Complaints

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

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  Aetna Inc.

  151 Farmington Ave Hartford, CT 06156-7003

• 

  Aetna Insurance

  7799 Leesburg Pike Ste 1100 Falls Church, VA 22043-2408

• 

  Aetna Insurance

  1301 Mccormick Dr Largo, MD 20774-5416

• 

  Aetna Insurance

  14048 Parkeast Cir Chantilly, VA 20151-4218

• 

  Aetna Health Plans

  7400 W Campus Rd New Albany, OH 43054-8722

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:01/21/2024

  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.

  Billing Dispute-Erroneus Charge
  
  Charged and billed an amount that was already paid. I recieved a bill saying I owed for medication. I purchased ********* ***** from *** ******** via online pharmacy on 10/17/23. I paid the amount because they would not ship without payment. I later recieved a bill and attempts to resolve failed. I reviewed the EOR and financial sumary and both clarified that I made payment and it went toward my deductible my deductible of $505.00 and I never reached that amount during the year. See documents attached.

  Business Response

  Date: 01/24/2024

  Dear Mr. ******* *********: 
  
  Please see our response to complaint # ******** for Ms. **** ***** that was received by us on January 22, 2024.  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 reached out internally to view the member’s concerns.  The Pharmacy Department  advised that the order ********** was generated by the prescriber submitting a new prescription, as the payment method on file was set as exclusive (for the member to authorize use of only) it was not applied to the order and was shipped with an invoice for $145.97, which the balance is still on the account as we have not received payment.
  
  The Explanation of Benefits is not proof of the payment being made; it just reflects the claim was processed.
  
  If the member has proof that that payment was made for the prescription, please provide a copy, and contact Aetna so we can investigate this matter further.  The member will receive a detailed Medicare 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. *****’ concerns.  
  
  Sincerely,
  
  Cindi D
  Analyst
  Medicare Executive Resolutions

  Customer Answer

  Date: 01/24/2024

  The enclosed information is from Aetna financial summary. The summary and plan information verify that a deductible of $505.00 is required. This was not met and according to thier records I paid the entire amount for this RX which was applied to my deductibe. See attached. Medications are not send out without payment information which was provided to you via phone call as requested. Can they verify the deductible was met?

  Business Response

  Date: 01/31/2024

  Dear Mr. ******* *********:
  
  Please see our response to
  complaint # ******** for Ms. **** *****, that was received by us on January 24, 2024.  Our
  Executive Resolution Team researched the concerns, and I would like to share
  the results of the review with you.
  
  Upon receipt of the concern, we immediately reviewed the
  member’s prescription order history. We found that the member’s order for ********* *** ** *** was received by her prescriber as a new prescription. We contacted the *** ******** Mail
  Order team to review the member’s concerns. The Mail Order team advised that the member’s payment method for order number
  ********** was set as exclusive (for the
  member to authorize use of only). This
  authorized a payment hold to ship the order to the member. The order was sent
  with an invoice for $145.97. The balance of $145.97 on the member’s account is
  correct.
  
  The Deductible Stage is the first payment stage for drug
  coverage. This stage begins when members fill their first prescription for the year. When members
  are in this payment stage, they must pay the full cost of drugs until they
  reach the plan’s deductible amount, which is $505 for 2023. The deductible is calculated by the member’s out-of-pocket costs they may pay for covered
  drugs. The cost for ********* *** ** *** has been applied to the member’s deductible. This does not mean that the copay has been paid. If the member has
  proof of payment for this order, she can email it to ************************************ 
  
  We have provided details of your prescriptions that have been applied to the member’s plan deductible.
  Fill Date: March 6, 2023
  Drug: ******** *** *** ****
  Deductible: $4.29
  
  Fill Date: March 20, 2023
  Drug: *********** *** *** ***
  Deductible: $3.73
  
  Fill Date: April 12, 2023
  Drug: ******** *** *** ****
  Deductible: $11.56
  
  Fill Date: April 21, 2023
  Drug: ********* *** *****
  Deductible: $0.88
  
  Fill Date: May 3, 2023
  Drug: ********** *** ***
  Deductible: $21.35
  
  Fill Date: July 5, 2023
  Drug: ******** *** *****
  Deductible: $40.61
  
  Fill Date: July 25, 2023
  Drug: *********** *** *** ***
  Deductible: $5.06
  
  Fill Date: August 28,
  2023
  Drug: ********** *** *****
  Deductible: $14.00
  
  Fill Date: October 3,
  2023
  Drug: ******** *** *****
  Deductible: $40.61
  
  Fill Date: October 16,
  2023
  Drug: ********* *** *****
  Deductible: $145.97
  
  Fill Date: November 2,
  2023
  Drug: ****** *** ******
  Deductible: $216.94
  
  
  The complainant will be receiving a detailed Medicare
  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. **** *****’ concerns.
  
  Sincerely,
  Jasmine W.
  Analyst
  Medicare Enterprise Resolution

• Initial Complaint

  Date:01/19/2024

  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.

  I signed up with Aetna in December because my previous provider wasn't able to continue with my medication. So I called Aetna to enroll with them. I spoke to a representative and she told me at the beginning of the year when my plan starts I will be eligible for a card every quarter they put $90 for food and over the counter items. It's the middle of January and I am still getting the run around for the fresh produce.
  I think their trying to take advantage of the disable community.
  Thank for your time and attention

  Business Response

  Date: 01/26/2024

  **** *** ******* ********** 
  
  Please see our response to complaint # ******** for Ms. ****** ****** that was received by us on January 19, 2024.  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 reached out internally to view the member’s concerns. In order to receive the additional benefits, the member must qualify by having certain conditions.   These conditions are based on claims processed or an attestation.  Since this is the member’s first year with Aetna, she can complete the self-attestation with Aetna MSO engagement hub, and once deemed eligible, Aetna's internal leadership will share the updated eligibility file with NationsBenefits Client Service Team and or IT to be processed.  On An outbound phone call was on January 23, 2024, to attest the extra benefit.
  
  We reviewed the call from January 19, 2024. The representative sent a task for the attestation to be completed.  A call back was made to you on January 23, 2024.
  The member will receive a detailed Medicare 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,
  
  Cindi D
  Analyst
  Medicare Executive Resolutions

• Initial Complaint

  Date:01/19/2024

  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 had a pelvic and transvaginal ultrasound conducted at ***** ********* on 9/23/2022. My insurance provider, Aetna, through my employer, ****, denied my claim and never contacted me regarding the denial. After almost a year later, I received a bill in the mail from ***** (attached) and proceeded to contact Aetna representatives to ask why my claim was denied. No clear answer was provided and eventually the claim fell outside their window to resend the claim. I submitted two appeals (attached) requesting additional information as to why my claim was denied and why Aetna refused to cover. The response to the first appeal was that this was not a service that Aetna would cover. The response to the second appeal was that Aetna did not cover transvaginal and pelvic ultrasounds in conjunction. I requested and submitted to Aetna the ***** ********* Diagnostic Report to show that the reason both procedures were performed was to isolate the cause of prolonged pain and cramping from my IUD, a preventative care measure to ensure no long-term side effects, and also further identified a cyst that had been developing. After the second appeal, my window to pay ***** was down to the last few weeks before collections, so I paid ***** for the procedures at the out-of-pocket adjusted rate of $440 on 12/23/2023. Aetna should have provided timely communication and covered 100% of the ***** procedures as both procedures were necessary to determine the root cause. I would like a reimbursement of the $440 I paid out-of-pocket to ***** *********.

  Business Response

  Date: 01/23/2024

  **** ******* **********
  
  Please see our response to complaint # ******** for ******** **** that was received
  by us on January 19, 2024. Our Executive Resolution Team researched your
  concerns, and I would like to share the results of the review with you.
  
  Upon receipt of the member’s concerns, we immediately reached
  out internally for review. We confirmed that procedure code *****
  (pelvic ultrasound) denied correctly as incidental. The denial indicates that
  it is not patient responsibility, so the provider should not have billed the
  member for this procedure. We also confirmed that procedure code ***** (transvaginal ultrasound) was denied for requested
  information not received. However, the clinical information attached to this
  complaint is sufficient enough to have the procedure reconsidered. We
  reprocessed the member’s claim on January 23, 2024, to allow $176.67 for the
  transvaginal ultrasound which applied to the member’s in-network deductible.
  The member should receive an updated explanation of benefits (EOB) within 7-10
  business days.

  Please know, if the member paid the provider in excess of the
  contracted rate (allowed amount) for this claim, she must contact them directly
  to obtain a refund, unless
  she signed an agreement to pay for non-covered charges prior to the services
  being rendered.

  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,
  
  Shay G.
  Analyst, Executive Resolution
  Executive Resolution Team

  
  

• Initial Complaint

  Date:01/16/2024

  Type:Order 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 Complaint in this matter involves Aetna medicare health plan gold, I signed up for the Aetna medicare advantage gold, at the end of 2023,through an insurance broker, who gave me miss information, I was told by him and by customer service for Aetna , that with this plan, that I am entitled to receive, amongst other things, 150 dollars quarterly for groceries, but I never received the card that I needed .and kept getting the run around from Aetna,and the insurance broker.they told that the card is in the mail, and then they would tell me that the card is in the mail,always something different and thus went on for 3 or more weeme meks,then some one at Aetna told me the only way I would be entitled to that card, was if I was diagnosed with congestive heart failure condition,why couldn't I have been told that in the first place, instead of making excuses and telling me lies.I am outraged at this type of behavior,it's 150 dollars every 4 months, not a million dollars,I am handicapped and was relying on that money for groceries

  Business Response

  Date: 01/26/2024

  **** *** ******* ********** 
  
  Please see our response to complaint # ******** for Ms. ******* ******, that was received by us on January 16, 2024.  Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.
  
  Upon receipt of the concern, we immediately reviewed the member’s plan benefits. Aetna Medicare Advantra Gold (HMO-POS) offers a $75 quarterly benefit allowance to pay for healthy food including meat, produce, and dairy products. Members eligible for the Healthy Heart Partnership Program will receive the $75 quarterly benefit allowance. 
  
  Members diagnosed with Congestive Heart Failure (CHF) are eligible to participate in Aetna’s Healthy Heart Partnership Program (HHP) which provides members with reduced cost shares and extra benefits to support them in managing their CHF. Members must actively participate in the care management program to receive these extra services. 
  
  Member eligibility must be determined through medical claims submission. Members cannot self-attest, only provider submitted medical claims with a diagnosis supporting the condition will qualify the member for eligibility. Contact the plan if you need help scheduling a visit with a provider.
  
  The member’s concerns have been investigated through our Member Misrepresentation process. The agent has stated that he did advise that high blood pressure and high cholesterol will make the member eligible for the healthy food allowance. Unfortunately, the information provided is incorrect. We have taken the appropriate action with the agent and his hierarchy for service improvements. 
  
  The Annual Election Period (AEP) runs from October 15 - December 07 each year. Beneficiaries can use this to either enroll in or disenroll from plans and return to Original Medicare. Elections become effective January 01 of the coming year. Members may not enroll in a new plan during other times of the year unless they meet certain special exceptions. For example, if a member moves out of the plan’s service area, want to join a plan in their area with a 5-star rating, or qualify for Extra Help with your prescription drug costs.
  
  The Aetna Medicare Advantra Gold (HMO-POS) plan has a $100 quarterly benefit amount (allowance) to pay for medical cost share expenses such as physician visits, lab work, and vision and hearing exams. It may also be used to pay for additional visits for a plan covered service that has a visit limit. We have partnered with Payflex to provide this benefit. Be sure to use the full benefit allowance amount each quarter because any unused allowance amount will not roll over into the following quarter.
  
  The Aetna Medicare Advantra Gold (HMO-POS) plan has a $135 benefit amount (allowance) each quarter to purchase approved over-the-counter (OTC) health and wellness items like first aid supplies, cold and allergy medicine, pain relievers, COVID‑19 tests, and more. The $135 benefit amount is available the first day of each calendar quarter. Calendar quarters begin in January, April, July, October. Be sure to use the full benefit amount each calendar quarter, because any unused amount will not roll over into the next calendar quarter. We have partnered with OTC Health Solutions (OTCHS) to provide this benefit. The benefit amount is not connected to a payment or debit card. The member will use her Aetna Medicare Advantra Gold (HMO-POS) member ID to confirm benefit eligibility, confirm available benefit amount, and make purchases. The member can purchase approved products online, by phone or in *** stores. For details view the ***** ******* ** ****************************
  
  The complainant will be receiving a detailed Medicare 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,
  Jasmine W.
  Analyst
  Medicare Enterprise Resolution

  Business Response

  Date: 01/26/2024

  **** *** ******* ********** 
  
  Please see our response to complaint # ******** for Ms. ******* ******, that was received by us on January 16, 2024.  Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.
  
  Upon receipt of the concern, we immediately reviewed the member’s plan benefits. Aetna Medicare Advantra Gold (HMO-POS) offers a $75 quarterly benefit allowance to pay for healthy food including meat, produce, and dairy products. Members eligible for the Healthy Heart Partnership Program will receive the $75 quarterly benefit allowance. 
  
  Members diagnosed with Congestive Heart Failure (CHF) are eligible to participate in Aetna’s Healthy Heart Partnership Program (HHP) which provides members with reduced cost shares and extra benefits to support them in managing their CHF. Members must actively participate in the care management program to receive these extra services. 
  
  Member eligibility must be determined through medical claims submission. Members cannot self-attest, only provider submitted medical claims with a diagnosis supporting the condition will qualify the member for eligibility. Contact the plan if you need help scheduling a visit with a provider.
  
  The member’s concerns have been investigated through our Member Misrepresentation process. The agent has stated that he did advise that high blood pressure and high cholesterol will make the member eligible for the healthy food allowance. Unfortunately, the information provided is incorrect. We have taken the appropriate action with the agent and his hierarchy for service improvements. 
  
  The Annual Election Period (AEP) runs from October 15 - December 07 each year. Beneficiaries can use this to either enroll in or disenroll from plans and return to Original Medicare. Elections become effective January 01 of the coming year. Members may not enroll in a new plan during other times of the year unless they meet certain special exceptions. For example, if a member moves out of the plan’s service area, want to join a plan in their area with a 5-star rating, or qualify for Extra Help with your prescription drug costs.
  
  The Aetna Medicare Advantra Gold (HMO-POS) plan has a $100 quarterly benefit amount (allowance) to pay for medical cost share expenses such as physician visits, lab work, and vision and hearing exams. It may also be used to pay for additional visits for a plan covered service that has a visit limit. We have partnered with Payflex to provide this benefit. Be sure to use the full benefit allowance amount each quarter because any unused allowance amount will not roll over into the following quarter.
  
  The Aetna Medicare Advantra Gold (HMO-POS) plan has a $135 benefit amount (allowance) each quarter to purchase approved over-the-counter (OTC) health and wellness items like first aid supplies, cold and allergy medicine, pain relievers, COVID‑19 tests, and more. The $135 benefit amount is available the first day of each calendar quarter. Calendar quarters begin in January, April, July, October. Be sure to use the full benefit amount each calendar quarter, because any unused amount will not roll over into the next calendar quarter. We have partnered with OTC Health Solutions (OTCHS) to provide this benefit. The benefit amount is not connected to a payment or debit card. The member will use her Aetna Medicare Advantra Gold (HMO-POS) member ID to confirm benefit eligibility, confirm available benefit amount, and make purchases. The member can purchase approved products online, by phone or in *** stores. For details view the ***** ******* ** ****************************
  
  The complainant will be receiving a detailed Medicare 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,
  Jasmine W.
  Analyst
  Medicare Enterprise Resolution

  Business Response

  Date: 01/26/2024

  **** *** ******* ********** 
  
  Please see our response to complaint # ******** for Ms. ******* ******, that was received by us on January 16, 2024.  Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.
  
  Upon receipt of the concern, we immediately reviewed the member’s plan benefits. Aetna Medicare Advantra Gold (HMO-POS) offers a $75 quarterly benefit allowance to pay for healthy food including meat, produce, and dairy products. Members eligible for the Healthy Heart Partnership Program will receive the $75 quarterly benefit allowance. 
  
  Members diagnosed with Congestive Heart Failure (CHF) are eligible to participate in Aetna’s Healthy Heart Partnership Program (HHP) which provides members with reduced cost shares and extra benefits to support them in managing their CHF. Members must actively participate in the care management program to receive these extra services. 
  
  Member eligibility must be determined through medical claims submission. Members cannot self-attest, only provider submitted medical claims with a diagnosis supporting the condition will qualify the member for eligibility. Contact the plan if you need help scheduling a visit with a provider.
  
  The member’s concerns have been investigated through our Member Misrepresentation process. The agent has stated that he did advise that high blood pressure and high cholesterol will make the member eligible for the healthy food allowance. Unfortunately, the information provided is incorrect. We have taken the appropriate action with the agent and his hierarchy for service improvements. 
  
  The Annual Election Period (AEP) runs from October 15 - December 07 each year. Beneficiaries can use this to either enroll in or disenroll from plans and return to Original Medicare. Elections become effective January 01 of the coming year. Members may not enroll in a new plan during other times of the year unless they meet certain special exceptions. For example, if a member moves out of the plan’s service area, want to join a plan in their area with a 5-star rating, or qualify for Extra Help with your prescription drug costs.
  
  The Aetna Medicare Advantra Gold (HMO-POS) plan has a $100 quarterly benefit amount (allowance) to pay for medical cost share expenses such as physician visits, lab work, and vision and hearing exams. It may also be used to pay for additional visits for a plan covered service that has a visit limit. We have partnered with Payflex to provide this benefit. Be sure to use the full benefit allowance amount each quarter because any unused allowance amount will not roll over into the following quarter.
  
  The Aetna Medicare Advantra Gold (HMO-POS) plan has a $135 benefit amount (allowance) each quarter to purchase approved over-the-counter (OTC) health and wellness items like first aid supplies, cold and allergy medicine, pain relievers, COVID‑19 tests, and more. The $135 benefit amount is available the first day of each calendar quarter. Calendar quarters begin in January, April, July, October. Be sure to use the full benefit amount each calendar quarter, because any unused amount will not roll over into the next calendar quarter. We have partnered with OTC Health Solutions (OTCHS) to provide this benefit. The benefit amount is not connected to a payment or debit card. The member will use her Aetna Medicare Advantra Gold (HMO-POS) member ID to confirm benefit eligibility, confirm available benefit amount, and make purchases. The member can purchase approved products online, by phone or in *** stores. For details view the ***** ******* ** ****************************
  
  The complainant will be receiving a detailed Medicare 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,
  Jasmine W.
  Analyst
  Medicare Enterprise Resolution

• Initial Complaint

  Date:01/16/2024

  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.

  On 11/29/2023 I signed up for Aetna Individual Health plan and paid the fee to become active on 12/01/2023. I have called over 10 times since 12/01/2023 for information on the policy and have been told several different things. The policy was never active and the most recent email I received from their billing department was my payment was applied to 11/01/2023-11/30/2023 and no refund is due. The policy was suppose to start on 12/01/2023 and I was never covered and told several different things when I called. I never received any information regarding coverage and when I called I was not covered as they told me it was pending and they had to send in a ticket. I was told I would receive a refund and after 10 days I called back and was told to send an email when they responded to the email they stated incorrect information and did not issue refund.

  Business Response

  Date: 01/22/2024

  
  Dear Mr. *********:

  Please see our response to complaint ******** for ******
  ******** that was received by us
  on January 16, 2024.  Our Executive Resolution Team researched your
  concerns, and I would like to share the results of the review with you.

  Upon receipt of the member’s concerns, we immediately
  reached out to the Individual and Family Plan (IFP) Escalations team to have
  the concerns reviewed. Per their review, they found the member has five policies
  with five different member identification (ID) numbers loaded into the Aetna
  system. Successful outreach was made to Ms. ******** and she was made aware of
  the findings. The member had at least three applications on the Marketplace
  along with signing up with the Aetna TeleSales Division. Ms. ******** made a successful
  payment on November 29, 2024, in the amount of $371.17. Ms. ******** advised
  she was currently enrolled with ****** and only wanted a refund from Aetna. All
  the member’s accounts were reviewed, and we confirmed there was no claim
  activity on the accounts. Th member’s plans were voided and a refund of $371.17
  is in progress back to the member’s original form of payment.

  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,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

  Customer Answer

  Date: 01/22/2024

  
  
  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:01/16/2024

  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 was required to apply for ****** ******** Disability Insurance in order to receive disability benefits from my former employer. July 2023, I began contacting my former employer to seek info how Medicare would work with my Aetna Health Insurance. I made numerous calls to Medicare, ****** ********, **** and Aetna. Both Medicare and ****** ******** said that my former employer or Aetna should provide this info. My mother passed away in July 2023 so I had to put my research on hold until early September. 9/6/23, I jointly called Aetna with a **** employee on the call. The Aetna employee I spoke with, Leann H***** told us Aetna was the primary payer and Medicare the secondary payer. Based on this I cancelled my Medicare Part B effective 9/6/23 (which Medicare backdated to 9/1/23) because Aetna said I had creditable coverage and they were the primary payer. I sent a copy of the Medicare cancelation form to Aetna 9/6/23 and again after I was told it wasn't received. 12/19/23 I received a letter from Aetna saying Medicare had become the primary payer 9/1/23 and that I owe the amount that they estimate Medicare would have paid 9/1-12/31/23. I immediately began calling Aetna, explained what I was told by Leann H*****. I called numerous times requesting a call back from Aetna Medicare team. I never received a call. I received an online survey from Aetna so I complained about the issue. 1/5/24, the survey dept. called me and they had done their research. I was told that I had done everything right and yes, they listened to my call and yes, Leann had told me Aetna was primary. The manager I spoke with, Christopher told me it was a training issue that had been address but they would or could NOT write off the loss. I have numerous medical bills I am now been back billed from all the providers I saw 9/1-12/31/23. Even the ******** form I had to send to Medicare clearly indicates in section 6 that ****'s insurance is my primary payer 4/2021 - 1/2027. I need help!!

  Business Response

  Date: 01/19/2024

  Dear
  ******* *********:
  
  Please see our response to complaint # ******** for ***** *********** that was
  received by us on January 16, 2024. Our Executive Resolution Team researched
  your concerns, and I would like to share the results of the review with you.
  
  Upon receipt of the member’s concerns, we immediately reached
  out internally for review. We
  confirmed that the member’s Aetna plan is set up to estimate Medicare Part B
  whether enrolled or not, once the member is eligible. Unfortunately, we are
  unable to waive the estimation. Please know, we reviewed the call placed on
  September 6, 2023, with Aetna representative Leanae. The member called
  informing she was advised by ****** ******** ********** *********** (****) that
  she must enroll into Medicare Part B as it’s required. Member stated if she
  cannot be covered by Aetna fully and get out of the Medicare deductible, she
  will cancel her plan. Leanae educated the member that per our system (coordination
  of benefits (COB) tool), Aetna is primary, Medicare is secondary, and Medicare
  Part B is not required by Aetna. The information provided to the member with
  respect to the order of benefits was correct. Then, they conferenced in *****
  from the **** benefits center who advised that Medicare Part B is required, otherwise
  the member will be responsible for what Medicare would have paid (estimation) which
  is correct per policy. ***** proceeded to advise that the member can disenroll
  from Medicare since she is planning to keep the Aetna plan. Although the Aetna
  customer service representative missed the opportunity to reinforce/revisit the
  Medicare Part B estimation during this interaction to set proper benefit
  expectations, all directions to disenroll were provided by the **** benefit
  center.

  Any eligible claims during the
  time period of which the member was enrolled with Medicare Part B should be
  covered as Aetna primary and Medicare secondary. However, any claims after the
  disenrollment from Medicare Part B effective September 1, 2023, would be
  subject to Medicare Part B estimation.

  If the member disagrees with
  our response, she has the right to appeal the claims for further consideration.
  In addition, we recommend that the member follow up with ***** and/or Lauren at
  the **** benefits center for additional questions concerning the disenrollment.

  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,
  
  Shay G.
  Analyst, Executive Resolution
  Executive Resolution Team

  Customer Answer

  Date: 01/30/2024

  Aetna did NOT provide accurate detail in their response.  They lied and this will be proven when my attorney which I was forced to hire subpoenas the recordings of all the calls I made to Aetna and USAA.

  1. ***** was on the 9/6/23 call to Aetna from the very beginning she did NOT join the call later

  2. Aetna told me they were the primary payer, not Medicare.

  3. No estimation of benefits was discussed during this call.

  4. While ***** is a **** employee she IS NOT in Human Resources NOR does she work for the **** Benefit's center.  She sells Medicare Advantage Plans to **** customers and has nothing to do with employee or former employee benefits.  USAA's Human Resources team transferred me to this department and even ***** was confused.  She simply suggested that I call Aetna and agreed to jointly call because I was so distressed.  ***** was aware that I had been trying since July 2023 to get information about how my Aetna insurance would work with Medicare from **** Human Resources and/or their Health Benefit folks (which is managed by a 3rd Party vendor not **** HR team).  

  5. I have attached the C******* (it took **** a month to even get me a filled out form) in which **** states they are the PRIMARY PAYOR, April 2021 through January 2027.  I turn 65 in January 2027.

  So Aetna gives me wrong information, **** couldn't provide an answer and neither could the Benefit Center **** outsources this to: So how am I supposed to make a sound decision when no one provided me with accurate information.  

  Business Response

  Date: 02/09/2024

  
  Dear Mr. *********:

  Please see our response to complaint ******** for ***** *********** that was received by us on February 08, 2024. 
  Our Executive Resolution Team researched your concerns, and I would like to
  share the results of the review with you.

  Upon receipt of the member’s
  concerns, we immediately reached out internally to have the concerns reviewed.
  The Plan Sponsor Liaison (PSL) for the member’s health plan contacted United
  Services Automobile Association (USAA) regarding the member’s rejection to our
  previous response. **** instructed Aetna to continue paying as primary. The PSL
  advised she would update the coordination of benefits (COB) on the member’s
  account. The member will need to contact the **** Benefit Center with any
  additional questions or concerns.

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

  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

• Initial Complaint

  Date:01/16/2024

  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.

  Aetna is practicing corrupt business practices. First they lied and told me I had medical insurance in ******* and not ********. The second lie was that they took an otc order a week ago, but never provided me with a confirmation number. The website clearly states orders take 2 days to process and ship. The customer service representatives are in their beds being very nonchalant while claiming to assist you by transferring the call or telling you to call back again at a later date. ******** stop being corrupt with your business practices!!!!!!! This is corruption because they ask for you to pay for the taxes to trace your bank card. Being a former state employee, I know this is a program by the state of ******** to help disabled people, NOT to steal and be corrupt!!!

  Customer Answer

  Date: 01/18/2024

  This complaint has been resolved. Thank you. 

• Initial Complaint

  Date:01/16/2024

  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.

  My provider requested prior auth for anterior cervical discectomy and fusion surgery on 10/17/23. PA was only partially approved, thus my neurosurgeon requested an appeal. Appeal was upheld citing several reason for denial. 1) Lack of network deficiency. I am in the out of area plan which means network availability should not be a consideration. 2) Lack of at least moderate central/foraminal and/or lateral recess stenosis or nerve root or spinal cord compression at C 4-5. MRI report which was supposedly reviewed by Aetna states “mild to moderate neuroforaminal stenosis” at C4-5. 3) Implants cannot be approved without being specified. The materials list was given to Aetna’s precert nurse per phone call with the neurosurgeon’s office and was faxed to Aetna on 11/02/23. I obtained all of the documents related to my prior auth from Aetna and the fax was included and should have been considered with the appeal. Appeal was not even submitted until after 11/17/23. Additionally, I feel it is appalling that Aetna is the only major payer which feels the use of synthetic cages/spacers are not medically necessary and require patient’s to have outdated and painful bone grafts instead. I have paid my premiums and this is a breach of contract in my opinion. The only partial approval of my surgery has led to possible permanent nerve damage plus unnecessary pain and suffering. Additionally, I mailed a request for external review on 12/07/23 through **** next day air with signature required. **** stated there is a “premium forward” in place at the address which is undeliverable. The external review phone# transfers to voicemail. I have left 4 voicemails over the last month and have never received a call. I attempted to fax my external review and the fax# on the external review form does not allow faxes. It appears Aetna does not actually allow external reviews, which is very concerning and unethical.

  Business Response

  Date: 01/22/2024

  
  Dear Mr. *********:

  Please see our response to complaint ******** for ****** ***** that was
  received by us on January 16, 2024.  Our Executive Resolution Team researched your
  concerns, and I would like to share the results of the review with you.

  Upon receipt of the member’s concerns, we immediately
  reached out to our Clinical team to have the precertification handling and the
  appeal case reviewed for proper handling. Clinical advised the precertification
  and the appeal cases were appropriately reviewed, and the case was sent for external
  review on January 04, 2024. We’re unsure about the issues regarding the member’s
  attempts to contact the external review vendor however, it appears her requests
  for external review were received and is currently in processing. The member
  will need to allow time for that external review to be completed. Once it’s
  completed, the member will be notified of the decision. The member’s appeal
  options with Aetna are now exhausted and we’ve confirmed the External Review
  Option (ERO) contact information listed in the appeal letter is correct. The member’s
  Better Business Bureau (BBB) complaint mentioned having her deductible and
  out-of-pocket maximum costs refunded back to her. Unfortunately, we’re unable
  to refund any financial responsibilities the plan requires. Deductibles and
  coinsurance amounts are the member’s legal financial obligation of the plan.

  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,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

  Customer Answer

  Date: 01/28/2024

  
  
  Better Business Bureau:
  
  
  
  I have reviewed the response made by the business in reference to complaint ID ********, and will accept the response with extreme prejudice. My statements were true and accurate and my prior authorization request was wrongly denied. I am accepting the response only due to the fact that I refuse to argue further with Aetna. I will proceed to do what is in my best interest to avoid permanent nerve damage. I find it odd that most of the BBB complaints proceeded with a phone call from an Aetna representative explaining the decision but I have received none. With regard to my external review. I was notified by the external review team that my complaint was received on 12/26/23. My complaint was mailed on 12/07/23 and arrived in ******* ** on 12/08/23. It took that long to be delivered to Aetna’s external review address due to a mail forward in place. That does not seem to be in patients best interest.
  
  
  
  Sincerely,
  
  
  
  ****** *****

• Initial Complaint

  Date:01/14/2024

  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.

  Regarding *** ******** Mail Order losing a fulfillment of a ****** prescription and refusal to admit their mistake and willingness to correct and send a replacement.
  
  Order # **********
  Date 01/01/2024

  Business Response

  Date: 01/17/2024

  Dear Mr. S****** **********
  
  Please see our response to the complaint # ********, for Ms.
  ****** ******, which was received by us on January 16, 2024. Our Executive
  Resolution Team researched the concerns, and we would like to share the results
  of the review with you.
  
  Upon receipt of the member’s complaint, we immediately
  reviewed the member’s account. It is our understanding that *** ****** ******’s
  concern is regarding the *** ******** Mail Order Pharmacy losing a fulfillment
  of a ****** prescription with order number **********. The *** ******** Mail
  Order Pharmacy refusing to admit the mistake, and willingness to correct and
  send a replacement order.
  
  We show our Executive Resolution Team was contacted about
  this same concern on January 10, 2024. At that time the complaint was forwarded
  to *** ******** Mail Order Pharmacy team and the *** Retail Leadership team to
  launch an investigation based on the concern.
  
  The *** ******** Mail Order team responded stating, order
  number ********** shipped on January 4, 2024, with **** tracking number
  **********************. The *** ******** Mail Order team identified there was
  no movement due to a backlog in the ******* area, which resulted in delayed
  packages and stalled tracking scans. The *** ******** Mail Order team confirmed
  the shipment was in route and the expected delivery date is January 16, 2024.
  
  The *** Retail Leadership team responded stating, the
  incident was reported to the Presidential Refuse to Fill Team for handling, and
  they will send a response directly to the member regarding this concern.
  
  Based on the conversation with the member and our Executive
  Resolution Team had on January 17, 2024, it was confirmed Ms. ****** received a
  temporary fill on January 16, 2024, at her local retail pharmacy, and confirmed
  that she received the *** ******** Mail Order number ********** on January 17,
  2024.
  
  Please know, the member will receive a detailed Medicare
  Resolution Letter within 7-10 business days with this response.
  
  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,
  Marilyn G.
  Analyst, Medicare Enterprise Resolution

  Customer Answer

  Date: 01/19/2024

  
  
  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:01/12/2024

  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.

  Re: Appeal Denial for ****** (*** ******** ID: **********)
  
  I am writing to express my deep concern and dissatisfaction regarding the denial of coverage for the prescribed medication, ******, under my member ID **********z This medication was recommended by my physician, *** ****** ******* of ******* * ****** ****** ** ********** ****, due to my medical necessity for weight loss, which was supported by a thorough appeal submitted by *** *******.
  
  Despite the compelling reasons outlined in the appeal, I received notice of denial from *** ********, and subsequent attempts to seek clarification or assistance in this matter have been unfruitful. Regrettably, the representatives I have contacted have been unable to effectively communicate the reasons behind the denial due to language barriers, hindering my ability to understand and address the situation.
  
  This denial of coverage for a medication crucial to my health and well-being has put me in a distressing position. As someone committed to improving my health through healthy lifestyle changes, the denial of this medication significantly impacts my ability to manage my weight effectively, posing risks to my overall health and well-being.
  
  I urge Aetna to reconsider and review this case thoroughly, taking into account the professional judgment of *** ******* and the medical necessity outlined in his appeal. Additionally, I request transparent and clear communication regarding the reasons for denial and a viable path to resolve this issue promptly.
  
  I kindly request your immediate attention to this matter and a swift resolution that ensures access to the prescribed medication in alignment with the terms of my policy.
  Thank you for your prompt consideration and anticipated cooperation in resolving this pressing issue.

  Business Response

  Date: 01/19/2024

  Dear Mr.
  ******* *********:
  
  Please
  see our response to complaint #******** for
  ********* ******* that was received by us on January 19, 2024. 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 to our Clinical Management Team, who reviewed Ms.
  *******’s concerns. Based on their review they confirmed that we have received
  an appeal under case ************* for the denial of the medication ******. It
  has been confirmed that the appeal upheld the denial of the medication ******
  as a plan exclusion.
  
  Ms. *******’s plan covers only certain prescription drugs in
  accordance with the plan and the preferred drug guide (formulary). This plan
  does not cover all prescription drugs. Ms. *******’s prescription drug benefit
  may be subject to pharmacy management programs including, but not limited to
  precertification, step therapy, quantity limits and drug utilization review.
  
  According to the member’s current pharmacy benefit plan,
  ****** is not a covered benefit. Drugs or medications that are used for the
  purpose of weight gain or loss, including, but not limited to stimulants,
  preparations, foods or diet supplements, dietary regimens and supplements,
  food or food supplements, appetite suppressants or other medications are
  contractually excluded. Ms. ******* may reference the certificate of coverage
  for full explanation of benefits.
  
  A
  copy of the appeal resolution letter has been including with this response.
  
  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