DELTA AIRLINES

Complaint: [redacted]
I am rejecting this response because: Aetna has, as yet, not reworked the claim which they have as yet failed to admit was mishandled by Aetna. The amounts on the claim have thus far not been reallocated vis a vis in network versus out of network. My zero balance is irrelevant at this point. It remains in Aetna's hands, SERIOUSLY. 
Sincerely,
[redacted]

Dear [redacted]
* Please see our response to complaint #[redacted] for [redacted] that was received by us on June 24, 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 Disability department to have the member’s concerns reviewed. We were advised that the member’s disability claim was approved and the approval has been communicated the member. The Disability department is also sending a letter with the details of the approval to the member.   I apologize for any difficulties the member encountered with the disability case manager.  It is our goal to provide the member with quality service and I regret any incidents that created the perception that we have not provided the member with adequate service.  These actions are not consistent with Aetna’s service standards and we appreciate you notifying us of the member’s experience.  I would like to assure the member that we have taken the appropriate actions to address the service issues the member experienced.   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 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 reached out to our Eligibility department and...

requested the policy be terminated per the member’s request as of December 31, 2015. Our records indicate that the policy reflects terminated as of December 31, 2015, and we have also approved the premium refund. Please allow 2-3 business days for the $248.42 refund to be electronic deposited in the member’s bank account.
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

Complaint: [redacted]
I am rejecting this response because: You have record of my calling twice. Both instances I was only given one amount as my responsibility which was $500. What is the point of providing this service for individuals wishing to be proactive and properly budget if false and inaccurate information is going to be provided? My decisions, twice, were based off your customer service reps provided information. Twice, not once, was I told "it would only be $500" and confirmed there would be no surprises. One of the reps even confirmed I had no deductible and some other fee so it was only $500. If you call to order something and get one price and proceed with this purchase would you not protest when you suddenly get billed for double the amount? Now that my calls are re-discovered I would like to hear both recordings myself as I don't believe I gave any room to misinterpret my concerns when checking my benefits and co-pays. Had there been one individual who even slightly gave mention to an additional $500 copay I could understand your not wanting to resolve the issue. This simply was never the case otherwise, as you have stated in both recordings I would have went to my hospital and had the co-pay waived now saving $1000 as you're claiming. I have provided several ways to contact me. Feel free to use any method. 
Sincerely,
[redacted]

Thank you for your inquiry received on 05/01/15 regarding complaint #[redacted] for Dr. [redacted].  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
 
Dr. [redacted] concerns were reviewed under case...

number [redacted]. Based on review of the information submitted, the invoice was processed as a “one-time exception” under electronic payment number [redacted]. Funds were deposited in Dr. [redacted] bank account on Tuesday 05/05/2015.
 
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]

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]

First it says my initial visit is covered which is not true I was charged a $50.00 copay. Second it says no limits but then in the next paragraph it states prenatal is limited to.... . They are contradicting themselves. Ultrasounds are routine to prenatal how can they not be covered? Meanwhile I have an email from another Aetna rep stating my ultrasounds are covered 100% and I am only responsible for a $50 copay. 
Complaint: [redacted]
I am rejecting this response because:
Sincerely,
[redacted]

Dear
[redacted]
Please
see our response to complaint #[redacted]
for [redacted] that was received by us on March 04, 2016.
During our review, we reached out to
our Dental department to address [redacted] concerns. It was determined that
the physical Dental identification cards are no longer available. I would like
to reiterate as advised in our previous response, that Dental ID cards are not required
to receive service.
However, as a onetime exception we have printed and laminated a copy of [redacted] dental ID card and mailed it on March 8, 2016.
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 [email protected].
Regards,
Julian
C[redacted]
Executive
Resolution Team

[redacted]  Please see our response to complaint [redacted] for [redacted] that was received by us on September 14, 2016.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. Our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur. I sincerely apologize for the difficulties the member experienced. As previously stated, the member’s medication required precertification. This is not [redacted]s way of saying that the member did not need the medication or to cause any delays. Precertification is required for many different medications.  Again, the two day delay was due to our Precertification department not being contacted until August 31, 2016. The medication was denied at the pharmacy on August 29, 2016, due to the precertification requirement. The provider called two days later to request the precertification and it was approved on the same day. The member and the provider were notified of the approval and the member picked up the medication that same day.  Based on our records, we have addressed [redacted] concerns on previous complaints. Therefore, 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 Mr. [redacted]s.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]
*Sincerely, As[redacted]Complaint and Appeals ConsultantExecutive 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 corrected. This 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, 2015.  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 $350 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 CST. A customer representative from Aetna called my daughter-in-law today at 10:27 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 false 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 you.
Upon receipt of the complaint we immediately reached out to
our Dental Claims...

department to have the member's concerns reviewed. We were
advised that they were able to have the claim corrected and the provider is to
be paid the additional money due for services rendered this week. The provider
and the member will receive a corrected explanation of benefits (EOB) within
7-10 business days or on our Aetna Navigator in 72 hours.
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. Unfortunately, in some instances, 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.
Concerning the customer service you experienced, our goal is
to provide exceptional service to our customers, and immediately resolve issues
when they do occur. I sincerely apologize for the frustrations and difficulties
you experienced and that we did not provide the level of service that you
rightfully expect and deserve. These actions are not consistent with Aetna's
service standards and we appreciate you notifying us of your experience. We
have addressed your customer service concerns directly with the representatives
who handled your calls.
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 our Disability department to...

verify why there was a delay in receiving your check, as well as when you should expect to receive your check. We confirmed that the check was sent overnight via UPS and shows delivered on April 30, 2015. We were advised that the delay was caused due to having the incorrect address on file. We 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 deserve. These 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] 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. I will file additional complaints if the same "accidental" errors occur again in the future. 
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because ::::::: I was able to make contact with AETNA and spoke with Ashley regarding my open complaint with AETNA. The case is still pending review. We are still in the process of working out the Medical Necessity and Need of Service. There has been a bit of back and forth on both Aetna and the referred physician. I would like to keep this claim open until a resolution is provided. I am confident when saying if Ashley would have been the "sales" rep that I spoke with at AETNA this complaint would not exist. She is truly helpful however; a resolution is what I need. I am paying AETNA $366.85 monthly for health services that are not catered to my immediate health or lifestyle. The prolonging of this complaint with no resolution has caused me loss of time at work, stress both mental and physical and financial hardship. I would like AETNA to make this right. This is becoming a complete nightmare. Please leave this case open. While this is truly private in nature, going public may be the best form of action to prevent false sales or lack of treatment/ assistant due to benefit deficiency.  Thanks for getting the ball rolling Revdex.com. As a Billion dollar corporation, AETNA should consider not outsourcing there business due to lack of training and development.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:
Sincerely,
[redacted]

Dear [redacted]    Please see our response to complaint #[redacted] for [redacted] that was received by us on October 23, 2017.  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 concerns reviewed. We were advised that all claims on file, including the treating physicians’ claim, are processed as participating for services rendered on September 04, 2017. The physician claim [redacted] shows a member responsibility of $43.36 towards the 20 percent coinsurance that was due and $173.42 was paid to the provider on September 19, 2017. Please have the member contact us directly at the email listed below if she is being balance billed any additional money outside the $43.36 that applied to the coinsurance.   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].   Sincerely,   Ashley W. Complaint and Appeals 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 the receipt of your complaint, we reached out to the [redacted] on May 19, 2016 to discuss his concerns and we have decided to work with the member directly to resolve his issues. 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, Tanika K. 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]

Thank you for your inquiry received on 05/14/2015 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 Life Insurance department...

for assistance, and were advised that the claim was processed and paid on 05/07/2015, in the amount of $174.40 under check number [redacted] to the estate of [redacted] and mailed to 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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]

HelloThank 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 member’s...

concerns. We listened to the phone call dated February 01, 2016 and confirmed that the member was quoted benefits that the diagnostic tests would be allowed at 100% after the $2600 deductible was met. The customer service associate explained that the member’s deductible had not been met. The associate did not educate the member on some of the procedure codes would be subject to medical review based on the member’s condition. We have provided feedback to the associate that handled the call. We also contacted our Claims department and verified that the member’s claim was processed according to the plan benefits. The procedure [redacted] was allowed and applied $952.93 toward the deductible. The procedure [redacted] and [redacted] were denied because they are considered experimental. The member's level one appeal denied on May 18, 2016. If the member disagrees with this decision, she may request a second level appeal. We can assist the member with the appeal submission. We attempted to reach the member on May 27, 2016 and left a message. We will make another attempt on Tuesday, May 31, 2016. The member can also contact me directly at ###-###-####.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,  LaShonda C.Complaint and Appeal Consultant Executive Resolution Team