Business Profile

Insurance Companies

Aetna Inc.

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Complaints

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

Customer Complaints Summary

1,331 total complaints in the last 3 years.
467 complaints closed in the last 12 months.

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Submit a Complaint

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

Initial Complaint
Date: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,

****** ****
Initial Complaint
Date:04/29/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was insured with AETNA for the entire year of 2024. On 2/5/2024, I was having a medical emergency and called AETNA to find an IN NETWORK urgent care. They provided me with an urgent care facility and sent me an email listing this one and others nearby. I have the 2/5/24 email! I paid my share of the urgent care of $50. Aetna never covered the claim. I've called NUMEROUS times and was given 3 different stories HOWEVER with a promise of a ONE TIME COURTESY to take care it. Each call I made, I was told to wait 7 to 10 business days before calling back. I was also told the rep would call me back and that never happened. Also, I was told to file dispute paperwork THAT COULD NOT BE UPLOADED, so I did and PAID money to copy and FAX the dispute at ******. I included the email too. I never heard back but have the confirmation the fax was received. Each call takes about 40 minutes or more to explain what happened, rep reading notes etc. I can't have all this wasted time back, but I would like this claim processed immediately and I would like $100 back for the cost of fax, postage, copies, and my TIME from aetna and for aetna to remove the mark against my credit report because I ALWAYS pay my bills on time and had a great score until now. I can prove that too!
Business Response
Date: 05/09/2025
**** ******* **********
Please see our response to complaint # ******** for ****** ******** that was
received by us on April 29, 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. Per Aetna’s policy, “we cover urgent care in the member’s Health Maintenance
Organization (HMO) service area when any apply:
• A delay in treatment, until the member’s primary care provider (PCP) is
available, could result in decline in member’s health
• The urgent care provider participates in the HMO service area.”
We confirmed that the member’s
benefit for urgent care was a $50 copay, which applied until the out-of-pocket
maximum was met. We also confirmed that we did receive Ms. ********’s paperwork and due to misinformation being
provided, her claim was reprocessed as a one-time courtesy on May 8, 2025, with
zero member responsibility. Ms. ******** and
the provider should receive an updated Explanation of Benefits (EOB) within
7-14 business days. Furthermore, the member’s call history was reviewed and
coaching has been provided. We also contacted Ms. ******** directly to provide her with the claim details.
Please know, we are unable to correct the member’s
credit profile. However, she can dispute this issue with the credit bureaus and
provide them with a copy of the updated EOB to show payment. I apologize for the frustrations and difficulties
the member has encountered while attempting to resolve this issue and regret
that this matter required much of her time in order to facilitate a resolution.
Unfortunately, we are unable to honor her request for compensation. We do
appreciate Ms. ********’s patience during the time
involved in researching and resolving her issue.

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,

Shay
G.
Analyst,
Executive Resolution
Executive
Resolution Team
Initial Complaint
Date:04/29/2025
Type:Service or Repair 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.
CVS is continually running me out of my diabetes medication, ********. When we call them, it is a hassle because they say they have to call the doctor and when I go to the doctor, they don't understand why it always has to be an issue with them because it is a standing prescription. I've already missed 2 dosages, and my blood sugar is rising and arguing with them on the phone isn't helping my health. They do not take care of their customers and every time I go there all I hear from other customers is how poor they are at helping customers or they also are continually running out of their medications.
Business Response
Date: 05/01/2025
**** ******* **********
Please see our response
to complaint # ******** for **** ********* that was received by us on April 29, 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 found that
there is a valid authorization on file for the member’s medication
effective December 19, 2023 – January 17, 2027, and that there isn’t anything
hindering Mr. ********* from ordering his medication. CVS confirmed that they
currently have the medication in stock and have not been without it for two
weeks. They also confirmed that there was a previous supply and demand problem
for this medication, but that issue has already been resolved. Please know, CVS
must order the medication upon request because they usually do not keep a lot
of stock on hand. However, it only takes one to two days to receive it. Furthermore,
CVS advised the day supply that the member fills is at his discretion, but we
do recommend that he fills the medication around the time he takes his last
dose. This will allow CVS a full week to obtain the medication for the next
fill and prevent any delays.

In addition, we reviewed the member’s call history and did not find any related
calls on file. If Mr. ********* would like to provide additional information
regarding his phone calls (the number dialed, reference number, date, time,
etc.) we will be more than happy to investigate this matter further.

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: 05/08/2025

Complaint: ********

I am rejecting this response because: the response is inaccurate and not what happened, I ordered the medication 2 weeks in advance and CVS blamed it on the doctor and then the doctor showed me paperwork showing that it is set up. CVS is at fault, not the doctor and not Atena.

Sincerely,

**** *********
Business Response
Date: 05/14/2025
**** ******* **********
Please see our response
to complaint # ******** for ****
********* that was received by us on May 8, 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 an order for the medication was placed on April 29, 2025. One box was
picked up on April 30, 2025, and two boxes were picked up on May 8, 2025.
Unfortunately, we were unable to locate an order that was placed two weeks
prior to April 29, 2025. As partners with CVS Health, we apologize
for the frustrations and difficulties Mr. ********* has experienced while
attempting to obtain his medication.
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: 05/14/2025

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and I'm only accepting this because I'm tired of dealing with them and I am looking at alternative to be able to get away from the CVS Company and I'm also looking at getting new insurance because Atena has partnered with CVS and I feel they no longer care about their customers.

Sincerely,

**** *********
Initial Complaint
Date:04/28/2025
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.
My name is *** ******. I am the spouse of ****** ****** and responsible for this bill.

In August 27, 2024 my wife ****** ****** went to the ***** ****** in 1790 Scenic Highway, Snellville, Ga 30078 for Dental treatment. **** ****** ID *******.

The bill of ($1203.75),,One thousand two hundred and three dollars and Seventy five cents was sent to Aetna insurance after treatment and over ten times WAS DENIED FOR NO REASONS .

I went for the ***e treatment on August 01, 2024 and the bill was fully paid by Aetna.
We are both insured by Aetna insurance ID #**** *****.

The treatments that were done was scheduled over (2) two years before it was done.

Several times I called Aetna with my wife on phone and put the Aetna Ofice online with The ***** ****** and the bill was not paid.

Some of the several times that I called Aetna Insurance are September 09,2024, September 11, 2024, September 19,2024, September 27, 2024, October 06, 2024, October 21, 2024, November 11, 2024, November 27,2024, November 29, 2024, December 03,2024, March 03, 2025, April 06, 2025, and April 16,2025.

ALL THOSE DAYS that we called AETNA INSURANCE, THEY INFORMED US THAT THEY WERE WAITING FOR MORE INFORMATIONS FROM ***** ****** IN ORDER TO PAY.
THEY REFUSED TO PAY AS OF NOW.

TWICE I ASKED AETNA INSURANCE TO SEND ME APPEAL FORMS TO APPEAL THEIR DECISONS. THEY PROMISED TO SEND THE APPEAL FORMS TWICE.
INDEED TWICE THEY LIED AND DID NOT SEND THE APPEAL FORMS. (March 03, 2025 and April 16, 2025).

The ***** ****** has written me over ten (10) letters harassing, threatened and demanding that I paid the bill that The Aetna insurance must paid as agreed. A COPY OF THE BILL ATTACHED.
The manager at the ***** ****** REFUSED TO TREAT US and cancelled all our Dental appointments until we paid the amount owed.

ALL I AM REQUESTING IS THAT AETNA INSURANCE PAID THE ***** ****** AS WE ALREADY PAID OUR CO- PAYMENTS.
AND APOLOGISED FOR ALL INC.ONVENIENCES , We are retired and paid our insurances monthly.
Business Response
Date: 05/05/2025
**** *** ******* *********:

Please see our response
to complaint #******** for ****** ****** that was received by us on April 29, 2025. Our Executive Resolution Team
researched your concerns, and I would like to share the results of the review
with you.

Upon
receipt of your request, we immediately reached out internally to have Ms.
******’s concerns reviewed. It has been confirmed that denial
for the periodontal scaling and root planning for the upper and lower left and
right quadrant were overturned. It was found that the claims for the services were
reprocessed to allow the overturned services. The member is owed a refund
from ***** ****** in the amount of $50.00. Ms. ****** will need to allow fifteen business days from
May 01, 2025, for the provider to issue the refund.

The services for the periodontal scaling and root planning for
the upper left quadrant will remain denied as it was found not be medically necessary. We have confirmed that the member cannot be charged for
this quadrant.

A copy of the updated Explanation of Benefits (EOB) and resolution
letter from the complaint ************* have been included 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 Ms.
******’s concerns. If there are any additional questions regarding
this particular matter, please contact the Executive Resolution Team at *******************************.

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive Resolution Team
Customer Answer
Date: 05/11/2025

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.
HOWEVER I STILL DEMAND AND APOLOGY FOR THE PAINS AND SUFFERINGS AND WHAT I WENT THROUGH TO GET IT RESOLVED'
AND THANKS TO THE BBB ORGANIZATION FOR YOUR EFFORTS AND ASSISTANCE.

Sincerely,

*** ******
Initial Complaint
Date:04/23/2025
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Aetna mixed up my paperwork with someone else's. They list a ***** ** ***** as the provider, and the date of service as 08/09/24. That is incorrect. The $21 amount is the right figure.

I requested reimbursement for an aquatics class taken through the ********* ***** ** Recreation Department. It began on January 7, 2025.

I filed an appeal. They sent me someone else's paperwork. My claim is not stale.

I am a senior citizen. I had a bone disease in my shoulder. My mobility is limited in that arm. The aquatics class is in my opinion the most beneficial thing I can do for the arm and shoulder. I went to a gym for about 13 years.
Business Response
Date: 05/07/2025
**** *** ******* **********

Please see our response to complaint
# ******** for *** **** **** that was received by us on April 23,
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. Appeal *********** is
pending good cause due to the date of service of the Explanations of Benefits
(EOB) showing in the case. It is not a
different member. We were able to find
the correct EOB and are working with the Appeals’ Department to add the correct
EOB, so the appeals can be worked.

Even though you are appealing, the
claim for the member’s reimbursement was correctly denied. In 2024, the member had a direct fitness reimbursement. In 2025, the fitness reimbursement is not
longer available. The member was sent
the Annual Notice of Changes in September, and it states Fitness Reimbursement
is not covered.
The member will receive a detailed
Medicare Resolution Letter within 7-10 business days.
We take customer complaints very
seriously and appreciate you taking the time to contact us and giving us the
opportunity to address *** ****** concerns.
Sincerely,
Cindi D
Analyst
Medicare
Executive Resolutions
Customer Answer
Date: 05/07/2025

Complaint: ********

The response was garbled. Aetna changed its reimbursement policy. I accept their conclusion. To resort to the vernacular, it is what it is. I DO NOT WANT A DETAILED LETTER OF EXPLANATION. Don't waste your time or my own.

Sincerely,

***** ****
Initial Complaint
Date:04/23/2025
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 requested a refund In Jan 25 for dental procedure for the amount of $2300.00 I have had customer department and then I spoke with someone in resolution department. I spoke with a Johnny and Chinni. I was told that the following check# *******, *******, *******, ******** for the amount of $2300.00. They also told me that a complaint form was sent out to me that I never received. My last conversation was on 042325 with someone who told me that the check was sent overnight and I should have received it on 042225. I am requesting my refund of $2300 immediately.
Business Response
Date: 05/06/2025
Dear Mr. Stewart Henderson:

Please see our response to complaint # 23240201 for Ms. Bryna Spector, which we received on April 23, 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 details. We received the member’s dental reimbursement claim on, November 21, 2024. The payment in the amount of $2,309.33 was issued on December 2, 2024. When the member advised us that she has not received her payment, we stopped the payment and reissued a new check on, January 17, 2025. We were notified by the member again that she did not receive her payment. The payment was stopped and reissued again on, March 29, 2025. We are very sorry for the inconveniences this has caused. We want to advise that a stop payment and reissue can only be processed if a member has not received the payment within 45 days of the check issue date. Any request that was made prior to the 45 days could not be processed. The Executive Resolutions Team has submitted a new stop payment and reissue request on the member’s behalf. On May 2, 2025, a new check was shipped to the member via UPS Overnight, I spoke with *** ******* on May 2, 2025, and provided her with the shipment tracking id number. On May 6, 2025, I contacted *** ******* again to confirm that she has received her payment.

We understand that there is still some concern about where the member’s previous payments were sent. We have contacted our internal financial team to confirm that there were three checks sent to the address on file.
Here are the last three checks that were mailed to this member, excluding the one for this request. We have received data to confirm the following checks that were sent.
Check Number: ********
Ship Date: January 22, 2025
**** First Class 6x9 Tracking ID: ******************

Check Number: ********
Ship Date: April 2, 2025
**** First Class 6x9 Tracking ID: ******************

Check Number: ********
Ship Date: April 22, 2025
**** First Class 6x9 Tracking ID: ******************

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

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

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution
Initial Complaint
Date:04/22/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am attempting to pay my monthly billing for a Silver Script Medicare Prescription Plan (mppp) online. The first time I received a statement in March 2025, I was unable to complete the payment process online so a customer service agent helped me to resolve the payment issue. I stressed that I wanted to make payments online without having to go through the 10 - 20 prompts required to get to a real person. When I attempted to pay the April monthly bill online, the same problem occurred. After 10 - 20 prompts I reached another customer service agent who asked 10+ questions to verify my identity and then offered to help me complete the payment. I told her I did not want help - I just wanted to pay online and demanded that the technical problem be fixed. I was advised that I still needed to go through the customer service agent, which is not the pay online option advertised. I hung up after making it clear that I wanted the technical issue resolved so I could pay online. After checking back in to my account I still cannot pay online.
Business Response
Date: 04/25/2025
**** *** ******* **********

Please
see our response to follow-up on complaint #******** for
*** * ****** ********** that was received by us on April 23, 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 Ms. **********’s account. We
have confirmed the member enrolled into a SilverScript Choice Prescription Drug
Plan (PDP) effective January 1, 2025. The member was mailed a confirmation
letter of acceptance into the Medicare Prescription Payment Plan dated December
27, 2024. This letter advises her that if she has questions, call us at
###-###-####, 24 hours a day, 7 days a week.

During our review of the member’s call history into our
customer service department at ###-###-####, we were unable to locate any call
history on the member’s account. Therefore, we do apologize as were unable to
determine why she had to go through 10-20 prompts to get to a live agent.

We have confirmed she was able to login to her ************
account on March 17, 2025, and April 18, 2025. Her session shows the member
accessing balance & payment from the profile page and seeing a $0.00
balance due for mail. The member successfully adds a method of payment for
mail. Please note: Ms. ********** does not get her medications from our Caremark
Mail Order Pharmacy; she has been getting her medications from Amazon Pharmacy.
We show Ms. ********** does access the Medicare Prescription Payment Plan tab
and appears to click on the “view invoices and more, opt out” link. When
clicking this link, a new window or tab opens, and we cannot see past this
point as the site redirects her to InstaMed to make a secure payment online. ********* a ** ****** ***** company, processes the
Medicare Prescription Payment Plan payments on behalf of the plan. The member
can contact InstaMed at ###-###-#### for assistance.

Please know, the Medicare Prescription Payment Plan is a new
voluntary payment option in the prescription drug law that works with our
member’s current drug coverage under the payment option that works with their
plan to help them manage their out-of-pocket Medicare Part D drug costs by
spreading them across the calendar year (January–December). All plans offer
this payment option and participation is voluntary.

This payment option might help our members manage their
monthly expenses, but it doesn't save them money or lower their drug costs.
Each month members continue to pay their health or drug plan premium (if they
have one), and members will get a separate bill from the plan to pay for their prescription
drugs (instead of paying the pharmacy).

When members get a prescription for a drug covered by Part
D, we’ll automatically let the pharmacy know that the member is participating
in this payment option, and they won’t pay the pharmacy for the prescription
(including mail order and specialty pharmacies). Even though members won’t pay
for their drugs at the pharmacy, they are still responsible for the costs. If
members want to know what their drug will cost before they take it home, members
can call the plan or ask the pharmacist.

Each month, we’ll send members a bill with the amount they
owe for their prescriptions, when it’s due, and information on how to make a
payment.

The member's March and April invoice mailed to her states
how to pay her bill as follows:

Online at c****************, by credit or debit card.

Through the mail, by check, and send to the address:

Medicare Prescription Payment Plan
**** *** *******
******** ** **********

To ensure timely processing of payments made by check, we
ask that our members to please include their Member ID on the check along with
the provided payment coupon at the bottom of their invoice. Additionally, if
paying for multiple members, please submit a separate check and payment coupon.

If Ms. ********** has questions about her payment, she can call
us at ###-###-####, 24 hours a day, 7 days a week.

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 G.
Analyst, Medicare Executive
Resolution
Customer Answer
Date: 04/28/2025
I tried again several times to make the payment online after receiving the latest instructions, which are repeated clearly on the ******** website. I am very tech savvy myself and even I was not successful following any of the instructions given to make the payment online and nothing had been updated in my account to process the payment. After several failed attempts again, it dawned on me to try a different browser other than ******. I then logged on to the ******** MPPP website through ****** ****** and was able to process the payment quite easily. No where on the website does it mention that payments cannot be made using ******, none of the customer service agents I spoke with mentioned that solution and in fact the response to BBB did not mention that solution either. I have wasted much time and energy trying to get this problem resolved and it could have been fixed so easily. How about putting that work around information on the website and through Customer Service agents as I can't be the only consumer who uses ****** to access the ******** website.
Business Response
Date: 05/09/2025
**** *** ******* **********

Please see our response to complaint # ******** for *** ** * **********, which we received on April 29, 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 our internal resources to identify any known issues with ************ and ******. We have not found any known issues that would prevent ****** users from accessing ************ and using Instamed to make online payments. We have found that members may be unable to view pop ups in the ****** browser if the pop-up blocker is enabled. Members can disable the ****** Pop-up blocker – laptop or desktop using the following steps:
-Select the ****** menu. Then select Preferences from the drop-down menu.
-Preferences pane will open and then select Security on the top row.
-Uncheck the checkbox Block pop-up windows.
-Close the Preferences window.

We confirmed that the latest version of ******, ******, ****, and ******* are supported on ************. Older versions might not include important security features, defect fixes, and new functionality.

We value any member feedback. We have sent the member’s feedback to our ******** Digital Team for further review.

Please note, Ms. ********** can also make payments through the mail, by check.
Medicare Prescription Payment Plan
**** *** *******
******** ** **********
To ensure timely processing of payments made by check, please include the Member ID on the check along with the provided payment coupon. Please submit a separate check and payment coupon if paying for multiple members. If our member has questions about their payment, call us at ###-###-####, 24 hours a day, 7 days a week. TTY users can call 711.

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. **********’s concerns.

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution

Business Response
Date: 05/09/2025
**** *** ******* **********

Please see our response to complaint # ******** for *** ** * **********, which we received on April 29, 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 our internal resources to identify any known issues with ************ and ******. We have not found any known issues that would prevent ****** users from accessing ************ and using Instamed to make online payments. We have found that members may be unable to view pop ups in the ****** browser if the pop-up blocker is enabled. Members can disable the ****** Pop-up blocker – laptop or desktop using the following steps:
-Select the ****** menu. Then select Preferences from the drop-down menu.
-Preferences pane will open and then select Security on the top row.
-Uncheck the checkbox Block pop-up windows.
-Close the Preferences window.

We confirmed that the latest version of ******, ******, ****, and ******* are supported on ************. Older versions might not include important security features, defect fixes, and new functionality.

We value any member feedback. We have sent the member’s feedback to our ******** Digital Team for further review.

Please note, Ms. ********** can also make payments through the mail, by check.
Medicare Prescription Payment Plan
**** *** *******
******** ** **********
To ensure timely processing of payments made by check, please include the Member ID on the check along with the provided payment coupon. Please submit a separate check and payment coupon if paying for multiple members. If our member has questions about their payment, call us at ###-###-####, 24 hours a day, 7 days a week. TTY users can call 711.

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. **********’s concerns.

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution
Initial Complaint
Date:04/22/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
On behave of a medical provider **** *** ******** ******* *** *********** tax # ********* - *** ******* ** * *** *** ***** ** *****. Physical Therapy Providers are all out of network. For the past year or so , Aetna is pricing claims incorrectly not based on patients policy which is R & C 80%. Aetna sends our claims to **** *******. When we call , it is confirmed the claim was under paid, that the pricing is incorrect and they sent for re pricing - but stated we need to provide a non contract with **** *******. We explain that there is none and if **** ******* is adamant about there being one, it is their responsibility to provide one, in proof of justifying this low payment. Claims are being sent back to review reimbursement, corrected pricing BUT we need to call 3 times every 30 days. NOT only this is against all laws but we as DRs need to call for 3 months just to get a payment for rendering service under patient policy !! this needs to be fixed
Customer Answer
Date: 04/23/2025
we are out of network providers therefor we do not have any contracts with them
Business Response
Date: 04/30/2025
**** ******* **********
Please see our
response to complaint # ******** for ***** ******* on behalf of **** *** *********** *** ******** ******* that was received by us on April 23, 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 this complaint is coming from a third party and is not coming
directly from the provider group. We would need the business agreement between the
third party and the provider group to continue with the complaint. This
business agreement has been requested twice, from two different people and we
have yet to receive the business agreement that states the provider group is
giving the third-party permission to act on their behalf. The attached document
to this complaint is not a business agreement and is not legible. The third
party would need to submit the business agreement in order for this complaint
to be reviewed.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address ***** *******’s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst,
Executive Resolution Team

Customer Answer
Date: 04/30/2025
Hello I work directly with the provider and the group. Not sure what business agreement is needed.

Thank you
Initial Complaint
Date:04/21/2025
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am a victim of healthcare fraud through the Healthcare Marketplace,having been signed up for a policy without my knowledge. The person committing fraud signed me up for Aetna *** Health, and we didn't discover any of this any months later attempting to file our taxes. We filed this case as fraud with the Marketplace,but it was ruled against me,because it was discovered an ambulance company when I was sick billed this insurance and got payment October 18,2024, hence it was felt since we used the insurance this wasn't fraud. The ambulance company was contacted and money was refunded to Aetna *** health on March 16th 2025. Healthcare Marketplace will not allow an appeal unless Aetna *** shows this money was refunded and allows an appeal to go forward. Ultimately the *** ***** *** **** ***** form invalidated. I have made numerous phone calls to Aetna *** call center and have offers of help,but no one has helped, plus the necessary communication doesn't go forward to the Healthcare Marketplace. I think they use a foreign call center and not scripted to handle this type of problem
Business Response
Date: 04/30/2025
**** ******* **********
Please see our
response to complaint # ******** for ****** ****** that was received by us on
April 22, 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
has been determined that the member was showing active from August 1, 2024,
through February 1, 2025. Only one claim was found for date of service October
4, 2024, the claim was paid to the provider on October 12, 2024. On March 6,
2025, we received a void replacement claim, this was done by the provider to
void the original claim. The original claim was voided, and an overpayment was
sent to the provider, on March 8, 2025, we recovered the overpayment. The original
claim has since been voided and the overpayment was satisfied. The member never
received an Explanation of Benefits (EOB) to show the claim was in fact voided
because in this case only the provider would generate an EOB. A detailed letter
was mailed to the member today so that letter can be used to show the
Marketplace the claim was in fact voided out. The member should receive this
letter by mail in 7-14 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. 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:04/21/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have been messaging you and calling Aetna since 02/07/2025 to try to resolve 3 bills that are outstanding with *****. I changed to and HMO in 01/01/2024. I believe this defaulted to Mercy Physicians and I called in 03/2024 to designate *****. The woman designated ***** and told me to let her know when I decide on a physician. I designated *** ******** and began treating with him on 05/20/2024. I have treated with ***** ever since. I have paid every copay from 05/20/2024 forward. I later received a message from ***** saying I owe $1,888.88. I immediately messaged Aetna and they said these claims were processed and I paid my co-pay and I owe nothing. ***** continued to say I owed them the money. I messaged Aetna again and they then told me that I had designated ***** ********* ******* ***** which was incorrect. There was some error at some point when my insurance defaulted to them and once I was made aware of this I immediately called Aetna and they said they corrected the mistake and back dated the designation so I would have no issues with bills being paid. I again was informed by ***** I owed this money. I then called Aetna, and on 03/12/2025 Marvin confirmed that I do not owe this money and that he was going to send the bills back for processing. I asked him to please call me on the Monday 03/17/2025 and he never did. I messaged Aetna and they said he called me and left me a voicemail. He absolutely did not call me nor did he leave me a voicemail as I have all records of missed calls and voicemails. ***** again insists I owe the money and it's now almost $2,000.00. I'm on the phone with Aetna right now and the woman said Martin submitted the bills (maybe only one of the three she can't tell) and that he called ***** and left a voicemail for them on 03/17/2025 then "washed his hands of this". He never called again to follow up with ***** and never called me. Please ask Aetna for messaging history and call history dated all the way back to 02/07/2025.
Business Response
Date: 04/29/2025
**** ******* **********
Please see our
response to complaint # ******** for ********* ****** that was received by us
on April 21, 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
has been determined that the member did call to change her Primary Care
Physician (PCP) on March 26, 2024, however, on that call the member services
representative advised that the PCP she had selected was determined to be a pediatrician
so the member could not use that particular provider, this is why the system
auto assigned the ***** ********** ***** as the PCP. The member services
representative offered to change the PCP to *********** ******, but the member
stated she would call back after she had researched the provider. The member
called back on November 13, 2024, stating that she thought her PCP had been
changed already. The member services representative advised that per the notes
from the March 26, 2024, call the member was supposed to call back to designate
her PCP. The PCP was changed on November 13, 2024, and back dated to October 1,
2024, as *********** ****** Physicians. Outreach was made to *********** ******
billing department, Marie R advised that she would resubmit the claims to Aetna,
this process can take seven to 10 business days to receive the new claims.
After the new claims are received it can take up to 30 business days for the
claims to be processed and finalized. Once the claims are processed and
finalized the member will receive new Explanation of Benefits (EOB). Marie R
also advised that she has placed a hold on the members account so that it will
not go to collections while we get the claims processed and finalized.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address Ms. Biddle’s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Customer Answer
Date: 05/01/2025

Complaint: ********

I am rejecting this response because:

I appreciate the response and this sounds promising, however, I have to reject the response at this time as I simply do not want this case closed until ***** has been paid.

Sincerely,

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

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