DELTA AIRLINES

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 our files reviewed to verify that we had...

the member’s name correct in our system. Our records indicate we have the member’s name in our system just as it shows in the Revdex.com complaint. Our records also indicate that we do not carry this employer’s medical benefits, only dental benefits. The employer’s medical benefits are with any of the following carriers: [redacted] and [redacted]. Aetna is not informed of which carrier the member selected, only the Human Resource department of the employer would have those records. Please contact your medical carrier to request a corrected medical ID card.
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

[redacted]
* Please see our response to complaint #[redacted] for [redacted] that was received by us on January 10, 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 Eligibility and Premium department to have the member’s concerns reviewed. We were advised that a termination file was received from the Marketplace on December 13, 2016 to terminate the policy with a date of December 27, 2016. The request for termination was completed on December 14, 2016, to reflect the term date of December 27, 2016. The member was refunded the prorated difference of $16.68 on December 16, 2016.   We verified our call history on file since the member stated he called to terminate the policy for the effective date of November 30, 2016, and was told by a representative that he did not have to take any action, but there are no calls on file related to this complaint. If the call was with the Marketplace, we do not have recordings for those calls, only the Marketplace would have a recording.   Unfortunately, the policy does not qualify to be terminated effective November 30, 2016, because the file received from the Marketplace was received with a termination date of December 27, 2016. If the member is still disputing the termination date, the member would need to reach out to the Marketplace appeals department a[redacted] to request the November 30, 2016, termination date. Only if the Marketplace appeals department approves the requested termination date would we be able to complete the full refund for the December premium.   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 there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   Sincerely,   [redacted]
[redacted]
[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] I have sent an email to Aetna as suggested. I'm hoping this can be resolved without further detriment to my credit. Thank you for your assistance in this matter.

Dear Ms. [redacted]:   Please see our response to complaint #[redacted] for [redacted] that was received by us on December 20, 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 Precertification department to have the member’s concerns reviewed. We requested that the Precertification department review the member’s request as soon as possible due to the delay the member was experiencing surrounding the request. We were advised that on Thursday December 22, 2016, our Precertification department spoke with the provider’s office and confirmed that the codes that were being requested did not require a precertification request and apologized that the request was not handled sooner.   The provider confirmed the member was aware she was using her out-of-network benefits and again apologized for the inconvenience the office and the member experienced. We have provided additional training and feedback to those involved in the handling of this request. The provider will contact the member to set up having the services rendered.   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,   Ashley W. Complaint and Appeals Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:There is still no way for me to know who the so called provider us on the claim forms.They refused to provide provider information (hospital clinic medical group) for the persons name in the provider column on there forms.I have to spend hours trying to guess and find out who they work for to verify if each claim is legitimate. They have resently deleted the false claim I caught but the time I need to spend verifying 100's of claims by the end of the year will bealot of wadted time on my part because they refuse to let me know who the provider is.This is not personel information as they told me. What clinic name or hospital or medical group they work at should not be considered personnel infomation they cannot provide on there forms. The clinics and hospitals provide the info to Aetna it's Aetna that refuses to put that on  there claims. Only other option is to send Aetna all the names on the claim forms and request special permision to find out the address of the persons billing address. Then I would [redacted] the address to find out what building is there and maybe find out who it is. I then have to message my kids at collage to see if they went there for something on that date. Collage kids have short memories. When I asked them ladt time they only remebered half of the claims.
Sincerely,
[redacted]

Dear Ms. Madelyn Sola:   Please see our response to complaint [redacted] for Jill Watts that was received by us on August 05, 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 Billing department to have the member’s concerns reviewed. We were advised the member was originally termed January 31, 2016, on January 15, 2016. On July 09, 2016, the system reenrolled the member under a new ID. We are still researching this issue as priority to prevent this from happening again.   We have refunded the premium of $213.72 back into the bank account on file. Please allow 1-3 business days (depending on the bank and how they handle electronic fund transfer requests) for this refund to be completed. Please accept my apologies for the difficulties the member has encountered with Aetna.   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 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]
for [redacted]. Our Executive Resolution Team researched your concerns, and I
would like to share the results of the review with you.
As addressed in our previous response the ID cards were
mailed prior to us receiving the retro-termination request of the policy by the
employer. We did not receive the request from the employer until December 30,
2015, which is after the ID cards were issued. Aetna is strictly an administrator
of the plan and has no control over termination requests made by employers. It is
the employer’s responsibility to notify the member of any terminations, not
Aetna.
Aetna also has no control over premium deductions that are
made for the policy. Aetna is never advised the premium rate of a member as it
is private information between the member and the employer. Again to reiterate,
the member will have to follow up with the Human Resources (HR) department with
these questions. Aetna will not be able to assistance why the member is paying
for a medical policy that is terminated.
There is a pharmacy policy only, not a medical plan, that is
effective for the member only, not his spouse. This is under a Medicare ID and
is sponsored by TX PDP. The member used these benefits in the month of April and this may be why the member is being deducted money for
a 2016 policy. The medical plan that was through the [redacted], is correctly terminated per the employer. To recap the member will need to follow up with the HR
department to have his questions/concerns addressed.
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 [email protected].
 
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:  This is not the information that [redacted] in the pre-certification department [redacted] gave me when she did the pre-certification.  I have tried to contact [redacted] multiple times and have yet to received a call back. I contacted Aetna because I couldn't find anyone in my area that was covered for the food allergy services I needed.  [redacted] found this person and sent me to them.  I only did what Aetna told me to do. Every time I call Aetna I get a different story.  When [redacted] filed the appeal she told me that [redacted] didn't do the leg work correctly when she did the pre-certification.  I have been told the pre-certification was not working because the doctor that was billing was [redacted] versus [redacted].  Then the next person told me they couldn't even see that [redacted] was the one billing.  I haven't been able to get any consistent answers from anyone at member services.This is the worst customer service I have ever experienced.  I just want this to be taken care of.  I have been dealing with this for over 6 months now.  I have been trying to get this resolved on my own and I feel like I have no other choice than to do it this way.
Sincerely,
[redacted]

Dear Ms. [redacted]   Please see our response to complaint #[redacted] for [redacted] that was received by us on July 06, 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 claims on file reviewed. We were advised that all claims on file have been processed and paid to the provider. We were not able to reimburse the member directly since the claim’s assignment of benefits was filled out to pay the provider directly, and by law we are not able to change this assignment.   If the member paid out of pocket for any services that were paid to the provider, please have the member contact the provider to reimburse the member directly. If the member wishes we can contact the provider’s on their behalf to seek the reimbursement. Please have the member send the provider’s names and the dates of services to the email address listed below and we would be more than happy to contact the providers directly.   We also consulted with our Eligibility department who confirmed there was not any mishandling on Aetna’s side for adding the child to the policy. We received the electronic file from the employer on December 28, 2015, to add the child to the policy. The file from the employer requested we back date the effective date to December 03, 2015, the child’s date of birth. We 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 Mrs. [redacted]   Sincerely,   Ashley W. Complaint and Appeals Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:Clearly we won't mutually agree ever on this point.  Unless you plan to resolve your billing process I still believe I am correct.
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 Claims department to...

have the member’s concerns reviewed. We were advised
that the claim was processed correctly according to the out of network
benefits. The member’s benefit when seen at an out of network urgent care
facility is reimbursed at 50% after the deductible is met.
Our records indicate that the
member did visit an urgent care facility in September but it was a different facility
than the one the member visited for the November date of service, which is why
the claims processed differently. It is ultimately the member’s responsibility
to verify the participation status of the provider. We did not locate a call on
file from either the member or provider prior to services being rendered to confirm
the coverage; therefore we are not able to make any exceptions for this claim.
The member will be responsible for any billed amount from the provider. While
we understand your concerns and recognize this is not the resolution you sought,
our decision remains unchanged. 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 [redacted] 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 #11432250 for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. As previously stated we have stopped all mailings as per the request of [redacted]. The Aetna mailings are not meant as harassment and we take all complaints seriously that come from our members. We will only consider reimbursing a premium if the member was unable to use the benefits under the policy. At this time there is no proof the member was not able to use his plan benefits, so we will not being reimbursing the member the four months that is being requested because of the member receiving Aetna mailings. 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, Ashley S. Complaint and Appeal Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:I now have 2 sets of  cards, both with the incorrect name.This is such a BS game your playing.  PLEASE SEND ME CARDS WITH MY NAME ON THEMAnd Revdex.com, please fix my name.  your just as bad as Aetna is!  When this form populates, it does not include [redacted]  Please fix
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 Claims department to have the...

date of service reviewed. We were advised that the member is not responsible for the billed charges because the facility failed to call the Pre-certification department in a timely manner. We confirmed that both the member and the provider’s explanation of benefits (EOB) state that the member is not responsible for the billed charges.
The provider did not call our pre-certification office within one day of discharge, so it will be their responsibility to file an appeal, not the member’s responsibility. We called the facility and left a voicemail with the billing department explaining that they should refer to their EOB which states they are to not balance bill the member. It also went on to explain that claim was denied due to failure to follow Aetna contractual notification requirements. We advised of the address they could send the appeal request to and left a call back number for any questions/concerns. We have also mailed another copy of the explanation of benefits to the provider for their records.
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].com.
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.
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 directly to the provider’s office to address the member’s concerns. We spoke with Dawn, at the New Berlin office, and we explained the situation that the claim was sent to us as performed at the [redacted] office. In our discussion with Dawn, we provided the payment ID and confirmed the address the payment was sent to and we were advised the payment went to their main office for Forward Dental, per the way the claim was submitted to Aetna by the provider.
We faxed the explanation of benefits to Dawn’s attention for review on Friday February 05, 2016. We called today, February 09, 2016, and spoke with Dawn and she advised that the main office submitted the claim incorrectly to Aetna, listing the wrong office, but that she was working internally within their offices to have the money applied to the member’s account.
The office was provided with my direct number for any future questions or concerns surrounding the claim. Unfortunately, we are not able to change the claim on file to show the correct office, the provider’s office would be required to submit a corrected claim for Aetna to be able to make any adjustments.
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 [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 reached out to
our Benefit’s...

department to review the coordination of benefits (COB)
information on file. It was verified that based on COB guidelines, the
determination of the mother’s plan being primary was correct. After receiving
confirmation that the daughter is now residing with the father, we consulted
with our Legal department to ensure there would not be any issues with making the
plan primary based on the information provided.
Given the living arrangements for the daughter we have made
the COB change based on this updated information. The COB has been updated to
show the father’s plan as primary for the daughter effective March 01, 2016. We
spoke directly with the member yesterday March 15, 2016, to explain in detail
our findings and he was accepting of our resolution.
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,
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] 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 from November 2014 between the...

servicing provider and our provider customer service representative. When we reviewed the call the provider was advised that in order to determine if you would be covered for the service to send in a predetermination to our precertification department. We provided the phone number to call and fax number to send Mr. [redacted] medical records for review to see if it qualified for medical necessity and was covered under the plan. Our records indicate that this was not completed by the provider until May 07, 2015. Unfortunately, the plan does not cover this surgery and we are unable to make any exceptions to allow coverage at this time. You are responsible for any copayments to the specialist for this visit.
I regret that our review could not have been more favorable and understand your frustration with this situation. However, we must make coverage decisions in accordance with your plan of benefits and our medical necessity guidelines.
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].
 
Thank you,
[redacted]
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because: I want it to be noted I have not received any such phone calls as I would have jumped at the chance to speak with someone other than "let me pass it on to my supervisor and someone will get back to you". I have been waiting for a call back from a supervisor since my initial call in December. It wasn't until these contacts through the Revdex.com that I now have two correspondence emails. No responses from my initial complaints through customer service, no phone calls since filing this complaint. I have requested to hear the recorded calls and to no avail. I clearly understand now the individual co pays for mom and baby as it has FINALLY been explained to me. Had this information been presented to me a year ago when I was initially inquiring on my expected fees there would not be any disputes. It's this simple: "I'm pregnant. What are my expected fees if I deliver at hospital A as I'm trying to decide between my (employer) hospital and this other and I do not want any surprise bills?" "$500. You have no deductible, which some people have, so you are only going to pay $500." Twice this happened with no mention of a second copay for baby from either rep. When a member calls, twice, to make sure they have accurate information and the rep verifies benefit/copay amounts, on two separate occasions, I think it's fair to believe the presented information is accurate when what it stated are identical responses. There was no room for error or misinterpretation in my questioning or answers received. At this point in time, I will be proceeding through small claims. Thank you, Revdex.com, for providing me the channel to have dialogue with someone higher up. 
Sincerely,
[redacted]