DELTA AIRLINES

Thank you for your inquiry received on 05/26/15 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 our Claims department and...

requested a claims audit to be done on Mr. [redacted] daughter [redacted] claims for the year of 2014. An audit has been completed and the majority of the claims for her fall under “early intervention” and the state of [redacted] require that we pay for these services in full. Most of the member’s  claims did have to be reprocessed because the system did not apply the charges correctly. Therefore, the deductible was indeed not been met for the 2014 year, as the member’s financial responsibilities only had $215.60 applied to that deductible.  The claims have now been reprocessed and corrected. 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 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 #[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 Marketing department to verify...

when the member would be receiving the gift card for going to the seminar on October 19, 2015. We were advised that the customers could receive a gift card one of two ways. First, fill out a BRC (business response cards, which are distributed to attendees at the Sales Seminars) either online or return by mail, as indicated on the BRC itself. Customers can also call one of the telephone number’s advertised in the TV/Direct Mail in the areas, where Sales Seminars are not available.
According to our records, we did not receive a valid BRC from Mr. [redacted] and the numbers that he called were not valid phone numbers for this year [redacted] card promotion. The numbers called were general Seminar Finder lines and last year’s gift card telephone number. Due to the confusion, we will issue a gift card to Mr. [redacted], which he should receive in the next 2 weeks.
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

Complaint: [redacted]
In response to Aetna: "he ... would be required to be seen by a participating provider to be able to be covered" and this is precicely what I did. I verified with Dr. [redacted] office that they were in network. After the office visit I never received any notification from Aetna stating that my claim had been denied. I only found out that there was a problem when [redacted] contacted me, almost SIX MONTHS LATER!
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: I purchased prescriptions after my employment date of 1/26/15 including the flu vaccination. You have not paid me for the prescriptions purchased in February 2015 and the flu shot. I will continue to escalate this as now you have not paid for general annual blood tests in the amount of $90.I HAVER NEVER HAD HEALTH INSURANCE ISSUES PRIOR TO THESE MULTIPLE EXPERIENCES WITH 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 immediately reached out to our Claims department to have...

the member’s concerns reviewed. We were advised that the claim is processed correctly according to the plan benefits. There is not coverage under the plan benefits for routine services rendered by an out of network doctor. I understand your concerns and recognize this is not the outcome you desired. However, our actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants. The member may file an appeal, which must be submitted in writing to the following address: Aetna- CRT Member Appeals P.O. Box 14463 Lexington, KY 40512 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 want to know the exact date they sent requested information to the medical provide.  Which provider, the doctor's name, and what address was this request for information sent to.  I have heard repeatedly they request information so it would be important of me, the patient, to follow up with the doctor to make sure they received this information and respond to Aetna.  I appreciate Revdex.com to go back to Aetna with this request for additional, more detailed information.
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 contacted our Customer Service department to review your concerns....

The supervisor contacted the member on May 17th to address his concerns. The Executive Office also attempted to reach the member but there was no answer. There was no voice mail option available. 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

From: [redacted] Sent: Friday, May 20, 2016 1:57 PMTo: Revdex.com <[email protected]>Subject: Re: You have a New Message from Revdex.com Serving Connecticut Regarding Complaint #[redacted]Please be advised that the check was sent; however, there was no apology.Nor was there additional compensation for the year-long wait my client had to go through. Nor has Aetna offered to pay for all of the attorney's fees generated by Aetna's failure to promptly pay.This company deserves an "F."[redacted]

Complaint: [redacted]
y.
I am rejecting this response because: Regardless of their policy there should Always be exceptions when it comes to NECESSARY dental work. Basically I feel Aetna has put their policy before my Health and safety. Was I just supposed to wait for their 1 year deadline as my teeth rot out ? I appealed through Aetna and they rejected that appeal.  and I just wanted to give them ample chance to repair the situation before going to less preferable means and causing negative publicity and cost much more in the long run but if that's that it takes to get them to do the right thing so be it.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:Dear Revdex.com,As you can clearly see from the response from Aetna, they can not even get my name correct in the correspondence about correcting my name!!! Please see the red areas below for my comments.While I will agree that the term "medical" may have been a poor choice for a description, what I was referring too in my complaint is my Aetna Vision cards.  Ashley is correct that Aetna carries my Dental coverage, but she is incorrect when she states that is all.  Aetna carries my vision as well.  Please see the attached pictures.  On my dental information, my name is listed correctly, on my vision information, it is listed two different ways on the same piece of paper, and both are incorrect.  And as far as contacting my employer for corrected cards, they do not issue the cards, they only provide information to the carriers who distribute the cards to the members.  When I signed up for the insurance, I filled out the paperwork correctly and with my full legal name.Bottom line is that I need my legal name reflected on my vision cards and other pertinent information related to insurance coverage.And to the Revdex.com, your system doesn't have my name listed correctly either.  If I have a complaint about the Revdex.com, who do I send that too.I have attached some pictures for your viewing pleasure.  I look forward to a response and mitigation of this matter[redacted] 
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 complain** 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 [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
[redacted]

Complaint: [redacted]
I am rejecting this response because:
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: I received an email stating "Upon receipt of the complaint we immediately reached out to our Claims department to have the member’s claim completed. The claim was finalized on July 29, 2015 under claim ID [redacted] and was paid to the member on July 30, 2015." This is untrue. We still have not received payment and were certainly not paid on July 30. It's August 5th. This has been exactly the kind of thing that has been frustrating during the whole process.
Sincerely,
[redacted]

Thank you for your inquiry received on 05/28/15 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 our Claims department, and had the member’s claims reviewed.  The member’s claims have now been reprocessed and corrected with [redacted] Part A only. 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 Ms. [redacted] concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

Dear [redacted]Please see our response to complaint # [redacted] for [redacted] that was received by us on November 7, 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 Marketing department to address [redacted] concerns. We confirmed that the card was shipped on 11/2/17 and it takes about 5-7 business days to receive. Please note that the card arrives in a plain white envelope from our vendor. 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,LaShonda C.Complaint and Appeal Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:Our coverage is supposed to be effective January 1, 2016.  I need this resolved ASAP.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:  The doctor's office still has NOT been paid.
Sincerely,
[redacted]

Complaint: [redacted]I am rejecting this response because:
It doesn't provide me with the laminated user Id card that I requested.  Further, when I wish to change my DMO, the new DMO won't have the information for me on file as described in Aetna's response.  Additionally I can't even find the Aetna home office phone number off line in my local yellow pages, much less remember it when calling or visiting a new DMO's office.  
I find Aetna's refusal to comply EXTREMELY UPSETTING!  If Aetna refuses to have a clerk print, laminate and mail a user id to me, I will at a minimum report this to the State of Colorado Department Of Law Office of the Attorney General.  I found them to be very helpful in getting [redacted] to comply with a recent consumer complaint I filed.   Sincerely,[redacted]

Thank you for your inquiry received on 07/01/2015 regarding complaint #[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 Aetna’s Student Health department for assistance,...

and for [redacted], eligible students are automatically enrolled in the Aetna Student Health Plan, unless a completed Waiver Form has been received by [redacted] by the deadline date which would have been 08/01/2014 for continuing students or 08/04/2014 for new students.
 
We do have Ms. [redacted] enrolled from 07/01/2014-06/30/2015, which means more than likely she did not submit a waiver which shows proof of other insurance. If this is the case, then she is enrolled for the 12 months and is responsible for the insurance premium. 
 
We do have a Broker that handles all waiver and enrollment questions and issues. Ms. [redacted] (the student) will need to reach out to them directly if she has further questions or issues. Ms. [redacted] may contact HSA Consulting at [redacted]; or online at: [redacted]
 
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]

Dear Ms. [redacted]:   Please see our response to complaint #[redacted] for [redacted] that was received by us on December 14, 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 provider’s complaint I reached out to them directly to obtain additional information. After speaking with the provider, I confirmed they received a call from Aetna’s Recovery department who was able to resolve their concerns. The provider had no additional concerns at this time.   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,   Kim B. Complaint and Appeals Consultant Executive Resolution Team

Dear [redacted]:   Please see our response to complaint #[redacted] for [redacted] that was received by us on January 31, 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 immediately reached out to our Claims and Customer Service department to have the member’s concerns reviewed. We were advised that the claim was submitted electronically to Aetna with the incorrect member information and our system processed the claim without the logic of the member’s demographic information not matching. Unfortunately, this is a learning curve for Aetna and we are working to have our system distinguish this information going forward to try to prevent this type of situation occurring for our members. Our records indicate that we have corrected this claim and zeroed out this claim under [redacted]’s policy and have processed the claim under the correct member at Aetna. The provider has also been educated on the issue and to be sure the correct information is submitted to Aetna for their patients.   Concerning the customer service the member experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur.  I sincerely apologize for the difficulties the member experienced and that we did not provide the level of service that the member rightfully expects and deserves. These actions are not consistent with Aetna’s service standards and we appreciate the member for notifying us of the experience. I would like to assure the member that we have taken the appropriate actions to address the service issues the member experienced.   I apologize for the frustrations and difficulties the member encountered while attempting to resolve this issue and regret that this matter required much of your time in order to facilitate a resolution. We do appreciate the member’s patience during the time involved in researching and resolving the issue.   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,   Ashley W. Complaint and Appeals Consultant Executive Resolution Team