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 Inc.

  99 Park Ave Rm 3R New York, NY 10016-1601

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  Aetna Inc.

  12209 Shaffer Rd Swanton, OH 43558-9425

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  Aetna Inc.

  4235 Electric Rd Roanoke, VA 24018-8445

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:08/01/2023

  Type:Customer Service 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 been in contact with Aetna for the past week in regards to my pending pre-authorization that was sent over from my doctor's office. I have requested many callbacks and have not received any. My authorization has continued to be declined, even though I have been on this medication for the past 4 years. I am now coming out of remission for my disease due to this delay, as I have been unable to receive the medication that is necessary for my life. I expect monetary compensation as well as a formal apology from Aetna for the pain and suffering I know endure, or I will have no choice but to contact an attorney. I, along with my doctor's office have been told lies and hung up on by several Aetna representatives. This is not how a a health insurance company should handle immediate requests for the sake of a patient's health. We have submitted MULTIPLE requests for this to expedited and have been promised callbacks and have not received any. I would like to reiterate that I am now in pain due to my disease, since I have had to go without my medication. This is strictly due to Aetna's negligence.

  Business Response

  Date: 08/01/2023

  
  **** *** **********
  Please see our response to complaint ******** for **** ********** that was
  received by us on August 01, 2023.  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 identified
  the member already had an open appeal in process. Upon review of that appeal,
  it appears the decision was rendered on July 31, 2023, and the decision was to overturn
  the previous denial. The provider was sent a copy of the approval letter via
  fax on July 31, 2023, and I’ve attached a copy of that letter to this response.
  Based on the clinical review notes in the appeal, it appears new clinical
  information was received which shows the member has been on this medication
  since February 2019 and has achieved and maintained remission. There were no
  errors identified in the handling of the member’s medication request and the
  new clinical information submitted by the provider’s office is what allowed the
  decision to be overturned.

  The member requested Aetna to compensate him for pain
  and suffering he’s experienced during the process of getting his medication
  approved. Unfortunately, Aetna doesn’t compensate for time spent on phone
  calls, following the appeals process, precertification process, etc. however,
  we do sincerely apologize for any inconvenience this may have caused to Mr.
  **********.

  We take customer complaints very seriously and
  appreciate you taking the time to contact us and giving us the opportunity to address Mr. **********’s concerns. 
  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

• Initial Complaint

  Date:07/31/2023

  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.

  In July 5 I noticed that most of my claims for 2023 and most of my already met deductible had disappeared from my online claims summary. I contacted Aetna via phone and after lengthy discussions was assured that the claims were inadvertently removed on would be re-entered in 7-10 days and I would be contacted. That my deductible and out of pocket would be updated and marked as satisfied. I received no call and no adjustment to deductible or out of pocket expenses was made. on the 19th of July I noticed even more claims all of my deductibles and out of pocket had been removed. I again call Aetna and was assured that I would receive a response by July 29th. Nothing.
  
  Aetna group ****************
  Id ***** *****

  Business Response

  Date: 08/01/2023

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

  Please see our response to complaint ******** for *******
  **** that was received by us on July 31, 2023. 
  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, I reached out to
  the Plan Sponsor Liaison (PSL) to have the concerns reviewed. The PSL advised Mr.
  **** is part of the 266 impacted members involved in an escalated rework project
  due to coding errors identified that have not been resolved. The project is
  currently being worked on as an escalated priority due to the timing. There
  were some system errors encountered at the onset of the project that caused some
  delays. The project is currently on track and a communication is expected to go
  out to all impacted members advising there are claims being zeroed out and
  getting reprocessed. The estimated time of completion as of right now is mid-August.
  Again, all impacted members will be receiving written communication regarding
  this issue. We understand how frustrating this issue is for all who are
  impacted and our teams are working diligently to get the issues resolved.

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

  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

  Customer Answer

  Date: 08/02/2023

  
  
  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.
  
  
  I will follow up if this action does not take place as described.
  
  Sincerely,
  
  
  
  ******* ****

• Initial Complaint

  Date:07/26/2023

  Type:Service or Repair 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 trouble ever since I have Aetna could never seem to get my benefit card for almost 2 months I cannot seem to get my prescriptions refilled I cannot seem to get registered to get contacts for my eyes I have my teeth super glued in and can't seem to get anybody to get my form over to be approved by Aetna. It is nothing but a run around now I have changed health plans again tonight ****** ********** which I will not use whatsoever cuz I feel like I was forced to change plans because my plan they do nothing for me it's nothing better run around on the app I can never get on the app and someone on the other side is stopping me from registering on the app they definitely need to be turned in get more professional on their apps these are my benefits I have the right to use all of my benefits if I need to. I will no longer go to my doctor cuz I do not know what insurance card to use now since they confused ** **** *** ** me by not sending it for a whole month or two and then by time I change again I don't get that card for another month or two so I'm missing out all my benefits because no one's turning in my claims I can't seem to get any prescriptions refilled I can't get my contacts for my eyes I'm running around with one contact in my eye for now 2 months now and I still can't see cuz I need to be renewed and I have a wonderful insurance but I can't seem to use it I'm getting very frustrated with all this Medicare benefits that I'm supposed to have but I never get.

  Business Response

  Date: 08/01/2023

  **** *** ******* **********
  
  Please see our response to your complaint # ******** for Ms.
  **** ******* that was received by us on July 26, 2023. Our Executive Resolution
  Team researched the concerns, and I 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 Ms. **** *******’s
  concern is about not being able to use her plan benefits. She also mentions not
  receiving her member ID card timely and providers not submitting her claims.
  
  After reviewing the member’s account, we confirmed the
  member was enrolled into an Aetna Medicare Assure 1 HMO D-SNP plan effective
  May 1, 2023, and a termination date of July 31, 2023. On April 22, 2023, we
  mailed the member a letter confirming her enrollment into the Aetna Medicare
  Assure * *** **** plan effective May 1, 2023. This letter included her member
  ID number. The letter advised:
  
  "This letter is proof of insurance that you should show
  during your provider appointments until you get your member card from us. This
  letter is also proof of your prescription drug coverage. You should show this
  letter at the pharmacy until you get your member card from us."
  
  We confirmed the member's ID card was mailed to her on May
  16, 2023.
  
  We confirmed the member has been using the online portal/app
  since May 29, 2023. After reviewing the members secure messages, she sent into
  our customer service portal the types of things she is asking would be things
  she would need to discuss with her attending providers as our customer service
  representatives are not medically trained to give medical advice. Which we
  confirmed she was advised in the replies from our customer service
  representatives.
  
  We confirmed the member has been getting prescriptions
  filled since May 8, 2023, through the plan at her local retail pharmacy.
  
  The plan pays up to $515 every year for non-Medicare
  covered prescription eyewear. You are responsible for any amount above the
  eyewear coverage limit. Our plan partners with EyeMed to provide your vision
  benefits. To find a network provider, search online at *********************** or call ###-###-####. If you choose to use a
  provider outside of the network, your services will not be covered. We
  confirmed we have not received any claims from an Ophthalmology provider for
  vision or contact lens, during the three months the member was enrolled into
  the plan.
  
  We confirmed the member went to her family practice on May
  8, 2023. The plan paid $0 on this claim, as the member has a spend-down
  deductible of $226.00. The member responsibility on this claim is $84.94 that
  applies to the spend-down deductible.
  
  We confirmed we received a dental claim from a dental
  provider for date of service June 21, 2023. This claim listed an oral
  evaluation and a panoramic radiographic image. The plan paid the claim and the
  member had $0 responsibility. We do not show any pre-determinations sent by
  this dental provider to have other dental work provided to the member. Which is
  required per her plan benefits to consider as medical necessity.
  
  Please be advised if the member has any outstanding claims
  from her providers between the dates of May 1, 2023, and July 31, 2023, while
  enrolled into her Aetna Medicare * *** **** plan, she can have her providers send
  those claims to the plan for processing.
  
  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

• Initial Complaint

  Date:07/26/2023

  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.

  1. Me and my wife chose the Aetna Medicare PPO three years ago.
  I have a Aetna Medicare PPO card since than issued by Aetna.
  I got the CT scan at the ******* ********* on July 14 , paid $660.
  I contacted Aetna for my coverage. They said I enrolled Aetna Medicare HMO.
  It’s not right, I have a PPO card(attached). This one should be corrected. If I requested HMO, I should have HMO card, but I have PPO card.
  2. I’m PPO policy holder, so my portion is $250(deduction).
  I request $410 refund from Aetna.

  Business Response

  Date: 08/04/2023

  Dear Mr. ******* *********: 
  
  Please see our response to complaint # ******** for Mr. ****** *** that was received by us on July 26, 2023.  Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.
  
  We contacted the provider and confirmed that the had signed an agreement to pay for service since the preauthorization was denied.  The provider also advised the member the cost was $600 if the procedure was not covered.  If the authorization was approved, the member’s cost share would have been $250 with your HMO Plan.
  
  The member has a right to appeal that can be done online at ***************** or mailed to:
  Aetna Medicare Grievance & Appeals
  ** *** *****
  ********** ** *****
  **** **************
  
  The member had enrolled  online in the Aetna Medicare Select Plan (HMO-POS) on November 23, 2022.  The ID Card for the PPO plan was sent on November 22, 2022.  A new card with the HMO Plan was sent on November 26, 2022.
  
  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 Mr. ***’s concerns
  
  Sincerely,
  
  Cindi D
  Analyst
  Medicare Executive Resolutions

• Initial Complaint

  Date:07/25/2023

  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 signed up for this type of insurance to cover prescriptions but ended up canceling and sending my card back to the company before the 30 day process after speaking to a representative that told me if I haven’t used the card then I wouldn’t be billed. I was told 2 times within the month of May and June that I didn’t owe anything but recently got a bill from them stating I owed them $64.40. I called them and explained to them that I was told I didn’t owe anything since I returned the card and the representative said not true because it was used. I asked them to send proof when the card was used and where but them would never provide me with the information. This company preys on senior citizens and I am requesting for them to zero out my account and send me proof as such since I don’t owe them anything

  Business Response

  Date: 07/28/2023

  **** *** ******* **********
  
  Please see our response to your complaint #******** for Ms. ***** ******* that was received by us on July 25, 2023. Our Executive Resolution Team researched the concerns, and I 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 Ms. ***** *******’s concern is about receiving a bill for $64.40. The member also mentions she was informed by our customer service that if she did not use her card/plan benefits within 30 days of enrolling, then she wouldn't be billed and could cancel her plan.
  
  We have confirmed the member was enrolled into a ************ ****** prescription drug plan. The members start date of her plan was April 1, 2023, and her plan end date is June 30, 2023. The member’s monthly premium is $16.10. The invoice mailed on June 14, 2023; the total amount due on this invoice was $64.40. The plan bills a month in advance on the invoices, therefore the invoice was reflecting July’s premium. Another invoice was mailed on July 12, 2023, and this invoice reflects the actual amount due of $48.30. (3 months X $16.10 monthly premium = $48.30)
  
  We confirmed the member’s account shows she received medications in April and June of 2023. We show monthly statements of her explanation of benefits were mailed to her that show she bought the medications and her cost-share of the amount she paid. The explanation of benefits would be the proof she is requesting we send to her.
  
  We reviewed multiple calls made into the plan above this concern. There were no errors found by our customer service representatives as on these calls the member was saying there was no *** Pharmacy close to her and she wanted to cancel her card and send it back. Our customer service representatives tried to help the member by providing her other local pharmacies in her area. However, the member insisted on canceling her plan. Our customer service representative mailed a disenrollment form to the member on May 25, 2023. We confirmed voluntary disenrollment was received on June 14, 2023. Keep in mind, the termination of a plan once we confirm disenrollment is the last day of the month that the disenrollment request id received. The member’s plan stopped on June 30, 2023. We confirmed we mailed the member a confirmation letter of her disenrollment on June 17, 2023. This letter states as follows: 
  
  This is to confirm your disenrollment from ************ ****** (PDP). Beginning July 1, 2023, ************ ****** (PDP) will not cover your prescription drugs.
  
  Please know the plan sends bills up to three months after a member is disenrolled from the plan. It is up to the member if they pay the balance on the account. The plan does not send unpaid balances to collection agencies. However, should the member ever choose to re-enroll into the ************ plan she would be responsible for any previous balances owed on her account. 
  
  The member will receive a detailed Medicare Resolution Letter, along with copies of her Explanation of Benefits, 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

• Initial Complaint

  Date:07/25/2023

  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.

  ****** ********** ******* charges 450 dollars per scan with no insurance customers. When they billed my insurance company they charged 3 times of the money what they charge to customers with no insurance.
  
  As a Aetna memeber, in this scenario, if my deductible is not, I will end up in paying 3 times the money which a non insured customer must have paid.
  
  Same thing happened to me with my eye doctor, where insurance told me to pay 3 times the money from what I had paid without insurance.
  
  We pay several thousand dollars in insurance premium each year to get discounted price, but learning the price get 3-4 times more than you get peanuts of discount, doesn't make sense.
  
  I am here bringing the dispute for charges made for services on -
  
  5/9 - opthomologist - non insured member should be paying 175-250
  7/15 - ****** ******* *** *********** - 450 per scan - flat rate.

  Business Response

  Date: 08/02/2023

  Dear Stewart Henderson:
  
  Please see our response to complaint
  #******** for ***** ******* that was received by us on July 25, 2023.  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 Claims department to assist with our investigation. After review we found that
  the claims in question were originally submitted to us with amounts higher
  than the providers’ contracted rates. We processed the claims using the rates
  that the providers agreed upon with Aetna, which was a reduction from the full
  reported charges. The provider represented the full charges as the actual
  amount being billed to the member, and our rates do represent a discount over their
  normal charges. If the providers offer other discounted rates under other
  circumstances that is an office practice under their own discretion as a private
  entity. Aetna can only enforce costs and pricing in terms of the providers’
  contracts with Aetna, for covered Aetna members. Since the claims were
  correctly paid in accordance with the member’s applicable benefits, and the contract
  Aetna has with the respective providers, we are unable to adjust the billing.
  
  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,
  
  William B.
  Analyst, Executive Resolution
  Executive
  Resolution Team

• Initial Complaint

  Date:07/24/2023

  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 coverage for my kids through the ** **** program for about a month (approximately June-July 2022) while between jobs. After a month I found a new job with employer provided coverage so I cancelled this plan. No problem there. But then a year later I got a letter about my plan being renewed. I called in confused and said I don't need the coverage, I did not request this and I already had an employer provided plan. They they passed me off to the local **** branch of the ** **** program who couldn't help me because they were in the process of initiating that branch and weren't up to speed yet. After being passed around and calling 3 different people I got in touch with the statewide ** **** and they said they removed me from the program. I thought it was taken care of but then the bills from Aetna ****** ****** **** started coming. I've spoken to someone there 3 times and they make an excuse about how I am cancelled but it won't update in the system until the end of the month. They said just throw the bills in the trash and ignore them and they would stop after May. They didn't. Three months have passed and I keep getting constant calls and mailings about my late bills. I don't need nor ever asked for the coverage so I'm never paying it, but they refuse to cancel it. Month after month the bills keep coming with a late due balance and a threat that coverage will be cancelled. I wish they would follow through on that threat. Beyond that I am worried about these past due charges going to collections. I never requested this coverage and I don't need it, so why am I being charged for it and they refuse to cancel it? Instead they send at least 6 or more mailings per month and constant phone calls. When I return these calls, no one there is able to cancel the plan.

  Business Response

  Date: 08/02/2023

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

  Please see our response to complaint # ******** for ******* ***** that was received by us on July 24, 2023. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

  Upon receipt of the complaint, we immediately reached out internally for review. During the information technology (IT) transition of children’s health insurance program (****) member identification numbers in April and May, issues were discovered with the integrity of the eligibility files from the State. It appears that had a direct impact on Mr. *****.
  
  We received an incomplete application on May 22, 2022, therefore the member was in an “Enrolled Incomplete” status prior to the IT transition. Per the office of ****, no member could be terminated if enrolled during this transition.

  We confirmed that the member is no longer enrolled with Aetna Better Health **** and his eligibility with the plan has been voided effective May 1, 2023. Please know, an email was sent to the State to update the member’s termination date. Per finance, Mr. ***** should not receive any further bills and should disregard the invoices he has received. Furthermore, the member’s call history has been reviewed for feedback opportunities.

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

  Sincerely,

  Shay G.
  Analyst, Executive Resolution
  Executive Resolution Team

  Customer Answer

  Date: 08/02/2023

  
  
  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, assuming that the billing does actually stop as promised. Thank you to BBB and Aetna for the speedy resolution.
  
  
  
  Sincerely,
  
  
  
  ******* *****

  Customer Answer

  Date: 08/29/2023

  After the previous message from Aetna Better Health Kids I believed the issue was resolved but unfortunately nothing has changed and they have continued to contact me and bill me. Please see the 3 attachments.

  The first attachment (chip1) came about 2 weeks after my last contact with the BBB after Aetna had promised to cease contacting me. This invoice includes a strange credit of $437.00, although I have never paid them for my non-existent plan. This invoice adds another $146.72 to the bill for non-existent plan. See the attachment (PA_DHS) for confirmation of my cancellation and ending of eligibility for CHIP coverage dated 4/25/2023. Note that this was 4 months ago.

  The second attachment (chip2) came today. This is yet another bill for $146.72.

  The third attachment (chip3) also came today. This is the strangest mailing from them yet; a welcome letter for a "new" plan and a membership card.

  What will it take for Aetna Better Health Kids to close these accounts for good and stop sending me bills. They could not get it done in 4 months?

  Customer Answer

  Date: 08/30/2023

  I'm updating this complaint again with additional mailings that I continue to receive referencing my son's "new benefits" that were confirmed cancelled 4 months prior.

  Business Response

  Date: 09/07/2023

  **** *** **********

  Please see our response to complaint ******** for *******
  ***** that was received by us on August 29, 2023. 
  Our Executive Resolution Team researched your concerns, and I would like to
  share the results of the review with you.

  Upon receipt of the concerns, we immediately reached
  out to our Aetna Better Health (ABH) Medicaid department for review. Upon
  completion of their review, they advised the system has been updated to show a
  term date of May 31, 2023. Additionally, the ABH department advised they will
  reach out to the state and ask them to send us a termination of coverage with a
  term date via the member eligibility file. At the time of the original
  complaint, our internal system showed the member was active as of May 01, 2023,
  with no term date. The state’s website shows the plan was active from May 01,
  2023, through May 31, 2023. However, the state did not send a May 31, 2023,
  term date on any subsequent eligibility files. Since there was no term date
  provided from the state regarding the eligibility, the member remained active
  effective May 01, 2023, with ongoing coverage. The system has now been updated
  to reflect coverage terminated as of May 31, 2023. Any notices sent were based
  upon the information sent to us from the state (eligibility file). Therefore,
  the notices we were sending are required to be sent per the state.

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

  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

• Initial Complaint

  Date:07/21/2023

  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.

  Back in March 2023, I called Aetna and asked if a certain PCP could be my designated provider and they said yes she was in network and I was OK to see her that day.
  Couple days later the provider bills me for almost 300 dollars because Aetna said she wasn't in network.
  That's hilarious, because your employees told me she was. I rejected there claim and asked for repayment.
  
  I don't care if she is or isn't in network, you told me she was. I'm not here to fund your company's employees incompetence the company is responsible for that.
  I've been fighting them since march to send me a refund check and they ***** with me everytime I call.
  This needs to be resolved otherwise I will consult a lawyer and you will be paying me back my money plus legal fees.

  Business Response

  Date: 07/28/2023

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

  Please see our response to complaint ******** for **** **** that
  was received by us on July 21, 2023.  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 Family Plan (IFP) team to have them review the
  member’s concerns. Our IFP team reviewed the call between the member and Member
  Services and determined the member could have easily misinterpreted the
  representative’s responses regarding confirmation of the provider’s network status.
  We did confirm *** ******* ********* is in-network with Aetna but not at the
  location the member saw *** *********. *** *********’s in-network location is
  the office located at 2*** ** **** ******* ***** **** ******** *******.
  Coaching and feedback along with additional training has been to the Customer
  Service Representative (CSR) the member spoke with.

  Our IFP team contacted the in-network location office
  to confirm if *** ********* is accepting new patients at this location. The
  provider’s office advised they’re not currently accepting new patients at this
  location. The claim in question is being reprocessed at the in-network benefit
  level as a one-time exception to honor the information Member Services provided
  to Ms. ****. Additionally, our IFP team is going to have a seasoned
  representative contact Ms. **** to go over her concerns and explain what to
  expect going forward. Ms. **** should allow 7-10 business days for the claim to
  be reprocessed. Going forward, any services rendered by *** ********* at an office other than the ***** **** ****** location, will not be covered at the in-network benefit level.

  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,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

  Customer Answer

  Date: 07/31/2023

  
  
  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:07/21/2023

  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 Aetna Medicare Insurance for my dental coverage and when I signed up for it originally back in August of 2021 I was told I would have 4500 in dental coverage but somehow I was put on a different plan that only had 1000 in coverage. I finally found out about the mistake and they put me on the right plan in February of this year. So they were taking the same amount out of my social security check every month and not paying anything towards my dental coverage because everyone just told me that they were going to just pull all my teeth out with No mention of dentures! I have tried to get them to at least pay for the extra amount to get my dentures done this year since it's only 1500 over my normal coverage. Since they didn't have to pay out the 4500 I was supposed to have already I don't think that's too much to ask! I already tried to work with them about the 1500 but they just tell me too bad! They are Not going to cover it!

  Business Response

  Date: 07/26/2023

  Dear Mr. ******* *********: 
  
  Please see our response to complaint # ********for Ms. **** ***** that was received by us on July 21, 2023.  Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.
  
  The member enrolled in The Aetna Medicare Choice PPO Plan in 2021 and 2022.  This plan had a $1000 dental allowance.  The member was sent her Annual Notice of Changes for 2022 on August 16, 2022, which advised her what plan she had. The member did not enroll the Aetna Medicare Dual Complete Plan (HMO D-SNP) until February 1, 2023.
  
  We reviewed the call from December 15, 2021.  The member was inquiring if there were any changes to the benefits for 2022.  The representative advised there were no changes but did not go over the dental benefit for 2022. The representative is no longer with Aetna, so no coaching could be sent.
  
  The member has reached her maximum allowance for your dental benefits for 2023.  The member’s dental allowance is valid for the year that the plan is in effect, so we cannot use her 2022 benefits for dates of services in 2023.
  
  The member may to want to contact Medicaid to see if they will pay for any additional dental benefits.
  
  The member’s Aetna Plan has a $0 premium.  The member’s payment that is taken out of her Social Security Check is her  Medicare Part B Premium.
  
  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. Mello’s concerns
  
  Sincerely,
  
  Cindi D
  Analyst
  Medicare Executive Resolutions

• Initial Complaint

  Date:07/19/2023

  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've been denied coverage on my prescription refills for months because Aetna wanted me to opt-in to a different program for 90 day refills through ***. Because I had not opted in, my coverage was denied. The 2 choices were to keep my current pharmacy or opt in to *** 90 days refills.
  I called about this issue and opted out. They say I will now be covered, but I have to submit a claim to be reimbursed for all the prescriptions I paid out of pocket these last few months while they wanted a decision.
  They have put the burden of time and money on me, because they wanted me to opt in to their partnership with *** which I assume is more lucrative for them.

  Business Response

  Date: 07/25/2023

  Dear *** ******* *********:

  Please see our response
  to complaint # ******** for ******* ********* that was received by us on July 19,
  2023. Our Executive Resolution Team researched your concerns, and I would
  like to share the results of the review with you.

  Upon
  receipt of the complaint, we immediately reached out to our Pharmacy team for
  review. We confirmed that the member’s plan does have a mandatory maintenance choice
  with the option to opt out provision. This means that after two 30-day fills,
  the member would need to move to a *** pharmacy or mail order to get a 90-day
  supply. However, with the option to opt out of this program, the member can
  continue to fill his medications at his local ******* Pharmacy for a 30-day
  supply. The member does not need to opt-in to this program as it is already
  included in his plan design. Since the member's plan includes the opt-out
  option, he would have had to request to do so with customer care to continue to
  use his local ******* Pharmacy. We also confirmed that the
  member opted out of this maintenance choice plan provision on July 18, 2023,
  and as a courtesy, we have backdated the opt out to the beginning of the
  calendar year, January 1, 2023.

  Unfortunately, we
  are unable to automatically process the claims for reimbursement without the
  needed information. To be considered for reimbursement, the Claims team would
  need the attached prescription drug claim form completed and detailed pharmacy
  receipts showing what the member has paid out of pocket. The pharmacy detailed
  receipt should include the following: prescription (Rx) number, the pharmacy’s national
  provider identifier (NPI)/ national council for prescription drug programs (NCPDP)
  number, national drug code (NDC) number of the medication, metric quantity/days-supply
  number, dispense as written (DAW) if applicable, dispensed quantity, provider's
  drug enforcement administration (DEA)/NPI number, date of fill, and the cost of
  medication.

  Once the member
  has filled out the form and have the detailed pharmacy receipts, the member can
  submit by mail to ***** **** *** ***** ******** ** ********** or by the fax number
  ###-###-####.

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

  Sincerely,

  Shay G.
  Analyst, Executive Resolution
  Executive Resolution Team