DELTA AIRLINES

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 had the member’s claims reviewed to see if they were processed correctly and if the member owed $We confirmed that the claims have been processed correctly and there were three procedures that were done that are not considered preventative services under the member’s planTherefor she is responsible for a total of $that applied to the member’s deductible
The member’s effective date per the file from the employer is January 26, We are not able to cover prescriptions prior to this dateIf the member paid for any medications out of pocket after this date please send in a completed claim form and attach the pharmacy receipt that is stapled to the medication when you pick up your prescription and we will be happy to review them for consideration of reimbursement
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

Thank you for your inquiry received on 05/01/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 *** *** ***
*** department for assistance, and the member’s check in the amount of $1,issued on 04/13/(Claim# ***)The *** policy is to allow a minimum of business days for delivery, which would be on 04/24/The member called on 04/27/to request the check be reissuedThe stop payment/reissue process took business daysThe check was sent via *** under tracking # *** shows that the package was delivered on 05/01/
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 ***

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

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me I hope to keep the complaint open until I receive the reimbursement from the company.
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 the complaint, we contacted our Claims department regarding the claim from April
23, from *** Vision CareWe confirmed that the plan does allow one routine vision exam every monthsBased on the plan benefits, the copay applies to a routine vision examThe total billed charge of $has been allowed at percentThe claim has been reprocessed to allow the all charges after a copay of $An explanation of benefits was mailed on June 15, which indicated the member responsibilityWe 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 MrChan’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Thank you,
*** **
Executive Resolution Team

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

Spoke on May 20th to ***, and then again today to someone else 6/8/15. He couldn't confirm that the reprocessing was completed after spending minutes on hold waiting and took my cell phone and said *** would call me back. Therefore, I don't agree to the response statement until someone actually calls me to clarify what was reprocessed and how they come up with this new number Complaint: ***
I am rejecting this response because:
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because: This is BS....My doctor calling on Nov14th was them checking to see if I was covered and your guy gave them a confirmation # which I will get from them....Your guy said I had to do the Month program and then go back to the insurance,,,,,,SO YES YOU AETNA TOLD MY DOCTOR I HAD TO DO THIS MONTH PROGRAM WHICH COST ME $300.......HENCH WHY YOU HEARD BACK FROM MY DOCTOR IN MAY....HMMMM LETS DO THE MATHMONTHS LATER, WHAT A COINCIDENCE You can lie all you want but the truth will come out....why don't you release the call and transcript so we can see for our self what your representative told my doctor...because I tend to believe my doctor and when I called in and had someone review the transcript she had a different version of what it said I Will show this Pitiful excuse to my doctor and see what they have to say about it. I've also filed a complaint with the *** *** of *** and I've had a local News Station interested in my story.....So like I said before....Keep liying the truth will come outI don't even care about the Surgery anymore you crushed that hope but YOU OWE me the $I spent on the moth prerequisite program Your Representative told my doctor I needed to do for your company!!!!
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
Upon receipt of the rejection we were able to verify that the check was never received or cashedWe have since reissued a check on May 21, 2015, for the amount of $1,to the home address on fileI sincerely apologize that the check information was not verified in our previous responses
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr ***’s 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 youUpon receipt of the member’s response, we requested a second review. The November 19, phone call between Dr*** office and our provider customer service representative did not indicate any incorrect information was providedWhen we reviewed the call, the provider was advised that in order to determine if the surgery would be allowed, the office would need to send in a predeterminationWe provided the phone number to call and fax number to send Mr*** medical records for review to see if it qualified for medical necessityOur records indicate that this was not completed by the provider until May 07, Unfortunately, the plan does not cover this surgery and we are unable to make any exceptions to allow coverage at this timeYou are responsible for any copayments to the specialist office visitWe apologize for any inconvenience this has caused the memberHowever, we must make coverage decisions in accordance with your plan of benefits and our medical necessity guidelinesWe 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 ***.*** **Complaint and Appeal Consultant Executive Resolution Team

Thank you for your inquiry received on 05/11/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 member and provider of service to
have the claims/itemized bills refaxed to Aetna, as the forms were not legibleOnce received, we were able to send to our Claims department for processingThe member should be expecting a reimbursement payment in the amount of $3,320.00, less her $copayment responsibility for each date of serviceWe apologize for any inconvenience or frustration 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 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 [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 Benefits department and verified the maternity coverage. We also listened to the recorded calls. The calls indicate only general maternity benefits were provided during the phone call. The claims in question were processed correctly in accordance to the member’s plan benefits. When the child is born and is added to the policy as an individual, the facility is able to bill separately for both mom and child for any charges related to the pregnancy. The submitted charges were sent for both the mom and child; which triggered the individual copays. 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.I attempted to contact the member to discuss the
outcome of our review. I left a message and have not received a return
call. 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

Hello,
Thank you for your inquiry, regarding complaint # 10744957 for Jessica P[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 Network department to have...

someone contact the facility to have all of their concerns addressed. Our department advised us that they spoke with the facility and advised that they have successfully added the associate as well as update the facility in our Aetna Better Health (ABH). We were also advised that the facility was provided a direct contact for any further questions or concerns.
Please accept my apologies for the difficulties you have encountered with Aetna. Our goal is immediately resolve issues when they do occur. Clearly, in your case, we fell short of that goal. We regret that your experience with Aetna was less than satisfactory and hope that we can better assist you in the future. 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 Ms. P[redacted]’s 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 [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...

confirm what date the member should have on file as a termination date. We confirmed that we had the incorrect information on file for the member. We have since updated the policy to show terminated as of December 31, 2015. We also sent the member’s dental claim back for same day reprocessing and it was completed yesterday, January 25, 2016. The provider will receive the payment and a corrected explanation of benefits within 7-10 business days.
Please accept my apology for the delay in processing the member’s claim correctly. 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 Ms. [redacted]’s 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

[redacted] Please see our response to complaint [redacted] for [redacted] that was received by us on June 12, 2017. 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 Customer Service department and determined that some problems occurred during the member’s initial request for the PCP selection. We confirmed that our systems reflect that [redacted] has been selected as PCP effective June 2, 2017. We also contacted the member and confirmed that the medical ID cards have been received.  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,[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 attempted to find the member’s ID number and plan...

information but were unsuccessful. We reached out to the Revdex.com to have them request more information from you. To assist you will you please advise of your member ID number and also confirm in writing that you wish to terminate your policy and which date you are requesting termination. If you do not wish to cancel this policy, we would be more than happy to assist in resolving your first issue by finding you a doctor since you said you were having difficulty finding one.
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,
[redacted]
Complaint and Appeal Consultant
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:what Aetna said all my claims are re-processed, simply it's not trueI logged into my account, as now the claim #[redacted]( part 2), #[redacted], #[redacted]  are still wrongly rejected based on educational charges not covered, even thoughwe are covered and received the pre-certification letter in advanceand claim # [redacted], #[redacted], # [redacted] are all partially denied saying provider's charges are over the agreed rate.  The insurance need pay the agreed part, as before, such as pay ($100 out of $150 billed) as processed correctly before, instead of simply denied the whole charge.and what Aetna said they will start to process my claims correctly, this is also not true, a new claim on 9/17/15 just shows up and got denied againI called the provider - [redacted], she told me that she was still was owed about $6000 from Aetna for the wrongly rejected claims and she is going to stop the service if she continue not to be able to get paidIn summary, what the Aetna said is simply not true and seriously damage our son's chance to get service and recovery.
Sincerely,
[redacted]

Complaint: 11096310
  State of CA Department of Insurance is investigating issuing a  new case +HCB-7050107 February 16, 2016.I will standby while the Department investigates the issues in complaint.
Sincerely,
Robert Whiteside

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 found that the...

claim was processed out of network as this lab is not apart of Aetna's network. We made an exception to reconsider the charges because this member did not have a choice in selecting this laboratory. The claim has been reprocessed and a check will be sent to this provider within 7-10 days.
 
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 Ms. [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.
Complaint and Appeals Consultant
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:
I know I called before I was admitted the call could have not been recorded or just been deleted on your part. I am going to research my call records from January and submit them. I know I called before I was admitted and was told the hospital was in network that is the only reason I was sent there.
Sincerely,
[redacted]