DELTA AIRLINES

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 have the call pulled to verify...

the information that was provided to the member. Our records indicate that the member advised the customer service representative that this procedure would take place in the provider’s own facility, with the doctor’s name and procedure code. Based upon that description the general benefits were provided to the member.
Information provided through member services is not a guarantee of benefits under the plan. The claim that was submitted to Aetna did not list the services rendered as being taken place in the office setting, instead in an ambulatory surgical center as outpatient surgery. Due to the way the claim was billed it triggered the deductible instead of an office visit copay. The claims in question were processed correctly in accordance to your plan benefits.
I realize that understanding your benefits can be challenging. It is our goal to be there for you when you need us, and I apologize that the assistance you received from our customer service representatives did not meet your needs.

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,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Thank you for your inquiry received on 07/06/15 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 made several attempts to reach out to Mr. [redacted] for additional information...

and were unable to get ahold of him via email or telephone. Voicemail messages were left with contact phone number for him to call us back so we can assist him. To date, Mr. [redacted] has not returned the phone calls or email. Furthermore, the Pharmacy department reviewed Mr. [redacted] file, and found no denials on file for any medications to date.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.
I thank you all very much for quickly responding and the courteous follow up call from Aetna's Complaint Dept.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: there are still claims (approx 6) that are still listed as "not approved". I will need proof that ALL claims have been accepted and there EOB via postal mail. I need this proof because Aetna can very easily change the status on their website; which I have personally seen those changes. Aetna between the dates of Feb 9 through Oct 31, 2015 was the only health insurance that was active. 
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.
We requested a copy of the letter to confirm the information
the member is requesting. We were able to verify the medical records request
was mailed on September 14, 2015, to address:
[redacted]
Records were sent to the main office address on file instead
of to the individual doctors since the member was seen by more than one doctor
in the date range records were requested. We requested records for any services
rendered from August 20, 2015 through September 19, 2015. Once the records are
received we will be able to review the claims on file for any benefits
available under the plan. If the provider has not received this letter, they
can contact our Provider Service Center and have the letter regenerated. They
can reference document control number: [redacted] when calling for a copy of
the letter.
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] 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 have the calls pulled related to...

the pregnancy coverage prior to services being rendered. The records indicate only general pregnancy benefits were provided during the call from the member. 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.
Aetna strives to provide the highest level of service, quality, and satisfaction, and to continually improve our processes. I want you to know that we appreciate your feedback because it gives us the opportunity to listen to our customers and make any improvements to our processes and the service we provide. Your opinion is valued at Aetna, and I trust that you will not hesitate to contact us when you need assistance.
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: AETNA ignored the already verified TIN by [redacted] in July. AETNA has made no effort to contact HER. She is in charge of physician contracts.
Sincerely,
[redacted] First name SPELLING correction

Thank you for your inquiry, regarding complaint #[redacted] for Joan H[redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. We contacted our Life coverage department to address the complainant concerns regarding a policy for [redacted]...

[redacted].  On May 10, 2016 we received the claims information and an Assignment of Benefits to [redacted]l Funeral Home. We allow up to 30-45 business days for claim processing. The claim was approved for payment and a check was issued in the amount of $3062.94 on July 06, 2016.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]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 reached back out to our Aetna’s Individual Plans and Eligibility department to have our records again and we have confirmed we do not have the copies of the money orders. We sent an email to the member on August 12, 2015, requesting the member to send in copies of the money orders for our records but we have not heard back from the member as of today. I sincerely apologize for any inconvenience this has caused for the member.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mrs. [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] 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 addressed. We were
advised that the claim was finalized on February 17, 2016, and the case manager reached
out to him the same day to advise of the claim decision.
Aetna strives to provide the highest level of service, quality,
and satisfaction, and to continually improve our processes. I want you to know
that we appreciate your feedback because it gives us the opportunity to listen
to our customers and make any improvements to our processes and the service we
provide. Your opinion is valued at Aetna, and I trust that you will not
hesitate to contact us when you need assistance.
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 have the call pulled to verify the...

benefits that were provided to the member prior to services being rendered. We confirmed that the customer service representative (CSR) quoted that the procedure would be covered when you have a medical condition that covers/warrants the services. At the time the member had not been seen by the provider so was unable to provide the CSR with the diagnosis code to completely verify the coverage under the plan.
When the claims were submitted to Aetna they were denied as not covered based upon the diagnosis that was sent to us. As a one-time exception, we have reprocessed the claims for the two dates in October of 2015 to allow services rendered.
Please allow 7-10 business days for your provider to receive any payment made on the claims.
Going forward if the member wishes to seek these services the member or provider must call our pre-certification department to request a review be completed for coverage under the plan or the member could be responsible for any billed expenses.
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

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 the Billing department to verify...

if the member was due a refund for overpaid premiums after she was no longer employed with the prevoius employer. We were able to verify that the member is due a refund as the premium was overpaid. The City of [redacted] is aware of the situation and they are currently working on refunding the member as quickly as possible. Since the City of [redacted] creates these deductions, please contact them for any questions about the amount of refund that is due and when they expect to have this refund to 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] 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 contacted our Claims department regarding the claims from June...

18, 2014. We confirmed the coordination of benefits for this member’s plan. The claims have been reprocessed for both health plans and payment will be made to Dr. [redacted] within 7 – 10 days. We 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] concerns. If 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 #[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 your complaint, we contacted our claims department to address your concerns. We have found that the claim for [redacted] recent hospital stay on date March 17, 2016 through discharge date March 23, 2016 has been adjusted and reprocessed. The provider should expect payment within 7-10 business days. The claim was initially denied for no authorization. We reviewed the authorization request and approved the in-patient visit based on medical necessity. I apologize for the frustrations and difficulties you have experienced while attempting to obtain payment for this claim. 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, Tanika K. 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 your complaint, we contacted our Claims department...

and
confirmed that the claim was reprocessed correctly based on our review. The
member is responsible for 10% coinsurance based on the plan benefits. The
claim was reconsidered for an additional payment of $112.70. The customer
service representative did not consider the plan benefit which allows 90% of
the allowed charges. The member’s portion was 10% of this amount so no
additional payment is due for this claim. 
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 [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

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 compliant we immediately reached out to
[redacted]...

to confirm the children were not active under the
policy. We were able to confirm the children were never active on any other
plan, making Aetna the primary payer for the claims on file.
After confirming that Aetna is
the primary payer, we immediately reached out to our Claims department to have
all the claims reprocessed and paid as primary to the providers. Please allow
7-10 business days for the providers to receive the payments as well as the
corrected explanation of benefits. Please accept my apology for the delay in
processing the claims correctly, and that it required
multiple attempts on the member’s part to resolve the 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 the member’s to improve our service and prevent issues
from reoccurring.
Our goal is to provide
exceptional service to our customers, and immediately resolve issues when they
do occur. 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 you 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 Dr.
Jain’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

Thank you for your inquiry received on 08/21/15 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 the Flexible Spending Account...

(FSA) department, and were able to find the system error with the processing of the member’s claims.  All claims have since been reprocessed correctly as of 08/20/15, and a check was issued on 08/20/15. 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].

Tell us why here...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 to review the...

member’s concerns.  We found that the lab charges billed from [redacted] were processed correctly. The charges billed were not a part of the preventative services and applied according to the medial benefit.  The benefit states that for diagnostic services billed at a participating lab, 100% is allowed after a $5000.00 deductible is met. The member is responsible for $64.44.We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr.  Karran ‘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 Appeal Consultant Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because: I have contacted my HR Department and they said that Aetna sets there premium price. 
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: Your advertising and marketing of this plan is misleading and deceptive.
Sincerely,
[redacted]