Complaints

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• Initial Complaint

  Date:11/25/2024

  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 signed up for a Medicare Advantage Plan through this insurance broker. The broker promised that nonemergency medical transport would be covered under the plan. However, I learned shortly after coverage began that the nonemergency medical transport promised was not offered for my service area. I am now required to pay out of pocket for nonemergency medical transport that I otherwise should have received under this plan.

  

  Business Response

  Date: 11/25/2024

  Thank you for taking the time to share your concerns about the non-emergency transportation benefit associated with your Medicare Advantage Plan. We genuinely regret the challenges you experienced and appreciate the opportunity to provide a detailed response.
  When we enrolled you in your Medicare Advantage Plan, our agency thoroughly explained all benefits available under the plan in your area, including the non-emergency medical transportation benefit. This benefit is an included feature of your plan and is indeed available in your service area. As part of our commitment to transparency and client support, we ensured you were fully informed about how to access and use this benefit effectively.
  The transportation service, however, is administered by a third-party company contracted through *****, and our agency does not control the operations of that provider. When you informed us that your 4:30 AM pick-up request was not accommodated due to driver unavailability, we immediately escalated the matter to our broker manager. At the same time, we advised you to reschedule the procedure to fall within the transportation companys regular operating hours to avoid further disruptions.
  We want to emphasize that we took every step possible to advocate on your behalf. We spoke with you multiple times, consistently escalating the issue to ***** and working to ensure your concerns were addressed. We also explained in detail that Aetnas non-emergency transportation benefit requires the use of a contracted third-party provider and that services arranged outside of their network would not be covered. Despite this, when you chose to use a non-contracted provider for your appointments, we continued to escalate the issue and even requested reimbursement for the out-of-pocket costs you incurred.
  While we deeply empathize with your frustration, it is important to clarify the scope of our role as your broker. We are dedicated to ensuring you have access to accurate information and the support needed to maximize your plan benefits. However, we do not control the day-to-day operations or service delivery of ***** or their third-party vendors.
  From our perspective, we have fulfilled our responsibilities ethically, morally, and contractually. We regret that the limitations of the transportation vendors operating hours caused you inconvenience, and we worked diligently to assist you throughout this process. We remain committed to supporting you and are here to help should you have any further questions or concerns about your plan benefits.

  Aetna received claims from Mr. Morgan for ground mileage for date of service 03/06/2024 in the amount of $240.00 and date of service 03/27/2024 in the amount of $275.00. The claims were processed as ground ambulance rides and accepted. No reimbursement was sent as the members cost did not exceed his copayment of $275.00.
  
  Aetna also received a reimbursement request for DOS 05/23/2024. This was keyed in and processed as DME. the member was reimbursed $175.50 and he was responsible for his 35% OON coinsurance of $94.50. If this would have been processed as NEMT the member would be responsible for their $275 co-payment and would not have been reimbursed for anything under that amount. 

  We have taken all measures to ensure that the client was taken seriously and the issue was resolved quickly and to the best of our ability! 

  
  

  Customer Answer

  Date: 01/10/2025

   
  Complaint: 22587797
  
  I am rejecting this response because:

  When Insurance Source sold me the Aetna Medicare Advantage Plan, they guaranteed me free nonemergency medical transport. Furthermore, they guaranteed that my address was within the service area for the third-party nonemergency medical transport carrier. Instead, each ride I attempted to book was cancelled. The first ride, dated February 28, 2024, was cancelled the day of, thereby preventing me from attending a necessary medical procedure. I was later informed that any ride I scheduled through ******** would be declined because I was out of service area for ********. Had this information been disclosed to me by Insurance Source at the outset, I never would have elected to purchase this Advantage Plan. Insurance Source then encouraged me to file out of network claims for all future rides, which they advised I could book through Lyft of ***** I was never informed that that out-of-pocket patient responsibility would be set at $275, thereby guaranteeing any transport I booked to and from the hospital would be my sole financial responsibility. 

  I have enclosed copies of my communications with Insurance Source and Aetna, which detail my appeal to Aetna and attempts to resolve the nonemergency medical transport issues with Insurance Source. This file also includes an accounting of events leading to the present. 

  
  Sincerely,
  
  ******* ******

  

  Business Response

  Date: 01/17/2025

  We are writing in response to the complaint filed by Mr. ******* and the rejection of our response regarding his experience with the Aetna Medicare Advantage Plan and the non-emergency medical transportation services provided through ********. We value every opportunity to address concerns and provide clarification in situations like this.
  As agents representing *****, we are responsible for clearly explaining the coverage options available under the policies we offer, as well as assisting clients in navigating the plan details. We thoroughly reviewed the Aetna Medicare Advantage Plan with Mr. ******* during our meeting, including the benefits such as non-emergency medical transportation, which is a part of the plan. At that time, we confirmed his eligibility and ensured that his address was within the service area for transportation through ********, as provided by ******
  Unfortunately, as agents, we do not have control over ****** operations or the actions of third-party providers, including ********. We understand that Mr. ******* experienced cancellations with his transportation services, as they were scheduled outside of operating hours, and we sincerely regret the inconvenience caused by this situation and we did explain to Mr. ******* ****** that he would need to schedule his appointments within normal operating hours to be able to better access the transportation option. However, we would like to reiterate that transportation service issues fall outside of our direct control. When Mr. ******** rides were canceled, we did our best to assist him by reaching out to Aetna and escalating the issue on his behalf. We clearly explained that if he used a transportation service that was not contracted with *****, the charge would not be covered, to which Mr. ******* ****** responded that he had no choice because he had to have the ride.  Additionally, when Mr. ******* ****** used a company outside of the Aetna network, we were able to work with Aetna to have the transport charges covered under a co-pay rather than the full amount.
  Although we understand Mr. ******** frustration with the resolution of his transportation issue, it is important to note that the terms of the coverage were clearly communicated to him. Regarding his out-of-pocket expenses for transportation, we understand that this was a point of confusion and frustration. However, as mentioned, we are a liaison between the client and the insurance company and must rely on the information and policies provided by *****. We sincerely apologize for any inconvenience Mr. ******* ****** encountered.
  In addition, when the issue persisted, we offered Mr. ******* the option of re-enrolling in his previous Cigna plan, as he had mentioned it offered certain benefits that were important to him. However, Mr. ******* declined this option, opting to remain with Aetna because he believed it offered better overall coverage.
  We regret that Mr. ******* has been dissatisfied with his experience, but we feel that we provided the best customer service available within the scope of our role as agents. We acted promptly to address his concerns, escalated the issue to Aetna, and provided clear explanations about the available options.
  Again, we sincerely apologize for the inconvenience caused and the confusion around the non-emergency medical transport benefit. We remain committed to providing the best possible service to all of our clients and assisting them in making informed decisions about their healthcare coverage.
  Thank you for your attention to this matter. Should you require any additional information, please feel free to contact us directly.

  Customer Answer

  Date: 01/28/2025

   
  Complaint: 22587797
  
  I am rejecting this response because:The few times that I actually got to speak with so called Brokers-Directly with Aetna Medicare Insurance I was told that it was misrepresentation from my so called insurance agent ****** *********. It was 2 weeks after I missed a procedure due to Transportation issues that I was actually able to talk to ******. My Transport Rides were schedule & confirmed a week prior to my appointment; less than 12 hours before my first ride, Safe Ride cancelled my Transport Rides & said that they do not do rides in my area.  ********************** Templeton is the mother of ****** *********. I have only spoken with Ms ********************** once-through all of this. All Ms ********************** is doing is covering for her daughter.
  
  Sincerely,
  
  ******* ******