ComplaintsforAetna Inc.

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Initial Complaint
11/18/2024
Complaint Type:
Billing Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
*** will not address an overcharge of a rx fill. I have insurance and they charged me more than the copay and looking it was also 4x higher than the ****** price. Their corporate email replied but never addressed the issue (Incident ID: *********** Please address and refund me my over payment
Customer response
11/18/2024
Issue has been resolved
Thanks
Initial Complaint
11/05/2024
Complaint Type:
Product Issues
Status:
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.
I had to have all my teeth extracted and knew that my insurance, ****** **********, would cover only a certain amount. I contacted Aetna because they have a stand alone policy. So they were taking $57.00 a month out of my bank account. I wasn't having the surgery until later in the year. At the time of my teeth extraction, they said that Aetna would not cover this. They told me that I could not have 2 policies of the same. I asked them specifically for a stand alone policy with Aetna. I called Aetna and they told me to contact ****** ********** showing that I was insured with them the same time I was insured with Aetna. I did this and they said there was nothing they could do for me. They said my account was closed and there was no way to get my $556.00 from them. They said my policy had lapsed for lack of payment. I would like to get my approximate $556.00 refunded back to me.
Business response
11/07/2024
**** *** ******* **********

Please see our response to complaint ******** for **** ***** ****** that was received by us on November 6.2024. 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. ************** has contracted with Aetna to manage your hearing aid benefit. We were not able to find anything in our systems for this member even with the date of birth. It does not appear that this member was ever enrolled directly with Aetna. There are third party vendors that sell Aetna plans and there are plans that only use Aetna’s provider networks. The member should refer to her bank statements to verify if Aetna/********** have been billing her or a third-party company. If she ever received an ID card or any documents about the plan, they would also advise where to call for assistance.

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

Sincerely,

Cindi D
Analyst
Medicare Executive Resolutions
Initial Complaint
11/05/2024
Complaint Type:
Customer Service Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
This complaint is with regards to Aetna ****** ******, a subsidiary of Aetna. I have had nothing but benefits and eligibility issues from the moment I enrolled with them some months ago. I have called over 8 times and spoken to countless member associates at Member Services who all take the same information over and over again; confirm they see the notes from my prior calls and then tell me they are going to do the EXACT same process to try and get it fixed as was done prior. I have asked to speak to supervisors - none are ever available so don't even bother. There was one very kind associated who spent a good while one the phone with me one day and called me back the next day saying the issues was fixed, it was not. When I ask to speak directly with the Eligibility and Benefits team - I'm told that's not possible. I have conference called with Aetna ****** ****** and Aetna commercial and they are still unable to figure out how to fix the benefits issues. I have explained to them over 8 separate times what I believe the problem to be and none of them seem to have a clue how to fix it or seem to care enough to escalate this to get it resolved. They just want to send it through the same process and act surprised when the same issues arises. I have called the State to very my information on file with them and been assured this is an Aetna issue. I even called all my prior insurance providers to check with them on this issue. I am waiting for a surgery to drastically improve my quality of life but no PA is getting processed or even reviewed given their system issues.
Business response
11/14/2024
**** ******* **********
Please see our response to complaint # ******** for ********* ********* that was received by us on November 5, 2024. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.
Upon receipt of your request, we immediately reached out internally to further research the concerns. After further review it was determined that the member has an active policy with an effective date of September 1, 2024, through the Aetna ****** ****** ** ******** ***** The member stated that Aetna ****** ****** ** ** was his primary insurance, but our system showed that the member had an Aetna Commercial plan as primary insurance. Outreach was made to the member to gather additional information. The Aetna Commerical Insurance being listed as primary was an internal error and has since been corrected. The member only has one Aetna plan which is the Aetna ****** ****** ** **, which is now showing as primary. Currently there is no authorization on file for the member’s upcoming surgery.
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,
ShaCarra B.
Executive Analyst, Executive Resolution Team
Customer response
11/15/2024

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

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
11/05/2024
Complaint Type:
Order Issues
Status:
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.
Aetna just sent me a letter that they no longer will cover my Prescriptions if they are under ninety days and doubled what I paid for them last month. This is messed up. I've been using them for health insurance for years and never heard of this happening before.
Business response
11/12/2024
**** ******* **********

Please see our response to complaint #******** for ******* ****** that was received by us on November 5, 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 immediately reached out internally to further research the member’s concerns. We confirmed that Mr. ******' plan benefits state “mandatory maintenance choice with opt out 30 day supply maximum 2 fills for retail and 90 day supply maximum for *** pharmacy and for mail order pharmacy”, which means the 90-day fill program that he is referring to was already effective on his account. Please know, this program applies to “maintenance medications” only, and since Mr. ****** had not filled any maintenance medications prior to receiving the letter, the program had not yet been implemented. In addition, we have reviewed the member’s claim history and could not locate where his medications had doubled in price. The last time Mr. ****** filled a medication was on October 1, 2024, which the cost was $12.35. Prior to that, he filled the same medication on August 23, 2024, which the cost was $8.85. The price change was not due to the program, instead, it was due to the negotiated rate increasing for this medication.

Per Mr. ******’ plan benefits, there is an opt out option which he can request by contacting our pharmacy customer service team. However, due to this complaint, we submitted the opt out request on Mr. ******’ behalf. As of today, the member has been opted out of the program. Should the member have any additional questions regarding the program, our opt out process, or his medication costs, he may contact our pharmacy customer service team by dialing the phone number on the back of his member identification card.

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

Sincerely,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Customer response
11/12/2024

Complaint: ********

I am rejecting this response because: I don't know what any of this means.

Sincerely,

******* ******
Initial Complaint
10/31/2024
Complaint Type:
Sales and Advertising Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I received a phone call that if my wife and I take part in a healthy home visit, we would each get a $100 gift card. My wife completed her visit on September 10 and I completed mine on October 14. We have not received any information about our gift cards. Each time we call we get transferred to different departments.
Business response
10/31/2024
Please have the complainant’s wife, **** *****, sign the attached authorization in order for an executive case to be opened.

Customer response
10/31/2024

Complaint: ********

I am rejecting this response because: The signed form is attached. Will not close the case until the matter is fully resolved. Thanks.

Sincerely,

****** *****
Business response
11/15/2024
Dear ******* *********:

Please see our response to complaint #******** for ****** ***** that was received by us on November 4, 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 immediately reached out internally to further research the member’s concerns. Please know, it was ******* ****** who contacted the member and his wife regarding the program, and they advised the members do qualify for the $100 rewards card. We confirmed that ******* ****** issued another rewards card to *** ***** on October 31, 2024, and *** ******* card was issued on November 12, 2024. We recommend that the members allow at least 7-10 business days to receive the rewards cards. In addition, the members’ call history is being reviewed and the necessary feedback will be provided.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ******* 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 response
11/15/2024

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
10/31/2024
Complaint Type:
Billing Issues
Status:
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.
Was forced to use Aetna insurance through my school. When I signed up for it and attempted to use my vision insurance, I was told that I couldn't be found. I contacted Aetna Medical who continually told me to contact their partnered vision insurance, ****** *********, even though I already had. ****** ********* continued to tell me to contact Aetna Medical. This continued 4 times before I eventually went to a vision provider to pay out of pocket. But considering it is covered by my insurance, the egregious amount that I'm paying should allow me to use it without issues.
Business response
11/04/2024
**** *** ******* **********

Please see our response to complaint #******** for ***** ***** that was received by us on October 31, 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 internally to have *** ******* concerns reviewed. Based on their review it has been confirmed that the member’s date of birth was submitted to Aetna incorrectly. We were able to correct the member’s date of birth to ********* *** ****. Our customer team has reached out to *** ***** to discuss her complaint and confirmation of the date of birth correction. Any additional questions or concerns *** ***** has, he can reach out to customer service at ###-###-#### for medical concerns and ###-###-#### for vision concerns.

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

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
10/29/2024
Complaint Type:
Service or Repair Issues
Status:
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.
On 10/29/2024 at around 9:20am Est I called Aetna Pharmacy to get assistance as the Agent of record. There was so much pushback I asked for a supervisor after waiting 17 mins supervisor Jasmine G. entered the call demanding my SSN or NPN. Upon providing my 8-digit NPN the supervisor assured me there is no way an NPN is less than 10 digits. I inquired on where she was getting this info, she told me Aetna. At which point I suggested the use of google. Unfortunately, the supervisor does not understand the proper use of google and the need to ensure the information you find is on a verifiable website. She did not ensure the information she saw was accurate. My concern is with her leadership and incompetence. How can she effectively lead a group of employees. She was so adamant that a National Producer Number is 10 digits that she passed the incorrect information to her subordinate who may then pass it to others because she was told by leadership. This is incorrect information spread to the masses because one leader is not properly trained. It wasted my time, and I just hope this is not the type of thing my client deal with when signing them up with Aetna.
Business response
11/01/2024
**** *** ******* *********:

Please see our response to complaint #******** for ******** ******* that was received by us on October 29, 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 internally to further research the complainant’s concerns. Based on the review we were not able to find the call that was mentioned in the complaint. We will need identifying information for the complainant’s client account to find the call for review.

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
Initial Complaint
10/29/2024
Complaint Type:
Sales and Advertising Issues
Status:
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.
Aetna runs a promotion where if you do a healthy home visit you get a gift card. Nowhere did they mention it was restricted to certain retailers. They also have no way for you to look up which retailers are included.
Business response
11/04/2024
**** *** ******* **********

Please see our response to complaint #******** for **** ******* that was received by us on October 29, 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 internally to have *** ********* concerns reviewed. Based on their review it has been confirmed from our ********************************* ******* team, when a member goes to the ***** website (****************) to activate their reward gift card they also have access to the list of retailers who accept the Healthy Home Visit (HHV) reward gift card. It has been confirmed that the member was able to use the $100.00 Visa gift card at Walmart on October 29, 2024, October 30, 2024, and October 31, 2024.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ********* 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
Initial Complaint
10/28/2024
Complaint Type:
Billing Issues
Status:
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.
I visited the ******** ** in ************ on 4/4/2024. Upon receiving my bill, I noticed that my HC ER Service was incorrect as they coded my visit as a Level V (CPT code *****). I called ******** to dispute the bill and did not receive an update on the dispute. I then visited in person to the ************ location and was given the run around. I was eventually told by the business office onsite that I needed to call and dispute. I called again to dispute and was told I would be contacted by a supervisor to understand my dispute in more detail. I was never contacted by a supervisor and the bill is still not resolved. I also contacted Aetna so that they could initiate the dispute on my behalf and the representative said that they have to process claims as they are provided by the medical offices. My bill is not correct. My CPT code was incorrectly coded as it does not align with my level of treatment during the time, my self reporting while there, underlying conditions, nor the level of triage. I have been billed incorrectly for my ER CPT code and I need Aetna to get it resolved.
Business response
11/01/2024
Dear *** ******* **********

Please see our response to complaint #******** for ***** ***** that was received by us on October 28, 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 internally to further research the *** ******* concerns. Based on the review of the claim we were able to reprocess the procedure code from the date of service April 04, 2024, to ***** from *****. The member’s cost share for the services rendered did not change. The member’s responsibility for the emergency room visit will be $821.44.

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

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive Resolution Team
Customer response
11/04/2024

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

I am rejecting this response because the cost share amount that I am responsible for should have changed. The cost difference between CPT code ***** ($701.44) and ***** ($1923.30) is drastically different. I am requesting a new itemized statement as well as confirmation that the code has been updated with ********.

Sincerely,
***** *****
Business response
11/06/2024
Dear ******* **********
Please see our response to complaint # ******** for ***** ***** that was received by us on November 4, 2024. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.
Upon receipt of your request, we immediately reached out internally to further research the concerns. After further review it was determined that claim processed and paid per the providers contract and members benefits available at the time of service. An Explanation of Benefits was mailed to the member on November 1, 2024, the claim has been processed and finalized and no further reprocessing or pricing will be done on the claim. The members cost share/members responsibility is $821.44. If the member does not agree with the claim decision the member can appeal the claim decision.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ******* concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst, Executive Resolution Team
Customer response
11/06/2024

Complaint: ********

I am rejecting this response because I would like to appeal this lackluster decision that has no evidentiary support.

Sincerely,

***** *****
Initial Complaint
10/28/2024
Complaint Type:
Sales and Advertising Issues
Status:
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.
I am getting unsolicited phone calls while at work asking me to complete surveys for Aetna.
Business response
11/11/2024
**** ******* **********
Please see our response to complaint #******** for ****** ******** that was received by us on October 28, 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 immediately reached out internally to further research the member’s concerns. Please know, without specific information (details of the call and/or phone number) we were unable to pinpoint which department is contacting Mr. ********. However, using the information we were given, it sounds like the member may be receiving first call resolution (***) survey calls that are made to all our members. We confirmed that Mr. ******** is in the process of being removed from receiving those contacts. However, we are unsure how long it will take for this update to take place. Furthermore, if the member wishes to be removed from receiving calls from Aetna altogether, he may request to be added to our do not call list as well. To be added to our do not call list, Mr. ******** may contact Aetna Member Services by dialing the phone number on the back of his member identification card. In addition, Mr. ******** has been assigned a direct point of contact, Mintrel, who will keep him updated until this matter is completely resolved. Mintrel attempted to contact the member today but was only able to leave a voice message containing their name, phone number and a brief description of why they called. Should Mr. ******** have any questions regarding this matter, he may contact Mintrel directly.

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

Sincerely,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team

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