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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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:04/21/2025
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 enrolled in an Aetna HMO plan through the *** for 2025. I researched carefully to ensure that my doctor was an in-network provider. Now, I am receiving notice from my doctor's medical group that as of April 1, 2025, Aetna will no longer include them for coverage. So, the plan that I specifically chose because my doctor was in-network is now NOT covering my doctor. If insurance indicates a provider is covered at the time of enrollment, they should uphold that contract for the enrollment period. I now have to try and find a new cardiologist and it is extremely difficult to establish. Aetna should be held accountable for this and reinstate coverage for my doctor.
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 your concerns, and I would like to share the results of the review
with you.

Upon
receipt of your request, we immediately reached out internally to have *** **********’s
concerns reviewed. Based on the review it has been confirmed that member was
informed that her cardiologist, *** ***** ** ******* was out-of-network as of
April 01, 2025, and any claims after April 01, 2025, would be the member’s responsibility.
After further review, we have confirmed that Ms. ********** does not have any claims
or referrals for *** ***** ** ******* or with ************ ******* ***** on
her account.

We
have engaged with our network team and was informed that Intercoastal Medical
Group’s contract was terminated on April 01, 2025, for business reasons. The provider’s
group was sent written notices 120 days prior to the termed date to allow members
time to locate an in-network provider.

We
have attempted to contact Ms. ********** on multiple occasions, by phone and
email ******************** without
any response. A detailed voicemail was left at the phone number we have on
file. A list of in-network Cardiologist was sent to the member’s email
********************.

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

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:04/17/2025
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 had Aetna CVS Bronze S: ******* plan last year via ********** ***********. I had met my annual out of pocket expenses in August 2024 but Aetna refused to pay for these two claims. I called twice and both times the reps understood the issue and said they couldn't figure out why I had additional out of pocket expenses when I had met my Out of Pocket in August 2024.

Both times they say they will call back with a resolution but NEVER did! How stupid is that of such a big company to pray on people? This is insane. I want my $50 back which I had to pay because the isurance refused to pay and refused to correctly reprocess the claims.
Business Response
Date: 04/21/2025
Dear *** *******
*********:

Please
see our response to complaint #******** for ******
****** ******* that was received by us on April
17, 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. It has been confirmed that there was an overpayment of his 2024 accumulator by $100.00 in December 2024. The three claims associated with the overpayment were
from the date of service December 14, 2024.
We
confirmed that all three claims were reprocessed. The claim details are as
followed:
Claim: EWPDHSMQN was reprocessed on April 21, 2025, billed total $90.05, Aetna paid $57.17, leaving a new member responsibility of $0.00.
Claim: EVADHPF0B was reprocessed on April 21, 2025, billed total $377.10, Aetna paid $0.00, leaving a new member responsibility of $0.00.
Claim: EHY2KK2R6 was reprocessed on April 21, 2025, billed total $170.00, Aetna paid $170.00, leaving a new member responsibility of $0.00.
The member and the provider will receive
the updated Explanation of Benefits (EOB) in 7-10 business days.

We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Mr.
Rosario’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:04/16/2025
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.
On this day April 15th 2025 at approximately 2:53 p.m. the doctor by the name of ******** ***** came to our home for an in-house visit for my wife and I through Aetna not only did she not confirm her arriving like she said she would once entering our home she was very disrespectful to everyone in my home and then she decided because she felt uncomfortable that she was no longer going to proceed with our schedule appointment that we made about a month ago she proceeded to argue with us and then picked up her stuff and left
Business Response
Date: 04/25/2025
Dear *** ******* *********:

Please see our response to complaint # ******** for *** ******* ********, which we received on April 16, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the concern, we immediately reviewed the member’s benefit details. The Healthy Home Visit provided by ******* gives our members access to preventive care at no additional cost. We are sorry to hear that our members did not have a good experience with their ******* Health clinician. The concerns were forwarded to ******* to be addressed. ******* Health has taken the appropriate actions with the clinician for service improvements. The clinician was sent educational material on best practices of providing exceptional care to our members. ******* has added notes on each account to not reschedule with the same clinician going forward.

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

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

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution

Customer Answer
Date: 04/26/2025

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:04/15/2025
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.
Claim submitted 3-23-25, for Aetna Hospital indemnity claim, Admission to hospital, sent all requested documentation several times, itemized bill and diagnosis codes that a normal person would not have access to, after finally getting the itemized bill and the diagnosis codes and sending over 10 emails with the pdf on April 9th to the 11th company clai** they can not see it but could see every other document sent prior. Called 4-14-2025. A request was escalated the agent found the document and was told I would get a call same day with an update, got a call they left a voicemail stating they did not see it in the system from a manager but the agent who escalated did. Woke up to an email 4 -15-2025, stating they do not see the document, This is unacceptable, I then sent the itemized bill again 6 more times via email and tried to upload to the Aetna website and now getting an error code. This is a plan I have paid into for years, They are stalling in taking care of the claim , once I was finally able to jump through so many hoops to get the itemized bill and codes,they now claim they do not see it anywhere but have had no issues locating all the documents they claim would not work.
Business Response
Date: 04/15/2025
**** *** ******* *********:

Please see our response
to complaint #******** for ******* **************
that was received by us on April 15, 2025. Our
Executive Resolution Team researched your concerns, and I would like to share
the results of the review with you.

Upon receipt of your request, we immediately
reached out internally to have *** **************** concerns reviewed. Based
on the review it has been confirmed that the required documents were received on
March 23, 2025, and April 01,2025. The claim ************ has now been processed with a total
benefit payment of $1,400.00. The benefit payment includes $1,200.00 for the
admission benefit and $200.00 for the one-day daily benefit. The payment will
be deposit into the member’s bank account on file.

We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address **.
**************’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:04/15/2025
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 have stage 4 breast cancer and my doctor wanted me to complete hyperbarics. This business said I should pay $3k and insurance would reimburse me after they ran it. After I paid the $3k this business refused to run my insurance. After months of going back and forth they finally ran my insurance. Per my insurance company all claims have been paid and this business still refuses to reimburse me my $3k. In addition, my insurance accidentally sent them a check that was meant for me in which they cashed it and therefore they have now been paid basically twice. Since my insurance made the mistake and sent my check to this business I feel like my insurance should be able to cut me a check for the missing $3k. This appears to now be the insurances fault as well sending my money to that business. I continue to fight with them with no return of funds. Like I said before I currently have stage 4 breast cancer and as you can imagine I can a ton of medical bills that the $3k could really help me pay toward debt. My insurance company continues to make this hard for me and being a cancer patient it has been a struggling and missing these funds are causing financial distress for me and my family. Any help expediting these funds being returned to me would be appreciated.
Business Response
Date: 04/22/2025
**** *** **********

Please
see our response to complaint # ********
for ******** ******** that was received by us on April 15, 2025. Our Executive
Resolution Team researched the member’s concerns, and I would like to share the
results of the review with you.

Upon
receipt of the complaint, we reached out internally to have the member’s
concerns reviewed. The member’s claims were processed, and a payment was issued
to the provider’s office for a total amount of $1,409.10, which is the
contracted rate. Please know, the payment was not issued to *** ********
because the assignment of benefits on the submitted claims was set to pay the
provider, plus the claims did not acknowledge that the member had paid the
provider up front. However, on April 21, 2025, Marla with the provider’s
billing office confirmed that the member has a credit of $3,000 in their system.
Marla also advised they a processing a refund for the member and it will be
issued in the form of a paper check within 30 days of April 18, 2025. We
confirmed the member’s mailing address with Marla, and she stated their system
was updated to match the address that we have on file. Furthermore, we
contacted Ms. ******** on April 21, 2025, and
she verified that she spoke to the provider’s chief financial officer (CFO) on April
18, 2025, and he advised that per his authorization, a refund in the amount of
$3,000 would be mailed to her as soon as possible.

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,

Herman M.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:04/14/2025
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am filing this complaint to seek coverage for ****** that has been denied repeatedly by Aetna. The problem is I meet their criteria to get the authorization, but they keep denying it for completely reasons. I have called them numerous times, and they all do the exact same thing. They say I am not covered for the wrong reasons, and when I explain that they put me on hold and connect me with ***. When Aetna gets off the call, *** just blames Aetna for denying the request and says I have to take it up with them. I have made at least 10 phone calls since January 2025, all with the same result. Here are the criteria I meet to have the drug covered under Aetna's policy;

1. The patient is 18 years of age or older
2. The requested drug will be used with a reduced calorie diet and
increased physical activity for chronic weight management in
an adult.
3. The patient has a body mass index (BMI) greater than
or equal to 27 kilogram per square meter AND has at
least one weight related comorbid condition (e.g.,
hypertension, type 2 diabetes mellitus or dyslipidemia

I have uploaded Aetna's policy on ****** where these exact requirements were taken from. There is no reason for Aetna to be denying this medication.
Business Response
Date: 04/17/2025
**** ******* **********
Please see our
response to complaint # ******** for **** ******** that was received by us on
April 14, 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 does not have Pharmacy benefits through
Aetna. The member’s pharmacy benefits are through ***/******** and the member
would need to contact ***/******** for any further questions or concerns at
###-###-####. Outreach was made to ***/******** to the Account Pharmacy
Manager, and we were advised that the medication for ****** was not approved or
covered for this member. A review was completed six times, and the required
necessary information was not received from the provider. The provider would
need to submit the required necessary information for the review. This
medication requires prior approval and ***/******** cannot review the request
without the required necessary information.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address *** ********** concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Initial Complaint
Date:04/13/2025
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.
I previoused in joint tow with progenitoric owned an bank account,(cheque's) to's-with's ;
******* ***** ****
*** **** ******* ******
************ ** *****
###-###-####¦??
The account was opened to the significance of relaying progenitoric rent and too store/save more funds,too be applied,applicable.
The very beginnings of the joint account in autumn,2024.
The incur/debits began here around the specifics of:
9th mth,2024.
10. mth,2024.
11. mth,2024.
12. mth,2024.
01. mth,2025.
02. mth,2025.
03 mth,2025.
The-this debit, the matter-material, the material matter, this hashed pivot of an such an bought claim i pre-lature, as-ased an non-misrealative, of no consented matter of given informative
too allow such an personal verbatim in word conversion at the moments time.
I would like to have an refund of all's monies toward such refunded back too's I **** ********* ******, in all due relatives in the form format of an cheque back too, *** ****** **** ************ ***************.
Business Response
Date: 04/22/2025
**** ******* **********
Please see our
response to complaint # ******** for **** ****** that was received by us on
April 14, 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 enrolled in a Whole Life Insurance
policy with an effective date of December 10, 2024. The application was
submitted on November 15, 2024, the policy was approved and issued on November
25, 2024, the policy pages were mailed to the policy holder on December 11,
2024. *** ****** contacted Aetna on February 4, 2025, stating that he did not
know about the policy and wanted to cancel and requested a full refund. The
policy holder was advised that we would need a written cancellation request and
provided the mailing address. Policy holder called on March 31, 2025, and again
on April 11, 2025, requesting cancellation and a refund. No further action was
taken due to not receiving the written cancellation request. On April 16, 2025,
the policy was cancelled with an effective date of December 10, 2024. A refund
of $54.78 was issued and mailed to the address we have on file. The policy
holder should allow 7-14 business days to receive the check.
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 *********************************.
Sincerely,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Initial Complaint
Date:04/10/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am filing this complaint against Aetna Dental due to an improper and premature recoupment action taken on our account.

We are currently in the middle of appealing a claim decision, and Aetna Dental had previously communicated that we would have until April 15, 2025 to resolve or respond regarding the matter. However, on April 10, 2025, I received a final notice letter in the mail dated April 3, 2025. Upon calling Aetna for clarification on April 10, 2025, I was informed that they had already recouped funds from another claim also dated April 10, 2025—prior to the agreed-upon April 15 deadline.

This action is not only premature but also denies us the opportunity to appropriately contest the decision or respond in accordance with the timeframe they originally provided. It undermines the integrity of the appeals process and puts us at a financial and administrative disadvantage. We were not given fair notice or any realistic opportunity to prevent the recoupment before it was processed.

Resolution Sought:
I am requesting that Aetna Dental reverse the recoupment immediately and pause all further collection actions until all appeal avenues have been fully exercised and exhausted. We expect a fair process and for Aetna to honor its own stated deadlines.

This behavior sets a concerning precedent and representative Joan in the Aetna overpayment department left me with little resolution and told me to escalate this through other channels. Case ID: ********* and letter IDs: *************** & ***************, *** *************
Business Response
Date: 04/17/2025
**** ******* **********

Please see our response to complaint
#******** for ***** *********** *** that was received by us on April 10, 2025.
Our Executive Resolution Team researched the concerns, and I would like to
share the results of the review with you.

Upon
receipt of the complaint, we immediately reached out internally to further
research the provider’s concerns. We confirmed that the overpayment is valid
and was due from the provider regardless of when it was recouped. The second
overpayment letter was expected to be mailed on March 10, 2025. However, while
we reviewed the provider’s disputes, the
overpayment file was pended from February 19, 2025 – April 2, 2025, and no
actions are taken on pended files. Therefore, the letter was not mailed until
April 3, 2025. Please know, the letter is system generated and the verbiage
regarding the 15 days cannot be altered. During our review, several representatives
were corresponding with *** **********, and we also mailed the provider two denial
letters for his dispute/appeal(s). Although the recovery took place on April
10, 2025, the funds cannot be refunded to the provider since the overpayment is
valid. The provider is more than welcome to proceed with his current appeal or send another dispute request; however,
the policy stands because the billed procedure codes are for orthodontist
billing only.

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

Sincerely,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Customer Answer
Date: 04/17/2025

Complaint: ********

I am rejecting this response because: ***** and ***** are considered diagnostic codes which is where the ***** numbers come from. ***** are for orthodontic purposes, this is one of the few insurance carriers that classify ***** and ***** as orthodontic only. ***** is for pre-orthodontic visit for records which usually includes photos and scans if needed, which therefore makes the need for ***** and ***** unnecessary for orthodontics since more than likely if a dentist bills ***** and ***** on the same claim Aetna would deny ***** and state it is part of the ***** benefit.

Sincerely,

***** **********
Business Response
Date: 04/24/2025
**** *** **********

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 the complaint, we reached out internally to have the provider’s
concerns reviewed. We reviewed the provider’s claim history and confirmed that
the original claim denied the two procedure codes ***** and ***** with the
reason that they are not eligible for payment under the dental plan. Please
know, the procedure codes are eligible to be billed when performed with
orthodontic treatment only. *** ********** has
indicated the services are not part of an orthodontic treatment plan.
Therefore, the claim was processed correctly as the billed procedure codes do
not qualify for coverage.

We take customer complaints very seriously and appreciate
you taking the time to contact us and giving us the opportunity to address Dr.
Fischgrund’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
Initial Complaint
Date:04/09/2025
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.
Injury to left shoulder occurred late 1/25

Saw orthopedic surgeon in mid. 1/25

Had MRI early 3/25

Had CT scan mid. 3/25

Returned to orthopedic surgeon and was diagnosed to need reverse shoulder replacement to fix problem

Aetna denied claim on 3/26/25 based on no non-invasive therapy performed

Went to PT on 4/02/25 and was told that I am not a candidate for physical therapy until after surgery

Have no use of affected arm and am in pain to the point of only sleeping from exhaustion

Looking for Aetna to promptly review my appeal and approve my appeal

If denied, giving consideration to a pain and suffering case. I have got my surgeon and physical therapist both telling me that surgery is my only option for normal function to return
Business Response
Date: 04/11/2025
**** *** ******* **********

Please see our response to follow-up on complaint # ********
for *** **** ********* which was received by us on April 10, 2025. After
receiving the complaint, we promptly conducted internal research.

Our Executive Resolution Team has finalized the research,
and I would like to share the results of the review with you.

We have confirmed in the member’s account, the concern
pertains to a preservice denial.

On March 17, 2025, we received a preservice authorization
request. From March 17, 2025, through March 20, 2025, the plan requested the
clinical records. Based on the available
records our medical director denied the requested procedure.

On March 21, 2025, a peer to peer was offered and on March
24, 2025, our medical director attempted to facilitate the peer to peer. Our
call was left unanswered, and the plan maintained the denial on March 26, 2025.

On April 8, 2025, the provider filed an expedited appeal, and
this was overturned. The authorization has been approved from April 9, 2025, through
October 9, 2025.

The member will receive the detailed Medicare response in
the mail within seven to ten business days.

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

Sincerely,
Jennifer
Analyst
Medicare Executive Resolutions
Initial Complaint
Date:04/09/2025
Type:Order Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am writing to formally address significant communication issues I faced while applying for Aetna Direct Dental and Vision coverage and to seek your assistance in resolving my application status.

Background: On March 8, 2025, I applied online for coverage through Aetna’s website and received a confirmation email indicating that my application was being processed. However, I encountered ongoing difficulties accessing my account, which led me to contact Aetna customer service multiple times.

Communication Challenges: Repeated Transfers: During my calls on March 28 and April 2, I was transferred several times without receiving clear answers about my application status, only informing me that they couldn't find an application, offering no resolution.

Ineffective Requests: On April 2, I made multiple requests to speak to a manager. Ultimately, I was informed that 207 applicants had applied through the direct care sand box and that I would need to reapply. Aetna made it clear during this call that there is nothing they can do regarding my request for retroactive coverage. Placing the fault on me for not calling, or reapplying. Absolving themselves of any responsibility. When I did call and was not directed to reapply, and only after I requested to speak to management more than once.

Impact: Due to the lack of effective communication, I incurred significant financial strain, having to pay $4,000 for dental work that I believed would be covered.
Business Response
Date: 04/18/2025
**** *** **********

Please
see our response to complaint # ******** for **** ****** that was received by
us on April 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 enrolled with an agent on April 2, 2025, and the plan had an effective
date of May 1, 2025. Unfortunately, the member’s application was part of a
technical issue that affected her enrollment and caused a delay in processing. Please
know, that issue has been corrected and the plan is now showing active with an effective
date of April 1, 2025. Furthermore, we contacted Ms. ****** on April 18, 2025,
and she advised the provider’s office will submit the claim to Aetna on her
behalf. In addition, we have reviewed the
member’s call history, and the necessary coaching has been provided.

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,

Herman
M.
Analyst,
Executive Resolution
Executive
Resolution Team

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