DELTA AIRLINES

They actually told me that if I did not receive the card in 2 weeks to notify them, not until June 30 as they told you that they told me, not true and I have the message from them stating so. However, I have since received the giftcard. Why in the world would they not answer the phones and say what they responded to above? The is pitiful poor customer service! Thank  you for your help Revdex.com!
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.
This member’s claim was processed and finalized on September 5, 2015. The member’s explanation of benefits was also mailed to the home address on file that day and is available for review on their Aetna Navigator account. The provider has been paid for the services and the member is only responsible for a copay.
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 immediately reached out to
our Customer Service...

department to have the calls pulled prior to services
rendered to see if the member was advised incorrect information. We located
only one call on file prior to services being rendered related to the procedure on January 20, 2016, where
the customer service representative (CSR) advised the member would have to meet
her $6000 deductible prior to Aetna paying for the service.
We did locate a call that took place after the services were
rendered where the CSR did incorrectly quote the out of pocket responsibility for the member,
but after calling the facility and confirming how they bill this service and
where it would take place, the CSR corrected the amount the member would be
responsible for. The CSR apologized and did state the member would be responsible for
meeting her deductible and she was going to be responsible for more than what
she originally quoted at the beginning of the call. We assure you that it is not our intent to mislead or misrepresent any
benefit that may or may not be available under your health plan.
The claims in question were
processed correctly in accordance to your plan benefits. 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. I realize that
understanding your benefits can be challenging, and regret that you had
difficulty when you tried to obtain information.
It is our goal to be there for
you when you need us, and I apologize that the assistance you received from our
customer service representatives did not meet your needs.  Be assured 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 [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

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 [redacted], the benefit center that enrolls the member into insurance policies. [redacted] advised us that the enrollment system is a “real time” enrollment; which means if the member clicked on enroll at any time while he was reviewing the benefits, the enrollment was captured. Even if the member clicked on the “x” button on the screen after he clicked enroll, the enrollment would still be captured. The system does not wait for the member to “accept or confirm” anything further. The member has to dis-enroll from the benefit for it not to go through.
Aetna and [redacted] have worked on updates to the system so there are more disclosures to help the member understand that if they click on “enroll” at any time, they are now enrolled in the product. Once the enrollment is captured, it is sent to the employer on a file and they start deductions. Please accept my sincere apologies for the difficulties you have 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 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 ConsultantExecutive Resolution Team

Complaint: [redacted]
I am rejecting this response because:  It is not an actual rejection but I have not received any reimbursement as of this date.  I checked their website and it shows the claim is still in progress.  This is certainly not resolved to my satisfaction.  Please keep it open until they actually pay!  Thank you.
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 Eligibility department to...

verify the member’s termination date. We confirmed it should reflect terminated on June 30, 2015, not May 11, 2015. We are having our eligibility department update the termination date to reflect June 30, 2015. We also had our Claims department adjust any claims that were affected by the incorrect termination date on file. Both dates of services on May 29, 2015, were sent for reprocessing and have been paid to the provider. The new claim IDs for the member’s records are: [redacted]- paid $555.08 and [redacted]- paid $105.48.
Please accept my apology for the incorrect termination date on file which led to a delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issue. Unfortunately, in some instances, procedural 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 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 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

Complaint: [redacted]
I am rejecting this response because:  1)   If my health care policy had been "terminated" after I received policy information and been had issued 2016 ID cards then why did AETNA not so notify me?2)  How come I was still paying for it?3) The first time I contacted AETNA customer service in February of 2016  I was told that the policy was effective for myself,  but not my wife.....which was opposite of the way it should have been.
Sincerely,
[redacted]

Dear Ms. [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on October 08, 2015.
The records indicate that Mr. [redacted]’s original effective date is October 1, 2014, with a 12 month waiting period. Since this criterion was not met, benefits are not eligible under the plan for the service performed on June 3, 2015.
We had the claim verified with our Dental department to review if there was any way any exceptions could be made; we also reviewed the original appeal information. However, our decision remains the same. Based on the guidelines of Mr. [redacted]’s policy that were provided in our previous response, the plan has a 12 month waiting period for type C services. The service performed June 3, 2015 was a type C service. Therefore, an exception could not be made. Our actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants.
I apologize for any difficulties this situation has caused Mr. [redacted]. 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].
Regards,
Julian C[redacted]
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:Your response states incorrectly that member received a check from Aetna on October 08, 2014 for $1,227.80 for code [redacted]I have not received or cashed that check from Aetna, which you should be able to easily verify.Please re-issue the check and this issue can be closed
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.    However, I am still waiting for the confirmation of the payment to the provider and the EOB to show that the 2 claims in Oct have been paid in full by Aetna.    I want to make sure that the EOB confirms what Aetna has agreed to do.
Sincerely,
[redacted]

Hello,
Thank you for your inquiry, regarding complaint #11129221
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 member’s concerns addressed. We were
advised that the member’s concerns were reviewed and that a resolution letter
is being mailed to the member explaining their findings. If the member has any
additional concerns after reviewing the resolution letter, there is a contact
number and address he can send future concerns to.
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

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

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

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 to our
Eligibility department and also reached out to [redacted] to
confirm the coordination of benefits information (COB). We confirmed that the
policy was active through the employer until May 01, 2015, when the member went
to a [redacted] plan. I have listed below when each plan was primary and secondary:
February 09, 2015 through April 30, 2015-- [redacted] primary,
Aetna secondary
May 01, 2015 through August 15, 2015-- Aetna was primary
because [redacted] became the [redacted] plan
August 16, 2015, through October 31, 2015-- [redacted] is primary
because Aetna became the [redacted] policy, so it reverts back to [redacted] primary
The claims in question were after August 16, 2015, therefor
would need to be billed directly to [redacted] to be paid as primary before Aetna is
able to review as the secondary payer. 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 **.
[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

Hello,
Thank you for your inquiry, regarding complaint #[redacted]
for Roy Freese. 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 request a review of the member’s policy on file. We
were advised by the member's employer, [redacted], to terminate the
policy. The member would need to follow up with their Human Resources
department regarding this issue, as Aetna is only an administrator of the plan
and does not control termination requests. I apologize for the inconvenience
and difficulty this situation 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 [email protected].
 
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because: This is not entirely resolving my problem with Aetna.  I am still being harassed by AETNA RX home delivery for a balance of $220.  My tier exception should have been applied to this order according to different associates spoken to in the last few months.  Since a mistake was made in applying a prescription against my deductible when it should not have been, this problem needs to be fixed as well.  According to the different representatives I spoke to, I paid more than I should have for my prescription back in January because of the tier exception which backdates to January the first of this year.  The response from Aetna does not explain what the reimbursement consists of.  Am I receiving a reimbursement for paying too much for the medication back in January? Or, am I receiving one for the emergency medication I had to purchase from a local pharmacy back in January because your company was negligent and left me without medication? I am tired of being harassed by these letters.  I am so tired and stressed from this mess, I cannot take it anymore! Your company does not even understand or care how much stress and anguish you have caused me since December.  This entire mess needs to be fixed, not just part of the problem but the whole! Lastly, I want to make sure that the person that responded to this complaint from Aetna understands that I am a female! I am not [redacted]. I am [redacted] That really shows me how much Aetna cares about their customers' complaints when they cannot even address the customer by their appropriate gender.
Sincerely,
[redacted]

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 Individual plan department for...

assistance, and were advised that they have credited the member’s account $35.00 to cover the fee.  However, we will not refund that as the account is still active.  The June draft will take $267.93 instead of the normal $302.93.  Also, please be advised, the member may cancel the Automatic EFT (Electronic Funds Transfer) at any time and opt for paper billing where we send an invoice each month.
 
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].

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
Eligibility...

department to have the member’s concerns reviewed. We were advised
that the policy will be re-opening with the effective date of January 01, 2016.
The member stated he made a payment, however the payment never posted on the
policy causing the policy to cancel as never in force.
The member would need to make his binder payment allowing
24-48hrs to post in the account. Then the member could call back to make a
payment for February and March. The member could reach us at ###-###-#### and
speak directly to a customer care associate to be able to take his premium
payment and be provided with a confirmation number. Please have the member
reference case number [redacted] when calling to make his binder payment. Once the
payment is processed and posted in the account the welcome packet and the
member ID card will be sent to the member within 7-10 business days after
payment posts.
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 [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

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

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.
please note - although the monies I paid out of pocket have been reimbursed, it took several weeks to do so. Also, please advise Aetna to check their records. Yes, my son is shown to have been added but due to a 'glitch' in their system it was not being shown properly, therefore causing the doctors office to charge me as if I had no insurance coverage. I was told this by multiple representatives upon calling Aetna. I hope this will not happen again, as this has caused unnecessary stress
Sincerely,
E[redacted]