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Insurance Companies

Aetna Inc.

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Complaints

This profile includes complaints for Aetna Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

1,336 total complaints in the last 3 years.
457 complaints closed in the last 12 months.

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The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:07/23/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
********* i am dennie husband she has advanced dementia and suffered a stroke 8 weeks ago is unable to file this i am her husband fileing for her I notifed Aetna back in Jan 2025 we could not afford the oulandished increase in premium from8.00 mo to 50.00 mo to discontinue our coverage as we secured better coverage for 10.00 mo I informed them we were stopping payment on the bank draft to them through TD Bank For some reason they felt they could push old people around and said i had to pay it as required by law The law does not require us to carry a prescreption drug plan so i stopped payment and informed cvs plan was no longer any good Aetna continued billing for plan even though no payment was being made and they were informed by phone on 3 different times i was no longer gonna pay the outlandish prem they were trying to collect
Business Response
Date: 07/23/2025
**** *** ******* **********

Please
see our response to your complaint # ********
regarding our member, **** ****** ****, that was received by us on July 23,
2025. Our Executive Resolution Team researched the concerns, and I would like
to share the results of the review with you below.

Upon
receipt of the complaint, we immediately reviewed **** ****** account. We have
confirmed the member enrolled into an SilverScript SmartSaver Prescription
Drug Plan (PDP) with an effective date of January 1, 2023.

In
2023, the SilverScript SmartSaver (PDP) plan included a monthly plan premium of
$8.40.

In
2024, the SilverScript SmartSaver (PDP) plan included a monthly plan premium of
$13.30.

On January
1, 2025, the SilverScript SmartSaver (PDP) plan was combined with our
SilverScript Choice (PDP) plan. In 2025, the SilverScript Choice (PDP) plan
includes a monthly plan premium of $48.30.

Member was set to automatic withdraw premium payments up
until February of 2025. The member’s monthly premium payments were received
through February of 2025; however, in February the automatic payment was
reversed, by the member’s financial bank institution, in the amount of $48.30. The
member began receiving monthly invoices in March of 2025. We confirmed no
further premium payments were received from the member; therefore, the member
was disenrolled as of May 31, 2025, due to non-payment of the monthly plan premium.

The plan’s Annual Notification of Change (ANOC)
booklet is sent to our members before September 30th each year to provide
sufficient time to review any changes and decide whether the plan will continue
to meet their needs in the next year. Medicare allows the member to make
enrollment changes during the Medicare Annual Election Period (AEP), which
occurs from October 15 to December 7. The plan encourages the member to review
all documents included with the ANOC to gain a full understanding of how the plan
will cover their prescription drugs and any cost amount changes being applied
in the upcoming plan year.

We
confirmed the plan mailed the 2025 Annual Notice of Changes (ANOC), which
included the Formulary (list of covered drugs), Pharmacy Directory, and
Evidence of Coverage (EOC) document, to the member’s email address of,
************************, on August 22, 2024.

We show the member did contact the plan on January 18, 2025.
The member contacted our customer care line and expressed concern with the
premium in 2025 increasing. The customer care representative reviewed the 2025
premium with **** **** and advised on when she can switch plans. The customer care
representative also filed the previous complaint case ************.

Within our response to the previous complaint the member was
mailed dated January 30, 2025, she was advised correctly that as per Medicare
guidelines, to disenroll outside of the Annual Election Period (AEP), which
occurs October 15 through December 7, beneficiaries must have a valid Special
Election Period (SEP). Some examples of a valid SEP include, but are not
limited to, moving to a new region, losing/gaining employer/union group health
coverage, or losing/gaining Extra Help.

There are three ways to disenroll voluntarily from a
SilverScript PDP:

· Submit a written disenrollment request, including the
reason for disenrollment and a signature. Disenrollment forms are also
available online at AetnaMedicare.com or by contacting Customer Care to request
a disenrollment form by mail. Members can mail the disenrollment request to
SilverScript ********* *******, ** *** ****** *********** ** **********, or fax
it to ###-###-####.

· Call 1-800-MEDICARE (###-###-####); TTY users call
###-###-####, 24 hours a day, 7 days a week.

· Enroll in another Medicare PDP while still enrolled in a
SilverScript PDP.

While members are waiting for their membership to end, they are
still an active plan member. To use their plan benefits, members must continue
to get their prescription drugs through a SilverScript network pharmacy, pay
the monthly premium, and abide by all plan rules until officially disenrolled.

Upon receipt of a disenrollment request, we assess for a
valid disenrollment period. If valid, we send the disenrollment request to the
Centers for Medicare and Medicaid Services (CMS) for approval. Upon approval
from CMS, we will disenroll the member and send them a confirmation of
disenrollment letter.

The member did not contact the plan regarding this concern again
until July 22, 2025. We confirmed the plan did not receive the required
disenrollment request in writing from the member, or notification from CMS that
the member enrolled into another plan and/or that CMS approved the member to be
disenrolled from the SilverScript plan with a valid Special Election Period
(SEP), prior to the member being disenrolled due to failure to pay plan premiums.
According to the CMS portal it does not show the member enrolled into another
plan with prescription drug coverage. We have confirmed as the last monthly
premium in the amount of $48.30 was received from **** **** in January of 2025,
she currently owes four months of 2025 monthly plan premiums at $48.30 per
month. Even though her plan is no longer active, she is still responsible for
her plan premiums during the time she was active with the plan. The member currently
has a balance owed on her account for the months of February, March, April, and
May, which totals $193.20.

Please
know, the member will receive a detailed Medicare Resolution Letter within 7-10
business days with this response, from us, as well.

We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address **** ****** ****’s
concerns.

Sincerely,
Marilyn
G.
Analyst,
Medicare Enterprise Resolution
Customer Answer
Date: 07/23/2025
They admit I notified them to drop the plan in January. They did not even though payment were stopped. There is no law that a prescription drug plan has to be carried. They continued on after being told they would not be paid. That is on them. My wife is very sick and they can just put it against her credit if they so desire. We cannot and will not pay them. If I had not notified them in January I would fell like I owed it. But I don’t feel obligated for this and they can do whatever they like. We have much better coverage for 10.00 mo.
Business Response
Date: 07/25/2025
**** *** ******* **********

Please see our response to your complaint # ******** regarding our member, **** ****** ****, that was received by us on July 23, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you below.

Upon receipt of the complaint, we immediately reviewed **** ****** account. We have confirmed the member enrolled into an SilverScript SmartSaver Prescription Drug Plan (PDP) with an effective date of January 1, 2023.

In 2023, the SilverScript SmartSaver (PDP) plan included a monthly plan premium of $8.40.

In 2024, the SilverScript SmartSaver (PDP) plan included a monthly plan premium of $13.30.

On January 1, 2025, the SilverScript SmartSaver (PDP) plan was combined with our SilverScript Choice (PDP) plan. In 2025, the SilverScript Choice (PDP) plan includes a monthly plan premium of $48.30.

Member was set to automatic withdraw premium payments up until February of 2025. The member’s monthly premium payments were received through February of 2025; however, in February the automatic payment was reversed, by the member’s financial bank institution, in the amount of $48.30. The member began receiving monthly invoices in March of 2025. We confirmed no further premium payments were received from the member; therefore, the member was disenrolled as of May 31, 2025, due to non-payment of the monthly plan premium.

The plan’s Annual Notification of Change (ANOC) booklet is sent to our members before September 30th each year to provide sufficient time to review any changes and decide whether the plan will continue to meet their needs in the next year. Medicare allows the member to make enrollment changes during the Medicare Annual Election Period (AEP), which occurs from October 15 to December 7. The plan encourages the member to review all documents included with the ANOC to gain a full understanding of how the plan will cover their prescription drugs and any cost amount changes being applied in the upcoming plan year.

We show the member did contact the plan on January 18, 2025. The member contacted our customer care line and expressed concern with the premium in 2025 increasing. The customer care representative reviewed the 2025 premium with **** **** and advised on when she can switch plans. The customer care representative also filed the previous complaint case ************.

We have also confirmed that even though the member notified customer care, there was never a request submitted in writing. Aetna follows Medicare Guidelines, and the member is required to disenroll from a plan in writing when the plan is an active plan when the member contacted Aetna in January 2025, to end the plan.

Medicare guidelines strongly encourage creditable prescription drug which is a good as or better than Medicare Guidelines. If the member does not have creditable coverage for 63 or longer, she can be subjected to a late enrollment penalty. The coverage for $10 a month that the member is paying is not considered a Medicare Advantage Plan for Prescription Drug Coverage, and that is why the plan was not cancelled once the member enrolled in it. That means, if there is prescription coverage with that plan, it is not considered creditable prescription drug coverage. Medicare Advantage Plans are the only plans that fall under the guidelines for individual plans.

Please know, the member will receive a detailed Medicare Resolution Letter within 7-10 business days with this response, from us, as well.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address **** ****** ****’s concerns.
Sincerely,
Cindi D
Analyst
Medicare Executive Resolutions
Customer Answer
Date: 07/25/2025

Complaint: ********

I am rejecting this response because:

Sincerely,

****** * ****
Initial Complaint
Date:07/18/2025
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
My name is ****** ***** *********. On July 14, 2025 I called Aetna through an customer service number listed online. I provided my Medicaid I.D to representative after discussing various types of plans I purchased a ****** *****l plan in the amount of 52.66. This payment was to cover the monthly payment and be the payment amount per month through automatic payments. After providing payment information in online application, to date I have not received a confirmation of payment nor am I able to obtain one from the company billing department. I am also unable to obtain a copy of the plan details on the account member page online until start date. This information was not told to me during the initial discussion with representative. I was assured my insurance details would be viewable in my membership account once I was registered. I am also unable to obtain any written confirmation of policy that state confirmation of payment are sent via mail. Therefore on July 18, 2025 I cancelled the ****** *****l insurance and requested a full refund. I am unable to obtain any confirmation of the cancellation or confirmation of the refund or policy.
Customer Answer
Date: 07/18/2025
Hello,
I am writing to inform BBB that I have spoken with the company Aetna through customer service. I was told my insurance was cancelled by an agent that my insurance would not cancel until August 1st 2025 although I cancelled on 7/18/25? When I asked to speak with a supervisor the supervisor Samuel told me it was cancelled non existent and refund was issued. Non of this written. I sent an email to the agent who opened the account and took my card information ( see attached) This is the only contact information I have for anyone at the company. I was told over phone I would receive confirmation of cancellation in mail 7-10 days. This is unacceptable after taking a online payment. I should be able to receive an online confirmation.
Business Response
Date: 07/22/2025
**** ******* **********
Please see our
response to complaint # ******** for ****** ********* that was received by us
on July 18, 2025. Our Executive Resolution Team researched the concerns, and I
would like to share the results of the review with you.
Upon
receipt of your request, we immediately reached out internally to further
research the concerns. After
further review it
was determined that the member is enrolled in an Individual dental plan. Our dental
department does not handle individual dental plans. The member is showing an
active coverage date of August 1, 2025, with no termination date. If the member
wishes to terminate coverage, the member must reach out to **********(Aetna
****** *****l) at ###-###-####, or by email at **********************************.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address Ms. *********’s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Initial Complaint
Date:07/18/2025
Type:Product Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
The issue is regarding CVS Benefits. Second Quarter benefits were not used due to extenuating family circumstances. I contacted Aetna CVS Benefits by phone on July 1, 2025 asking if anything could be done so I could still use the $50 benefit as I rely on it to purchase pain patches and other needed items. I was told that a one-time courtesy re-instatement of the benefit was allowed and I would be contacted within 48 hrs. I did not receive a call. I called again on July 7 and the representative said she put another request in and I should receive a call within 48 hrs. I never received a call. I called again on July 9th and was transferred to Aetna member services. A representative there talked to me at length then gave me a reference number stating that the benefit of $50 should be back on my benefit card in 5 days (July 16). By Friday July 18, the amount was still not reinstated so I called again. I was then told that the benefit would not be reinstated even though two different people I had spoken to had told me a one-time courtesy reinstatement would be granted. Aetna should honor the one-time courtesy as promised by their employees. If Aetna employees are giving faulty, deceptive information to their clients then Aetna should address that with the employees but they should honor the promise made to reinstate the $50 benefit to a retiree who is living on a fixed income and relies on these types of benefits.
Business Response
Date: 07/21/2025
**** *** ******* **********

Please
see our response to your complaint #******** for our member, *** ***** ********,
that was received by us on July 18, 2025. Our Executive Resolution Team
researched the concerns, and I would like to share the results of the review
with you.

Upon
receipt of the complaint, we immediately reviewed the member’s account. We have
confirmed the member’s plan includes a CVS Over the Counter (OTC) Wallet with a
$50 quarterly benefit amount. According to the 2025 Evidence of Coverage, the
plan documents state the member’s $50 quarterly benefit amount will be
available on the Aetna Medicare Extra Benefits Card the first day of each
calendar quarter. Calendar quarters begin in January, April, July, and October.
The plan documents advised members to be sure to use the full benefit amount
each quarter, because any unused benefit amount will not roll over into the
next quarter nor will it roll over into the next plan year. There are no
exceptions to request additional or unused funds to be added to the member’s
card.

We
show the first quarter was used as of March 30, 2025. We confirmed the second
quarter was not used by the member. The deadline to use the second quarter $50
allowance was June 30, 2025. We reviewed the call history on the member’s
account and found there were no customer service errors made by the plan’s
customer service representatives with whom the daughter had spoken with on July
9th and July 18, 2025. The daughter was advised on July 9, 2025, a
request for a one-time courtesy to add the unused second quarter $50 allowance
could be requested, however, this is no guarantee that it will be approved. She
was advised this can take up to five days to be reviewed and completed. On July
18, 2025, she was advised the request was denied.

On
July 18, 2025, we escalated the concern to our internal partners CVS OTC
Benefits Department. We asked them to review the calls on their end made by the
daughter on July 1st, July 7th, July 9th and
July 18, 2025, for a possible one-time exception of the second quarter missed
in the amount of $50. We received a response on July 21, 2025, stating that due
to the incorrect information being provided to the member and the daughter, the
unused $50 allowance was added to the member’s card ending in ****.

We
show the member's third quarter OTC wallet allowance of $50 was added on July
1, 2025. On July 21, 2025, an additional $50 was added due to the incorrect
information being provided to the member and his daughter. We confirmed the
member has a benefit allowance available in the total amount of $100 that will
expire on September 30, 2025.

Please
know, our member will receive a detailed Medicare Resolution Letter within 7-10
business days with this response, from us, as well.

We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ***** ********’
concerns.

Sincerely,
Marilyn
G.
Analyst,
Medicare Enterprise Resolution
Customer Answer
Date: 07/21/2025

Better Business Bureau:

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

Sincerely,

***** ********
Initial Complaint
Date:07/17/2025
Type:Billing Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Aetna has refused to approve my prior Authorization, even though the procedure is covered by my health plan. I followed all of the required steps but Aetna refuses to approve the Authorization. Aetna has denied my claim in bad faith, even after the procedure is recommended by a certified physician. Aetna has accepted payments from me for 12 months in regards to this surgery. But now Aetna refuses to approve my prior Authorization now that account P.A. has been requested by the doctor.
Business Response
Date: 07/22/2025
**** ******* **********
Please see our
response to complaint # ******** for ******** ******** that was received by us
on July 17, 2025. Our Executive Resolution Team researched the concerns, and I
would like to share the results of the review with you.
Upon
receipt of your request, we immediately reached out internally to further
research the concerns. After
further review it
was determined that the incorrect facility was listed on the prior
authorization, the member’s plan requires ********* ******* to be performed at an
********* ** ******* ***** facility and that is why the prior authorization was
denied. The prior authorization has since been updated and confirmed that the
facility is an *** facility. The approval letters have been updated and sent to
the member and provider today approving the surgery. The member and provider
should receive the updated approval letters in 7-14 business days.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address Ms. ********’s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Customer Answer
Date: 07/22/2025

Better Business Bureau:

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

Sincerely,

******** ********
Initial Complaint
Date:07/15/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I switched insurance during open season, in December of 2024, the women confirmed over the telephone that I had switched and I didn't find out until June of 2025 that I wasn't fully insured because somewhere between the open season and January 1st 2025 someone over at Aetna had dropped the ball and I wasn't fully covered.
starting in January in 2025 i started radiation treatment at that time the women had said my coverage wasn't going through so i had expressed that i had switched insurance and gave her my new Aetna plan number.
Later in May 2025 i started receiving invoices from ******** ******* and ************* ****** totaling around 3,000. also at that time i got a bill from social security stating i haven't made a payment for Medicare which Aetna was supposed to make a portion of the payments.
so at the first of June i called Aetna and at that time they told me " I wasn't fully insured" though it wasn't at fault of mine they would not go back to the start of 2025 and backpay the invoices.
this is my case number at Aetna *****.
so now I am fully insured starting July 2025 but I have been Paying since January of 2025 making it to where they should be backdating these invoices.
Business Response
Date: 07/18/2025
**** ******* **********
Please see our
response to complaint # ******** for ****** ***** that was received by us on July
15, 2025. Our Executive Resolution Team researched the concerns, and I would
like to share the results of the review with you.
Upon
receipt of your request, we immediately reached out internally to further
research the concerns. After
further review it
was determined that the member is enrolled in Aetna Advantage through the
Postal Service Health Benefits program. Claims from January 1, 2025, through
May 31, 2025, were sent back for reprocessing to allow at 100 percent. The
member terminated his Medicare part B coverage, which cancels his Medicare Advantage
plan. We are unable to see premium payments paid to Medicare. The member would
need to contact Medicare regarding his premium payments. A detailed letter was
mailed to the member today, the member should expect to receive this letter by
mail in 7-14 business days.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address *** *****’s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Initial Complaint
Date:07/14/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have had multiple problems with Aetna rejecting a valid claim for my Binge Eating Disorder therapy over the past six months. My claims are consistently being rejected for an "invalid diagnostic code," however when my provider - *** ******* ******* - calls to discuss with Aetna, it is determined the diagnostic code on the superbill ******** is - in fact - valid. I have three claims that have been rejected, and despite numerous requests to customer service to have these claims re-evaluated, I am consistently told the diagnostic code is wrong and a corrected superbill needs to be resubmitted. Additionally, with each interaction over the past three weeks, I have requested a call from a supervisor. Each time I am told I will receive a call within 2 business days, and I have yet to receive a call.

The last person my provider spoke with was named Maria, and the reference number provided for that case is *********. I would like to understand the following:

1. Where the claim being re-evaluated stands;
2. Why my claims are being rejected despite the valid diagnostic code;
3. If the diagnostic code is - in fact - invalid, the correct diagnostic code that needs to be used;
4. How I can have the rejected claims re-evaluated and actioned without needing to go through customer service; and
5. How this can be prevented going forward.

I have attached a copy of my most recent superbill from July 3 that was rejected for an invalid diagnostic code for your review and comment. Thank you.
Business Response
Date: 07/18/2025
**** *** ******* **********

Please
see our response to complaint #******** for ******** ***** that was
received by us on July 14, 2025. Our
Executive Resolution Team researched your concerns, and I would like to share
the results of the review with you.

Upon receipt
of your request, we immediately reached out internally to have Mr. *****’
concerns reviewed. It has been confirmed that the diagnostic code ******
became a header category (Binge Eating Disorder). This means a more specific
option should be chosen by the member’s clinician. For example, to indicate
the severity of the binge eating disorder, the member’s clinician would need
to use a more specific code such as ******0 for mild disorder, ******1 for
moderate, ******2 for severe, ******3 for extreme, ******4 for in remission, or
******* for unspecified, etc. This change went into effect on October 1, 2024.
Multiple unsuccessful attempts have been made to contact Mr. *****’ provider
via email and phone calls to discuss this diagnostic coding update.

We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Mr.
*****’ concerns. If there are any additional questions regarding
this particular matter, please contact the Executive Resolution Team at *******************************.

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive
Resolution Team
Customer Answer
Date: 07/21/2025
Hello, my provider confirmed that he received an email from Aetna on Wednesday, July 16 with the coding update and he will be reissuing me superbills with the new coding. I would like to keep this complaint open until Aetna processes the superbills. Is it best to reject the response until that time?
Thank you,
**** *****
Initial Complaint
Date:07/10/2025
Type:Delivery Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Aetna sent a prescription to the wrong address and I am trying to seek a credit for my next prescriptin. Phalyn from corporate has elected to ghost me with limited information and other colleagues trying to help. I’ve filed a state complaint as well.

Phalyn does not answer calls at ###-###-####
Business Response
Date: 07/17/2025
**** *** ******* **********

Please see our
response to complaint #******** for **** ***** that was received us on July 10, 2025.
Our Executive Resolution Team researched the concerns, and I would like to
share the results of the review with you.

Upon
receipt of the complaint, we immediately reached out internally to further
research the consumer’s concerns. The member had a
prescription that was sent to the incorrect mailing address due to an old
Caremark profile that was selected and the address had an active range set to
April 11, 2122. This caused the systems to auto select as the preferred address
to ship to and, unfortunately, was not corrected prior to shipment. The member
cost share was $1.94.

On May
09, 2025, the dates on the alternate address were corrected to end on April
11, 2022, and the default primary address for this member was updated so going
forward any prescriptions for this account will ship to the correct primary
address. A reshipment was sent to the member, who confirmed receipt on May 12,
2025.

Typically,
a letter is then mailed to the member to sign and return confirming that they
did not receive the original shipment of medication so that a credit can be
applied to the account. Due to the escalation, the pharmacy team allowed a
one-time courtesy and did not require the letter be signed and returned. The credit
of $1.94 was applied to the reshipment order in place of payment method to
cover the cost so the member was not charged twice.

We take customer complaints
very seriously and appreciate you taking the time to contact us and giving us
the opportunity to address ****’s concerns.

Sincerely,

Phalyn C. |Analyst, Executive Resolution
Executive Resolution Team

Customer Answer
Date: 07/17/2025

Better Business Bureau:

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

Sincerely,

**** *****
Initial Complaint
Date:07/09/2025
Type:Customer Service Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am a medical provider who is submitting medical claims to Aetna. Aetna is processing my patients' claims and payments to an office I am no longer affiliated with. I have spent over 4 hours on the phone with provider services as well as their credentialing department and no one from Aetna can seem to help me resolve the matter. I have 5 call reference numbers from the last month alone where I get completely conflicting information depending on the representative who I am speaking with. Most recently was call ref # ********** with Jon C. I asked to speak to this representatives supervisor and they told me "that is not happening". This specific representative told me completely contradicting information during the same phone call. Other call ref numbers include *********, *********, *********, *********. I am continuously getting shuffled between the claims department and the credentialing department which seems to be completely separate entities within Aetna as neither of them can see the call reference numbers from the other departments to reference what is happening. Provider services tells me they cannot help me and to call credentialing, credentialing tells me they cannot help me and to call provider services. When I do finally get someone who has an idea of what to do, they recommend an endless loop of submitting a new application for my current tax id. I informed them I have done that * times (with reference numbers) and the panel is closed in the area so the application is denied immediately. They tell me without having that application on file, there is no way to fix the issue. I ask them how I am supposed to put the application on file if it is denied initially then they tell me its my fault for submitting claims without having in network status. Some Aetna reps have also told me Aetna is not able to fix the issue and I have to contact a separate entity unaffiliated with Aetna to get this fixed. I called that entity and they informed me that is incorrect.
Customer Answer
Date: 07/10/2025
Hello,
My current (new) Tax ID number is **********. My current (new) group NPI is **********. My individual NPI is **********. Current practice name is ***** ***** * ******** ************ ******** ***. Address is **** * ****** *** ******* ** ******
My old office affiliation is **** ******** ************ doing business as ******* ************ *** ********* ******* *** ******** *** ****** ** *****. Tax ID is **********.
I am happy to speak to an Aetna supervisor to provide more detailed feedback. Thank you.
Customer Answer
Date: 07/16/2025
Hello,
Are you able to ask Aetna to have a supervisor reach out to me directly or provide me with an Aetna supervisor's direct line and contact information?
My contact information is as follows:
Office- ************
Cell- ************
I have not heard back from Aetna in a weeks' time since providing the information they asked for.
Thank you for your time.
Business Response
Date: 07/24/2025
Dear ******* *********:
Please see our
response to complaint # ******** for **** ********** that was received by us on
July 10, 2025. Our Executive Resolution Team researched the concerns, and I
would like to share the results of the review with you.
Upon
receipt of your request, we immediately reached out internally to further
research the concerns. After
further review it
was determined that the provider is now using a different Tax Identification Number
(TIN) and address then what we have on file and in our system. A network ticket
was submitted under *********, this ticket was submitted to update the provider’s
address and TIN, once completed the Network representative will make outreach
to the provider directly to provide the next steps. The provider would have to
wait for the TIN and address to be updated in our system before submitting
claims that need to be reprocessed under the correct TIN and address. If the provider
has any questions or concerns going forward the first step is reaching out to
the Provider Contact Center, there the provider can get assistance from a Provider
Services representative, the telephone number is **************.
We take customer
complaints very seriously and appreciate you taking the time to contact us and
giving us the opportunity to address *** **********’s concerns. If there are
any additional questions regarding this particular matter, please contact the
Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst,
Executive Resolution Team
Customer Answer
Date: 07/25/2025

Better Business Bureau:

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

Sincerely,

**** **********
Initial Complaint
Date:07/08/2025
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Aetna is refusing to pay for dental extractions on 7/16/2024 & 11/04/2024. Extractions are listed as covered, for in-network & out-of-network dentists, in my 2024 Aetna Summary of Benefits, page 97. My dentist has called Aetna's Provider Services 3 times, & was told the extractions are covered & the claim would be reworked. I was told by Aetna Supervisors 4 times on the phone, that the extractions are covered & the claim would be reworked. Aetna sent a letter of denial saying my dentist is out-of-network. I filed an appeal & on 2/18/2025 Aetna sent a letter saying my appeal was approved & that my claim was reprocessed on 2/17/2025. When nothing arrived, I contacted Missouri State Health Insurance Assistance Program for help. Jerry Simon attempted to call Aetna 3 times, had to leave a message & didn't receive a return call. I had called that number 8 times, left a message & did not get a call back. I called Medicare & filed a complaint. On 5/20/2025 a woman named Holly called from Aetna, saying she would help resolve the issue. She gave me her personal phone number ###-###-####. On 6/13/2025 Holly called & said she would send Aetna's form to request reimbursement & would mail it that day. Nothing has come. I called Holly's number 3 times & had to leave a message. She didn't return my calls.
Yesterday I filed a complaint with our ******** ******** ******* against Aetna. Are they falsely advertising coverage or doing a bait & switch??? I would like a refund of the $470 (2 extractions @ $235 each) that were listed in my covered benefits. And an investigation to see who in Aetna is stopping my approved claim numerous times would be greatly appreciated. What Aetna is doing is illegal.
Business Response
Date: 07/17/2025
**** *** ******* **********

Please see our response to BBB Complaint #********, for *** ****** *********, which was received by us on July 8, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

We are writing to provide a formal resolution regarding your dental claims for services rendered by *** ******** ****** on July 16, 2024, and November 4, 2024.

Upon receipt of the concern, we immediately reviewed the member's account. Our records confirm your enrollment in the Aetna Medicare SmartFit (HMO-POS) plan, effective January 1, 2024, with no Low-Income Subsidy (LIS) applied.

Upon initial review, both claims were processed with a member responsibility of $235.00 each, due to denial reasons related to oral surgery and out-of-network referral. However, on December 12, 2024, both claims were adjusted to reflect $0.00 member responsibility.

We acknowledge that some subsequent communications may have caused confusion, and we sincerely apologize for any inconvenience this may have caused.

The member’s appeal, received on December 30, 2024, was reviewed under Appeal ID *********** and was approved. A decision letter confirming this outcome was sent to the member on February 18, 2025. Although the claims were reprocessed on February 17, 2025, additional manual intervention was required to finalize the resolution.

We are pleased to confirm that both claims have now been fully resolved:

• Claim ********* (Date of Service: July 16, 2024)
Paid in full: $2,405.00

• Claim ********* (Date of Service: November 4, 2024)
Paid in full: $429.00

A total payment of $480.24 (including $470.00 in principal and $10.24 in interest) was issued to the member under Payment ID ******** on July 15, 2025. Updated Explanation of Benefits (EOBs) will be mailed to the address on file.

Please note the following important clarification:
*** ******** ** ****** is an out-of-network provider with Aetna. The appeal was approved due to a misquote provided to the member’s provider indicating the service was covered. According to the 2024 Evidence of Coverage, non-routine dental care is only covered under specific medical circumstances. While this service was not a covered benefit, the appeal was granted in light of the miscommunication.

We also want to acknowledge that certain interactions during this process did not meet our service standards. We have addressed this internally and provided additional coaching to the representative involved. The member’s feedback is invaluable, and we sincerely apologize for any inconvenience caused.

The member will receive a written resolution letter within 7-10 business days.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *********’ s concerns.

Sincerely,

Melissa R.

Analyst, Medicare Executive Resolution
Medicare Complaint Team
Initial Complaint
Date:07/08/2025
Type:Sales and Advertising Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have repeatedly informed this company I am not interested in obtaining insurance through them. I have repeatedly informed this company that I have insurance. I have repeatedly asked this company not to call me. They have called me four times this morning. They called me twice last week. They called me twice a week before I don’t know how to make them stop calling me.
Business Response
Date: 07/08/2025
**** *** ******* **********

Please see our response
to complaint #******** for ****** **** that was received by us on July 08, 2025. Our Executive Resolution Team
researched your concerns, and I would like to share the results of the review
with you.

Upon
receipt of your request, we immediately added Ms. ****’s information to our Do
Not Contact List.

We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Ms.
****’s concerns. If there are any additional questions regarding
this particular matter, please contact the Executive Resolution Team at *******************************.

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive
Resolution Team

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