DELTA AIRLINES

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted] I do hope Aetna will make the needed service and technology improvements. 
Sincerely,
[redacted]

[redacted]   Please see our response to complaint #1[redacted] that was received by us on October 27, 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 Enrollment and Eligibility department to have the member’s concerns reviewed. We were advised that the member added the dependent effective June 02, 2016, which caused a rate change in the premium effective the first of July. The member paid the old premium rate for the July premium which caused the dependent to be terminated from the policy and the premium was refunded.   The member made a payment on October 10, 2016, and the account was reinstated. The payment was made one day prior to our automatic dunning process (termination process) for the current period which was September 01, 2016 to September 30, 2016. Due to the payment being received but not posted to the account at the time of the dunning process, the account was terminated again in error. We sincerely apologize for the incorrect handling of the policy.   The account was reinstated on October 28, 2016, with no lapse in coverage. The member will have to make the premium payment for November by November 30, 2016, at the latest to avoid a termination. Any claim that may have been occurred during the time of adjusting the plan can be resubmitted for consideration since there was not a lapse in coverage.   We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Haner’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]   Sincerely,   [redacted] Complaint and Appeals Consultant Executive Resolution Team

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.
 
An Aetna client advocate investigated the situation...

with Dr. [redacted] being listed in the [redacted]. Unfortunately, Dr. [redacted] is still listed under a location on [redacted] that he no longer practices in and is not contracted under the practice the member went to for services.  The practice is not contracted at all with Aetna.  We apologize for any inconvenience this may have caused the member and his wife. The member does have the option to appeal if they so choose. The member can submit an appeal in writing to:
 
Aetna- CRT Member Appeals
[redacted]
 
The request should include:
• Name, date of birth, Member ID, and address
• Any other claim documents or records or other facts they would like us to consider.
 
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]

Dear
Ms. Shea,
Please
see our response to complaint #11096310
for Robert
Whiteside that was received by us on February 17, 2016.
We
would like to advise that the specific supporting information Mr. Whiteside
submitted was received from a Department of Insurance inquiry on February 16,
2016 and a response will be provided by March 08, 2016 after the received
information is reviewed. 
I
would also like to again advise that Aetna did not attempt to intimidate,
threaten, delay or deceive Mr. Whiteside, 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 Mr. Whiteside’s issues to
determine if Aetna had appropriately handled his claims. It was not Aetna’s
intention to infer that Mr. Whiteside was being investigated; only that Aetna’s
handling of his claims and concerns was being investigated. 
I
apologize for any difficulties or confusion this may have caused Mr. Whiteside.
We take customer complaints very seriously and appreciate you taking the time
to contact us and giving us the opportunity to address Mr. Whiteside’s concerns. 
If there are any additional questions regarding this particular matter, please
contact the Executive Resolution Team at [email protected].
Regards,
Julian
Cano
Executive
Resolution Team

Hello, Thank you for your inquiry, regarding complaint #[redacted] for Jared G[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 Eligibility department to verify the policy. Our records indicate the policy was effective on November 10, 2014, and terminated on January 01, 2015. We received a retro-termination request from the employer to back date the termination to January 01, 2015. Any termination requests are forwarded to [redacted] from the employer.[redacted] cannot refund premium payments. If the member is seeking a refund for the policy he must contact his Human Resources department to request.  I apologize for the frustrations and difficulties you encountered while attempting to resolve this issue. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. G[redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].com. Thank you, LaShonda C.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 Aetna Student Health (ASH)...

Claims department to have the member’s concern addressed. We were advised that the member’s plan has a $250 annual deductible. The visit on July 07, 2015, was for an urgent care visit (sick visit) and was applied to the 2014/2015 plan year deductible in the amount of $224.58. The member would be responsible for this amount. The visit on December 07, 2015, was also an office visit (sick visit) and was applied to the 2015/2016 plan year deductible in the amount of $218.30. The member would be responsible for this amount as well.
The plan renewal date is based on the academic year, not a calendar year. The plan renews on September 01, 2015, therefore the member’s deductible is renewed as well.
The member did have two other claims on file that were paid in March of 2015, but those visits were preventative visits, and under Health Care Reform, are not subject to the deductible and are paid at 100%.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. Tran’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 contacted our Customer
Service department to review the phone calls requested. We reviewed the call
dated January 20, 2016, where the customer service representative explained the
plan benefits and advised the member that her $6000.00 deductible would need to
be met prior to Aetna paying for the service.
We also located a call that was placed on February 23,
2016.  The representative did misquote
the member responsibility at the beginning of the call. During the call, the
representative placed the call on hold and contacted the facility. The CSR
confirmed the procedure and billing information. The CSR then apologized and
provided the correct benefits that would apply based on the provider’s billing
method. We assure you that it is not our intent to mislead or misrepresent any
benefit that may or may not be available under the member's health plan. The
claim for services performed on January 22, 2016 has been reviewed. It was
processed correctly according to her plan 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].
 
Thank you,
 
LaShonda C.
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 contacted our Life Insurance department to verify...

what information was needed to complete Ms. [redacted] request. We were advised that we had the incorrect information on file for Ms. [redacted] and we had a consultant reach out directly to Ms. [redacted] to discuss the error and have it corrected. As a courtesy we have obtained an invoice for payment of the death certificate(s) she obtained and sent to us and we are going to reimburse her. I would like to express my sincere condolences on the passing of your son. I’m genuinely sorry if this situation caused you any additional stress during an already difficult time in your life.
 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
[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 on file reviewed for
accuracy. We were advised that the claims for the date of service in question were
not processed correctly. We have had the claims all combined into one claim, the
new claim ID [redacted], and had it reprocessed per the benefits to pay the
provider directly. The provider and member should receive a corrected
explanation of benefits within 7-10 business days, as well as the provider
receiving payment for the services rendered. The member does have a copay responsibility
which will be listed on the explanation of benefits.
Please accept my apologies for the inconvenience and
difficulties you experienced while trying to obtain payment for your
claims.  Our goal is to pay claims timely
and accurately, and to promptly resolve issues when they do occur. 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.
Chang’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 Aetna Pharmacy Management...

team (APM) to verify if they had any records of reimbursements that were sent to Ms. [redacted] and if we had received any reimbursement requests that had not been paid out yet. To prevent any private health information being released for public view I have attached the medications that have been reimbursed to Ms. [redacted], which includes claim numbers, paid amount and the paid date. If you do not receive these checks within 30 business days we will be able to place a stop pay on the checks and reissue them.
Please let us know if there are any other medications that you have submitted to us that are not listed so we may better assist you. Please provide us with a copy of the reimbursement request so that we may have that reprocessed as quickly as possible for you. I have also attached for reference, the claim form that needs to be mailed with reimbursement requests and the correct address that it should be mailed to. Please keep in mind to reimburse pharmacy claims we will need the attached form as well as the pharmacy receipt that is stapled to the top of your prescription when you pick up your medication. This shows Aetna how many are being filled, the refill amount left, and amount paid.
Please accept my apology for the 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 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: 11411231
I am rejecting this response because: This claim is absolutely without doubt is preventative laboratory testing for the reasons already mentioned. I was told by the phone representative of Aetna that they do consider situations like mine to be covered as a deviation of routine preventative. I will not accept that this claim is not covered.
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 attempted to reach out to the facility to discuss the balance...

bill you were receiving. The facility was again unwilling to write off the amount the member owed. Due to the circumstances we had the claim reviewed under the member’s policy for balance billing. Our Claims department advised the member was eligible for balance billing reimbursement. The claim has been reprocessed and the member will be receiving a check for the balance bill difference. Please allow 7-10 business days to complete this request due to the check amount. Please note the member will be responsible for the deductible and coinsurance amounts, as this amount is not including in the balance bill check.
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

Dear [redacted]: Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on February 13, 2018. We understand that [redacted] is requesting that we print the hospital, clinic, or medical group’s name along with the name of the physician on claims filed to us. Unfortunately, our systems do not currently have the capability of displaying the name of the group a physician is affiliated with if claims are submitted by the individual physician.  This information is based on how the providers submit claims to us and how the provider’s demographic information is loaded into Aetna’s systems.  If [redacted] does need additional information about any physician submitting a claim for him or his family, our Member Services representatives are available to assist him. As future opportunities occur to make system enhancements, [redacted] recommendation will be taken into consideration.  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] Sincerely, Christopher B. Complaint and Appeals Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because: I tried calling Aetna for a month and a half trying to get everything they needed for my claim. Every time I called they needed new documents which I provided. My doctor even sent everything they needed. Also when I called they kept telling me different things. So I went without pay for a month and a half because of this which also means my bills didn't get paid, myself and my daughter barely had food to eat. I did everything I was suppose to and also my doctor. The denial I feel isn't accurate. 
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: The response did not address the fact that tens of thousands of dollars of x-Rays and MRIs were not covered from a recent hospital stay, and those services were covered at s rate of 100% per my plan policy. Additionally, there's a $3,000 out of pocket maximum, therefor, Aetna should not be sending me bills for anything in excess of the $3,000 out of pocket maximum. This includes a bill I received from Aetna for in excess of $119,000 that I received this week for a portion of that hospital stay. Please re-review these claims and adjust.
Sincerely,
[redacted]

Thank you for your inquiry received on 05/18/15 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 Aetna’s [redacted]...

[redacted] ([redacted]) for assistance, and were advised that [redacted] is considered a maintenance medication, as it typically used daily to improve urination. We have explained this member’s unique situation to the plan, and they have approved an override to bypass the maintenance choice requirement for the next 2 refills. If the member is still using the medication after 2 more refills, we can revisit and review at that time.
 
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]

Dear [redacted]
Please
see our response to complaint #[redacted]or [redacted] that was received by us on February 24, 2016.
During our review, we reached out to
our Benefit’s department to address [redacted] concerns. It was determined
that the claims in question were processed correctly in accordance to the
member’s plan benefits. As a member of Aetna, the member or their authorized
representative has the right to file an appeal about coverage for service(s)
when the member is not satisfied with the original coverage decision. Appeals
can be filed in writing to Aetna or by calling Aetna’s Member Services Unit at
the number on the member ID card.
While we understand the member’s concerns
and recognize this is not the resolution [redacted] 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
apologize for any difficulties or confusion this may have caused [redacted] 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]
Regards,
Julian
C[redacted]
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 Pharmacy Pre-Certification...

department to verify if we had received any forms from the doctor’s office for a pre-cert for a brand name medication. We did not find any forms on file, so we faxed to the office the pre-cert form on May 22, 2015 to the number provided to us. We received a confirmed receipt for the form, please see below:
Your fax was successfully sent to Dr. [redacted].
 
Fax number: [redacted]
Subject: Pre-Auth Form
Status: (success)
Completed: 1:42:48 PM, Friday, May 22, 2015 Sent pages: 3 of 3
Duration: 0:00:46
 
Please accept my apologies for the difficulties you have encountered with Aetna. Our 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 deserve. Your concerns have been forwarded to our management team for improvement opportunities. I 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] 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

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 immediately reached out to our Claims department to have...

a comprehensive review of the member’s claims completed. We were advised that there were not any claims, as of now, that were not processed as primary during the period of dual coverage. If the member has a specific claim that needs reviewed please advise of the date of service and the provider and we would be happy to review.
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