DELTA AIRLINES

Thank you for your inquiry received on 09/15/15 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.
 
We reached out to the Individual Plan’s department, and...

the member is not due a refund.  According to the member’s record, the Marketplace stated he was not eligible for a tax credit for the month of January 2015, so he was billed the full premium of $239.83.  Aetna does not control or determine eligibility of tax credits for Marketplace members, and cannot make any changes without permission from the Marketplace.  A refund of $216.00 was processed in error on 01/23/2015, and sent back to the member’s credit card.  A plan change and premium change was received from the Marketplace on 01/12/2015, and was made effective 02/01/2015.  The February bill then produced the charge back of the $216.00 that was refunded in error and the new rate of $23.83.  If the member is disputing that he should have a tax credit for the month of January, then he needs to contact the Marketplace at ###-###-####.
Furthermore, the ebilling system was down previously, but the issue is now resolved and the member should now be able to access his account. We apologize for any inconvenience this may have 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]’s concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].

Hello,
Thank you for your inquiry, regarding complaint #*** for *** ***. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
We apologize if our previous response was misunderstood or upset the member in any way, we assure you that it is not our intent to mislead or misrepresent any information that was relayed to the member regarding the payment. We mailed a check to the member on July 30, 2015, to the home address on file. Our records indicate that this check was received and was cashed on August 13, 2015.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mrs. *** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
 
Thank you,
*** **
Complaint and Appeal Consultant
Executive Resolution Team

Thank you for your inquiry received on [redacted] 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.
 
We reached out to the Flexible Spending Account (FSA)...

department, and the member’s check for $20.00 has been reissued as of [redacted]. We apologize for any inconvenience this may have caused.
 
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].

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 the Eligibility and Billing...

department for the member’s employer to verify why there was an increase in premiums. We were advised that this member has the [redacted] plan. Aetna does send out notifications each year of the benefit changes and rates. Federal members have a choice; it is a passive enrollment, meaning if they do nothing, they will stay in the same plan. This letter is sent to all members and is mandatory from Office of Personnel Management (OPM). The member needs to refer to her Human Resources department in regards to the premium amounts, as Aetna has no control in the premium rate changes, Aetna is strictly an administrator in the plan benefits.
This member has been receiving this letter each October since she has been a member with Aetna. The address that we have on file is [redacted], **, [redacted].
Also, the member is still in the old enrollment code. We continue to send her letters to switch her enrollment code to the correct one for her area. I have attached a copy of this year’s letter that has already went out to members.
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 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 the complaint, we contacted our Dental Claims department to confirm the member's orthodontic benefit. The total fee billed by the provider was $3716.00. Based on the dental plan benefit, it is to allow 50% which is $1858.00. Based on previous claims, we have already paid a total of $1644.87. The remaining balance due was $213.13. A check for this amount was mailed to your provider on April 22, 2016.Please accept my apology for the delay in processing the claim correctly, and the multiple attempts on your part to resolve your issue. We have provided feedback regarding your customer service concerns.  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] Thank you, 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 immediately had the call pulled and listened to so we could...

verify what information was provided to Ms. [redacted]. We confirmed that she was provided incorrect information and due to the nature of the complaint we made a one-time exception and reprocessed the claim to pay the member. The member was mailed a check on May 12, 2015, to the home address on file. The claim was reprocessed to reflect this change under claim ID [redacted]. The member will receive a corrected explanation of benefits or it is available to view on our Aetna Navigator online.
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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
 
Thank you,
[redacted]
Complaint and Appeal Consultant
Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint #[redacted]or [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 Eligibility department to verify...

if the member should have active [redacted] coverage with Aetna. We confirmed that the member’s employer switch to a new health insurance carrier in the middle of 2015 and the member is no longer covered by Aetna. We were advised that a representative from the member’s Human Resources (HR) will be reaching out directly to the member to confirm that her coverage is with United Health Care. The member will need to contact either her HR or United Health Care with any benefit or eligibility questions. I apologize for any inconvenience this may have caused for 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 [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 the complaint we immediately had the claims for the [redacted] family reviewed. We were...

able to verify that there were a few claims on file that were delayed in processing due to not have diagnosis codes submitted with the claim. Once we received the diagnosis codes we were able to process the claims in a timely manner. At this time all claims on file have been processed and finalized.
Most of the family’s claims on file were processed and finalized within 10-15 business days of receipt. If the member sees an out of network provider the payment of the claim is going to be based upon a reasonable and customary rate, not determine by Aetna, and will pay the percentage of the allowable. If there is a particular date of service that the member feel was not processed correctly or disagrees with the payment, the member may file an appeal with our Customer Resolution Team.
Please accept my apology for the delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issue.  Our goal is to pay claims timely and accurately, and to promptly resolve issues when they do occur.  When issues do arise, we take them very seriously and do our best to understand how and why the errors occurred and determine what we can do to prevent a recurrence.  We continually use feedback like yours to improve our service and prevent issues from reoccurring.
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 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 Ms. [redacted]: Please see our response to complaint # [redacted] for [redacted] that was received by us on January 11, 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 contacted our [redacted] department to address the member’s concerns. We reviewed the member’s current plan benefits and found the member is enrolled in a [redacted] Plan. This plan does not include [redacted] prescription drug coverage.  The member’s pharmacy benefits are covered by [redacted]. The member can contact [redacted] Member Services at ###-###-####. [redacted] will be able to supply you with the information you need to get your prescriptions including the PCN and BIN numbers for their plan. They can also send you an [redacted] ID card. Aetna representatives aren’t able to give you the PCN and BIN numbers for an [redacted] plan because they’re a separate company. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. Gattermeyer’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected]. Sincerely, LaShonda C. Complaint and Appeal Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because: I went to the doctor and asked for a preventative care yearly physical. I was told that all tests done were common tests done for preventative care and nothing more.Aetna claims "The benefit states that for diagnostic services billed at a participating lab, 100% is allowed after a $5000.00 deductible is met. The member is responsible for $64.44," but that is simply not true.  Preventative care is 100% covered (I've included an attachment which is highlighted to show this), not 100% - $64.44.Check the tests done vs all common preventative care tests and you will see that nothing out of the ordinary was done. This is insulting that I go for my free 100% covered preventative care annual physical and come out having to pay extra for it even though this is what I pay every paycheck to receive.If everything is not 100% covered in an annual preventative care yearly physical, then we should be notified of this upfront, not after we go to the doctor and have it done. This seems like a bait and switch practice to trick us into getting Aetna insurance only to later find out we are not getting what was promised to us. Had I known I would have to pay out of pocket on top of my regular payments, I would have gone to another provider. Make this right and give what was promised.Sincerely,
[redacted]

Complaint: 11[redacted]
I am rejecting this response because: This does not change the fact that I had to go 2 days with out necessary medication and due to Aetna playing doctor (deciding that my age isn't appropriate for a medication) my life was put on the line. I do not accept Aetna's absurd procedures and disregard of human life. It's not just my life that is put on the line. Daily Aetna plays this game with several of their customers and the evidence is right on their [redacted] page. Hundreds of angry people who are tired of the same thing. I will continue to keep this case open for myself and all the others like me who have been toyed with just so that Aetna could play doctor the prescriptions.  
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 compliant we immediately reached out to our Health Savings Account...

(HSA) department to have the member’s concerns addressed. We were advised that prior to receiving this complaint the member’s account was already updated with the contribution for December 2015. We confirmed the member’s money was deposited on January 13, 2016, and an email was sent to the member on January 14, 2016, advising her of the deposit.
Please accept my apology that we did not provide the level of service that you rightfully expect and deserve, and my assurance that your concerns are getting the highest level of attention at Aetna. I would also like to thank you for sharing your experience with us. It is feedback like yours that helps us address issues and prevent them from reoccurring.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. Stiles’ 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 December 5, 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...

our Claims department to address the member’s concerns. We reviewed the October 16, 2017 claim and found that the claim originally processed under the incorrect contract for [redacted]. The claim initially allowed $189.00 and was applied to the member’s deductible. However, Aetna determined that an error was made and reprocessed the claim at the correct provider contract rate on December 2, 2017.  The correct allowed amount for the service should have been $283.50. This resulted in an increase of the member responsibility by $94.50.  The member is responsible for the $94.50 because his deductible was not met.We apologize for the inconvenience that 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]’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 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 this complaint our office had already received a letter from the member...

regarding the same complaint. The consultant reached out to speak with the member to let him know we would research the issue. The member was advised that his claim was processed correctly according to his coordination of benefits. There will be no additional payments made on the claim.
I understand your concerns and recognize this is not the outcome you desired. Our actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’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

Dear [redacted]    Please see our response to complaint #[redacted] for [redacted] that was received by us on November 02, 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 immediately reached out to our Claims department to have the member’s concerns reviewed. We were advised that the authorization on file had to be updated to correct how the claims were being processing under the member’s plan. We updated the authorization on file to have the claims processed at the full billed amount. We also had any claims on file that were not allowed at the full billed amount of $210.00, corrected. Additional payments will be released within 7-10 business days and a corrected explanation of benefits will also be sent to the member for her records. If the member has any other claims that process incorrectly in the future she can email me directly at the email address listed below and I will have them handled immediately.   Please accept my apology for the delay in processing the member’s claim correctly, and that it required multiple attempts on her part to resolve the issue. Unfortunately, in some instances, errors do occur. When they do, we take them very seriously and do our best to understand how and why the errors occurred and determine what we can do to prevent a recurrence. We continually use feedback like this to improve our service and prevent issues from reoccurring.   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]   Sincerely,   Ashley W. Complaint and Appeals Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:
Supposedly the money was sent. If this is actually the case, then it will be accepted. I am taking all precautions since from day one, including submissions here, there have been inaccurate commitments.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: Aetna has not made any attempt to contact me as indicated in their response. I have not received any emails from them dated Nov. 6th or otherwise. I even checked my spam folder. They already have my tax ID on file. It has been submitted to them with each call that I made to them. Also, a W-9 has been sent more than once. This is just a small example of what I have been experiencing over the past 5 months. No resolution.
Sincerely,
[redacted]

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.
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 Network department to...

have the member’s concerns reviewed. We were advised
that both providers listed in the compliant are participating with the member’s
plan, and that our list of surgeons the member is locating online is up to date
and correct. We called and spoke with [redacted] at [redacted] office and
advised her that she was given incorrect information from our provider service center
and that the member was within the network if they wish to continue their
member/provider relationship. Our Network department will reach out to the
provider’s office to educate them on their contracts and plans they participate
with.  
Our goal is to provide accurate
and reliable information when you need it and to immediately resolve issues
when they do occur. Clearly, in your case, we fell short of that goal. We
regret that your experience with Aetna was less than satisfactory and hope that
we can better assist you in the future. I would like to assure you that we have
taken the appropriate actions to address the customer service issues the member
and the provider have experienced.
Aetna strives to provide the highest level of service, quality,
and satisfaction, and to continually improve our processes. I want you to know
that we appreciate your feedback because it gives us the opportunity to listen
to our customers and make any improvements to our processes and the service we
provide. Your opinion is valued at Aetna, and I trust that you will not
hesitate to contact us when you need assistance.
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,
 XE "Type Name"Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team XE
"Title/Business Area"

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