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 someone reach out to Ms [redacted] to speak with her about having a case manager assigned to her issueMs [redacted] and the Aetna representative spoke in length about this issue and although she does not qualify for a case manager at this time since the surgery has already taken place but we were able to get to the bottom of all the issues Ms [redacted] was encountering We have worked with [redacted] extensively on this issue and we have had all of Ms [redacted] claims adjusted correctly under Part B of her plan [redacted] has also corrected their system so that this error will not continue in the future and the medication will process under Part B of the plan Please accept my sincere apology for the delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issueUnfortunately, in some instances, procedural errors do occurWhen 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 Please also accept my apologies for the difficulties you have encountered with AetnaI’m sorry that our representatives were not able to assist you on your numerous callsOur goal is to provide quality service and satisfaction to our members, and I sincerely regret that you did not receive the service you should rightfully expect and deserveYour concerns have been forwarded to our management team for improvement opportunitiesI hope that going forward we will be able to regain your confidence in us We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms [redacted] concernsIf you have any additional questions regarding this particular matter, please do not hesitate to contact the Executive Resolution Team at [redacted] Thank you, [redacted] Complaint and Appeal Consultant Executive Resolution Team

Thank you for your inquiry received on 05/05/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 for assistance, and found the claim was originally processed incorrectlyThe amount of $has been added back into the member’s Aetna HealthfundWe 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] 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 Claims department to verify if the services rendered by Dr [redacted] on August 21, 2014, were paidWe verified that the claim was reprocessed and paid to the provider as an EFT payment on March 25, 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 issueWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms [redacted] concernsIf 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 [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 Disability department to verify why there was a delay in receiving your check, as well as when you should expect to receive your checkWe confirmed that the check was sent overnight via UPS and shows delivered on April 30, We were advised that the delay was caused due to having the incorrect address on fileWe have since had this updated to reflect the correct address, so there should not be any further delays in receiving future checks I sincerely apologize for any difficulties you encountered with your disability case manager We strive to provide the highest level of service and satisfaction for our members, and I sincerely regret that you did not receive the service you should rightfully expect and deserveThese actions are not consistent with Aetna’s service standards and we appreciate you notifying us of your experience I would like to assure you that we have taken the appropriate actions to address the service issues you experienced We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms [redacted] concernsIf 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: Aetna's response to my Revdex.com complaint ID [redacted] on May 27th, 2015, is "The prior authorizations have been updated and correctedThis should not happen in the future for these medications Also, the claims already filled are being reversed and reprocessed." To confirm that the issue is resolved, my daughter-in-law, Tracy Schatteman, contacted Aetna on Friday, May 29, I listened in on the speaker phone The representative at Aetna told us that my Part B medication claims have not been paid out to the pharmacy yet and that the Part B medications have not counted toward my out-of-pocket maximum In other words, Aetna has NOT rectified the situation as they claimed in their correspondence to you!At that time, we were informed that Aetna has special representatives that handle transplant recipients and that these representatives should have been working on this issue all along This is the first we have heard of these special representatives The standard customer representative also told us that it was her understanding that Aetna would cover my transplant antirejection drugs under Part D instead of Part B This is completely unacceptable for several reasons First, it is clear under Medicare rules (http://www.medicare.gov/coverage/prescription-drugs-outpatient-limited-coverage...⇄ that immunosuppressive medications are covered under Part B when a person receives an organ transplant while on Medicare and there are no time limits for me because I was entitled to Medicare at the time of my kidney transplant due to my age Second, if Aetna covers my antirejection drugs under Part B as they are legally required to do, they should pay out 100% of the cost because I have met my out-of-pocket maximum for the year If Aetna processes my medications under Part D, they would only cover 80% of the cost and I would need to pay over $per month coinsurance for my medications The customer representative said that she could not transfer me to the transplant specialists because they were not available at that time This is possible because we called Aetna fairly late in the afternoon on Friday After a lengthy discussion with the standard customer representative, we requested that a case manager be assigned to us and that we be given a direct phone number for a representative so that we can have one person follow this case with us (this is one of the stipulations of our original Revdex.com request) We were promised that an Aetna transplant specialist would contact us today, June 1st by noon CSTA customer representative from Aetna called my daughter-in-law today at 10:am CST [redacted] was not a transplant specialist but finally provided us with a direct phone number [redacted] ext [redacted] ) She took more information about the date of my kidney transplant I also provided her with phone numbers for my kidney transplant team and the pharmacy I use for my specialized immunosuppressive medications [redacted] said she would call my daughter-in-law back this afternoon or tomorrow morning I am hoping that Aetna will be able to resolve this situation in the very near future However, I cannot close my complaint with Revdex.com until they actually perform the actions that claimed to you that they have already done I would appreciate it if you can contact Aetna as to why they made claims to you about resolving my issue 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 youUpon receipt of the complaint, we contacted our Claims department regarding the claims from June 18, We confirmed the coordination of benefits for this member’s planThe claims have been reprocessed for both health plans and payment will be made to Dr [redacted] within – daysWe apologize for the inconvenience this has caused We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mrs [redacted] concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, [redacted] Executive Resolution Team [redacted] ***Complaints and Appeals ConsultantExecutive Resolution Team [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 have reviewed our records and they indicate a check was mailed to the member on July 03, 2015, to the home address listed in the original Revdex.com complaintWe show that the check was cashed on July 16,
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’ concernsIf 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

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is tentatively satisfactory to meHowever if upon receipt of the check I find that the amount is not close to the amount I calculated, I will be opening up the case or starting a new one againI realize dealing with these complaints is not easy and I appreciate that the company finally got to the bottom of this, however I have been told in the past that the claims from before August should have been processed by the medical claims department and they still disappearedI did receive in the mail the very claim I sent you guys and it was rejected for not being within the coverage time, it was very vague and doesn't specify exactly which prescription claims were rejected, which is not helpfulBut I was told to disregard this rejection and will be looking forward to the check, as of a few weeks ago I have not had the funds to even pay the copays to take my anxiety and depression medication, life has been a struggle, and this will helpI really hate filing these claims with the Revdex.com and hope I will not have to do this againI need the therapy, I need the medication, I am not frivolously spending money through the health insurance, and appreciate that my complaints are taken seriously
Sincerely,
*** ***

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 do apologize in our previous response we incorrectly named the wrong servicing providerWe are aware that it is not Dr*** that would have called on your behalf for bariatric benefits but Dr*** with *** *** *** as stated in our first response
We still are not going to be able to make an exception and cover these services as it is not a covered benefit under the planThe member’s option is to contact member services and request they open an appealThe member can also write to our Customer Resolution Team and request an appeal for the denial of the surgeryOur records indicate an appeal has not been requested by the member or provider
Iregret that our decision could not be more favorable empathize with your situation andI want to assure you we reviewed all the documents and available information before issuing this responseI understand your concerns and recognize this is not the outcome you desiredHowever, 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*** concernsIf 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 05/26/regarding complaint #*** for *** ***. 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 for assistance
regarding the claim for the services rendered by Dr*** *** on 03/06/The claim processing details are below: Claim number ***, billed under Dr*** with the billed amount of $This was originally processed allowing $and paying the provider $This was sent for rework as this is a non-participating provider and he does not accept contract ratesThis lead to the claim number ***Claim number *** is the rework of claim number ***We paid the difference of the original allowed/paid amount of $to the member on November 14, We then requested $back from the memberThe member called to discuss this and was told to reimburse $since she already paid $to the provider ($- $= $403.31)However, Aetna continued to pursue $from the memberThen claim number ***, Emergency Group of *** Professional, processed under the group name, instead of the provider name (Dr***), so we zeroed the claim to show the correct claim under the group name, new claim number is ***Emergency Group of *** Professional is a participating providerTherefore, we allowed $99.21, paying $which included interestWe have rescinded the overpayment request for the member in the amount of $109.90, since the member paid the provider
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

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 youUpon receipt of your complaint, we contacted our Pharmacy department and found that the reimbursement request were for claims that were prior to this member’s coverage through the Aetna Pharmacy Management (APM) planThe plan was active with Aetna Student Health however for the 2013-school year, the pharmacy claims should have been submitted to the medical plan for processingI have forwarded a copy of the receipts to the medical teamA check is being issued and should be mailed within 7-days.
We apologize for any inconvenience this has caused the memberWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
*** **
Complaint and Appeal Consultant Executive Resolution Team

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 youUpon receipt of your complaint, we contacted our Benefits department and determined that this
member is currently enrolled under the group, ADP Total SourceADP Total Source does not cover transgender reassignment servicesAetna, however, is a LGBT friendly company which means that Aetna supports the communityWe apologize for any inconvenience this has caused the memberHowever, we must make coverage decisions in accordance with the plan benefitsWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

Thank you for your inquiry received on 06/05/regarding complaint #*** for *** ***. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
As previously advised, since the claims in question were foreign claims, which did not have procedure codes on the claims, we reached out to Dr*** to verify the services that were renderedThe requested information has not been received from Dr*** who completed the dental work on Ms***We have sent a second request as of 06/11/to Dr*** for the information needed for processing of the claimsOnce this information is received, we will be able to review the claims accordingly
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’ concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

Complaint: ***
I am rejecting this response because: You are a joke......You don't have a clue do you?????? I believe NOTHING you sayDR*** wasn't even the doctor to call to Pre-Qualify me so Nice try......You wanna try for a 3rd Strike!!!!! I truly hope the Revdex.com is seeing my responses and your incompetence........It's fine you can continue to fleece hard working people out of their money with no consequences.....I guess you have no trouble sleeping at night doing it....IF you truly want to go over my case call me directly at ***....At least lie to me in person!!!!!!!!
Sincerely,
*** ***

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 youUpon receipt of your complaint, we contacted our Pharmacy department and found that the
plan pays 100% for drugs labeled as Smoking Cessation Aids. The product dispensed is a generic for *** SR which is labeled as an Antidepressant. The benefit would only apply to the generic to *** which is also ***. However, it has to be the product labeled as a smoking deterrent to be eligible for $cost shareWe have entered an exception and placed an override to allow for the dates of service submittedA check will be mailed within business days
Going forward, the member needs to obtain a prescription written for *** with substitution permissible in order to be eligible to obtain the generic to that product, *** 150mg SR, a $cost shareThe antidepressant product isn’t labeled by the FDA as a smoking cessation drug, only the actual generic for *** is
We apologize for any inconvenience this has caused the memberWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
*** **
Complaint and Appeal Consultant Executive Resolution Team

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
Upon receipt of the complaint we immediately had the email pulled that the member states she was provided incorrect information by a customer service representative (CSR)We confirmed that indeed Ms*** was given incorrect information regarding her ultrasound and stated we would cover it 100% after a copay was paidDue to this incorrect information being provided we made a one-time exception to pay the deductible amount owed by the member directly to the providerThis was completed today June 19, Going forward for any ultrasounds the member has she will be responsible for any amount that applies to her deductible
We also confirmed that we provided Ms*** the plan information in the email that verifies the information in our previous Revdex.com response which states there are exceptions to the prenatal coverageThat includes:
Routine prenatal care includes:- The initial and subsequent history- Physical exams- Monthly visits up to weeks gestation- Biweekly visits to weeks gestation- Weekly visits until delivery- Recording of weight- Blood pressures- Fetal heart tones- Routine chemical urinalysisServices that are not considered routine prenatal care include:- Office visit to confirm pregnancy- Ultrasounds- Certain Pregnancy diagnostic laboratory tests- High Risk Specialist Visits- Amniocentesis- Fetal Stress Tests- Inpatient admissions- Delivery including Anesthesia
In reference to the doctor’s visit that applied a $copay on May 14, 2015, the copay was applied to the fetal stress test that was completed on this dayAs listed above that service is not considered a prenatal service that is covered at 100%The member is responsible for a $copay for this date of service
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf 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

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this research is satisfactory to me
Sincerely,
*** ***

Thank you for your inquiry received on 05/18/regarding complaint #*** for *** ***. 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 Plans department for
assistance, and were advised the member lost her tax credit through the Marketplace effective 04/01/This change was loaded into the system on 03/16/2015. Aetna is not privy to the reasoning and has no control over the plans or rates that the member is eligible for through the Marketplace. The member would have received a letter(s) from the Marketplace advising of the loss of tax credit and the reasoning behind the change. Aetna did not pull the auto draft for this member in April due the timing of the plan change and the issues with the billing cycle. April and May’s premium of $(total of $875.32) was auto drafted on 05/04/2015. The invoice was available online on 04/29/2015, as auto drafted members do not receive an invoice via mail.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***

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
Upon receipt of the complaint we immediately went through the claims and totaled what was owed to each provider and how much was owedPlease see the attachment that explains what is owed for the member
In regards to the member being sent to collections, this information is not something that is provided to AetnaIf the member is requesting assistance with this please provide all documentation and we will assist as much as we can to resolve any collections the member owes
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms*** concernsIf 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

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
Upon receipt of the complaint we immediately reached back out to the Revdex.com
on April 28, 2015, to verify some information we need to be able to research this issue furtherWe have yet to receive this information back from the Revdex.com as of May 05, To be able to further assist you please provide the following information and we will be happy to review it:
Father’s full name, date of birth and last address on file for him
Documented proof that you are the beneficiary for your father so we may speak with you in regards to the life insurance policy
A copy of the letter was received from Aetna stating there is an unclaimed life insurance policy
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’ concernsIf 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