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:04/09/2025
Type:Delivery Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
In January of 2025 I switched my plan with Aetna to the elite plan and I was told I would get a new membership card mailed out to me along with a special benefits card of $50 monthly benefit.card. Soon my membership card came but not my extra benefits card. I called and was told I had to wait for 14 days.I called them and told I was given incorrect information. and to call at 24 days. Third call told a new card would be sent out to me, February 28 card mailed. After several calls, I was told conflicting things. They kept saying to me that they do not do rollovers, and I keep explaining that this is not a rollover. This is money that you owe me. Some told me yes they can put it back on my card once I received the new one and to call. When I called I was told, no it can't be done. After explaining the other conversations I had previously I was still told no. Again stating they don't do rollovers. I appealed this with Aetna and I was denied I attached the copy of the denial letter. I then appealed that decision and have heard nothing back from them. Again the money was there but by them not sending me out a replacement card in a timely manner I was not allowed to use it. There is no tracking controls on their mailings. They are blaming it on the postal service losing the letter with the card. With that I do agree, it happens. What I do know is that it was not my fault and I shouldn't be punished by losing that money because of an error somewheres beyond My control. I contacted them plenty early in the month to send me out a replacement. I explained to them that it's not like I'm asking for a million dollars, but being on social security disability I could really use that $50 for groceries. This is also the reason I switched plans to that plan with them.So this is what I'm asking for is to have that money reinstated to my account. And also for them to stop calling this a rollover. In my situation, it is to reinstate money that is owed to me, not a rollover.
Business Response
Date: 04/18/2025
**** *** ******* **********

Please see our response to complaint # ******** for *** ***** *******, which we received on April 9, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the concern, we immediately reviewed the member’s plan details. We found that the member gets an Extra Supports Wallet with a $50 monthly benefit amount (allowance) on the Aetna Medicare Extra Benefits Card to pay for:
-Over****************;counter (OTC) approved health and wellness products including allergy medicine, pain relievers, first aid supplies, and more.
-Transportation including gas at the pump, public transportation, and certain ride share services.
Gas must be purchased at the pump by swiping the card and selecting credit as the payment type. The card cannot be used to purchase gas or products inside of a store at the gas station. Gas purchases are subject to holds and funds may be unavailable while that transaction is being processed.
-For ride share services, you will need to download the corresponding app and add the Aetna Medicare Extra Benefits Card as your payment type.
-Utilities including gas, electric, water, sewer, landline, cell phone, and internet service. The utility provider must accept ****. Utility expenses must be paid directly to the utility provider using the card.
-Personal care products including paper towels, shampoo, soap, and more.

Members can use these funds in the following ways:
-Retail - In-store at participating retail locations – To find a participating retail location near you, visit *******/Aetna or call ###-###-#### (TTY: 711).
-By Phone –Call ###-###-#### (TTY: 711), 8 AM- 8PM local time, 7 days a week, minus federal holidays.
-Online – Visit *******/Aetna or download the *** OTCHS app to a mobile device from the App Store or ****** ****

The member filed a complaint on, February 26, 2025. The complaint ID is, ************. The Complaints Team mailed a resolution letter to the member on, March 11, 2025.

The original *** Extra Benefits card was shipped to Mr. ******* on, February 1, 2025. The card was sent to the address on file. The plan made no error sending out the extra benefit card in a timely manner. A replacement card was shipped on February 28, 2025, to the address on file,

We are very sorry that the member did not receive the first card that was sent to him. We understand that his plan began on February 1, 2025. The member was unable to use his monthly allowance for February because he did not receive his card.

We have forwarded the member’s concerns to *** Over the Counter Health Solutions (OTCHS). OTCHS has advised that a balance adjustment of $100.00 ($50.00/month) was applied to the member’s April balance as a one-time exception. There is $121.82 available for the month of April. This allowance will not rollover. The member must use the amount available before May 1, 2025.

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 Mr. *******’s concerns.

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution

Customer Answer
Date: 04/28/2025
I am happy to say that this matter has been resolved in a very timely matter after I contacted the better Business bureau. I was denied twice to resolve the matter on my own. I consider this case closed and I just hope this doesn't happen to somebody else. Thank you to the better Business bureau and also thank you to Aetna for their work on this matter.
***** *******. ###-###-####. ** ****** *******. ******* ** *****
Initial Complaint
Date:04/09/2025
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.
Aetna accessor Melissa came todo assessments for 1 of my kids and she decided todo all of them without telling me about anyone else and decided todo all assessments. I have 4 kids and she told she is coming todk 1 kid . And then when i asked to increased ****** hours she wasnt listening and making rassist comments. Later she went home and told
Me she will reduce everyone hours i told her u didnt even saw kids how can u do that thats wrong ill
Complain to aetna . Then she told
Me she want to come again which was april 7th i told her thets Fine i kept all Kids home and she saw them On beds and then she wasnt listening to me and was rude kept interrupting me didnt let me speak and left later she called me and said i reduced all kids hours. I got so upset to how can she do this she bluntely told me they dont need it u can file complaint. She discriminated aganist me and my kids which by law isnt right. As a resolution i need justice and I want to increase ****** hrs i also provided a script from her doctor due to chsnge in her needs she needs more
Help and other kids that she reduced hours i want them to be back to same
Hours they werre as before.
Kids name
****** ***** ******** ***** ***** ***** and ******** ***** more info upon request.
Business Response
Date: 04/22/2025
**** ******* **********
Please see our
response to complaint # ******** for ***** ***** that was received by us on
April 09, 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 all four children are enrolled in Aetna Medicaid, the
hours that were cut are as follows: ***** ***** went from 18 hours to 11 hours.
Time was taken away for feeding, due to being seen feeding self during the
assessment, he also attends school full time. ******** ***** went from 20 hours
to 10 hours. Mother asked for increase hours, and it was not approved due to
behavioral issues, this falls under parental responsibility, member was seen
playing with a cell phone, attends school full time. ****** ***** stays at nine
hours, denied the increase hours of 40 which were requested by mother. Mother
is requesting more hours for supervision for safety due to the recent mental
health issues. This falls under parental responsibility, she is being home
schooled at this time. ******* ***** went from 31 hours to 11 hours due to ADL
capability improvement of the child. Mother stated that he uses assistive
device to walk, however, child was seen playing on a cell phone. The assessor
did not see any signs of devices in the home, and member was walking without
any evidence of a struggle. Child attends school full time. The mother was
advised that safety and supervision fall under parental responsibility and is
in accordance with ******* * ********* no hours should be approved for parental
tasks like supervision for mental health needs. The mother may appeal with supporting
medical documentations. This issue was also forwarded to the ******** ***** ******
team due to the mother stating alleged discrimination. The concerns with the
assessment were reviewed by the leadership of the Case Management/Personal
Preference Program (PPP). All assessments were completed following the standard
process applied to all Aetna Better Health *** ****** members.
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: 04/22/2025

Complaint: ********

I am rejecting this response because:

Sincerely,

***** *****
Customer Answer
Date: 04/22/2025
Aetna accessor mellisa discriminated
aganist my children she kept telling me
they dont need this they dont need that care rejecting thier needs she kept telling me its all parental responsibilities which isnt true for everything. I have to cook seprate meals for ******** he has diabeties he needs special care even in the past aetna tried to reduce hours for ******** after appeal i did they agreed for 31 hrs a week now again they did are trying to reduce his hours i completely disagree with this decision. And i have right to appeal i have to buy septate grocery for him he requires more care for insulin his sugar goes high and low very quickly and he wear diapers he is incontinent we have todo septate laundry for him bedsheets, shower he needs
help, grooming toiletting, eating, feeding mobility they recuded his hrs to 10-11 which is not acceptable.
Business Response
Date: 04/25/2025
**** ******* **********
Please see our response
to complaint # ******** for ***** ***** that was received by us on April 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 the complaint, we immediately reached out internally to further research *** *****’ concerns. The plan confirmed that this matter was
already resolved with the State of *** ****** and the resolution has already
been provided. Please know, our previous reply will not change. The resolution
states the appeal and grievance department worked together with other Aetna
Better Health departments to review *** *****’ grievance and to take the appropriate
actions. *** *****’ concerns including the assessment, and its final score have
been reviewed by the leadership of our case management/personal preference program
(PPP).
******** needs were determined via a comprehensive
needs assessment on April 1, 2025. Ms. ***** requested additional PPP hours and
sent the case manager a new prescription. ****** was subsequently reassessed on
Monday, April 7, 2025. Based solely on the results of the personal care assistant
(PCA) tool utilized for all reassessments, ****** was approved for nine hours. Please
be advised that all assessments were completed following the standard process
applied to all Aetna Better Health of *** ****** members.
The other children’s (*****, ********, and *******)
needs were also reassessed on Monday, April 7, 2025. We confirmed that all
children were assessed on the same day as they have been in the prior years,
and regret there may have been a miscommunication about which children were
being assessed. Based solely on the results of the personal care assistant
(PCA) tool utilized for all reassessments, the children were approved for nine
hours. Please be advised that all assessments were completed following the
standard process applied to all Aetna Better Health of *** ****** members.
Aetna complies with applicable federal civil rights
laws and doesn’t discriminate based on race, color, national origin, age,
disability or sex (consistent with ** *** * ************ and does not exclude
people or treat them less favorably because of race, color, national origin,
age, disability or sex.
If *** **** would like to appeal the decision, she can
appeal in the following ways:
*In writing via mail (Aetna Better Health of *** ******, Attention: Member Services, ** *** ****** ********** ** **********)
*By calling member services at ###-###-####
*By sending a fax to ###-###-####
*By submitting a request online at ****************.
Along with supporting documentation, Ms. ***** must
submit the attached member consent form. However, Ms. ***** must also be aware
of the timely filing limit to submit an appeal. For internal appeals, the
timely filing is 60 calendar days from the date on the initial notification/denial
letter. The timeframe for members/providers to request an appeal with continuation
of benefits for existing services is on or before the last day of the current
authorization, or within ten calendar days of the date on the notification
letter, whichever is later.
We take customer complaints very
seriously and appreciate you taking the time to contact us and giving us the
opportunity to address Ms.
*****’ concerns. If
there are any additional questions regarding this particular matter, please
contact the Executive Resolution Team at *******************************.
Sincerely,

Shay
G.
Analyst,
Executive Resolution
Executive
Resolution Team
Customer Answer
Date: 05/05/2025
I have replied to this already but not sure why u didnt get it. We r still under disputing reduction of hrs in care ppp program for my son *******h.
i also compaint to ** state of insurance they are investigating it. This matter is still not resolved yet.
Initial Complaint
Date:04/09/2025
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 writing to file a formal complaint against Aetna regarding a recent issue I encountered with the insurance provider that has resulted in significant financial burden, time loss, and emotional distress.

On February 10, 2025, I contacted Aetna customer service to confirm coverage for a specific medical procedure provided CPT code and diagnosis code. The representative assured me that the procedure would be covered under my plan. Based on this confirmation, I proceeded with the treatment on February 12, 2025, and paid the full cost out of pocket.

After submitting the claim for reimbursement, I was shocked to receive a denial of coverage. I filed a first-level appeal, which was also denied, despite the fact that I relied on Aetna’s initial confirmation to make my medical decision. The treatment was medically necessary, and I have seen significant improvement in my condition since receiving the procedure.

This situation has caused me unnecessary financial hardship and significant emotional distress. The misinformation I received from Aetna about coverage was false and led me to make an informed decision based on inaccurate information. I could have opted for other treatment options had I been properly informed.

I am seeking reimbursement for the procedure costs, as well as an official review of the misleading information I received from Aetna. I am also requesting that Aetna takes responsibility for this error and ensures that it does not happen again to other members.
Business Response
Date: 04/14/2025
**** *** ******* **********

Please see our response to complaint #********
for ********* *********** that was received by
us on April 09, 2025. Our Executive
Resolution Team researched your concerns, and I would like to share the results
of the review with you.

Upon
receipt of your request, we immediately reached out internally to have Ms.
***********’s concerns reviewed. Based on the review it has been confirmed that
that procedure code ***** denied correctly as experimental and investigational.
This denial is consistent with the Aetna’s Clinical Policy Bulletins (CPBs)
related to blood and blood productions, including platelet rich plasma
injections.

During
the review of the member’s call history, we found that on the February 10, 2025,
the advocate did advise that the procedure code ***** would be covered. However, on February 12, 2025, the member was
informed that the procedure was not covered by or billable to their insurance.
We contacted member’s provider and received a copy of the financial agreement
with Ms. ***********’s signature. This agreement indicates Ms. ***********’s
agreed to self-pay for the services and that it is not covered by insurance.

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: 04/15/2025

Complaint: ********

I am rejecting this response because:
the provider agreement doesn’t proof anything. I asked aetna if the service is covered and, they told me it is covered. Based in this response I proceeded with the provider. Aetna can not lie or provide false information and trap patient and then take no responsibility.

Sincerely,

********* ***********
Initial Complaint
Date:04/08/2025
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.
******** mail deducted 225$ from my *** card on 3/21 by Their mistake.
I spoke to their agent in February saying them to cancel all orders that I dont want to use them , he didnt do it. I have phone recordings. Instead they charged my card and they took my money, my claims are being denied since then because if insufficient funds.
Since then I reached out to ******** phone number ****** ****, spoke with Victoria "supervisor" 5x who didnt want to refund immediately the moment they intercepted shipment instead they are keeping my money hostage for almost a month! While my claims are being denied because if insufficient funds. Another supervisor "Princess" said she processed the refund , money still didnt come.
I escalated further nothing happens. If I dont get the money by Monday 00:01 april 7th, i will escalate further to CEO David J***** followed by a lawsuit. They cant keep ******* ** ***** ***** taking all the money doing nothing while working ppl are denied benefits.
I want refund and I want 100$ for 6h of speaking on the phone with their useless representatives
Business Response
Date: 04/18/2025
Dear ******* *********:
Please see our response
to complaint # ******** for ********* ******** that was received by us on April 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. Our mail order team confirmed that on January 29, 2025, Mr.
******** requested the mail order prescriptions be canceled. Unfortunately, the
request was not handled appropriately, and coaching was provided to the
representative involved. *** ******** did escalate his concern to two
supervisors who followed the correct process of submitting the refund request.
However, these requests are handled by a different department and refunds are
only issued once the shipment has been returned. The package was received back
on April 9, 2025; hence a refund was issued on April 10, 2025. Furthermore, if
*** ******** made payments out-of-pocket for copays or coinsurance during the
time that his Health Savings Account (HSA) had insufficient funds, he can
request a refund by calling his account administrator, **** ** ************.
We apologize
for the frustrations and difficulties *** ******** encountered while attempting
to resolve this issue and regret that this matter required much of his time in
order to facilitate a resolution. Unfortunately, we are unable to honor Mr.
********’s request for compensation. We do appreciate *** ********’s patience
during the time involved in researching and resolving his issue.
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,

Brittany
F.
Analyst,
Executive Resolution
Executive
Resolution Team
Customer Answer
Date: 04/21/2025

Complaint: 23163559

I am rejecting this response because:
I spent over 8 hours and I spoke with 4 different supervisors not 2
You should compensate me for my time

Sincerely,

********* ********
Initial Complaint
Date:04/08/2025
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 a ***, ********, Aetna, Silverscripts, or whatever customer.
I filed a claim in December for which I am getting a run around. Below is a brief synopsis of my issue. You can review the files for yourself.
I have been communicating with ******** for 3 months and get nowhere. Each paper communication has a different message.
I have made many phone calls to the customer service line - to no avail. If you wish to speak to someone who can help, you wait 30+ minutes, then get disconnected. I spoke to one supervisor who told what information was needed. He told me he would call me back on a Monday. He left me a number to call him at. I did obtain all of the information asked for. He did not call. I called him only to find out his extension was an unmonitored mailbox. (from an anonymous ******** employee: that is standard practice for an annoying customer - it's an internal joke).
I have provided the required information on several occasions.
I had a very unpleasant call with a woman named Nancy who claims she is the highest in the company and refused escalation.
I have spent 3 months dealing with rude people who always have an excuse. The ironic part is they all have different reason why they can't pay. I have denial letters that contradict each other. The latest is stating that I did not provide the ***** number, which I have provided on more than 1 occasion.
I have asked for the Medicare rulings cited but have been refused.
I am frustrated beyond belief. I am reporting to Medicare and ***.
I believe I am owed reimbursement for my drug and compensation for my time and aggravation caused by Aetna.
I have filed a complaint with *** ********** ******** Medicare Part D, As their website that my right. I just receive a Dismissal' letter because they stated that I did not supply my name, Policy #, etc. Which I have supplied on their form I filled out.
I have supplied every piece of information requested multiple tiimes.
Business Response
Date: 04/17/2025
***** ******* *********

Re: BBB Complaint #********:

We’d like to share our findings with you about your question. We are writing in response to your email of January 3, 2025, regarding a matter for our member ******* *******. It is our understanding that Mr. ******* is inquiring about the denial of his drug purchase in his providers office for ***********. Member is also upset that he has spent 3 months dealing with rude pharmacy customer service associates and believes he is owed reimbursement of $2500.00, for his drug *********** and compensation and for his time. The member spoke to a supervisor about a December pharmacy claim he filed. The member was advised what’s needed to process the claim correctly, but no return call back, and he was supplied a non-working call back number. Member stated each paper denial communication has a different reason Silverscript can't pay. Currently ***** ********** ******** Medicare Part D appeal denial is stating the member did not provide the ***** number, name, Policy #, which the member states he has provided on more than one occasion. Member is also not happy with Manager Nancy who stated she is the highest in the company he could speak with and refused escalation.

Upon review of the account, Silverscript has confirmed that we have smaller dosage’s ***** for the drug ***********, but not for the dosage amounts of 75mg and 80mg the member supplied. Silverscript has advised the member on numerous occasions that the *** or ***** is required to process the claim reimbursement. Silverscript has run test claims with the *** the member has provided, and all have come back as non-payable claims due to invalid *** or *****.

The member was also advised that the requested drug was not eligible for purchase for weight loss until January 1, 2025, with the required preauthorization and purchased from a pharmacy setting, which was not completed by the member. You also had to have a combination of diagnosis to be eligible to purchase the drug, like diabetic and cardiac disease, which you do not have. The member was sent multiple denial letters for the medication. Please note, drugs can have more than one reason for a denial. All the denial reasons supplied to the member were correct per his plan documents and our conversation on April 15, 2025, advising him of the policy that he asked for previously and did not receive.

When a claim is submitted by the member or the provider, it is reviewed to ensure all the necessary information is included. If information is missing, this could cause a denial. If all the appropriate information is included, the claim is reviewed to determine if the service or prescription is a covered benefit. Not all services/prescriptions are covered, and/or may require a pre-authorization. If it is determined that the service is not covered, then a denial is sent to you, as an Explanation of Benefits. That document will give the reason(s) for the denial, and the instructions on how to file an appeal, if you believe the decision is incorrect.

We show the member’s reimbursement information was received in the system and completed on 01/21/2025. For the medications, ********® (***********), ******** and *********, prior authorization is required. Authorizations states that without these medications being authorized first, the member will not be reimbursed for his out-of-pocket payments. Therefore, the member’s claim was denied.

The member was previously advised to have his physician to contact our Coverage Determination & Appeals department at ###-###-#### 7 am to 8 pm (CST), Monday through Friday.
The member may also have his physician fax a completed Coverage Determination form to ###-###-####.

Your physician can also mail the form to the following address:
*** ******** Part D Services
Coverage Determinations & Appeals
**** *** *****
*****
******** ** **********

Per page 35 of your 2024 Evidence of Coverage for SilverScript Choice (PDP) Chapter 3

Using the plan’s coverage for Part D prescription drugs.

SECTION 7 What types of drugs are not covered by the plan?

Section 7.1 Types of drugs we do not cover.

This section tells you what kinds of prescription drugs are excluded. This means Medicare does not pay for these drugs.

If you get drugs that are excluded, you must pay for them yourself. If you appeal and the requested drug is found not to be excluded under Part D, we will pay for or cover it. (For information about appealing a decision, go to Chapter 7.)

Here are three general rules about drugs that Medicare drug plans will not cover under Part D:
Our plan’s Part D drug coverage cannot cover a drug that would be covered under Medicare Part A or Part B.

• Our plan cannot cover a drug purchased outside the United States or its territories.
Our plan usually cannot cover of*******;label use. Of*******;label use is any use of the drug other than those indicated on a drug’s label as approved by the Food and Drug Administration.
Coverage for of*******;label use is allowed only when the use is supported by certain references, such as the ******** ******** ********* ******* **** *********** and the ******* Information System.

• In addition, by law, the following categories of drugs are not covered by Medicare drug plans: 36 2024 Evidence of Coverage for SilverScript Choice (PDP)
Chapter 3 Using the plan’s coverage for Part D prescription drugs

• Non&*****;prescription drugs (also called over&*****;the&*****;counter drugs)
• Drugs used to promote fertility
• Drugs used for the relief of cough or cold symptoms
• Drugs used for cosmetic purposes or to promote hair growth
• Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
• Drugs used for the treatment of sexual or erectile dysfunction
• Drugs used for treatment of anorexia, weight loss, or weight gain
Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale

If you are receiving “Extra Help” to pay for your prescriptions, the “Extra Help” program will not pay for the drugs not normally covered. However, if you have drug coverage through Medicaid, your state Medicaid program may cover some prescription drugs not normally covered in a Medicare drug plan.

Upon review of the calls you made to the plan, the member was previously advised that the calls were reviewed, and we did not meet our quality standards, and the associates were coached for the errors found on the calls. Per the members conversation with Nancy, the member was very rude and utilized profanity on that call and also with three other associates and all the calls were disconnected for the profanity use.

The member requested to have each associate call him back personally and apologize and I denied the member’s request. I advised the member this is not our policy.

Thank you for allowing *** ******** the opportunity to be of assistance. We thank you for the opportunity to address our member's concerns. By affording us the opportunity to investigate these issues, it enables us to improve upon our quality of service to our members. We apologize for the inconvenience this has caused.

Sincerely,

Melissa R.

Analyst, Medicare Executive Resolution
Medicare Complaint Team
Initial Complaint
Date:04/07/2025
Type:Order Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Aetna, this is in regards to your supposed health insurance “plan” known as ***** ****** *******. You are the parent company. My husband and I purchased *********** ******* off the **** health connector , because he was out of work and my work , a therapy group practice , doesn’t supply insurance. We had no money and you suggested *********** *******, as it was only $500 a month and you claimed that it covered my *******. I require ******* medication for my ulcerative colitis. Without it, I become VERY ill and have to be hospitalized. *********** ******* lied about this. My ******* is not covered. My colonoscopy will not be covered. My office visits are not covered. My doctors have had an impossible time getting in touch with Anyone from *********** ******* to talk about this. For a while, you couldn’t even locate me as a member. This makes no sense. Because of *********** *******’s lies , I am at risk of getting very very sick now. The $500 we’ve been paying monthly is effectively wasted money. I’d like to see all that money returned to us. We do not have a lot of money. We are barely scraping by. You took advantage of that situation. The **** gov rep has gotten many complaints about ***********. Please return the money.
Business Response
Date: 04/08/2025
***** *** **********
To better assist Ms. ******** with her concerns regarding ***** ******, we require additional information. We ask that Ms. ******** please submit a picture of the back of her member identification card.
Once received, we will investigate further.
Thanks
Shay G.
Analyst,
Executive Resolution
Executive
Resolution Team
Business Response
Date: 04/14/2025
**** ******* **********

Please
see our response to complaint #******** for ***** ******** that was received by us on April 7, 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 Ms. ********’s
concerns. Please know, Aetna is not the administrator of ***** ****** plans, we
only rent their networks. Therefore, we are unable resolve Ms. ********’s concerns.
As a courtesy, we can reach out to the plan administrator on Ms. ********’s behalf.
However, to do so, we require additional information. Please have Ms. ********
submit a copy of the back of her member identification card for review. Once
received, we will be more than happy to contact the ***** ****** plan administrator
for further assistance.

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,

Shay G.
Analyst,
Executive Resolution
Executive
Resolution Team
Initial Complaint
Date:04/07/2025
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.
Hello,
Aetna is not covering my claim for which I obtained pre-approval. Had the same issue last year. Don't believe their 7-10 business days for reprocessing and a call back - there's never a call back when their agents use that line, it's a delay tactic.

Contacting the BBB seems to be the only way for Aetna to respond to paying members.

They had to pay a federal/state fee for covering a claim of mine so late.

Don't know what more Aetna needs than their own pre-approval. Guess that's a meaningless promise to their members.

If you're able, please steer clear of Aetna and their unethical business practices if you value your health.

Thank you
Business Response
Date: 04/16/2025
**** ******* **********

Please
see our response to complaint #******** for ****** ******* that was received by us on April 7, 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 member’s
concerns. We confirmed that Ms. ******* had an active
authorization on file for the procedure code in question, effective February
19, 2024 – February 18, 2025. We found that the claim for date of service
February 17, 2025, was processed correctly at the in-network benefit level. Please
know, Ms. *******’s benefit for in-office surgery is 30 percent after
deductible, and at the time the services were rendered, the deductible had not
been met. Therefore, the member’s cost for this visit went towards her patient
responsibility. In addition, we reviewed the member’s call history and
identified an opportunity to provide feedback. Coaching has been provided to
the representatives involved. As a courtesy, a representative from the member’s
plan contacted her directly to address her concerns. Ms. ******* will also be mailed a separate resolution letter detailing our 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,

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

Complaint: ********

I am rejecting this response because I am waiting on an updated EOB without the *** remark about experimental or investigational services not being covered.

Sincerely,

Ms. *******
Business Response
Date: 04/30/2025
**** ******* **********
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 the complaint, we immediately reached out internally to further research the
member’s concerns. We confirmed that a corrected claim was received and
processed on April 24, 2025. Therefore, the visit no longer shows as being
experimental or a non-covered service. The new Explanation of Benefits (EOB)
dated April 26, 2025, shows that $99.48 went towards the member’s deductible. Please
know, Ms. ******* should receive the updated EOB within 7-10 business
days, or she can obtain a copy online at aetna.com. Ms. ******* will also be mailed a
separate resolution letter detailing our 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,

Brittany
F.
Analyst,
Executive Resolution
Executive
Resolution Team
Customer Answer
Date: 05/05/2025

Complaint: ********

I am rejecting this response because:
Hello,
A $65 copay was completed on the date of service. I don't see it applied on the EOB. The Aetna agent I first spoke with, Leslie, said this was a reason for reprocessing the claim.
Thank you

Sincerely,

****** *******
Business Response
Date: 05/12/2025
**** *** ******* **********

Please see our response
to complaint #******** for ****** ******* that was received by us on May 05, 2025. Our Executive Resolution Team
researched your concerns, and I would like to share the results of the review
with you.

Upon
receipt of your request, we immediately reached out internally to have Ms. *******’s
concerns reviewed. Based on the review we have confirmed that the claim *********
was processed correctly according to the member’s 2025 benefits. The 2025
benefit for the in-office surgery is 30 percent coinsurance AFTER the
$6,795.00 deductible has been met. The member had not met the deductible prior
to the service date of February 17, 2025. The claim ********* processed correctly
with a $60.00 copayment according to the 2024 benefit for the in-office
surgery.

Copayments
are a fixed amount that the member will pay for a covered healthcare service,
at the time of service. The copayment is limited to a provider visit or
picking up a medication. This does not include an in-office procedure, only
the office visit. Coinsurance is the percentage of the total bill the member
will pay after the deductible is met. The deductible is the amount the member
will pay for the service rendered until the set amount is met.

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
Initial Complaint
Date:04/07/2025
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.
CVS says my Atena insurance isn't found and they denied me. I'm very sick. I've been paying Atena for over 3 years through *********.
Business Response
Date: 04/09/2025
**** ******* **********
Please see our
response to complaint # ******** for ******* ****** that was received by us on
April 7, 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 has active coverage. The policy became
effective February 1, 2022, with no gaps or lapse in coverage. The member has
filled and submitted three prescription claims and had no issues with getting
the medications. The member is active and has medical coverage. Based on the
screenshots the member provided, the member identification number is being
typed in with a space and should not be. If the member has any further
questions or concerns with his plan or benefits, he can contact the number
listed on the back of his 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,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Initial Complaint
Date:04/04/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have Medicare Advantage medical insurance AETNA PPO for 6 years. In November 2024, I had laboratory blood tests at ***** *********** in ******** ** and prior to blood draw I have confirmed that the listed tests were covered by AETNA. It was confirmed by ***** technician. However, in several weeks I have received a bill for $294 and then another one for $1,321 . My call and filing complaints to AETNA were useless because AETNA refused to cover these tests explaining that they were investigational. I have sent them a proof that these test were not investigationa as per American Medical Association.

Another isuue: as per y allowance by AETNA in 2024, I was allowed to spend up to $800 for sport equipment. Prior to buying that, I have called AETNA twice and confirmed the list of covered items. Hovewer, when i submitted a claim for reimbursement,. I have received only 30% of allowed amount. All my calls and complaints were not addressed.
Eventually ,i have sent a letter to AETNA CEO. After long time, I had a call from Kathie regarding ***** charges and sporting euipment. She ensured me that she has been working to resolve these issues but then disappeared and I was not able to find ANY connections to contact her.

And lastly, one more issue. I am AETNA provider as a PCP and I have re*****ed clarification with credentialing process which has been lasting for years. Same situation: I had calls from some persons, then some email stating that my *****ion has been worked out, but.....
Last email communication I hgad with Daniele G***** who promissed to speed up a process but... also disappeared.

Why i am writing to BBB. As I know, ANY official letter. concerns, complaints MUST be responded within 2 weeks. Hovewer, AETNA failed to take care of its members and its providers, AETNA completely ignores and fails to follow its own policies. Inspite of my very minimal use of medical benefits from AETNA, it does not want to consider ANY resolution in member /provider favor.
Business Response
Date: 04/10/2025
**** *** ******* **********

Please see our response to
follow-up on complaint # ******** for Dr. Alexander
Fink that was received by us on April 4, 2025. Our
Executive Resolution Team researched the concerns, and I would like to share
the results of the review with you.

We have identified
the concern that our member, *** ********* ****, has is about a complaint
letter he previously sent to the Aetna CEO. He mentions receiving a call from
Kathy regarding the ***** *********** charges and the fitness sporting
equipment. He states she assured him that she has been working to resolve these
issues but then he never heard from her, and he was unable to find any
connections to contact her. We understand how frustrating this
can be and we take our members concerns very seriously.

Upon on review, we found *** **** is referring to his
previous executive complaint received on February 25, 2025, filled under case ***********.
This case was handled by our Executive Resolution Team’s analyst Kathy S. There
were three concerns in this case, a bill that he received from *****
Diagnostics Clinical Laboratories, a fitness reimbursement claim, and his
provider credentialing concerns. This case shows it was closed verbally with
*** **** on February 25, 2025, and a written resolution letter was mailed to him
on February 26, 2025. The written response stated as follows:

“Per our conversation on February 25, 2025, you stated you
faxed an appeal for both claims a week ago. I suggested you call me the end of
the week to see if the appeals are on file as I did not see them as of our
conversation. I advised the network
concern showing you with two different designations, is being handled by our
Provider Executive Resolution Team.”

The written resolution letter included our executive analyst
direct contact phone number if he had additional *****ions.

We confirmed there were phone communications between our
Executive Analyst, Kathy and *** **** up through March 6, 2025. On March 3,
2025, Kathy confirmed on a call with him that his appeal was received. However,
during the call review we found he was advised that he would receive a response
in 30-days regarding the decision of the appeal. This was incorrect information
as the appeal turnaround timeframe is as follows:

The appeals department has 30-days to respond for a standard
pre-service appeal, for services not yet provided.

The appeals department has 60-days to respond for a standard
post-service appeal, for services that have already been rendered.

We do apologize for the incorrect information provided on
the appeal response timeframe. We have sent a service improvement coaching to
our manager of our Executive Resolution Team to address the error located with
our executive analyst, Kathy. We use the service improvements to educate, and
retrain, the analyst to improve our services to our members.

In addition, we have reviewed the claims on his account and
show claim ********* was received on November 19, 2024, from ***** ***********
******** ************* *** for date of service November 11, 2024. The total
billed amount is $851.23. The claim paid the provider on November 20, 2024, in
the amount of $43.31. The member responsibility is $294.77.

We also show claim ********* was received on November 20,
2024, from Athena Diagnostics, Inc for date of service November 11, 2024. The
total billed amount is $1,321.32. The claim is denied, and the member
responsibility is $1,321.32. The explanation of benefits dated December 13,
2024, states the reason of this denial as:

Charges for or in connection with services or supplies that
are, as determined by us, considered to be experimental or investigational are
excluded from coverage under the member’s plan. To obtain more information
regarding coverage of this service, go to our website and enter the denied
procedure code 86366 in the search field. Member’s can also review our Clinical
Policy Bulletins. In addition, since *** **** is a physician, he may also use
our provider portal on Availity. From the Availity Home page, select Payer
Spaces, Aetna, then Code Edit Lookup tools.

We show we received another claim under ********* on March
14, 2025, from Athena Diagnostics, Inc for date of service November 11, 2024.
The total billed amount is $1,321.32. The claim is denied, and the member responsibility
is $0. This claim was denied as a duplicate claim that we’ve already considered
for payment under claim *********.

We show the fitness reimbursement claim was received on
January 4, 2025. The total submitted amount is $791.69. The claim lists three
pickleball paddles/racquets that he purchased at ****** ******** ***** on
December 18, 2024. The plan reimbursed the member for one pickleball
paddle/racquet in the amount of $299.55 on January 18, 2025, as only one
pickleball paddle/racquet is allowed to be reimbursed.

We confirmed an appeal was received on March 3, 2025,
regarding the denied service lines on the fitness reimbursement claim M10836095
and claim ********* with ***** *********** Clinical Laboratories, Inc. As this
is an appeal for services already rendered our appeals department has 60 days
to make a decision. We have confirmed the appeal is in progress and has a
response due date of May 2, 2025. *** **** will receive a response with the
outcome of our appeal departments decision on or before the appeal case due
date of May 2, 2025.

We do not show an appeal on file regarding the denial of
claim ********* in the amount of $1,321.32. Please know, if a member disagrees
with their cost share applied on a claim, or if a claim is denied, they have
the right to file an appeal. The only way to overturn a decision made by the
plan, is to utilize the appeal process.
Appeals can be submitted either in writing or on our website,
www.aetnamedicare.com. Members have 60 days from the date on their explanation
of benefits statement to file an appeal, this timeframe can be extended if the
member can provide a valid explanation for the delay. We have attached an
appeal form to this response for convenience.

Lastly, we reached out to our provider network management
team and Danielle G***** confirmed she has been in contact with *** **** as his
concern is still being looked into. She also advised she would reach out to him
directly and provide him an update on his provider credentialing concerns.

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 Team
Initial Complaint
Date:04/04/2025
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 file a complaint regarding the repeated and wrongful termination of my health insurance coverage. Despite consistently providing all requested documentation and meeting all eligibility requirements, my coverage has been terminated multiple times without proper explanation or justification. This pattern has caused significant distress and disruption to my access to necessary healthcare.

Each time my coverage is terminated, I am forced to go through a lengthy and frustrating reinstatement process—submitting documents I have already submitted, spending hours on the phone, and being told conflicting information by different representatives. I have complied with every request in a timely manner and have kept detailed records of my communications and submissions.

The repeated terminations appear to be the result of administrative errors or system flaws, not any action or inaction on my part. This ongoing issue has not only affected my ability to receive medical care but has also jeopardized my financial stability, as I am left responsible for costs I should not owe.

I am requesting a thorough investigation into my case, a permanent resolution that ensures my coverage is maintained without interruption, and a formal explanation of why these terminations have occurred. I am also requesting confirmation that my coverage is currently active and will remain so.
Business Response
Date: 04/18/2025
Dear ******* *********:
Please see our response
to complaint # ******** for ******* **** that was received by us on April 4, 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 multiple files
were sent to Aetna from the *********** regarding Ms. ****’s enrollments and terminations.
Unfortunately, the details surrounding the enrollments and terminations are
located within the ***********’s systems, not Aetna’s systems. In addition, the
*********** owns the enrollments for the on-exchange plans and Aetna is unable
to change the enrollment details provided to us by the ***********. With each
file that was sent to Aetna, we were only told that Ms. ****’s plan changed. As
of April 1, 2025, Ms. ****’s plan is inactive.
On April 11, 2025, Amanda B. from Aetna spoke to
Ms. **** and advised her that the *********** will need to be contacted directly
to initiate an escalation for reinstatement. Thus, a conference call was made
with Ms. **** and the *********** to initiate an enrollment escalation. They
have provided a turnaround time of 30-45 days. Please know, Amanda B. provided
her direct contact information should Ms. **** have any further questions
related to this concern.
We take customer complaints very
seriously and appreciate you taking the time to contact us and giving us the
opportunity to address Ms. ****’s concerns. If there are any additional questions
regarding this particular matter, please contact the Executive Resolution Team
at *******************************.
Sincerely,

Brittany
F.
Analyst,
Executive Resolution
Executive
Resolution Team

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