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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.
460 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:09/22/2022
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.
My son was treated in an in-network facility from an out of network provider on 5/13/2022. Aetna insurance denied my appeal and I am on the hook for 1,800$ when there is a federal law effective 1/1/2022 about the No Suprise Act where patients can’t be billed for services when receiving care at an in-network facility. Aetna has failed to give a formal letter of denial and a adhere to new federal law. Aetna needs to settle this issue by paying the correct part and following federal law:
Business Response
Date: 09/26/2022
**** *** ******* **********
Please
see our response to complaint # ******** for ******* ***** that was received by us on September 22, 2022. 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 for review. Per our policy, the claims were processed correctly at the higher benefit level. Please be advised that we reached out to
the provider’s billing office to confirm the member’s balance and spoke with
Lauren. Lauren advised that the member was originally being balanced billed,
however the balanced billed amount has been written off per the
Federal No Surprises Act. Lauren confirmed that the member is only responsible for
the patient responsibility shown on the claims which is in the amount of
$189.37.
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.
Complaint and Appeals Analyst
Executive Resolution Team
Customer Answer
Date: 09/28/2022
Complaint: ********

I am rejecting this response because:Aetna has provided incorrect and false information. Attached you will see a bill showing my responsible portion that Aetna has failed to cover that I am being billed for from two out of network providers that I received while an in network facility. Aetna is currently in violation of the federal no surprise act.

To summarize again I was in a in-network hospital from 5/13-14 where without my knowledge two medical providers rendered services who were out of network with my insurance. I would encourage Aetna to lookup the detention of the federal surprise no act as this is a very serious offense.
If this is not resolved within the next 30 calendar days I will have no other choice and will be forced to report this to a higher government agency or official I.E local senate office if Aetna is unable to resolve this. The claims that need to be resolved are #********* and #*********

Sincerely,

******* *****
Business Response
Date: 10/03/2022
Dear Mr.
Stewart Henderson:

Please
see our response to complaint #******** for
******* ***** that was received by us on September 28,
2022. 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
for review. It has been confirmed that the claim for Ms. *****’s son ******* Richard
from the date of service May 13, 2022, was processed at the highest benefit
level. It has been confirmed that the provider’s office has written off the
balanced billed amount per the Federal No Surprises Act. It has been confirmed
that the member is only responsible for the patient responsibility shown on
the claims which is in the amount of $189.37. This amount has been applied towards
the in-network deductible.

I have attached a copy of the Explanation of Benefits that
shows the member’s responsibility.

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:09/19/2022
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.
Patient has Aetna Premier PPO insurance. Patient saw in-network Specialist on Sep 2, 2022. ....................................................................................................................................................................

Patient paid $45 copay for in-network Specialist. Provider is charging additional $50 for x-ray.
....................................................................................................................................................................

According to Aetna's contract, i.e. 63 of 2022 Evidence of Coverage for Aetna ******** Premier Plan (PPO), patient is responsible for SINGLE COPAY only. Patient's plan has Copays only.
....................................................................................................................................................................

Aetna is ignoring their contract with the Patient and says they have no control over how the Provider bills the insurance.
....................................................................................................................................................................
What is the purpose to have Aetna as Health Insurance if they ignore their contract and allow the Provider to bill the Patient whatever they want. It seems if Provider bills Patient Million dollars, Aetna will say they have no control over how Provider bills the Patient, hence they must pay.

....................................................................................................................................................................

I attempted to appeal this within Aetna but was ignored.
Business Response
Date: 09/21/2022
**** *** ******* **********

Please see our response to complaint #********for Mr.
****** ********* that was received by us on September 19, 2022. 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 have confirmed
the member’s claim ********* received on September 05, 2022, and claim
********* was received on September 10, 2022. We also confirmed the two claims
were originally processed by the system and not a physical claims processor.
Please know the system may not recognize it was the same place and date of
service as the claims were submitted five days apart, therefore the system
processed the two claims as if they were separate procedures done on the same
day. Please know, all of our claims are processed as they are received from the provider and are paid according to the ******** allowable rate as we are contracted through Medicare. We also confirmed the member’s appeal was not ignored. We show Appeal No:
************ shows received September 16, 2022, and has a due date of November
15, 2022. The Appeals Department has 60 days to make a decision. We reprocessed
the claims aforementioned above and confirmed the member is now only responsible
for the one copay amount. The member will receive a ******** 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,

Marilyn G.
Analyst
Executive resolution, Enterprise Resolution Team
Customer Answer
Date: 09/21/2022

Complaint: ********

I am rejecting this response because:

Provider still says Patient owes $50. Provider is waiting on Aetna's actions. Patient cannot make follow-up appointment with Provider till Aetna fixes this.

Sincerely,

****** *********
Business Response
Date: 09/28/2022

Dear Mr. Stewart Henderson:

Please see our response to complaint # ******** for Mr.
****** ********* that was received by us on September 21, 2022. Our Executive Resolution Team researched the
concerns, and I would like to share the results of the review with you.

We contacted the provider’s billing office and spoke with a
representative, Anna, on September 23, 2022We advised that the member’s claim
for date of service September 2, 2022, was processed on September 20, 2022, and
a payment in the amount of $82.76 was sent to the provider on September 21,
2022. We also advised that the member
has a $0 balance. Anna advised that she would document that a payment was made
and remove the member’s outstanding balance from their system.

We contacted the provider’s office again on September 23,
2022, and spoke to a representative, Myra. Myra confirmed that the member has a
$0 balance, and can now schedule an appointment. The member will receive a
detailed ******** 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,

Cindi D
Analyst
******** Executive Resolutions
Initial Complaint
Date:09/19/2022
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.
Aetna should be ashamed of the horrible customer service and the worst insurance protection possible. In my plan, preventatives tests are covered at 100%. If this is not resolved amicably by Aetna here, I will pursue Civil Court, Small Claims Court case against them for misleading and failure to provide proper services. I will also complaint to the ** Attorney General's office.

During the peak of COVID-19 pandemic, I wanted some routine preventative tests. Unfortunately, all Primary Health Care providers in *** were busy due to the pandemic, and were only selecting patients who needed immediate/critical care. Hence I contacted Aetna to get guidance.
Multiple representatives informed me that if I use an in-network laboratory and if the preventative tests are covered, Aetna will be able to pay me back via the claims form. Multiple representatives confirmed that all tests I am mentioning are covered and if I use ***** *********** (which is considered in-network for Aetna), I will get the out-of-pocket expenses.
I went to ***** *********** for the tests and the bill was $124. I submitted my bill via Claims form but it was denied stating that I used an out-of-network provider. I went to ***** ***********, the report generated is through ***** -- but Aetna just wanted to wash their hands and not pay the bill. I appealed with supervisors via case numbers ******** and ********** and talked to multiple supervisors (Kimberly, Jessie, Loraine, Mia) who on call would said it should be approved as everything in the claims looks perfect but later on denied again. Everyone kept giving different reasons of denial.

Hence, I am claiming $124 for the preventative tests done in the in-network lab they suggested me plus compensatory and punitive damages totaling around $500 related to their inefficiency/malpractice of their business. They must realize the time and effort it has taken me to claim what I should have gotten on day 1 of contacting them.
Business Response
Date: 09/27/2022

**** *** **********
Please see our response to complaint ********
for ***** ***** that was received by us on September 19, 2022.
Our Executive Resolution Team researched your concerns, and I would like to
share the results of the review with you.
Upon receipt of the member’s concerns, we immediately
reached out internally to the Plan Sponsor Liaison (PSL) to have the claim
reviewed. Upon reviewing the claim, it appears the member went to ***** **********
for the labs but the labs were read and/or billed by a third party billing
vendor under Health Labs. Health Labs is not an in-network provider. Since the
labs were performed by ***** **********, we’ve allowed a one-time exception to reprocess
the claim at the in-network benefit level. A** member copayment, deductibles
and coinsurance will still apply to the claim. The claim has been routed for
reprocessing and the member should allow 10-14 business days for that claim to
be reprocessed. The member will receive an updated Explanation of Benefits (EOB)
once the claim has been reprocessed.
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 a** additional *****ions regarding this particular matter, please
contact the Executive Resolution Team at *****************.
Sincerely,
Desti** S.
Analyst, Executive Resolution Team

Customer Answer
Date: 10/06/2022

Complaint: ********

I am rejecting this response because:
I paid $124 out of pocket for medical tests which were told to me by Aetna representatives (before purchasing the tests) that ALL of them are preventative and will be covered at 100%. On BBB's re***** Aetna reprocessed my claim but only sent $80 via check (yet to be received) and denied some tests, even though they had promised to cover it at 100%. Hence, I reject their response.
I will pursue legal action against Aetna for [remaining claim amount, compensatory (time/effort spent) and punitive damages (failure to provide services during the worst times in the century i.e. a pandemic)] by reaching out to the ** Attorney General's office and also through Civil Courts.

Sincerely,

***** *****
Initial Complaint
Date:09/19/2022
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 filed a claim for a non ******** provider. Aetna has a contract to pay per their parameters if the physician is non ********.
He is now updating his ******** info..
However, Aetna is fully aware that he is not a ******** provider and owes me approx. $13 thousand dollars, dating back to 2021.
Moreover, I filed my claims 7 times and the 1st 6 times were "lost" by Aetna.
Can BBB help me in this matter?
Thank you,
******** *******
Business Response
Date: 10/06/2022
**** *** ******* **********
Please
see our response to complaint # ********
for ******** ******* that was received by us on October 03, 2022. 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 for review. We
confirmed that the provider in question became ******** primary on March 01,
2021. The member previously sent us a written letter from the provider stating
he is not a ******** provider. However, we cannot reprocess the claims with the
letter provided, and both the member and provider have been made aware of that.
To proceed with reprocessing, we need an official ******** affidavit opt-out
letter from the provider. On September 15, 2022, the provider emailed the plan
sponsor liaison and member advising that he filled out the affidavit and sent it to ********,
who will process the document within the next two months. Please be
advised that we will continue processing the member’s
claims for the provider for dates of service August 11, 2021-August 16, 2022,
as soon as we receive the affidavit.
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Mr.
Lananna’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: 10/09/2022

Complaint: ********

I am rejecting this response because:
The provider is NOT a ******** provider. He has written several letters and taken all the necessary steps to strauighten out the issue with ******** (which should take another 6 weeks).
In the meantime, Aetna knows he is NOT a ******** provider and is using this , clearly, to avoid their contractual obloigations. I followed all the instructions previously given to me by Aetna and by my compan'ys benefits administrator.
In the meantime, I am up to almost $15 thousand out of pocket.
I propse a copmpromise; Aetna pay me what I'm owed and if for some (impossible) reason the paperwork doers not come through, I will reimburse them. I can keep their amount in Escrow.

Sincerely,

******** *******
************
Business Response
Date: 10/11/2022
**** *** ******* **********

Please see our response to complaint #******** for ******** ******* that
was received by us on October 10, 2022. 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 for
review. We confirmed that the provider in question became ******** primary on
March 01, 2021. Once the opt-out affidavit letter that was sent to ******** on
September 15, 2022, is processed, and received by Aetna, then we will be able
to continue to process the member’s claims for dates of service August 11,
2021-August 16, 2022.

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

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive Resolution Team
Customer Answer
Date: 10/13/2022

Complaint: ********

I am rejecting this response because:
The doctor is in private practice and Aetna is not telling the trut. The physician is a profesor at a leading medical school and hospital. Perhaps, the hospital takes ******** but my physician is in private practice and does NOT accept ********.
I sincerely ask BBB to help me in resolution. I unfairly have had to reimburse this physicain over $14 thousand.
The physician is NOT a ******** provider. He NEVER opted in. Aetna is not telling the truth.
The physicain is a professor at a hospital and Medical Scool. Perhaps the hospital is on ******** but the physicain is in PRIVATE PRACTICE and has never taken ********.
Aetna had "lost" all the claims for 18 months. I had to send them SEVERAL times before they acknowledghed recepit.
Please help me in this case.
Thank you,
******** *******
************

Sincerely,

******** *******
Business Response
Date: 10/14/2022
**** *** **********
Please see our response to complaint ******** for ******** ******* that was received by us on October 14, 2022. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Upon receipt of the member’s concerns, I immediately reached out internally to the Plan Sponsor Liaison (PSL) for the member’s health plan. I was informed the member has ******** as his primary coverage and Aetna as his secondary coverage. The member has been advised of the process regarding his claims for Dr. ******. Per the PSL, the provider doesn’t accept ********, but he never officially opted out of accepting ******** via the opt-out form. This form must be completed and submitted to ******** to be processed. Dr. ****** informed the PSL on September 15, 2022, he completed the form and officially submitted it to ******** for processing. ******** advised the provider it could take up to 60 business days for that form to be processed. Once the form is processed, Aetna can retroactively reprocess the member’s claims with ******** as primary and Aetna as secondary. Until then, the claims will remain pended. This information has been relayed to the member on multiple occasions. Also, the member has direct contact with the PSL and should continue to work with the PSL moving forward regarding any questions or concerns he has.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. ********* concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *****************.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team
Initial Complaint
Date:09/14/2022
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.
In June I was approved for a breast reduction. In June I was also laid from my job. I called in June (Calls Recorded) because I was told that if you have been approved for a surgery you have until a certain time to have it, even if you are no longer with your company. I was advised I had until December the 3rd. On August 5th I called to see what was needed to meet my deductible & see if paying bills, I had received in the mail, if I paid them would that be lowering & going towards my deductible & was told yes. I paid over $700 in bills.by Monday it hadn't updated on the Aetna website, so I called back. August 8th I was told it would take up to 2 weeks to a month. I advised I was on a time schedule & needed to know before then so the Doctor could update my balance due 30 days before surgery, I asked again if what I paid lowered my deductible & was told yes and she would send me a letter via email stating I had paid the $700 plus. I then went to pay a few more bills totaling $869.19...To weeks later find out I was given incorrect information several times and all those bills were already included in my deductible & that co pays didn't even go towards the deductible at all. So many things could have been done differently if the reps had given me correct information. I am unemployed & had been saving money & using gift money to have a surgery that is considered medically necessary. This has been something that has been needed for decades & I finally find a doctor to do it & get approved & I feel like that was snatched from me. I have called for weeks & the supervisor that was assisting me & no supervisor requested thereafter has returned my calls. I know from the supervisor Mae C****** (agent ID ******) that the call was recorded & listen to. Also, a complaint was filed (reference #**********). She advised me that they would honor what I was told. I have not heard from anyone & time is wasting. Please help me.
Business Response
Date: 09/23/2022
**** *** ******* **********
Please
see our response to complaint # ******** for ******** ****** that
was received by us on September 14, 2022. 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 for review. We confirmed that the
insurance will not cover the member’s surgery in December due to plan
termination. We attempted to reprocess the
member’s claims due to the information provided. However, we were unable to do
so because the claims were already processed correctly. The total patient
responsibility applied to the claims was $540.00. All the amounts,
except for the $50.00 copayments, have already been applied towards the
deductible. Unfortunately,
we are unable to apply more than the amount that the member is responsible for, towards the
deductible. The member had several claims for the provider, Novant Health, and
each claim applied the appropriate member responsibility. We found that the itemized information the member previously submitted does not
indicate she made upfront payments. The member's plan terminated in July of
2022, and the invoices show payments were made after the termination, in August
of 2022. There was no incorrect information given prior to the service dates. The member’s documentation also show she paid the actual amount of her responsibility.
In addition, she made payments for dental services which are not covered under
medical, nor would they be applied to the medical deductible. If the member has
paid any amount in excess of her actual responsibility (per claim processing),
then the provider is responsible for refunding her the difference since they were
in network at the time the services were rendered. Please note that we have
reviewed the member’s call history and the necessary feedback and coaching has
been provided. The member has also been contacted by team lead, Mae C., who
also advised that the claims were processed correctly. Mae will contact the
member again today, to discuss further options.
If the member chooses, she can elect Consolidated
Omnibus Budget Reconciliation Act (COBRA) within 60 days of her insurance
termination date. Based on the termination date we have in the system, this
plan termed on July 31, 2022. The member must elect the coverage by September
30, 2022. To inquire about enrolling, the member must contact COBRA at *************
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Ms.
Parker’s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at ******************
Sincerely,

Shay
G.
Complaint and Appeals Analyst
Executive Resolution Team
Customer Answer
Date: 09/23/2022

Complaint: ********

I am rejecting this response because:
It is incorrect. I called in June to find out how long I had to have the surgery, if in case i was no longer employed with that company. As stated previously I was told I had until December the 3rd. That set the tone for everything going forward. I had been given correct information then, I would have known I only had until July the 31st to have the surgery. When i made my next call on August 5th. I still wasnt informed i was no longer covered for surgery. Not even the following Monday, August the 8th was I informed. Several calls were made after that in August & it wasn't until after several complaints of given incorrect information for my deductible was I informed by a manager that my coverage ended in July. It should not when I was given the incorrect information. As it's your job to see my account & inform me. The question was asked, " if i pay bills i received via mail, will that go towards my deductible" & the answer both times on August 5th was yes & again on Monday the August the 8th, I asked again. I filed complaints & was then informed by a manager i would be compensated for what i had paid if the recorded calls indeed had Aetna employees telling me i could pay bills i had received in the mail for services still owed. So mentioning one was a dentist bill doesn't matter bc I wasnt informed that, those didnt count nor was I informed copays didnt count until I spoke with that manager. This is unacceptable. No accountability has been taken & the whole response is telling me things I now know but was never informed of.

Sincerely,

******** ******
Business Response
Date: 10/07/2022
Dear Stewart Henderson:

Please see our response to complaint #******** for ******** ****** that was received by us on September 26, 2022. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Upon receipt of the member’s concerns we immediately reached out to the Plan to assist with our investigation. We verified that at the time of the authorization, the approval letter included the following language: “This coverage approval is NOT effective and benefits may not be paid if: 2. The member is no longer covered at the time the approved treatment/services are actually performed.” We reviewed the recorded call the member referenced and verified it did not state that the plan was terminated, nor did we indicate that coverage would be available after the plan terminated.

The member may extend their coverage via the Consolidated Omnibus Reconciliation Act (COBRA), and did elect to extend her coverage from July 01, 2022, to July 31, 2022, through this option. She would have been covered for services in this period. COBRA can extend coverage for a longer period and the member may or may not be able to extend their coverage to include the surgery date. The member will need to contact COBRA at ###-###-#### to discover if she has any options remaining to her.

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

Sincerely,

William B.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:09/13/2022
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.
Aetna did not pay for my medical test because they stated my provider did not refer me for the test. My PCP is the one that ordered the test. My provider is in-network and the provider that completed the test is in-network. My provider ordered the test for me, I did not self- refer. No way I could have self-referred. AETNA is just deny claims for no legitimate reason. I have appealed to them twice and they denied. There is no outside third-party to review appeals.
Business Response
Date: 09/16/2022
**** *** ******* **********

Please see our response to complaint
#******** for ******
****** that was received by us on September 13, 2022. 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 to the Plan Sponsor Liaison
for the PA Employees Benefit Trust Fund (PEBTF), who reviewed Mr. ******’s concerns.
Based on their review they confirmed that Mr. ******’s Primary Care Physician (PCP)
can still submit the required referral and include the date of service January
21, 2022, in the comments section/field and then the claim will be reviewed
and reworked for payment. The preferred method is for the referrals to be
submitted prior to the date of service.

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

Sincerely,

Marshell H.
Analyst,
Executive Resolution
Executive
Resolution Team
Customer Answer
Date: 09/16/2022

Complaint: ********

I am rejecting this response because:I contacted my PCP when I received the denial. My pcp then submitted a letter to AETNA stating that I was referred for the tests on that date. So AETNA already has this letter. Also, I received the denial of the appeal today. They went and changed their reason for denial AND the amount listed for the procedure was wrong. AND they told my wife thaat they could not talk to her because there was no release on file. I faxed in a bunch of papers for the appeal, along with the release to let my wife talk. It leads me to believe that the information I faxed was not reviewed for the appeal because they didn't know. If a provider is in network and my pcp, does that mean they have a contract with Aetna, and is responsible for coordinating all care? Isn't that the point of an HMO? So this is between Aetna and the provider if it wasn't done properly, not me the client. I never self referred myself.

Sincerely,

****** ******
Business Response
Date: 09/26/2022
**** *** ******* **********
Please see our response to complaint # ******** for ******
****** that was received by us on September 16, 2022. 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 for review. We confirmed that a referral was required for the
member’s claim to be processed. To assist the member, we tried to contact the
provider multiple times to advise them to submit a referral so we could back
date it to the date of service January 21, 2022. Unfortunately, we were unable to make contact
with anyone in the provider’s office. However, as a courtesy, we will allow the
letter that the provider previously submitted to serve as a form of referral.
Our system has been updated with the referral information, and the member’s
claim has been sent back for reprocessing. The member should receive an updated
Explanation of Benefits (EOB) 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. If there are any additional questions regarding this
particular matter, please contact the Executive Resolution Team at
*****************.
Sincerely,
Shay G.
Complaint and Appeals Analyst
Executive Resolution Team
Initial Complaint
Date:09/09/2022
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 saw a healthcare provider/Specialist which is a 70$ co-pay with my insurance until I hit Max-out-of-pocket which then all services are covered fully. I hit Max out of pocket before these 2 office visits which took place on July 19 with ******* ********* and August 15th with ****** ****** but still payed the co-pay in order to see the doctor. The doctor office said that I need to contact my insurance to get re-imbursed as they do not see an overpayment on my account. I have been calling Aetna Customer Care at ************** for the past month to get reimbursed and I still have not received a check. When I speak to a agent they dont know what im talking about and I ask for a supervisor only to be put on an endless hold.... I stayed on hold for over 2 hours and still no one answered.
Business Response
Date: 09/16/2022
**** *** ******* **********

Please see our response to complaint
#******** for Jeffrey Partridge
that was received by us on September 09, 2022. 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 to our claims team, who
reviewed Mr. ********** concerns. Based on their review they confirmed that the
claims from the dates of service July 19, 2022, and August 15, 2022, were processed
with no member responsibility. The claim from the date of service July 19, 2022,
was processed and a payment of $70.00 was issued to Mr. ********, per check
number ***************. The check was
issued to the member because it was indicated on the claim that $70.00 was
paid in the provider’s office. The claim
from August 15, 2022, was processed to allow 100% of the allowed amount. There
was no member responsibility for this claim. Aetna is not able to confirm any payments
that were made to the provider’s office for the date of service August 15,
2022. Any refunds that are due to Mr. ******** will have to come from the providers
office.

I have attached copies of the
Explanation of Benefits for both dates of service.

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

Sincerely,

Marshell H.
Analyst,
Executive Resolution
Executive
Resolution Team
Initial Complaint
Date:09/09/2022
Type:Billing Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Two claims submitted have not been paid due to being coded incorrectly by Aetna. I received medical services on June 6 and July 1. Both visits were to same physician( ****** *****). I called Aetna in June, on July 28, on August 9 and Sept. 8. I have reached out by email to complain and have been told it is being worked on, it is in process, please allow at least 25 business days,etc. Ihave received three bills from ******* ****** looking to be paid and was also told by an Aetna representative that they would call ******* ****** but have seen no evidence of that. I have an outstanding bill of $298.21 and am afraid I will start to accrue interest fees. I also filed a grievance with their Medicare division as I have little confidence that this is a priority for them . Customer service for Aetna used to be very good but it’s been outsourced and I feel there is no sense of urgency or understanding. Any help would be most appreciated.
Business Response
Date: 09/19/2022
**** *** ******* **********

Please see our response to complaint # ******** for Ms.
****** ******* that was received by us on September 9, 2022. 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 the member’s claims were
processed incorrectly. The claims for dates of
service June 6, 2022, and July 1, 2022, have been reprocessed at the in-network benefit level, and the
provider was sent a payment on September 19,
2022. Please note that the member is responsible for a copayment in the
amount of $40.00 per visit. We contacted the Provider’s
office today, and the representative stated she would update the member’s
account once the payment is confirmed. The representative also advised that the
member will not be charged any interest or additional fees on the previously
sent bills. In reviewing the member’s call history, we were unable locate a
call where we previously contacted ******* ******. However, we have provided
the necessary feedback and coaching to the representatives involved. The member will receive a detailed Medicare Resolution Letter
within 7-10 business days.

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

Sincerely,

Cindi D
Analyst
Medicare Executive Resolutions
Customer Answer
Date: 09/24/2022

Complaint: ********

I am rejecting this response because: as of today I still show an unpaid bill and received another electronic bill for $298.21 with *** **** ****** ** *** *******

Sincerely,

****** *******
Business Response
Date: 09/28/2022
Dear Mr. Stewart Henderson:

Please see our response to the rejection of complaint
# ******** for Ms. ****** ******* that was received by us on September 26,
2022. 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 the member’s claims for dates of service June 6, 2022, and July
1, 2022, have been reprocessed at the in-network benefit level, and the
provider was sent a payment on September 19, 2022, in the Medicare allowable
rate amount of $113.16. Please note that the member is responsible for a
copayment in the amount of $40.00 per visit. We contacted the Provider’s office again today, and the representative stated the statement the member is referring to
went out on the September 20, 2022, to My Chart. The payment in the amount of
$113.16 for claims ELY1ZQNZJ and EDY1Z9ML900 was received from Aetna on
September 23, 2022. They confirmed the member’s account has been corrected and
she has a $0.00 balance owed. They did advise if she goes to her My Chart
account again, she will see that $0.00 balance. The member will receive a
detailed Medicare Resolution Letter within 7-10 business days.

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

Sincerely,

Marilyn G.
Analyst, Executive Resolution, Enterprise
Resolution Team

Customer Answer
Date: 09/30/2022

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:09/07/2022
Type:Product Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I paid for glasses in the amount of €126.50 on 10 June 2022. I checked with Aetna prior to receiving my glasses, I would have to pay for them, and send the receipt to receive a refund through a claim. I filed a claim on 20 June 2022, and the claim was approved within a few days. Approximately one month later on July 20th, I called Aetna to ask why I haven't received my payment. I was told my payment was arriving via check in the mail. I found this odd, because in my claim, I added my account and routing number to receive my refund with. I said okay and decided to wait until this check came. I then waited more than a month, and on 30 August 2022, I still hadn't received my check. I called back, and after spending more than an hour on the phone and giving the representative my banking information again, I was told it would be deposited on 02 September 2022. It is currently 07 September 2022 and I have not received my refund.
I would call them to try again, however I can barely hear what they are saying, and the connection is always terrible.
Business Response
Date: 09/08/2022

**** *** **********
Please see our response to complaint ********
for ****** ******* that was received by us on September 07, 2022.
Our Executive Resolution Team researched your concerns, and I would like to
share the results of the review with you.
Upon receipt of the member’s concerns, I immediately
reached out internally to the Plan Sponsor Liaison (PSL) for the member’s plan
to inquire about the reimbursement. The member submitted his claim on June 14,
2022. The claim was reimbursed to the member via a check on June 23, 2022. This
claim was to be reimbursed via the member’s reimbursement election on record.
Therefore, the check was stopped and payment was wired to the member’s account
on September 07, 2022 for a total of $135.12.
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,
Destiny S.
Complaint and Appeals Analyst
Executive Resolution Team

Customer Answer
Date: 09/10/2022

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. The money was deposited into my account. Thank you both very much for the quick resolution!

Sincerely,

****** *******
Initial Complaint
Date:09/07/2022
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 dental insurance through my work. I had implants and bone grafts procedures done. I contacted Aetna prior to those procedures to make sure they are covered and they confirmed they are 50% covered. I also bought the premium/ most expensive plan to make sure everything is covered. However after the procedure Aetna sent a letter to the dentist asking for the date of my teeth extraction and when my dentist sent it to them, they didn’t reply until after few months asking for the dates again and I think this happened again and after almost a year, Aetna rejected the claim citing things like non-covered procedure and extraction was done prior to insurance date!!! I was only insured by Aetna for couple of months so of course the extraction will be prior to that since most dentists wait for 3 months prior to putting the implants in. Also this was never mentioned when I contacted them prior to the procedure. When I contacted Aetna, they filed an appeal and promised to get back to me very soon. It has been months and there’s nothing from them. To make things worse, the page to file a claim on their website doesn’t work so you can’t file a claim online!!!!!
I had Aetna PPO and my member ID was *********
Business Response
Date: 09/09/2022
**** *** ******* **********

Please see our response to complaint
#******** for ****** ***** that was received by us on September
07, 2022. 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 to our Dental Team who reviewed
Mr. *****’s concerns. Based on their review we have approved a one-time exception
to pay the implant graft (*****) and the implant (D6010) on tooth #19.

The
claim from September 28, 2021, for Dr. ******* *********, has been reprocessed
to pay the provider $804.50 and the member responsibility is $50.00 that
applied to the deductible and $804.50 that applied to the coinsurance.

A
copy of the Explanation of Benefit will be sent to Dr. ******* *********
office on Monday September 12, 2022, when it becomes available.

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 [email protected].

Sincerely,

Marshell H.
Complaint and Appeals Analyst
Executive
Resolution Team
Customer Answer
Date: 09/09/2022

Complaint: ********
I appreciate the prompt response by the insurance and their willingness to reconsider but

I am rejecting this response because: I don’t have co-insurance and the outstanding charges were at least 1500 not including 1400 prior to the procedures. I request that the insurance pays at least 1500

Sincerely,

****** *****
Business Response
Date: 09/15/2022
**** *** ******* **********
Please see our response
to complaint # ******** for ****** ***** that
was received by us on September 11, 2022. 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 for review. We
confirmed that the member’s claim was allowed as a one-time exception to pay
the implant graft (*****) and the implant (D6010) on tooth number 19. These two
procedure codes are considered a major service under the member’s plan.
According to the benefits, approved major services are covered at 50 percent
after deductible, with a calendar year maximum of $2,000.00 that applies to all
services. Therefore, the member was rightfully held responsible for the
coinsurance amount. No further services will be paid by the insurance because
the remainder of the services preformed were not a covered benefit under the
member’s plan. Mr. ***** can refer to his benefit booklet for plan coverage,
exclusion, and limitations.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address Mr. *****’s concerns. If there are
any additional questions regarding this particular matter, please contact the
Executive Resolution Team at *****************.

Sincerely,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team

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