Business Profile

Insurance Companies

Aetna Inc.

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Complaints

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

Customer Complaints Summary

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

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

Initial Complaint
Date:08/16/2022
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
This complaint is about my experience updating my credentialing with Aetna. I have been an in-network mental health provider with Aetna since the year 2020, and with differing employers and Tax IDs. I started my own private practice this year and applied to have my new Tax ID credentialed with Aetna. I began this process in April and have yet to get a clear response from the Aetna network. I have spoken to multiple representatives and submitted multiple applications with no confirmation or approval from Aetna. For example, I submitted an application online in early May as per instructions I received in a letter from Aetna in April. I received no feedback from Aetna about that application. After multiple calls to customer service I was informed that the application was never processed and I needed to re-apply. I was not given a clear reason as to why this application was not processed. My most recent application was submitted on June 7, 2022, over 60 days ago, and have yet to receive any kind of response. I also submitted a “ticket” via customer service on July 28-over 2 weeks ago- about the delay; again, there has been no response at all. To say that this experience has been disappointing would be an understatement. It has truly been a nightmare, and I am hoping to connect with someone who can resolve this immediately and update my Tax ID so that I can accept Aetna patients. No one has given me a clear answer as to the reason for this delay. My patients are very upset as well, as some have been unable to be seen without insurance coverage, and others have been paying out of pocket costs in order to not have to switch mental health providers. I am requesting that my application is immediately approved and backdated to June, so that my patients who have been paying out of pocket costs can receive reimbursement, as there have clearly been multiple mistakes and oversights by Aetna regarding my applications, which has caused huge costs to myself and my patients.
Business Response
Date: 08/17/2022

Dear Mr. *********:
Please see our response to complaint ********
for ***** **** that was received by us on August 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 provider’s concerns, I immediately reached
out internally to our Network department. They responded and advised a contract
has been sent to the provider for review and signature and an email was sent to
the provider advising that contract was sent and is awaiting his signature. Once
the provider reviews and returns, the process can be continued.
We take customer complaints very seriously and
appreciate you taking the time to contact us and giving us the opportunity to address *** ****** concerns.
If there are any additional questions regarding this particular matter, please
contact the Executive Resolution Team at ******************
Sincerely,
Destiny S.
Complaint and Appeals Analyst
Executive Resolution Team

Customer Answer
Date: 08/19/2022

Complaint: ********
I am rejecting this response because: Aetna sent me a contract and I completed it. They set my effective date as 8-17-22. I am not satisfied as I want a retroactive effective date due to the inconsistencies and extreme delays. I have attached additional documents to support my experience. 1) After attempting to submit an online application on 4-12-22, the message I received from Aetna to instead fax a letter. 2) The letter I faxed to Aetna, as per their instructions, on 4-13-22. 3) The letter I received from Aetna on 4-14-2022, with conflicting information, telling me that I should in fact apply online. I applied online on 5-1. This is the application Aetna "lost" despite me received a confirmation number. I only learned this after many phone calls to customer service, on 6-7 a representative informed me the application was never processed and I re-applied as per his instructions. Rep told me it should be processed in a few business days. I attached 4) the email confirmation stating it would be reviewed within 60 days. I never received a response until complaining to the BBB. Despite many calls and attempted escalations. For these reasons, I want my effective date extended back to June 7th. Thank you.
Sincerely, ***** ****
Business Response
Date: 08/25/2022
Dear Mr. Stewart *********:
Please see our
response to complaint # ******** for *** ***** **** 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 the
complaint, we immediately reached out internally for review. We confirmed that due
to the difficulties *** **** has experienced, our Network team is willing to
provide him with a retroactive effective date. However, a new agreement
must be filled out and returned before the system can be updated. Our Network
Relations Specialist sent an email to the provider on August 23, 2022,
requesting that he returns the new agreement with a signature so that we can
update the effective date. We confirmed that the provider has signed the
agreement, and our Network team executed and returned it back to the provider
with an effective date of June 01, 2022. In addition, we searched the system
for claim impact and did not locate any claims that needed reprocessing.
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ****** concerns.
If there are any additional questions regarding this particular matter, please
contact the Executive Resolution Team at ******************
Sincerely,
Shay
G.
Complaint and Appeals Analyst
Executive Resolution Team
Customer Answer
Date: 08/25/2022

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 SO much for your help getting this issue resolved.

Sincerely,

***** ****
Initial Complaint
Date:08/15/2022
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.
On Wednesday, August 19, 2022, I discovered after a scheduled doctor's appointment that my advantage Part-C Aetna Medicare, effective June 1, 2022, was canceled without my knowledge. I received my Aetna Medicare Welcome package and enrollment card and was taken aback to find out that I had been dis-enrolled due to an Aetna agent's error which canceled an updated application and a previous application at the same time. The reason was marked, other. The updated application was filed on March 3, 2022, and Aetna Medicare canceled both on March 31, 2022. The Go-Medicare rep called Aetna Medicare on that same day and the Aetna Medicare Associate acknowledged that the revised application and previous one had both been canceled on March 31st and that he would need to start a new application that would be effective September 1, 2022. I am new to Medicare and was excited when the Go Medicare Rep shared the Aetna Advantage Part C plan with me, however, if this is an indication of the quality of care that Aetna Medicare provides, it is subpar. I also called Aetna Medicare directly and asked for a supervisor (after speaking with 2 Aetna Reps), I gave my number and was told that a supervisor would call me. It's been 5 days and I'm still waiting for a return call.
Business Response
Date: 08/25/2022
**** *** ******* **********

Please see our response to complaint # ******** for Ms. ***** **************** that was received by us on August 15, 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 reviewed the enrollment call and found the agent enrolled the member on March 31. The agent should have submitted the application in May for a June 1st start date. We contacted the Enrollment Department to have the member enrolled in the plan starting June 1, 2022, due to the agent’s error. We reviewed the calls from customer service. No errors were found since they would not have been able to see a second application was incorrectly sent, and the plan was not active. The member’s plan is now active. 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
Initial Complaint
Date:08/12/2022
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.
Back on April 7, 2022 I had my annual physical with my PCP *** ***** *******. The physical included a referral from my PCP to have bloodwork and urology done at a nearby hospital, ******* *******, which I had done the same day. I later received a bill from the hospital in the amount of $39.53 for the routine tests. I have called Aetna multiple times and spoken to representatives who told me that they couldn't get in touch with the doctor, though I was able to. When they finally contacted his staff, the Aetna reps were told that they had to contact the hospital, which they did and a hold was put on the bill. Months later, I start receiving bills from the hospital again.

I have never paid for routine checkup before and I've been trying to have this balance cleared before it goes to a collection agency. Please help resolve this issue. Thank you.
Business Response
Date: 08/16/2022
**** ******* **********

Please see our response to complaint #******** for ****** *********** that was received by us on August 12, 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 our Claims department to assist with our investigation. Our initial review discovered that the claims were submitted as a non-routine exam and lab services. We contacted the provider to confirm this and they advised that the member did come in for a routine annual checkup. They advised they would review the member’s information and send a corrected claim. Once we receive the corrected claim we will reprocess and notify the member.

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,

William B.
Complaint and Appeals Analyst
Executive Resolution Team
Initial Complaint
Date:08/11/2022
Type:Order Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have a dental plan via Aetna with 5 dependents. The bio mom of one of the dependents contacted my insurance and provided false information and had my policy changed to reflect her as a primary insurance and Aetna as secondary. Aetna could not verify that she was who she portrayed to be. Their HIPPA compliance questions are the policy holder name; dob; the chilids name dob and the policy holders address. This is information that is easily accessible via the internet; no request for policy number; employer information; nothing personal. Aetna made a change to my policy information based on a phone call from someone they could not verify as a party to the dependent. I don't understand how Aetna can make a change without verifying the person on the phone or contacting the insured to confirm the information. Yes I understand the Bio Mom can get information on policy and cost, but my plan is not protected from anybody calling in and making changes based on verifying the policy holders name; date of birth and address. Like I said you can do an internet search and obtain that information
Business Response
Date: 08/17/2022

**** *** **********
Please see our response to complaint ******** for ******** Johnson that was received by us on August 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 member’s concerns, I immediately reached
out internally to our HIPAA and Privacy team. Per their review of this case and
the details of the case, the biological mother is able to call into the plan regarding
benefit coverage and claims. We understand the member’s concerns regarding the HIPAA
questions not being “difficult” enough to keep the account secure. This was sent
to our Policy team to review for future policy reviews, edits, updates and
changes. I was not able to locate a call from the biological mother changing
the Coordination of Benefits (COB) on the plan. It appears a claim was received
that triggered the COB change. We are unable to identify if the biological
mother changed the COB at the provider’s office. If that’s the case and a claim
was received indicating the child has other insurance (as primary insurance),
that could have triggered the COB change. However, I’ve confirmed with our COB
team that, even in the event stepparents are the policyholders of the plan
carrying the dependent child in question, the birthday rule applies. Therefore,
the stepmom’s policy would be primary, and the stepdad’s policy would be
secondary. The policyholder of this plan may choose to implement a password
restriction on her account, but it cannot include the dependent child in
question. However, when the dependent turns 18 years of age, she can choose to
password restrict her account. Neither parent will be able to speak on the dependent’s
behalf without authorization once she turns 18 years old.
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:08/11/2022
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 provided proof of a valid covered claim from a medical procedure in January. Starting in June I started emailing asking why the claim was denied since I had coverage. They assured me it would be sent for reprocessing which takes 7-10 business days. After 7 additional emails to the Company asking about the claim, they assure me it is escalated and being reviewed. This has been over 2 months of emailing and asking for resolution. This claim would put me at my out of pocket max and I feel they are holding this claim for processing as they would have to pay for my medical bills the remainder of the year. I told them I was going to the BBB and still have not heard a satisfactory response on when this claim would get resolved.
Business Response
Date: 08/19/2022
**** *** **********
Please see our response to complaint
#******** for ********
***** that was received by us on August 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 Ms. *****’s concerns, we
reached out to our Claims team to have the claim reviewed. It was found that the claim had initially been
submitted and denied with a reason stating that assistant surgeon services are
not covered by the plan for the code billed. The claim had then been resubmitted, and an incorrect denial was applied
stating that the claim was for after the member’s coverage had ended.
With the additional review, it was found
that the surgery notes had been previously reviewed by our Clinical Review team,
and it was stated that the primary and assistant surgeon’s billing of the
procedure code on the invoice should be denied as incidental to the primary procedure
performed. Incidental services are not
paid separately. The claim has been
updated to reflect the correct denial reason as can be seen on the attached
EOB.
As per the EOB, this claim is protected
by the Federal No Surprises Act, which became effective January 1, 2022. The act states that out-of-network providers
who perform services at an in-network facility are not able to bill for more
than any deductible, coinsurance, or copayment applied. As there was no deductible, coinsurance, or
copayment applied with the denial, Ms. ***** is not responsible for any part of
the claim.
Since a bill has been received from the
provider, the next step is to contact the federal agency at the No Surprises
Helpdesk at ************** or ***********************. She can also visit our website at *******************************************************************************************************.
We take customer complaints very
seriously and appreciate you taking the time to contact us and giving us the
opportunity to address Enter
title and complainant last name’s concerns. If
there are any additional questions regarding this particular matter, please
contact the Executive Resolution Team at *****************.

Regards,
Chris B.
Complaints and Appeals Consultant
Executive Resolution Team
Customer Answer
Date: 08/22/2022

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:08/10/2022
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.
On Jan 10th of 2019, I visited the doctor. I didn't receive a bill. In 2021 I received a collections notice. I called the insurance agency, collections, and hospital multiple times. Finally, on Jan 20th, 2022 I was on a conference call with 2 insurance agencies I had at the time. Aetna was chosen as the primary. They told me they would resubmit the claim that day. I have reference numbers to price it. The collections agency was told by Aetna they were resubmitting it. Present day it is still in collections. I called Aetna to get this resolved. They are trying to say they do not have access to my account because it has been longer than 2 years. I was on the phone with multiple people. They kept transferring me around. To places that didn't even have to do with the visit. I finally got ahold of someone who would be able to help. They hung up and didn't say anything. They did this multiple times to me. I asked to speak to a supervisor and they wouldn't let me. I sat on hold for 41 min on August 10th,2022. I was never able to get this resolved. This bill is in collections. it has been multiple years and this is still not taken care of, I do not want this to affect my credit. I would like them to reprocess this claim. Pay the collections agency to take care of this once and for all. I have logs and confirmation numbers from Jan 20th, 2022 from every party involved. On this day I spent 2 hours on the phone as well.
Business Response
Date: 08/24/2022
**** ******* **********

Please see our response to complaint #******** for ***** ***** that was received by us on August 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 member’s concerns we immediately reached out to our Claims department to assist with our investigation. We found that the member’s claim remained unpaid and the plan was now cancelled and the runoff period ended. This means we no longer had direct access to the account used to pay claims. We reached out to the Plan to assist, and they were able to reopen access to the account to pay the claim as promised. On August 24, 2022, we paid $286.81 to the provider via Electronic Funds Transfer. The patient’s coinsurance is $11.36, which is their full responsibility. A statement will be released to the member and provider within seven to ten business days.

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

Sincerely,

William B.
Complaint and Appeals Analyst
Executive Resolution Team
Initial Complaint
Date:08/10/2022
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have tried for seven years to get my primary coverage (Aetna for ******** ****) and my secondary coverage through my husband's plan (Aetna through **** ******* ***** ******* to coordinate with each other. I have spoken to innumerable staff that explain they can’t see both plans, and they’re only able to help me one or the other, give me a separate number to call and more than once gotten the exact same representative that gave me the number. I have sent multiple copies of each of our insurance cards showing each other and our three children as dependents, and yet the benefit coordination doesn’t happen. We get collection notices from multiple service providers saying my primary insurance refuses to pay because they're aware of but can't confirm my secondary coverage. This is flat out unacceptable.
Aetna customer service has been horrendous, incompetent, and frankly embarrassing that each of our global companies even use such a low-end provider. I have written previous complaints, challenged EOBs with detailed messages, and every time someone responds I am assured there won't be any issues going forward, given apology after apology for the inconvenience. At this point they’re a menace.
It has been countless hours on the phone, chats, and email messages. I cannot afford to keep wasting effort on this non-issue. Seven years is not an exaggeration, it is the length of time that my husband has worked for **** ******* this is just infuriating. I will be sending the same message through the secondary coverage portal, to the Aetna Liaison of ******** and **** *******, and to the Senior Management of Aetna’s entire enterprise, and the better business bureau.
We have no choice in who our employers select for their providers, but it doesn’t mean we should have to put up with things like this. I am outraged that I am still making the same request after seven years. I know that the CEO of Aetna and his family would never deal with this, we shouldn't either.
Business Response
Date: 08/18/2022
**** *** **********
Please see our response to complaint
#******** for ******
**** that was received by us on August 10, 2022. Our Executive Resolution Team researched your concerns, and I would like
to share the results of the review with you.
We reached out to the areas that work directly with the
******** and ** ******* plans. It was
confirmed that our systems do properly reflect that the ******** policy is
primary for Mrs. **** and her children but secondary for her husband. The PF
Chang’s policy is reflected as secondary for Mrs. **** and her children and
primary for her husband.
A field service advocate, Sandra O******** reviewed the
situation as well and has discussed the claims involved with Mrs. ****. One claim was determined to have been
processed incorrectly, and the advocate is continuing to work with the Claims
team to resolve the issue. She is also coordinating with both plans to determine additional steps that can be taken to prevent any further issues from occurring. We apologize
for any frustration or inconvenience this matter has caused.
We take customer complaints very
seriously and appreciate you taking the time to contact us and giving us the
opportunity to address Mrs. ****’s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at [email protected].

Regards,
Chris B.
Complaints and Appeals Consultant
Executive Resolution Team
Customer Answer
Date: 08/19/2022

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 as I have been able to work with the Liaison assigned to ********. There are several other bills and claims that she is working to resolve.

Sincerely,

****** ****
Initial Complaint
Date:08/09/2022
Type:Order Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am legal guardianship of ****** * ****** who is denied lifesaving and rehab care from Aetna. They fraudulently got her into a Medicare plan that she didn’t belong in which restricts her care instead of add value. She has a/b and tricare for life which is all she needs.
Business Response
Date: 08/10/2022
Hello,

The below BBB complaint requires an authorization. The member is ****** ******/************. Once received, we will open a case and proceed with a review. Thanks

Customer Answer
Date: 08/10/2022

Complaint: ********

I have attached the order which appoints me as ****** * ****** guardianship of her person and estate. Do you still need me to fill out the form? She cannot sign it.

Sincerely,

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

************
Business Response
Date: 08/19/2022
**** *** ******* **********

Please see our response to complaint # ******** for Ms. ******* ******* on behalf of Ms. ****** ****** that was received by us on August 10, 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 for review. We reviewed the member’s enrollment history. We have found that the concerns about the member’s enrollment in the plan was taken through the Market Misrepresentation process. The plan conducted an agent investigation. Upon review of the enrollment call, the agent failed to review Ms. Phelps’ medical providers and did not discuss dental, vision, and hearing benefits prior to the submission of the enrollment. Based on review of the available information and the agent’s written statement and sound recording, the findings are that the case is substantiated, and counseling has been provided to the agent. We have added this to the agent’s file for tracking and monitoring. The member has been disenrolled effective August 1, 2022 at the request of her court appointed guardian. We reviewed the member’s prior authorization history. We have found that the prior authorization request for long-term acute care admission was received on July 11, 2022. The request was denied on July 14, 2022 as not medically necessary. A peer-to-peer review was completed on July 14, 2022. The Medical Director upheld the denial after the peer-to-peer review as care could have been provided at a lower level such as ventilator capacity at a Skilled Nursing Facility. The denial was upheld, and Appeal rights were given to the provider. We received an appeal for the denied long-term acute care admission on July 27, 2022. The appeal was completed on July 30, 2022. The appeal decision was to uphold the denial. The plan submitted an external appeal to ******* ******* ******** on July 30, 2022.The external appeal is pending response from ******* ******* ********. The member will be receiving 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,
Jasmine W.
Coordinator
Medicare Enterprise Resolution

Customer Answer
Date: 08/21/2022

Complaint: ********

it is true the findings were that the salesman was disingenuous and because of that Aetna agreed to remove my mom from the plan and retroactively. She immediately got transferred to the ltach care she needed since June. because of this whole situation my mother suffered and was not able to get the proper care she needed when she needed Aetna is going to be responsible for this.

I am rejecting this response because:

Sincerely,

******* *******
Business Response
Date: 08/25/2022
**** *** ******* **********

Please see our
response to complaint # ******** for Ms. ******* ******* that was received by
us on August 22, 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’s plan was termed through the membership
misrepresentation process. We apologize for the inconvenience of the
member being denied acute care. We are required to follow Medicare
Guidelines. If all required guidelines are not met, we are required to
deny the request. The member has Tricare. Tricare may have paid for
the costs denied. The representative 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
Anaylist
Medicare Executive
Resolutions
Customer Answer
Date: 08/25/2022

Complaint: ********

I am rejecting this response because:

I have heard this many times "we have to follow the medicare guidelines" but the weird thing is once we removed her from the Aetna plan she was able to move directly to the acute care setting and is now under MEDICARE A/B. So how come with plain Medicare she was able to get the care she needed if it was denied because of medicare guidelines? Please explain.

Sincerely,

******* *******
Initial Complaint
Date:08/09/2022
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.
My son, ******* *** ******* (DOB: ******), required feeding therapy, as recommended by his pediatrician due to his slow weight gain and slow 45-60 minute feedings as a consequence of his tongue and sucking issues. Prior to *******’s first visit on 06/15/22 at ******** ****** ******, a representative from ******** (Hayley) called Aetna and spoke with Mark on 06/14/22 to determine coverage. Mark informed Hayley that ******** was Tier 2 care, and that we had $258.44 remaining on my deductible for tier 2 care and would also owe $38.14 (25% copay) for the initial visit, for a total of $296.58 to be paid by me. Because the initial evaluation was quoted as tier 2 in-network, it was expected that all follow-up visits would also be tier 2 in-network at 25% copay (~$50 per visit to be paid by me). When I got the bill from ******** ($1230.00 for visits 06/15/22, 06/20/22, and 06/28/22) and observed that the claim was considered to be “out-of-network” on my Aetna portal, I called Aetna on 7/18/22 and spoke with Kristopher. After listening to the 6/14/22 phone call between Mark and Hayley, he agreed that the claims should be processed as Tier 2 because that was the information that Aetna provided to ********. He instructed me to put in an appeal, which I did on 07/20/22. The appeal was denied, stating that the claims were 'out-of-network', but doesn't acknowledge that Mark (Aetna employee) made a mistake by saying the care was Tier 2 on that original phone call on 06/14/22. I cannot pay this bill to ******** because of Aetna's mistake and am requesting that the claims for all of *******'s feeding therapy visits (06/15/22, 06/20/22, 06/28/22, 07/06/22) be paid for by Aetna, as originally promised.
Business Response
Date: 08/17/2022
Dear Mr. *********:
Please see our response to complaint ********
for ****** *** ******* that was received by us on August 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 the member’s concerns, I immediately reached
out internally to the Plan Sponsor Liaison (PSL) to have the member’s concerns
reviewed. Per the PSL’s response, the member’s benefit guide is very clear
regarding in-network vs out-of-network and what providers are considered
out-of-network for the member’s plan (see page 7). ******** ****** ****** (i******** ***** ******** *********** ***** ******* ******** *** ***** ***** *** *** ***************
We did pull the provider’s benefit verification phone
call and the customer service representative did quote the provider the lower
in-network benefit at 75% after deductible. Based on the inaccurate
information, we requested for this to be reprocessed at the lower in-network
benefit as a one-time exception. That request was approved. The member should
allow 7-10 business days for that claim to be reprocessed. Please note, this is
a one-time exception and going forward, the services will be processed at the
tier 3 level (out-of-network) which means the member will be responsible for a
higher out-of-pocket cost.
I’ve also included the member’s benefit guide as an
attachment to this response. This is a beneficial tool for the member, and we
encourage the member to review it and refer to it as needed. This is something
the member should hold onto.
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 [email protected].
Sincerely,
Destiny S.
Complaint and Appeals Analyst
Executive Resolution Team

Business Response
Date: 08/17/2022
Dear Mr. *********:
Please see our response to complaint ********
for ****** *** ******* that was received by us on August 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 the member’s concerns, I immediately reached
out internally to the Plan Sponsor Liaison (PSL) to have the member’s concerns
reviewed. Per the PSL’s response, the member’s benefit guide is very clear
regarding in-network vs out-of-network and what providers are considered
out-of-network for the member’s plan (see page 7). ******** ****** ****** (i******** ***** ******** *********** ***** ******* ******** *** ***** ***** *** *** ***************
We did pull the provider’s benefit verification phone
call and the customer service representative did quote the provider the lower
in-network benefit at 75% after deductible. Based on the inaccurate
information, we requested for this to be reprocessed at the lower in-network
benefit as a one-time exception. That request was approved. The member should
allow 7-10 business days for that claim to be reprocessed. Please note, this is
a one-time exception and going forward, the services will be processed at the
tier 3 level (out-of-network) which means the member will be responsible for a
higher out-of-pocket cost.
I’ve also included the member’s benefit guide as an
attachment to this response. This is a beneficial tool for the member, and we
encourage the member to review it and refer to it as needed. This is something
the member should hold onto.
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 [email protected].
Sincerely,
Destiny S.
Complaint and Appeals Analyst
Executive Resolution Team

Customer Answer
Date: 08/23/2022

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, as long as all dates of service will be billed at the standard savings tier (6/15, 6/20, 6/28, 7/6). Even though the 7/6 date isn’t on the same claim number as the first three dates, we didn’t receive a bill showing the out of network charges until after 7/6/22.

Sincerely,

****** *** *******
Customer Answer
Date: 08/23/2022

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, as long as all dates of service will be billed at the standard savings tier (6/15, 6/20, 6/28, 7/6). Even though the 7/6 date isn’t on the same claim number as the first three dates, we didn’t receive a bill showing the out of network charges until after 7/6/22.

Sincerely,

****** *** *******
Initial Complaint
Date:08/08/2022
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
This is my second BBB complaint concerning Aetna. My company manages dozens of mental healthcare providers, and once again we are dealing with getting our providers credentialed with Aetna. They have given us misinformation concerning the provider's credentialing process. They are now telling us we must "start over. We were told this will take 90 business days minimally. They don't take any responsibility for this bad information, and when you try to find someone with any authority to do anything, you can't find an email or a phone number to reach anyone. I have a hit a wall with my representative. I cannot accept that I should wait at least 5 months for a provider to be credentialed with Aetna. They take months to either link or credential a provider, and that's just the way it is. Meanwhile, there is a mental health epidemic in the US. I do not get the sense that Aetna is interested in working with it's providers or that they are open to improving their process. If we didn't have so many patients with Aetna insurance, I wouldn't even bother with them.
Business Response
Date: 08/11/2022
**** *** ******* **********
Please
see our response to complaint #******** for ******** ***** that
was received by us on August 08,2022. 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 Aetna’s
credentialing and onboarding process takes a minimum of 90 days to be
completed, and our Credentialing team has notified Ms. ***** that we cannot guarantee a lesser timeframe. Unfortunately, our policy cannot be waived or changed. To
date, we have completed a review of all providers and will be submitting a full
review of all claims for both commercial and Medicare members. Currently,
there are three providers pending credentialing, all within 90 days of
submission. Ms. ***** has three direct resources on our Behavioral Health team
(Tina D., Vanessa M., and Valencia W.) that she can contact directly to monitor
the status of her providers. Please note that Vanessa has been meeting with Ms.
***** on a regular basis for several months and Valencia has been assigned as Ms.
*****’s point of contact. In addition, Valencia and Vanessa are scheduled to meet
with Ms. ***** today, to review all her concerns. Tina is also scheduled to
meet with Ms. ***** on August 12, 2022, to discuss any other questions that she
may have. Going forward, Ms. ***** will continue to work with her direct
resources until the credentialing and claim processes are complete.
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 s*****************
Sincerely,
Shay
G.
Complaint and Appeals Analyst
Executive Resolution Team
Customer Answer
Date: 08/12/2022

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,

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

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