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 reached out to
our [redacted]...

department. Our [redacted] department attempted to reach the member
on April 05, 2016, to find out more information regarding the complaint.
Unfortunately, our [redacted] department has yet to hear back from the member
about the details surrounding this complaint. Once we receive more information
and details about this complaint, whether it is related to benefits, customer
service etc. we will be able to research further. Please have the member
contact our [redacted] department if they wish to pursue the complaint further.
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 reviewed all of Aetna’s records from this...

member’s previous complaints and appeals, and our responses which addressed in full detail all of the member’s concerns.
During the period in question, the member had coverage under two policies, one with [redacted] and one with Aetna Life Insurance Company (Aetna). However, the pharmacies were only aware of the individual policy with [redacted] and were not aware that [redacted] had an additional small group policy with Aetna. This resulted in numerous claims not being submitted to Aetna and the member being responsible for out-of-pocket expenses. Some of these claims were processed and then denied for various reasons, such as being filled to soon or pre-certification required.
Our records indicate that Aetna appropriately addressed each concern [redacted] presented to Aetna and the [redacted] (**I) over the past few years.
Aetna did not attempt to intimidate, threaten, delay or deceive [redacted], nor did it attempt to discourage submission of claims. In fact, where Aetna made reference to its legal department or compliance area reviewing the matter, we were only indicating that they were providing a higher level review of [redacted]’s issues to determine if Aetna had appropriately handled his claims. It was not Aetna’s intention to infer that [redacted] was being investigated, only that Aetna’s handling of his claims and concerns was being investigated. If the member has a specific claim or concern at this time that has not been addressed previously we would be more than happy to assist. Otherwise we consider this matter closed.
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 [email protected].
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 Claims department to verify...

if the services rendered by Dr. [redacted] on August 21, 2014, were paid. We verified that the claim was reprocessed and paid to the provider as an EFT payment on March 25, 2015. The new member Explanation of Benefits (EOB) was mailed the member’s home address on March 25, 2015, reflecting this payment of the claim.
Please accept my apology for the delay in processing your claim correctly, and that it required multiple attempts on your part to resolve your issue. 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,
[redacted]
Complaint and Appeal Consultant
Executive Resolution Team

Hello, Thank you for your inquiry, regarding complaint# [redacted] for Robert C[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 for claim review. We...

determined that the services should allow up to the 80th percentile of Fair Health for emergent services. The emergency claims for date of service: July 30, 2015 have been reprocessed. The member and provider will receive an explanation of benefits within 7-10 days. The claim for date of service August 27, 2015 was determined that it processed correctly. The member’s plan states that follow-up care is not considered an emergency or urgent condition and is not covered as part of any emergency or urgent care visit. 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. C[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   Tell us why here...

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

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

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. I must add however that I called [redacted] today and they stated that a payment for $655.98 was made on May 25th and not earlier as Aetna said. The provider also told me that a payment is still pending and Aetna's payment is about $20 short but I will not be responsible for this as I already paid my coinsurance in 2015. Overall, I think I will no longer be billed because I am only responsible for the coinsurance. 
Sincerely,
[redacted]

From: [redacted] Sent: Thursday, May 05, 2016 9:12 PMTo: [email protected]: My Complaint v. Aetna Insurance Co. No. [redacted] Thank you for finally getting someone at Aetna Insurance Company to respond. Despite the information provided in my complaint,...

Aetna claimed it needed more.  I provided it.Then Aetna next said that it needed a signed Authorization from my client in order to communicate with me.  I provided it.An authorization is not necessary, as I am the attorney for the beneficiary under an Aetna Life Insurance Co.  I have been requesting payment from Aetna since February 2015.   All documentation has been provided to Aetna (birth certificate of the beneficiary, who is the son of the decedent, the death certificate, and other documents verifying the familial relationship).   According to one Aetna representative, Aetna completed its review in October 2015.  However, Aetna never paid the benefits.  I have been making numerous telephone calls to Aetna for the past year.  I have been promised return telephone calls, but no return calls are EVER made.  Then on March 21, 2016, I received an email from an Aetna adjuster, Angela P[redacted], who is handling this matter, stating that payment would be made.  She asked "where to send the check" and I provided the mailing address.  However, no payment was made.  I sent a follow up email requesting the status to Ms. P[redacted], but she ignored my inquiry.   After I filed a complaint with you, I did receive a request for more information and an Authorization as stated above.  I provided the Authorization, even though I am counsel for the beneficiary and I have provided Aetna with all of my client's documents.   I expected a response from Aetna, but there has been none.  I find it unconscionable for Aetna to withhold the payment of benefits when its policy states, in black and white, that payment will be made "within 10 days" upon proof.   If Aetna completed its review in October 2015, payment should have been made then.  Instead Aetna waited five (5) months to even communicate its acceptance of the obligation to pay, and even further, Aetna has still refused to make its payment to the beneficiary.  The failure of Aetna to respond to my inquiries, and its neglectful handling of my client's claim, is simply outrageous.   I hope that there is a remedy, not only for my client, one that will penalize Aetna for its sub-standard business practice.  Aetna should pay my client the policy amount, plus attorney's fees and costs, and damages.   If not, I will be filing a claim for bad faith.   Thank you,[redacted]

Thank you for your inquiry received on 06/16/15 regarding complaint #[redacted] for member: [redacted].
You may reference Aetna Case number [redacted], with a due date of 06/30/15.
If you have any additional questions regarding this particular matter, please contact the Executive Resolution...

Team at [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 contacted our Customer Service department to review your...

concerns. We have confirmed that the name change was completed on May 4, 2016. A new medical id card was sent by mail on May 5, 2016. We have also reviewed your claim history and found that there are no claim denials due to this error. We apologize for the inconvenience this has caused you. 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

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 Eligibility department and found that this member's plan is active and paid up to current. I contacted the member to advise of...

the resolution on June 15, 2015. I informed the member that the auto-debit option was selected when she enrolled in Aetna Navigator. I also explained that the balance of $611.90 was applied for payments due from April, May and June. After the initial phone call, I was notified that the member must cancel her plan through [redacted] @ [redacted]. Aetna can not cancel this policy because it is an exchange plan. In follow up, I made several attempts to contact the member at [redacted] and left a message advising to cancel through [redacted]. If you have any further questions, please contact us at [redacted].

Complaint: [redacted]
I am rejecting this response because:
[redacted] stated in their response that the policy was "terminated" Jan 1, 2015.  Why then have I been paying them for this coverage all of 2015?   They just made my case for me.  Thank you.  I want a return of my premiums for a policy that I am paying for that was cancelled, Jan 1 2015, according to the response from [redacted].  Also [redacted]s response indicates that they do not keep accurate and/or comprehensive records of EVERY call from their members.  I called Atena at least 4 times about this issue.  Including a call on or the day before I filled this complaint with the Revdex.com.  I have a record of that call and I received a call back from a manager out of their South Carolina office.  [redacted]s response doesn't indicate a record of those calls to and from [redacted] therefore they CLEARLY are not capturing records of EVERY calls which explains why they may not have a record of my call with my request to cancel their coverage or confirmation that was given my wife and I.  My wife was on the cancellation request call me & the recent calls aforementioned and can attest to the validatity of my complaint & dealings with [redacted] regarding this matter.  Based on [redacted]s response and unwillingness to resolve this I am inclined to fill further complaints with the attorney general(s) office of the various states where they conduct this part of their business.  I may also consider legal action for fraud.   [redacted] can resolve this with me directly or I will pursue additional action.  
Sincerely,
Jared G[redacted]

Can you please request either the member’s ID number or Date of Birth to be able to start an investigation for this complaint? We are not able to locate him with just his name and zip code search. Thank you,Ashley

Hello,
Thank you for your inquiry, regarding complaint #11103156 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 Accounting department to...

have the member’s concerns reviewed. We were advised by [redacted] that the claim needs to be submitted to [redacted] as they were given all the financial details and [redacted] will pay the claim.
The member did submit a claim that was received on December 31, 2015, but the claim was not processed until January 06, 2016. Per [redacted] will handle all Run Off and Grace Period processing. No further processing by will be completed by Aetna as of January 01, 2016.
We sent the request back to the member on January 06, 2016 and advised the member to resubmit to [redacted] since they are responsible for handling the Run Off and Grace Period. Please have the member send the information directly to [redacted] with their new account information. 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]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 Claims department to...

have the member’s claims reviewed. We were advised
that the services rendered require medical records to be submitted by the
provider. At this time we have yet to receive the medical records requested
from the provider so we are unable to process the claim. Once they are received
we will be able to process the claims for any benefits available under the
plan.
Our goal is to provide accurate
and reliable information when you need it and to immediately resolve issues
when they do occur. 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. Your concerns
have been forwarded to our management team for improvement opportunities.
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

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

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]

Complaint: [redacted]
I am rejecting this response because:
I did call and talk to the market place and they said that I had to go through Aetna. I called both places three times and no one called me back and let me know what was going on. And each time nobody could tell me anything. Passing the buck to each other. As far as autopay I never set up Autopay with Aetna. so why did they Autopay my account. Plus I payed them $100.00 on July 1st. What happened to that money. And when I talked to Aetna last month they stated that they could not found out anything because my Account was closed for the time in question.  Aetna need to straighten this out. And yes I did turn in all of my paper work. And no I don't have Autopay with Aetna set up. They took that apond themself and set that up themself. Aetna needs to fix this, not the market place. This is Aetna's problem.
Sincerely,
[redacted]

this issue has been resolved. please close thx