Chevron USA, Inc.

I did receive the advertised gift card 2 weeks after receiving the insurance packet.  I also received a second identical insurance packet from Aetna.  I would highly recommend that Aetna include the gift card in the insurance packet, or at least a note stating when it should arrive.  Otherwise customers are left with the impression that the card was forgotten.

Dear Ms. [redacted]   Please see our response to complaint #[redacted] for [redacted] that was received by us on June 22, 2016. 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 to the Claims department to have the member’s concerns reviewed. We are currently in the process of reviewing and correcting any claims on file for the member. We have contacted the member directly to let him know we are working to rectify the situation and will contact him directly once the claims review has been completed.   We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Cohen’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
* Sincerely,   Ashley W. Complaint and Appeals Consultant Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint #[redacted] 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 to our Premium and Billing...

department to have the member’s concerns reviewed. We were advised that the member was not terminated for nonpayment; she was terminated for no longer being eligible by the [redacted] Exchange. The member would have received several letters from the [redacted] prior to the member’s termination. Aetna has no control over the policies that are created under the [redacted] Exchange; we are strictly administrators of the member’s plan. Aetna has no control over a member’s termination.
The member was drafted two months in error for November’s premium due to a system error. A refund was issued on November 06, 2015, for the $174.35 that was withdrawn in error. The member’s plan was terminated correctly per information received from the Marketplace. If the member is wishing to dispute the termination she will need to contact the [redacted] to inquire why her plan was terminated. I sincerely apologize for any inconvenience this has caused 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. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Dear [redacted]:   Please see our response to complaint #[redacted] for [redacted] that was received by us on May 14, 2018.  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 a Teladoc representative. They researched this issue and have provided a response. The member stated that they felt like the Aetna Teladoc services charged her a service fee for no service provided. The member said that all the Teladoc provider did was tell them to go to urgent care and the member said that she could hear child noises in the back ground.   In reviewing these concerns, the Teladoc representative conducted a thorough review of the case and determined that the treatment was medically appropriate. The member did receive advice from the physician. We are sorry he was unhappy with his Teladoc consult. Member satisfaction is very important to Teladoc, and to us, and we strive to provide the best care and best experience to all our members. Teladoc approved a refund of the member's consult fee. A refund has been processed in the original form of payment to the member.   We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   Sincerely,   Michael H. Sr. Complaint and Appeal Analyst Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:
Sincerely,
[redacted]I called them  because I wanted to go to a local facility to have the ultrasound done they told me that facility was out of network. I asked them where can I go that is in network they gave me the information I provided in the complaint they confirmed to me that that’s what they told me the address and the phone number I went to that location per their instructions which were was out of my way but I had it down there because that’s where they told me to go. Then they’re claiming the facility they sent me to was out of network. I would like an independent party To review the recording because they will not let anybody else listen to it that should solve the problem. They will not give me access to the recording of me and the representative.  In the two appeals I made they never said that they told me it was out of network in that conversation they are flat out lying I have a feeling this is a common practice there and they have procedures to cover this up  I have a feeling this is a common practice there and they have procedures to cover this up.  If independent party can review the conversation I will happily except their findings. The representative did read to me Word for Word what I was told and agreed with me that I was told to go to that facility by address and phone number as they are in network. Why won’t they let anybody else listen to the recording that will solve the whole matter.

Hello,
Thank you for your inquiry, regarding complaint# [redacted] for [redacted]. Our
Executive Resolution Team researched your concerns, and I would like to share
the results of the review with you.
Upon receipt of your complaint, we contacted our Claims department...

and
confirmed that the claim was reprocessed correctly based on our review. The
member is responsible for 10% coinsurance based on the plan benefits. The
claim was reconsidered for an additional payment of $112.70. The customer
service representative did not consider the plan benefit which allows 90% of
the allowed charges. The member’s portion was 10% of this amount so no
additional payment is due for this claim. 
We apologize for any difficulties and inconvenience this has caused the member.
We take customer complaints very seriously and appreciate you taking the time
to contact us and giving us the opportunity to address [redacted] concerns.
If you have any additional questions regarding this particular matter, please
contact the Executive Resolution Team at [redacted].
 
LaShonda C.
Complaint and Appeal
Consultant
Executive Resolution Team

Dear [redacted]: Please see our response to complaint #[redacted] for [redacted] that was received by us on March 15, 2018.  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 reached out...

to the contact within Aetna who is the liaison between Aetna and the plan sponsor who offers [redacted]’s policy, [redacted]  We were advised that [redacted] has selected [redacted] as the pharmacy benefits manager who administers the prescription coverage for their employees.  As such, Aetna is not involved in determining benefits for his prescription medications or in setting the requirements for coverage of maintenance medications.  Aetna only administers the benefit plans that cover medical and behavioral health services.  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   Regards, Chris B. Complaints and Appeals Consultant Executive Resolution Team

Thank you for your inquiry, regarding complaint# [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. Upon receipt of your complaint, we contacted our Pharmacy department and confirmed that the prescription...

has been shipped and delivered to the member. We have spoken to the member and confirmed receipt of his medication. We apologize for any difficulties and inconvenience this has caused 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. [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Complaint: [redacted]
I should get a full refund.  It's obvious your online billing system is filled with glitches.  It's not my fault that your system was unable to process my request.  It is downright criminal that you would erroneously bill me with your inefficient system and have the audacity to refuse to give me a refund.
Sincerely,
[redacted]

Hello,
Thank you for your inquiry, regarding complaint #[redacted] for [redacted]. 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 to our [redacted] department to have...

the complaint reviewed as priority. Our records indicate that the original appeal was received on August 18, 2015, and was being handled as an expedited appeal request. We were requesting a power of attorney from the member’s son; due to [redacted] guidelines we must obtain this to discuss any appeal information. On August 19, 2015, we received a request from the member’s doctor to complete a peer to peer. The member’s medical records were reviewed again by a medical director who overturned the appeal on August 20, 2015, and allowed the member to be transferred to the rehabilitation center.
Please accept my apologies for the difficulties the member has encountered with Aetna. I’m sorry that our representatives were not able to assist the member when his son or he called. Our goal is to provide quality service and satisfaction to our members, and I sincerely regret that the member did not receive the service he should rightfully expect and deserve. His concerns have been forwarded to our management team for improvement opportunities. I hope that going forward we will be able to regain the member’s confidence in us.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
 
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Thank you very much for the response and final assessment.
Sincerely,
[redacted]

Hello,
Thank you for your inquiry, regarding complaint [redacted] 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 to our Enrollment and Eligibility...

department to have the member’s concerns addressed. We were advised that this member changed plan options in 2016. The member changed from the CDHP plan, enrollment code EP1, to the Aetna Direct plan, enrollment code [redacted]
The FEHBP brochure states in section 5: “If you terminate your participation in this Plan, any remaining Medical Fund balance will be forfeited.” If the member would have stayed in the same plan, the funds would rollover from year to year, but due to the plan change the member forfeited the funds in the 2015 account.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Freedman’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Hello, Thank you for your inquiry, regarding complaint# [redacted] for [redacted] Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. Upon receipt of your complaint, we contacted our Claims department and confirmed that we have...

not received a claim from [redacted]. We contacted the provider’s office and confirmed the member’s health coverage. We also verified that the location is participating with the member’s plan. The provider will resubmit the claim to Aetna. Once we receive the claim, we will process and send an explanation of benefit to the member. We apologize for any difficulties and inconvenience this has caused the member. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]. LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Hello, Thank you for your inquiry, regarding complaint #[redacted] for [redacted]. 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 contacted our Claims department  and confirmed that both dates of service were processed correctly . The claims are being allowed at the in-network benefit but the member is responsible for a deductible prior to the claims paying at 80% when billed as outpatient hospital visits. The member would have been responsible for a specialist copay only if she was seen at a doctor’s office. I understand your concerns and recognize this is not the outcome you desired. However, we must make coverage decisions in accordance with your plan of benefits.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]. LaShonda C.
Complaint and Appeal Consultant Executive Resolution Team

Thank you for your inquiry, regarding complaint # [redacted] received on 08/24/15 for [redacted] 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 contacted our Vision department and verified the spelling of the member’s name. A card was mailed to the member on the 8/21/15. The [redacted] system can confirm when a card was sent but cannot provide an image of the card from that mailing. Since [redacted] cannot verify the image of the card mailed out with [redacted] included, we decided to reissue a second card.  You should receive within 7-10 days.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]. Thank you,
LaShonda C.
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because: As of today, 4/11/18 this is still not resolved. I received a paper check from Aetna for $1490.40 for services on 10/15/16, and nothing for services on 10/17/16. I have been working with Erik (a manager) since 3/27 and this is still not resolved. I paid [redacted] $2162.75 today, $672.35 of which is my patient responsibility (despite my EOB on 11/22/16 stating I only owed $28.38 out of pocket for 10/17/16 services and $197.40 out of pocket for 10/15/16 services). I still have a debt of more than $900 with [redacted]/Collections Agency because Aetna is supposed to be sending them payment, which still has not been received as of today.When I spoke with the collections agency today, I was told that while they will note that my "DEBT WAS PAID IN FULL" (once they receive the remaining $900+ from Aenta...assuming it comes) it is not guaranteed that this can be removed entirely. So to summarize, my bills STILL aren't paid, I'm pay WAY MORE than I should for these services (services I had no choice in using during the birth of my child), and my credit is impacted thanks to Aetna. 
Sincerely,
[redacted]

Hello,
Thank you for your inquiry, regarding complaint #[redacted]
for [redacted] 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 reached out to our Dental
department to have the...

member’s concerns reviewed. We were advised that the
information the member received from the Aetna response team was correct, Aetna
no longer provides dental ID cards, so we are unable to honor the member’s
request. We sincerely apologize for any inconvenience this has caused the
member.
With the member’s Aetna Dental plan, all the dentist office will
need is the member ID number or SSN and our provider call center phone number.
We can then provide them with the eligibility and benefit information. Dental
ID cards are not required by providers and the offices are aware that Aetna no
longer issues ID cards. They rely on rosters or online patient eligibility and
benefit information to verify member’s coverage. The member is on a DMO plan,
which requires a Primary Care Dentist (PCD) to be assigned to. The office which
he is assigned to receives a roster each month with his name showing he is
assigned to the office. Please have the dental office refer to page two of
their roster, where the member’s plan information is located.
Also, members can still access their dental ID card on Aetna
Navigator and the Mobile App. When printing the ID card from Aetna Navigator,
the member may want to adjust the window margins in the printing options to
have the ID card fit to his approval. The member can also download the Aetna Mobile
App onto any mobile device, where there will be easy access to pull up an ID
card and present it to the dental office.
We take customer complaints very seriously and appreciate
you taking the time to contact us and giving us the opportunity to address Mr.
Edmund’s concerns. If you have any additional questions regarding this
particular matter, please contact the Executive Resolution Team at [email protected].
Thank you,
Ashley S.Complaint and Appeal Consultant
Executive Resolution Team

Dear Ms. [redacted]:   Please see our response to complaint #[redacted] for [redacted] that was received by us on August 02, 2016.  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 to our Claims department to have the member’s date of service reviewed. We were advised that the claim was originally billed with a modifier and then was corrected to show no modifier. We have confirmed with the provider’s office that a modifier was not supposed to be billed with the claim so we were able to have this corrected and finalized for the member and the provider.   The new claim ID for the member’s records is [redacted] with a responsibility of $129.90 that applied toward the member’s deductible. The corrected explanation of benefits (EOB) will be available to both the member and the provider within 48 hours. Once the provider EOB is available we will contact the office to clarify what the member’s out of pocket responsibility should be for this date of service.   Please accept my apology for the delay in processing the claim correctly, and that it required multiple attempts on the member’s part to resolve the issue. Our goal is to provide accurate and reliable information when the member needs it and to immediately resolve issues when they do occur. Clearly, in this case, we fell short of that goal. We regret that the member’s experience with Aetna was less than satisfactory and hope that we can better assist the member in the future.   We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. Xiao’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   Sincerely,   Ashley W. Complaint and Appeals Consultant Executive Resolution Team

Revdex.com res sent 05/15/17 @ 05:12pmDear [redacted]: Please see our response to complaint #[redacted] for [redacted] that was received by us on May 09, 2017. 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 contacted Overpayment department to address the member’s concerns. We have confirmed that all pended overpayments have been stopped. We are no longer pursuing funds from your providers, since the member was active during the date of services. We also verified that all claims where money was recouped from the provider’s, have been reprocessed and  payments reissued. Please allow time for payments to be processed and posted by each provider. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Sincerely, LaShonda C.Complaint and Appeals Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because: You have record of my calling twice. Both instances I was only given one amount as my responsibility which was $500. What is the point of providing this service for individuals wishing to be proactive and properly budget if false and inaccurate information is going to be provided? My decisions, twice, were based off your customer service reps provided information. Twice, not once, was I told "it would only be $500" and confirmed there would be no surprises. One of the reps even confirmed I had no deductible and some other fee so it was only $500. If you call to order something and get one price and proceed with this purchase would you not protest when you suddenly get billed for double the amount? Now that my calls are re-discovered I would like to hear both recordings myself as I don't believe I gave any room to misinterpret my concerns when checking my benefits and co-pays. Had there been one individual who even slightly gave mention to an additional $500 copay I could understand your not wanting to resolve the issue. This simply was never the case otherwise, as you have stated in both recordings I would have went to my hospital and had the co-pay waived now saving $1000 as you're claiming. I have provided several ways to contact me. Feel free to use any method. 
Sincerely,
[redacted]