covered in the prenatal category.

  Additionally, the office visit to ******* ******* ******* *********** on 1/15/25 is also covered on page 18 of the policy, as it was regarding pregnancy care.

  I expect Aetna to cover these services fully, as outlined in their policy documents.

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

  Business Response

  Date: 06/05/2025

  Dear Stewart *********:
  

  Please see our
  response to complaint # ******** for ********* ****** on behalf of *** ****** 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 previous response remains valid and unchanged. The
  claims in question do not fall under Preventive Prenatal nor Standard Prenatal plan
  benefits. Preventive Prenatal is not all inclusive of any service provided by
  the attending OB during the pregnancy. The plan is processing claims per Aetna
  guidelines and paying the claims based on how the provider bills the claims. If
  the member does not agree with the decision, they can submit an appeal using
  the attached Member Complaint, and Appeal form. The member can submit the
  appeal form and any documentation necessary to the appeal to the fax number or
  mailing address listed on the bottom of the form.
  

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

  Sincerely,
  ShaCarra B.
  Executive Analyst,
  Executive Resolution Team

  
  

• Initial Complaint

  Date:05/12/2025

  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 had surgery on May 2nd a month before I contacted Aetna to see if I was covered for a meal plan since I'm disabled on my left hand and was having carpal tunnel surgery on my right hand and was told I was.I called again and told them that it was an outpatient surgery and again was told I was covered,On May 1st I verified again and was given the number to ****** market that would supply the meals for 7 days.On May 2nd I traveled to the ********** ** ******* hospital for surgery returning home later that day.Once home and after resting I called ****** market that I had the surgery they said to call back in a few days they hadn't received the discharge information from Aetna being a Friday I waited till Tuesday the 6th I called them and they said they still have not received from Aetna and said to call Aetna and have them call Nations Market and they would get the meals out.So I called Aetna and now was told I didn't qualify because it was an outpatient I told them that's not what I was told by 3 different reps and I asked to speak to a supervisor and Shemika said I did not qualify because I was not discharged from a qualified medical facility I said that the ********** ** ******* hospital is qualified then she said it was an outpatient surgery.Isaid that they lied 3 times to me why give me the number to ****** market if I didn't qualify?She put in a grievance on that day and said I would hear from someone in 24-48 hours.That was the 6th today is the 12th no one called.I called Aetna again and they now say 30-60 days well that doesn't do me any good .So I called Aetna corporate office to file a complaint and Christopher could help

  Business Response

  Date: 05/15/2025

  **** *** ******* *********: 
  
  Please see our response to complaint # ******** for *** ***** *****, which we received on May 12, 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 plan details. According to the member’s benefits, after a member is discharged from a qualifying Inpatient Acute Hospital, Inpatient Psychiatric Hospital, or Skilled Nursing Facility stay, they may be eligible to get up to 14 freshly prepared meals for a 7‑day period. These meals are provided to help support recovery or manage health conditions. The plan Evidence of Coverage (EOC) booklet provides details about this benefit. The EOC states, Observation and outpatient stays do not qualify for this benefit. Meals must be scheduled for delivery within three months of the qualifying discharge as long as the member is enrolled in the plan.
  
  We understand that the member contacted the plan prior to her surgery. On April 28, 2025, the member spoke with a plan customer service representative about her meal benefit. The member asked if she is eligible to receive meals after her surgery. The representative provided the member with the benefit details. The representative failed to provide clarification about the benefit requirements. We have taken the appropriate action with the representative for service improvements. 
  
  On May 6, 2025, a customer service representative filed a grievance on your behalf. The grievance team can take up to 30 days to resolve member complaints. We are very sorry that the member did not receive a phone call back in the timeframe she was provided. The Executive Resolutions team has taken over the review of the member’s internal grievance. 
  
  We want to offer some information about our ********* *** ****** (***) is a program. ********* *** ****** (***) is a program to help connect members, family members, caregivers, and their loved ones with resources in their community that their plan does not cover. The *** team helps our members, and their caregivers, connect to resources in their community through a search and referral service to help with managing everyday needs. *** Consultants can help members with the following types of programs:
  Adult daycare programs
  Assisted living facilities.
  Caregiver consultation and support
  Emergency response systems (When the member does not have LifeStation benefits)
  Home Cleaning Agencies
  Food aid (Meal and grocery delivery)
  In-home care agencies
  Local senior activities/community services
  Local senior centers
  Nursing homes
  Pet care
  Senior housing
  Senior living options
  Support groups (Alzheimer’s, grief, etc.)
  Education materials on diverse topics
  And much more
  
  ********* *** ****** (***) Direct Number: ###-###-####
  Days of Operation: Monday through Friday
  Hours of Operation: 8:00 AM – 5:00 PM (These times apply for all continental US time zones.)
  
  There’s no cost to call *** and they don’t have financial relationships with the companies that they refer members to. Members are not committed to using *** or the programs it offers. Many of the services offered through the program may have associated costs (for example, house cleaning). If services with an associated cost are chosen, they (members/caregivers) are responsible to pay those expenses.
  
  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 Ms. Bujno’s concerns.
  
  Sincerely,
  Jasmine W.
  Analyst
  Medicare Enterprise Resolution
  
  

• Initial Complaint

  Date:05/09/2025

  Type:Customer Service Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I submitted a claim and didn’t hear anything from Aetna about it for over a month, so I logged into my Aetna online account to check on it. Upon logging in, I saw that my own name (even though I am the member) was completely absent from the online portal, and only my wife’s and two children’s names and claims appeared. There was not a single claim for me in the Aetna online portal. So I called Aetna to tell them that there was a glitch in their system and that I and all my claims were missing from the online portal. The representative I spoke with that day (May 7th) told me that she was able to view many claims for me in her system. Because they weren’t displaying for me, she connected me with tech support. Tech support told me they’d look into it so we got off the phone, and later that day they emailed me saying that there were no claims for me in their system. I emailed back same day (5/7) saying that there are in fact claims for me in Aetna’s system, they’re just not displaying in Aetna’s online portal (which it seems is all tech support is able to see, so it seems that departments are siloed - the non-tech support rep I talked with WAS able to see my claims. But tech and regular reps and systems are not communicating effectively with each other. I received no response whatsoever to my email. So on 5/9 I called Aetna. A rep told me that there were no claims for me. The rep told me that pharmacy claims do not display in the online portal. This was incorrect info because pharmacy claims are displaying for my family members in the online portal. The rep also told me that the claim I was looking for was “unprocessable”, but no EOB or any other communication had been generated to tell me that, which seems against plan policy and possibly illegal. There is no record whatsoever of this claim in my Aetna online account, but some Aetna reps are able to see it on their side. Once a claim is submitted, it should remain visible to the member even if it’s not yet processed.

  Customer Answer

  Date: 05/12/2025

  Updated email exchange - problems persisting as they were

  Customer Answer

  Date: 05/13/2025

  Last Friday, Aetna's behavioral health department promised me that a supervisor would be calling me by phone that day. No supervisor ever called. Today I called to follow up. The representative I spoke with told me that if Aetna categorizes a claim as unprocessable, that claim will not appear in the member's online portal, and the member will NOT be notified that the claim is unprocessable and the member simply needs to notice that the claim is missing from the online portal (there's no way for the member to track it) and the member then needs to call Aetna to find out what happened to the claim, and Aetna will then tell the member over the phone that the claim is unprocessable.  That is the process.  Is that even legal?

  Business Response

  Date: 05/19/2025

  **** *** **********
  
  Please see our
  response to complaint # ******** for *** ***** that was received by us on May
  9, 2025. Our Executive Resolution Team researched the member’s concerns, and I
  would like to share the results of the review with you.
  
  Upon receipt of
  the complaint, we reached out internally to have the member’s concerns
  reviewed. We confirmed that the member’s online portal is functioning
  correctly. The online portal only displays medical, pharmacy, and dental claims
  that are in a processed status. However, when the member logged in to his
  online portal, his claims consisted of rejected and un-processable claims which
  are not viewable online. Additionally, the claim submitted by the member was
  missing a diagnosis code and was in a rejected status. We were able to obtain
  the missing diagnosis code from the provider and processed the member’s claim
  on May 13, 2025. Please know, the claim is currently visible online under claim
  number *********. In the future, a diagnosis code is required to process the
  member’s claims in a timely manner. Mr. ***** should receive an Explanation of
  Benefits (EOB) within 7-10 business days. Finally, it was explained to the
  member during a supervisor call on May 13, 2025, that there was an error when
  the claim was received, and it should have been originally denied for missing
  information instead of being rejected. A claim denial would have notified the
  member what information was needed. This was a system issue, and it is being
  reviewed for updates. Furthermore, Mr. *****’s call history is being reviewed
  and the necessary coaching will be provided to the representatives involved.
  
  Our goal is to
  provide accurate and reliable information when needed and to immediately
  resolve issues when they do occur. Clearly, in this case, we fell short of that
  goal. We regret that the member’s experience with Aetna was less than
  satisfactory and hope that it can be better in the future. Please know we have
  shared the member’s concerns with management for improvement opportunities.
  
  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,
  
  Herman M.
  Analyst,
  Executive Resolution
  Executive
  Resolution Team

  Customer Answer

  Date: 05/19/2025

  
  
  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:05/05/2025

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On 4-22-25 I was checking the ****** ******** website and discovered that my drug plan with Aetna had increased the premium from, what started at $7 per month, is now in 2025 $40 dollars per month. I take no prescription drugs which is why I opted for a low cost plan. I also discovered that I was never notified about the change. I checked my email and had no message from Aetna in the fall of 2025. I did see messages from the two previous years. This denied me the opportunity to purchase different insurance during the open enrollment period. When I spoke with customer service they told me they offer no other plans, that they had consolidated the cheaper plan with the premium plan and converted it to the new plan. Everyone was notified via email of the change and since I missed the open enrollment period I will have to wait until October 2025 to change plans. This amounts to an additional $400 per year from my ****** ******** check, my only source of income. I am requesting a billing adjustment back to $7 per month since I never received notification and was denied the opportunity to change plans. Since this is how Aetna does business I will be switching plans as soon open enrollment period begns.

  Business Response

  Date: 05/06/2025

  **** *** ******* **********
  
  Please
  see our response to follow-up on complaint #******** for
  *** ***** ********* that was received by us on May 5, 2025. Our Executive
  Resolution Team researched the concerns, and I would like to share the results
  of the review with you below.
  
  Upon
  receipt of the complaint, we immediately reviewed the member’s account. During
  our review, we have confirmed the plan received an online application
  through original Medicare’s website from *** ********* on November 19, 2021.
  This application was received as a request of enrollment into the SilverScript
  SmartRx Prescription Drug Plan (PDP) due to her being new to Medicare. *** *********’s
  application was approved by original Medicare and her ************ ******* PDP
  became effective December 1, 2021.
  
  The plan mailed *** ********* a confirmation of enrollment
  letter dated November 26, 2021. The letter states as of December 1, 2021, she should
  begin using ************ ******* (PDP) network pharmacies to fill her
  prescriptions. The monthly premium for your plan is $7.20.
  
  We show *** ********* requested to have her monthly premium
  payments withheld from the S***** ******** ************** ***** on November 21,
  2021. We confirmed her automatic payments to be withheld from the SSA was
  approved and effective as of January 1, 2022.
  
  We would like to mention, we encourage our members to make
  well-informed healthcare decisions. The plan is required by Medicare to notify
  our members of any changes being made to their current plan. To assist with
  this, every year in the month of September we send our members an Annual
  Notification of Change (ANOC).  We
  encourage our members to read these documents as soon as they receive them to
  ensure that the plan is still right for them heading into the new year. This
  information is for them to review prior to the Annual Election Period (AEP),
  which takes places from October 15, through December 7, of every year. During
  the AEP, members may make plan changes. If they do not make any changes; they
  will remain in the same plan with any changes that were contained in the ANOC
  becoming effective January 1st. The enrolment periods are set by original Medicare
  and not by the plan. The information on how a member can end their membership
  with the plan is provided in their plan documents Evidence of Coverage plan
  booklet. All the members essential plan documents are located online at
  *******************************. This information can also be found in the
  Medicare & You 2025 handbook.
  
  We confirmed the member was mailed her ANOC notifications in
  2021 and 2022. Beginning in 2023, the member’s account was set to receive plan
  documents including her monthly explanation of benefits statements, as well as
  the ANOC notification, via edelivery (email). The member would not have any emails received from us in the fall of 2025, as that is a future time frame. We have confirmed the member was emailed her ANOC documents
  in September of 2023, and 2024 calendar year. Sometimes these emails can be directed to their spam or junk folders within our member's email accounts. The ANOC includes information on
  the monthly premium cost changes, along with any other plan changes for the upcoming plan calendar year. The monthly premium plan changes from the time she enrolled into
  the plan up until current is as follows:
  
  In 2021, the ************ ******* (PDP) plan included a
  monthly plan premium of $7.20.
  
  In 2022, the ************ ******* (PDP) plan included a
  monthly plan premium of $7.00.
  
  On January 1, 2023, the plan name changed from SilverScript
  SmartRx (PDP) to SilverScript SmartSaver (PDP). In 2023, the SilverScript
  SmartSaver (PDP) plan included a monthly plan premium of $4.20.
  
  In 2024, the SilverScript SmartSaver (PDP) plan included a
  monthly plan premium of $5.20.
  
  On January 1, 2025, the SilverScript SmartSaver (PDP) plan
  was combined with our SilverScript Choice (PDP) plan. In 2025, the SilverScript
  Choice (PDP) plan includes a monthly plan premium of $40.20.
  
  Please know, Medicare will only allow members to disenroll
  at certain times during the year. From October 15 through December 7, members
  can join, switch, or drop a Medicare health or drug plan for the following
  year. Generally, members can’t make changes at other times except in certain
  situations, such as if they move out of SilverScript Choice (PDP)’s service
  area, want to join a plan in their area with a 5-star rating, or qualify for
  (or lose) Extra Help paying for prescription drug costs.
  
  What is Extra Help?
  People with limited incomes may qualify for Extra Help to
  pay for their prescription drug costs. If members qualify, Medicare could help
  pay for their drug costs, including monthly prescription drug premiums, annual
  deductibles, and coinsurance. Additionally, those who qualify won’t have a
  coverage gap or a Part D late enrollment penalty. Many people qualify for these
  savings and don’t even know it. For more information about this Extra Help,
  members can contact their local ****** ******** office, or call ****** ********
  at ###-###-#### from 8 AM to 7 PM Monday through Friday. TTY users should
  call ###-###-####. Members can also apply for Extra Help online at ****************.
  
  The
  member will receive a detailed Medicare Resolution Letter within 7-10 business
  days with this response.
  
  We
  take customer complaints very seriously and appreciate you taking the time to
  contact us and giving us the opportunity to address *** ***** *********’s
  concerns.
  
  Sincerely,
  Marilyn
  Analyst,
  Medicare Executive Resolution Team

  Customer Answer

  Date: 05/06/2025

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because: I did not receive an email from this company to my email address or in my spam or junk folders in 2024. I have checked all of those folderrs. HOWEVER, I stiil have the emails I did receive from this company in 2022 and 2023, regarding changes in the plan. I can't explain that but I was NOT notified of the changes in the cost of the plan, in time to make changes to my plan. Obviously, if I had received that email I would have made those changes. Maybe when the price of the plan has increased to more than five times what the patient was paying originally, a reputable company, who is really concerned about their patients, would make sure to make several attempts to notify them using various ways to do that. The Aetna plan I have as a supplement notified me by mail o fthe changes in that plan. I definetely feel that this was deliberate and as soon as I am able to change plans I will be leaving Aetna completely.
  
  
  
  Sincerely,
  
  
  
  ***** *********

  Business Response

  Date: 05/12/2025

  ***** ******* **********
  
  Re: BBB Rejection Complaint # ********:
  
  We have identified within your Better Business Bureau (BBB) case #********, for our member ***** ********* that she did not receive an email for her Annual Notice of Changes (ANOC) from SilverScript Prescription Drug Plan (PDP) to her email address for the plan year of 2025. Member states she checked her spam and junk folders, with no document found. Member also stated, she was not notified in time to review and make changes to the 2025 plan and feels this was deliberate. We understand how concerning this can be and we take your concerns very seriously.
  
  Upon the plan’s receipt of your BBB case, our Executive Resolution Team immediately reviewed *** *********’s account. During our review, we confirmed the plan received an online application through original Medicare’s website from the member on November 19, 2021. *** ******** application was received as a request of enrollment into the ************ ******* Prescription Drug Plan (PDP) due to her being new to Medicare. *** ********* application was approved by original Medicare and her ************ ******* PDP became effective December 1, 2021. 
  
  The plan mailed *** ********* a confirmation of enrollment letter dated November 26, 2021. The letter states as of December 1, 2021, the member should begin using the ************ ******* (PDP) network pharmacies to fill the member's prescriptions. The monthly premium for the member's 2021 plan is $7.20.
  
  We show *** ********* requested to have her monthly premium payments withheld from the S***** ******** ************** ***** on November 21, 2021. We confirmed *** ********* automatic payments to be withheld from the SSA was approved and effective as of January 1, 2022. 
  
  Annual Election Period (AEP), which takes places from October 15, through December 7, of every year. During the AEP, the member may make plan changes. If the member does not make any changes; shewill remain in the same plan with any changes that were contained in the ANOC becoming effective January 1st. Original Medicare sets the enrollment periods, not the plan. The information on how the member can end her membership with the plan is provided in her plan documents Evidence of Coverage plan booklet. 
  
  All *** ********* essential plan documents are located online at *******************************. This information can also be found in the Medicare & You 2025 handbook.
  
  We confirmed *** ********* was mailed her ANOC notifications in 2021 and 2022. Beginning in 2023, *** ********* account was set to receive plan documents including her monthly explanation of benefits statements, as well as the ANOC notification, via e-delivery (email). We have confirmed *** ********* was emailed her ANOC documents in September of 2023, and 2024 calendar year.
  
  At times, these emails can be directed to the member’s spam or junk folders within the member’s email account. The ANOC includes information on the monthly premium cost changes, along with any other plan changes for the upcoming plan calendar year.
  
  We understand that *** ********* stated she did not find the document in her junk or spam but we have confirmed that the ANOC was sent on September 2, 2024 at 14:45:55 and the email was read on September 13, 2024 at 15:44:11. The email was confirmed to be sent to the address of [email protected], which is what we have on file and per the member's original Medicare application.
  
  *** ********* was advised in the previous BBB complaint that on January 1, 2025, the SilverScript SmartSaver (PDP) plan was combined with our SilverScript Choice (PDP) plan. In 2025, the SilverScript Choice (PDP) plan includes the member's new monthly plan premium of $40.20.
  
  Please know, Medicare will only allow a member to disenroll at certain times during the year. From October 15 through December 7, you can join, switch, or drop a Medicare health or drug plan for the following year. Members can’t make changes at other times except in certain situations, such as if you move out of SilverScript Choice (PDP)’s service area, want to join a plan in the member’s area with a 5-star rating, or qualify for (or lose) Extra Help paying for prescription drug costs.
  
  Silverscript has confirmed that there are two Five Star Rated plans available in the member’s area if she is not pleased with her current plan. *** ********* can also apply for Extra Help to pay for her prescription drug costs with instructions below.
  
  What is Extra Help? 
  People with limited incomes may qualify for Extra Help to pay for your prescription drug costs. If you qualify, Medicare could help pay for your drug costs, including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify won’t have a coverage gap or a Part D late enrollment penalty. Many people qualify for these savings and don’t even know it. For more information about this Extra Help, you can contact your local ****** ******** office or call ****** ******** at ###-###-#### from 8 AM to 7 PM Monday through Friday. TTY users should call ###-###-####. You can also apply for Extra Help online at ****************.
  
  We want to thank you for the opportunity to address your concerns. We value your feedback and thank you for bringing *** ********* issue to our attention. It is through valuable input such as yours that we can improve upon our services and member satisfaction. We apologize for the inconvenience this may have caused you as our valued member.
  
  Sincerely,
   
  Melissa R.
  
  Analyst, Medicare Executive Resolution
  
  Medicare Complaint Team

  Customer Answer

  Date: 05/12/2025

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because: I did not receive the email to my email address and like I stated in my earlier response, when changing a patient's insurance premium amount to more than 5 times the original amount a reputable company would make sure that the patient is notified by more than just a single email since it appears that sometimes emails don't get to the patient. And I I also stated in my previous response that Aetna supplemental insurance notified me by postal mail of a change in my premium amount. I also don't know how my notifications were changed to email only either. So like I stated in my previous response, I will be changing both of my insurance plans, drug and supplemental insurance with Aetna, as soon as I possibly can. I also plan on letting all my friends and family know exactly the kind of company Aetna is, untruthful, deceiving and unconcerned about patient's needs. Please don't cloud the next response with all the prior verbiage of how we got to this place we've reviewed that twice now.
  
  
  
  Sincerely,
  
  
  
  ***** *********

• Initial Complaint

  Date:05/01/2025

  Type:Product Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I had Aetna Medicare which gave you 1200.00 for the year to spend on a product regarding to health. I purchased an ***** * Watch on Dec. 12, 2024 and sent in my receipt. They denied the claim due to it not being an approved receipt. I called back in January and sent them more information which was more than enough information and again denied. I sent in third claim by fax_ of course no response this entire time so I called today. It is being denied because it is over 75 days. I have never received any information regarding time frame because I was told it was reopened and no other information was ever sent or told to me by phone when I called. I would never of purchased this if I knew I would not get rembursed. Please advise

  Business Response

  Date: 05/13/2025

  **** *** ******* ********** 
  
  Please see our response to complaint # ******** for *** ****** ***********, which we received on May 1, 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 plan details. We found that the member’s 2024 plan included a direct member reimbursement (DMR) allowance of $1,200 each year. We received the fitness reimbursement request on, December 17, 2024. The request denied advising that there was no itemized receipt included with the request. There was an Explanation of Benefits statement sent to the member on, February 11, 2025. The Explanation of Benefits statement provided you with the denial reason and asked that the member send the request with the itemized receipt. After reviewing the original request, we found that the member provided the correct documents with her request. We are sorry that the member’s request denied in error. We have provided feedback to the Claims Team for service improvements.
  
  The member’s fitness reimbursement has processed on, May 12, 2025. A check for $477.51 has been issued on, May 13, 2025. Please allow up to 45 days to receive the payment by mail.
  
  Our members have the right to ask Aetna for an appeal. Members must request appeals 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 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

  Customer Answer

  Date: 05/14/2025

  Thank you so much for your help in this matter. I will expect a reimbursement check soon. ****** *********** 

• Initial Complaint

  Date:05/01/2025

  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.

  My ****** said I was covered for 3 months but I paid 4 months premiums. A call with AetnaCVSHealth on 3/7/25, call reference number listed in form below, with AetnaCVSHealth and ************ *********** confirmed that I would be receiving a refund of $72.42 and it while it would take approx 14-20 days to process I would in fact be receiving it. I've spent 4-6 calls and hours of my life trying to get this refund after it never showed up on time. Nobody was able to help. Today 4/30/25 I spoke with a supervisor and he said he has to call me back and get ************ *********** back on the line to discuss. Why? The matter was already resolved on 3/7/25. Why is it taking so long to send me my refund and why have I wasted so much time dealing with this. I have no confidence that I'll even get this refund. Hoping for some help from the BBB.

  Business Response

  Date: 05/06/2025

  **** *** ******* **********
  
  Please see our response to complaint #******** for ****** **** that was
  received by us on May 01, 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. It has been confirmed by our enrollment team that a
  termination file has been sent to Aetna directly from *** ******* *** ******
  (****) reflecting the member’s coverage effective
  date of April 01, 2024, and the
  termination date of June 30, 2024.
  
  Our
  enrollment team has updated *** ****** termination to June 30, 2024, matching
  the records from ****. A refund was submitted to the member in the amount of
  $72.42 on May 06, 2025. The member will receive the refund in 3-5 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. 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: 05/09/2025

  
  
  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. The full refund was received on 5/7/25. I want to thank the BBB for their part in this process.
  
  
  
  Sincerely,
  
  
  
  ****** ****