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

1,333 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:09/01/2022
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 had dental work done by ******* * ****** on 4/20/22.
I am happy with the work and price. I paid in full by debit card on 4/20/22.

A claim for reimbursement was sent to my insurance company, Aetna.
I have contacted Aetna numerous times for months but I still have not been reimbursed.

I want to be reimbursed $488.00

Thank you.

My Aetna Member ID: ************
Aetna Claim #: *********** $337.00
Aetna Claim #: *********** $151.00
Total to be sent to me: $488.00

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

Please see our response to complaint # ******** for Mr.
******* ******** that was received by us on September 1, 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. The member has a direct dental
benefit, which means if the provider participates, the payment will be made to
the provider. Dr. Nguyen is in network with the plan. The
payment was sent to the provider even though the member filed for reimbursement.
The provider was paid at the ******** allowable rate. We contacted the
provider’s office and confirmed a payment was received. The provider will
contact the member and refund him. 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 Mr. ********’s
concerns.

Sincerely,

Cindi D
Analyst
******** Executive Resolutions
Customer Answer
Date: 09/12/2022

Complaint: ********

I am rejecting this response because:
Aetna stated that payments were sent to the provider (my dentist) Dr. Nguyen, who is in network. This is not correct.
According to Aetna claims website, payments were sent to ******* ******* *. I don't know who ******* ******* *. is. ******* ******* * is not my provider. I have never seen ******* ******* *.
Why were the payments sent to ****** ******* *? Only Aetna knows.

Sincerely,

******* ********
Business Response
Date: 09/15/2022
**** *** ******* **********

Please see our response to complaint # ******** for Mr. *******
******** that was received by us on September 12, 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 treating dental
provider was paid for the services rendered. On May 11, 2022, $488 was paid to
the provider/dental practice for both claims, with check number *******. Our payments
are set in our billing system to go to the Practice/Facility (Supplier) not the
treating Dentist/Provider when they are part of a practice. 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
Initial Complaint
Date:08/31/2022
Type:Sales and Advertising 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 have already filed a complaint with aetna through the bbb and was assured by aetna that i would not get any further calls from matrix= i have gotten calls on 8/9 at 2:16, 8/18 on 7:46, 8/26 at 5:29, 8/30 at 5:20. -that is just the august calls-i do not understand why aetna would sell my info to an independent company without my consent and allow them to annoy their customers
Business Response
Date: 09/02/2022
**** *** ******* **********

Please see our response to complaint
#******** for Ms. ******** **** that
was received by us on August
31, 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 you filed
a BBB complaint July 12, 2021, regarding calls from our Healthy Home Visit
(HHV) under case ************ and it was resolved on July 13, 2021. Per the
notes on that case, the member was added to the Do Not Call (DNC) list for this
program. The calls resumed this year. We escalated this issue to our HHV team. We
confirmed that your member identification (ID) number changed from the
2021 plan year to 2022. Our HHV team indicated that
this is the reason why the calls continued. The HHV program goes by the member
ID for the DNC list. We put the request in and opted you out of this program under your new member ID number. This request can take
up to 30 days. DNCs generally last 3 years. There is no guaranteed permanent
DNC, again, as member IDs can change. 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,

Denise A | Analyst, Executive Resolution
Customer Answer
Date: 09/02/2022

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:08/30/2022
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am a provider and I have not been paid for service rendered to an Atena member between May 2022 and July 2022. I submitted my claims to Atena 3 times following the initial submission and Atena still has not filed or process them correctly as in- network claims. I have a single case agreement (****************) which has been verified numerous times. I have called Atena every other week over the course of 2 months attempting to solve this issue. I have spoken with 2 different supervisors, the initial one was a man who calls himself Levi, yet no progress has been made. Levi stated that the claim was escalated and still I have not received payment. He has not followed up because today, 8/29/2022 I was told it was not processing and the claim department hasn't worked on my claim at all. I asked to speak with Levi twice and have not been able to speak with him again but he apparently responds to emails when the representatives contact him about my claim. He states to them that there is no way for him to communicate with the claims department outside of an email to get my claim paid out. I am missing months of pay in the amount of $1,190 for services provided on 5/31, 6/1, 6/8, 6/15, 6/22, 6/29 and 7/13 all in the year 2022. My case number for this matter is **********.
Business Response
Date: 08/30/2022
**** *** ******* **********

Please see our response to complaint #******** for ****** ********
that was received by us on August 30, 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 Ms. ********’ concerns. Based on their review it has been confirmed that there
is an in-network single case agreement on file for the Aetna member ****
********. The claims for the dates of services June 01, 2022, through July 23,
2022, will be reprocessed per the in-network single case agreement. You will receive
the updated explanation of benefits once the claims have been finalized. We do
not have a claim on file for the date of service May 31, 2022.

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,

Marshell H.
Complaint and Appeals Analyst
Executive
Resolution Team
Customer Answer
Date: 09/01/2022

Complaint: ********

I am rejecting this response because: There was a claim on file for 5/31/2022 and I received a call about it today. It has been addressed, however Aetna applied $120 of payment to the member instead of directly to me. The member has only paid copays and has never paid for a session. After speaking with someone the only way to resolve this is to put it in writing and ask for the check made to the member be voided and I receive the check. Once this is complete the matter can be settled.

Sincerely,

****** ********
Business Response
Date: 09/07/2022

Dear *** **********
Please see our response to complaint ******** for ****** ******** that was received by us on September 02, 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 provider’s concerns, I immediately reached
out internally to have those concerns reviewed. Per the review completed, claims
for dates of service (DOS) May 31, 2022, June 29, 2022 and July 23, 2022, are not
on file. Claims were processed and paid for DOS June 01, 2022, June 08, 2022,
June 15, 2022 and June 22, 2022. The payment was issued on August 30, 2022 and
were sent to the provider under check number ****************
If the provider would like claims processed for May 31,
2022, June 29, 2022 and July 23, 2022, those will need to be submitted to us
for processing. The provider should also make sure line 13 of the claim form
(Release of Information [ROI] field) is appropriately completed to ensure
payments are sent to her rather than the member.
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,
Destiny S.
Complaint and Appeals Analyst
Executive Resolution Team
Initial Complaint
Date:08/29/2022
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.
Hi, my current *** blood work is not be payed and being put into my deductibles. The test are on the National Coverage Determination
Procedure Code: ****** *****
***** **************** ***** ***** ******* ********** Including Monitoring) and are medical necessity and should payed my the insurance company.
Claim July 7,8th 2022
Business Response
Date: 09/02/2022
**** *** ******* **********
Please
see our response to complaint # ********for ****** ********* that was received by us on August 29, 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 claims are processed correctly. According to the
member’s plan benefits, labs are covered in full
only when part of an annual routine physical exam, and even then, only certain labs
are considered routine. We confirmed that there are no routine physical exam
claims on file. National Coverage Determination is a ******** regulation
stating ******** policies must cover these tests. The member’s plan covers
these tests, but payment is made only when the deductible is met. Coverage for
these tests was not denied. If the member disagrees with the claim determination,
he has the right to appeal by following the instructions on the attached Aetna
Member Complaint and Appeal form. Please note that the appeal request must be timely
and in writing to be considered.
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:08/29/2022
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.
May 2016 AETNA provided medical benefits for a medically necessary procedure. All required documents were provided during that time. ******* was assigned as my point of contact due to inconsistent information being provided during contact attempts with AETNA. The procedure was eventually covered by AETNA.

In August 2022 I made contact with AETNA to discuss a medically necessary revision. I am scheduled for my procedure on 12/8/2022. I have already paid a deposit of $650 to retain my procedure date. The doctor performing my procedure is currently in network with AETNA. AETNA representative advised me if I were to have my before 10/2022 (which is the date the dr is no longer in network with AETNA) my procedure and facility would be covered as in-network - 80/20.

I have no control over my doctor's availability. The feedback and pressure from AETNA stating the sooner the better have created anxiety when I think about the cost being spent if I am forced to pay out of network 50/50 based on the feedback provided.

I am now looking to partner with AETNA to discuss "how" to resolve this using my in-network benefits with the doctor that I have now grown to trust and find comfort with. I have multiple documents available to provide support.
Business Response
Date: 08/29/2022
**** *** **********
Please see our
response to complaint ******** for **** **** that was
received by us on August 29, 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) for the member’s plan to have the concerns reviewed. The PSL
advised a Transition of Care (TOC) request can be submitted close to October. The
TOC is to request the provider be considered at the in-network benefit level
for the December surgery and follow-up visit after surgery. There is verbiage
on the TOC form that states, “For existing members: TOC coverage can also apply
when your doctor or facility leaves the plan’s network or changes network status
or if certain laws or regulations require coverage. Approved TOC coverage
allows a member who is receiving treatment to continue the treatment for a
limited time at the highest plan benefits level.” I’ve attached a TOC request
form to this response for the member to use, if she chooses.
The member didn’t provide any
information or details regarding the type of procedure/surgery being done in
December however, during our review, we noticed there was no precertification
on file for any upcoming procedures or surgeries. Not all procedures require
precertification. However, the member may want to speak with her provider to
ensure a precertification is not required for her surgery. If the surgery is being
done inpatient, a precertification will be required. If the surgery is outpatient,
it would depend on the procedure codes. The member and the provider can use the
procedure code(s) to verify if a precertification is required for outpatient at
the following link: ********************************** **********************************************************
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,
Destiny S.
Complaint and Appeals Analyst
Executive Resolution Team

Business Response
Date: 08/29/2022
**** *** **********
Please see our
response to complaint ******** for **** **** that was
received by us on August 29, 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) for the member’s plan to have the concerns reviewed. The PSL
advised a Transition of Care (TOC) request can be submitted close to October. The
TOC is to request the provider be considered at the in-network benefit level
for the December surgery and follow-up visit after surgery. There is verbiage
on the TOC form that states, “For existing members: TOC coverage can also apply
when your doctor or facility leaves the plan’s network or changes network status
or if certain laws or regulations require coverage. Approved TOC coverage
allows a member who is receiving treatment to continue the treatment for a
limited time at the highest plan benefits level.” I’ve attached a TOC request
form to this response for the member to use, if she chooses.
The member didn’t provide any
information or details regarding the type of procedure/surgery being done in
December however, during our review, we noticed there was no precertification
on file for any upcoming procedures or surgeries. Not all procedures require
precertification. However, the member may want to speak with her provider to
ensure a precertification is not required for her surgery. If the surgery is being
done inpatient, a precertification will be required. If the surgery is outpatient,
it would depend on the procedure codes. The member and the provider can use the
procedure code(s) to verify if a precertification is required for outpatient at
the following link: ********************************** **********************************************************
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,
Destiny S.
Complaint and Appeals Analyst
Executive Resolution Team
Initial Complaint
Date:08/29/2022
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 have Aetna insurance through my employer, the ************ ** **, for which I pay for an upgrade. I was recently diagnosed with diabetes. I contacted member services at Aetna to learn what benefits cover diabetes supply. I was told they are covered 100% with NO RESTRICTIONS. I was emailed the policy and learned that's not totally true, some commonly used monitoring machines aren't covered. My local pharmacist advised I would also require a prescription to access the benefit. Not mentioned in the benefits. I got one. Back to the pharmacy, they aren't 'in network for that benefit.' I called again. *** is in network. I drove there. The *** brand supplies were declined outright. Full retail only. That pharmacist and I called member services together and AFTER AN HOUR WITH THE REP finally learned that only *** (which is owned by Aetna) AND only those with a clinic attached are in-network for the benefit. I was instructed on how to have the script rewritten, which *** to go to, and what to ask for. My doctor complied. I called the *** in question. They packed the supplies ordered. I drove 45 minutes to pick them up and the system charged first $15 and then, when pressed to recheck the system $25.
Business Response
Date: 08/31/2022
**** *** ******* **********
Please
see our response to complaint # ******** for ****** ******* that was received
by us on August 29, 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 benefit for diabetic supplies is 100 percent, no deductible. We
reviewed the member’s call history and located two calls (One from August 23,
2022, and one from August 25, 2022) related to diabetic supplies. We found that
the representatives handled the calls appropriately as they answered all the
member’s questions correctly. To obtain his diabetic supplies, the member must
choose an in network provider from the National Durable Medical Equipment (DME)
list which can be found at **************************************************************************************.
However, should he choose to visit a *** Pharmacy, it must be an in-network DME
supplier and considered a Health *** or ****** ****** type facility for the
supplies to be considered at 100 percent, no deductible. Per the telephone call
received by the member on August 25, 2022, the *** Pharmacy he visited was not
considered a Health *** or ****** ****** which is why he had a patient responsibility.
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

Customer Answer
Date: 09/01/2022

Complaint: ********

I am rejecting this response because:
Shay G. does not mention the fact that when I went to one of their in-network medical *** pharmacies after calling ahead to confirm their story, my claim was denied. When I called my two closest in-network DME suppliers, the first, ******** ** *********** ** does NOT carry diabetic supplies. The second ***** ** *******, told me I needed to test 4x daily to be eligible for durable medical supplies. I was advised to stop fussing and pay out of pocket. In frustration I called Aetna again and had the rep put me on the phone with a supplier she could assure me would supply my equipment. I was connected to an outfit in ********** who mailed me supplies at the end of the week.

I've requested my union let me know if alternative insurances. I will switch away from Aetna if there is any other.

Sincerely,

****** *******
Business Response
Date: 09/06/2022
Dear Mr. Stewart Henderson:

Please see our response to complaint #******** for ****** ******* that was received by us on
September 01, 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 reviewed of
Mr. *******’s concerns. Based on their review there were are no denied durable medical
equipment medical claims found. If Mr. ******* chooses to visit a ***
Pharmacy, it must be an in-network DME supplier and considered a Health *** or
****** ****** type facility for the supplies to be considered at 100 percent,
no deductible.

Mr.
******* does have other options for other health insurance carriers besides Aetna.
However, this type of change is allowed during open enrollment. Open enrollment
for active employees will be held October 17, 2022, through November 04, 2022.
Mr. ******* can contact his employer (*****) to inquire about an exception for
a carrier change outside of open enrollment, but there is no guarantee that it
will be allowed.

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.
Complaint and Appeals Analyst
Executive
Resolution Team
Customer Answer
Date: 09/06/2022

Complaint: ********

I am rejecting this response because: The company denied they rejected my claim when I attached a photo of the form from *** that says 'Rejection' at the top. What I want is a rewritten policy THAT CLEARLY STATES THE CRITERIA FOR 100% COVERAGE IN THE FIRST SENTENCE. OTHERWISE THE POLICY IS A LIE. A better solution would be Aetna actually fulfilling the policy AS WRITTEN - 100% COVERED NO RESTRICTIONS. I suggest that as a second option because I am dropping Aetna. I would appreciate NO FURTHER CONTACT FROM EITHER BBB OR AETNA UNLESS IT'S TO EDIT THEIR REWRITE.

Sincerely,

****** *******
Business Response
Date: 09/07/2022

Dear Mr. Henderson:
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.
I understand the member the member is requesting no further
contact from Aetna; however, I wanted to ensure the member is aware of his
pharmacy benefits being carved out to *** ********. Previously, we informed the
member there were no denied claims on file for diabetic supplies. This was
under the medical claims. Any pharmacy claims would have been under ***
********. If the claim for diabetic supplies was submitted under the pharmacy
benefits when it should have been under medical, a rejection for that claim would have been appropriate.
If the member has any questions or concerns regarding his pharmacy benefits, he
may contact *** ******** at ************. The information regarding the
diabetic supply coverage is correct and an in-network provider must be used for
those supplies. The link to the National Durable Medical Equipment (DME) providers
was previously provided. If the member chooses to use ***, it must be a *** or
****** ****** facility. If the member would like and/or needs a copy of his Summary Plan Description (SPD for his plan, he can contact his employer's Human Resources (HR) department and request another copy be provided to him.
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
Initial Complaint
Date:08/29/2022
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.
I have worked for the State of ****** for over four years, as well as my husband. We are double covered, I have an economy plan and he has Aetna's Top level coverage. He lists me as a dependent on his policy and I list him as dependent on my plan. We BOTH have Aetna and they have coordinated benefits for him, but not me. This was discovered when I all of the sudden started getting calls from providers saying Aetna was not paying claims, and representing to providers that they had asked me for more info. I got no letters, no emails, no phone calls... when I called Aetna last month, I was told all of the issues stemmed from COB not being set up on my account. I assumed since Aetna sent us both TWO insurance cards showing we had each listed as a dependent that nothing more, other than telling providers about double coverage and showing them both insurance cards. This is all my husband had to do and his COB worked fine. A week ago, I went to a specialist for a follow up and was pulled aside by the financial office to be admonished about my insurance company needing to pay claims. So, again I called Aetna, and was told this time that the problem was the provider was out of network. Aetna even conferenced the specialist's finance people in on the call and the provider insisted that were in network, yet the CSR wanted to argue with the provider. I now have ZERO trust that they will process claims correctly going forward. Looking back, I've had to pay balances at providers that my secondary insurance should have covered. My question is why would it be advantageous for Aetna to audit every single claim for the last four years when the outcome likely will be that they owe me and my husband a lot of money. Since having this issue, I've heard from numbers of folks who have had similar problems with Aetna and COB. This ALL seems VERY scammy. Deny claims for some odd reason, then when called on it, they manufacture sine other reason not to pay.
Business Response
Date: 08/30/2022
**** *** ******* **********

Please see our response to complaint #******** for ******* Albright
that was received by us on August 29, 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 Plans Sponsor Liaison
for the State of ****** who review Mr. ********** Coordination of Benefits
(COB) concerns. Based on their review it
has been confirmed that the Coordination of Benefits (COB) information was updated
on July 29, 2022. The claims from the
dates of service April 01, 2022, through August 08, 2022, have been reviewed
and reprocessed per the Coordination of Benefits (COB) information.

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 [email protected].

Sincerely,

Marshell H.
Complaint and Appeals Analyst
Executive
Resolution Team
Initial Complaint
Date:08/24/2022
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 visited the clinic on Feb 8, 2022 and the scheduled my annual dental exam for 1 hour. But the clinic was not able to finish the procedure during the scheduled visit and asked me to pay a second visit on Feb 23, 2022 as a follow up which was not supposed to happen since the clinic was supposed to finish their job during the Feb 8 visit at once. Then I scheduled my second annual exam on Aug 10, 2022. But the insurance company denied the payment since that was my third visit to the clinic and my annual exams should be two. I don't think it's fair because my "second visit" should be an annex to the first one and they should be considered a whole exam, not two separated ones. I think either the August exam should be covered. My payment of $138 was not only unreasonable but also ridiculous.
Business Response
Date: 08/31/2022
**** *** ******* **********

Please see our response to complaint #******** for ******* ****
that was received by us on August 24, 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 and the phone call with
the dental office, they have confirmed that Mr. **** misunderstood his
benefits and frequency regarding the date of service August 10, 2022, and the plan
will allow a one-time exception to allow the cleaning to be paid at 100
percent. Mr. **** will no longer be
eligible for any further routine dental cleanings for the remainder of 2022.
The plan will start over again on January 1, 2023, and the routine cleanings
will reset to two per calendar year.

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.
Complaint and Appeals Analyst
Executive
Resolution Team
Initial Complaint
Date:08/23/2022
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.
I have a claim from **** ******* ****** on February 1, 2022 for an amount of $74,761.44 that was denied due to an error in the coordination of benefits. I called for the first time on 5/27/2022 at 1:25PM to provide information on my secondary insurance. I followed up on 6/3/2022 at 11:00 AM, 6/10/2022 at 1:33PM, 7/1/2022 at 12:49 PM, and finally on 7/8/2022 at 2:38 PM. Every time I have called, I have been given a different explanation as to why the denial of the claim has not been resolved, or I have been told that the claim is still being recycled and I need to wait a certain amount of business days. The claim was resolved on July 28, 2022, and Aetna estimated that I would owe $314.56 to **** ******* ******. On 8/22/2022, I received an updated Explanation of Benefits, which stated my coverage of this charge has been re-evaluated and denied. Their statement is "Your provider asked us to reconsider these services. Our review finds that our original decision correct." Please let me know if more information is needed.
Business Response
Date: 08/24/2022
**** *** ******* **********

Please see our response to complaint
#******** for **** ******* that was received by
us on August 23, 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 Management Team,
who reviewed Mr. ********* concerns. It has been confirmed that both claims that
were submitted for the dates of service February 01, 2022, through February
02, 2022, have been processed for payment as of July 28, 2022.

Claim
*********** paid $21,842.88 and the member responsibility is $314.56 that applied
to the coinsurance. Claim *********** paid $1540.45, and the member responsibility
is $385.11 that applied to the coinsurance.

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.
Complaint and Appeals Analyst
Executive
Resolution Team
Customer Answer
Date: 08/26/2022

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. Thank you for the assistance!

Sincerely,

**** *******
Initial Complaint
Date:08/19/2022
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.
We as a medical group have been trying to speak with anyone in provider contracting/provider relations with Aetna and can get zero communication back from Aetna regarding a legal matter. We are a contracted provider group who has mailed a certified legal letter that is time sensitive on Aug 5th 2022 and have received zero communication back and the call center just tells us up to 90 days for us to get a response. I need to speak with someone at Aetna in order to get this legal document that is time sensitive completed and I find it very discouraging that nobody can call or email back. We have Mailed Certified, We have Faxed, We have emailed and have gotten zero communication.
Business Response
Date: 08/24/2022
**** *** ******* **********

Please see our response to complaint
#******** for ******
******* on behalf of ********* ****** *** ******** that was received
by us on August 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 your request, we immediately reached out to our Network Team, who
reviewed Mr. *******’s concerns. It has been confirmed that the ownership change
request has been approved, and the requested signature page has been sent back
to the provider’s office as of today August 24, 2022.

I
have spoken with the office of ********* ****** *** ******** and confirmed
that that signature page has been received.

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.
Complaint and Appeals Analyst
Executive
Resolution Team

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