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Initial Complaint
10/28/2024
Complaint Type:
Customer Service 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 requested in network participation w/ Aetna as a behavioral health provider on 7/10/2024. After submitting my inquiry, I received an email update w/ my request ID (********). The email provided instructions which indicated that I reach out to ###-###-#### for status update after 60 days. After approximately 95 days, I reached out and spoke w/ a provider credentialing customer service agent. She could not locate my request for in-network participation using my request ID, NPI, EIN, or name- all of which were provided at the time of my initial inquiry. She provided no help or solutions to solve this problem. Aetna makes it extraordinarily difficult to gain in-network participation as a behavioral healthcare provider. I am just extremely disappointed that I waited this long, only to find that my request doesn't actually exist. I just wish Aetna took situations like this more seriously and streamlined their credentialing process- especially when behavioral healthcare is proven to promote overall physical health prosperity and well being. It would seem Aetna does not care about filling it's network w/ high quality behavioral healthcare providers.
Business response
11/05/2024
**** ******* **********

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 for further review. We confirmed that this concern is being addressed by Grisel S., who is working with the provider to find out more information. Grisel stated she will review the provider’s call history for feedback opportunities as well as all our systems to find out what happened with *** ********* application. In addition, Grisel has agreed to remain as the provider's direct point of contact until this matter is fully resolved.

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
Initial Complaint
10/25/2024
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 am writing to dispute the unpaid claim for lab services provided by ******** ********* ************ ***. on March 29, totaling $581.50. These labs were necessary for managing my thyroid condition and were conducted while I was actively covered under my Aetna plan through ******** ******. However, despite submitting a dispute, the claim remains unresolved, with both Aetna and ******** ****** citing issues ranging from incorrect coding to an inaccurate employment status. To clarify, I left ******** ** April 5, after my lab work on March 29. When I initially disputed the claim, I was informed that the coding needed correction, but subsequent feedback stated the denial was due to my employment status. These inconsistencies have left me without a clear resolution, with each company pointing to the other. As the labs were conducted within my active coverage period, I request that Aetna process the payment for these services. Please let me know if any further information or documentation is needed to resolve this issue. Thank you for your attention to this matter.
Business response
11/04/2024
**** ******* **********
Please see our response to complaint # ******** for ****** ******** that was received by us on October 25, 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 concerns would need to be addressed and responded to by ********. On November 1, 2024, a letter and an authorization form were mailed to the member. The member should receive this form by mail in 7-10 days, the member must complete and sign the form and return it. Once completed someone directly from ******** will make outreach to the member once the form has been received,
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
Initial Complaint
10/23/2024
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 have been going to the same primary care doctor for about 17 years. They have an in house lab that does any bloodwork and xrays that is one floor down from my providers office in the same building. In the past, other insurance providers have recognized test that were ordered as part of an office visit, as covered under the office visit with primary care clause of their policy. Aetna choses to view them as hospital lab work because of how they are billed by ****** ******* ***** and require that our full deductible be paid prior to them covering anything. Nothing has changed with how they bill their tests since I had bloodwork done a few years ago. When I spoke to an Aetna Agent (Noah), their solution was that "next time" I should have my doctor send the tests to a lab that is cheaper for Aetna so I would pay less. As they have an in house lab, they do not send samples for basic blood work out at all. So in order for this to work I would have to drive to a ***** diagnostics testing center to have my blood work done. Costing me extra time and money, all while unwell. It seems that Aetna does everything they can to pass costs off to the consumer or the doctor. If they processed the tests I had on 9/10/24 as ordered as part of an office visit with my primary care provider, per a conversation between my husband and another Aetna agent, there would only be a $40 copay. I would like my bill to be adjusted to reflect that.
Business response
10/24/2024
Dear *** ******* *********:

Please see our response to complaint #******** for **** ************ that was received by us on October 23, 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 claims team, who reviewed Ms. ************’s concerns. Based on their review they confirmed that the claim from the date of service September 10, 2024, was processed correctly based on how it was submitted from the servicing provider. The billing office at ****** ******** was contacted and they have confirmed that the claim was submitted correctly and there were no errors found.

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
10/21/2024
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.
******* ****** ****** *** ******** received 3 letters dated October 8, 2024 by mail stating previous communication was sent on July 10, 2024 stating that "the executed contract agreement with **** was incomplete or incorrect, and to contine participation in the Aetna Network, you must execute a new agreement no later than July 19. This communication also detailed instructions on how to execute to correct contract. To date we have not received your response. Accordingly, Aetna will terminate your network participation. We'll also remove you for our providers directories if applicable" I contacted a rep with Aetna Provider Services Network Management on 10/21/2024 to follow-up on the letters we received. I spoke with Jez. Upon checking, Jez notifies me that the incorrect practice name is associated with Tax ID: ********* and practice NPI: **********. The correct information for Tax ID ********* and NPI ********** should e ***** ***** ******** ****p. The rep tells me I need to submit a letter of intent with a ** with the correct information. However, the pactice name change to ******* ****** ****** *** ******** WAS NOT initiated by us. The incorrect name associated with TAX ID ********* was made BY AETNA. There have been numerous mistakes like this by Aetna. We did not cause them. We effectively did our part when we went through credentialing with Aetna with a CORRECT W9. The name change was made recently. The rep did not explain who or what **** is. I asked to be transferred to a Supervisor/Manager. While on hold, I was transferred to a recording that said "this number is not available or working". Someone from Aetna needs to contact me to get a better explanation of the meaning of the letter we received AND to correct the incorrect practice name! We have patients with Aetna policies and we do not want claim denials based on Aetna's negligence and mistake. Apparently, the only way to get things properly addressed is to submit complaints in every form of communication.
Business response
11/01/2024
**** ******* **********

Please see our response to complaint #******** for *** *****, representing ******* ****** ****** *** ********, that was received by us on October 21, 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 investigate. One of our network representatives reached out to the provider and is working with them directly to resolve their concerns. They will remain in contact until this is completed.

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,

William B.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
10/18/2024
Complaint Type:
Customer Service 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 have been trying to reach my case manager, N****** G*******, several times to receive help with my Healthy Food Card and Asthma benefits as part of my plan. I have called Member Services more than 15 times, and they are unable to help. N****** provided Member Services who then gave me two phone numbers to reach her. The first phone number ###-###-#### she gave is an invalid, disconnected phone number. The second ###-###-#### number she provided to Member Services is the Claim Appeals department phone number. Can you please reprimand and fire Ms. N****** G******* for her lack of response, providing false information, not doing her job concerning the wellbeing of her clients, and for her lack of consistency with myself and Member Services? And please provide me with a new Case Manager to provide the benefits my plan has available. I have never seen such a dysfunctional company with even worse workers.
Business response
10/21/2024
**** ******* **********
Please see our response to complaint # ******** for ***** ***** that was received by us on October 18, 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 outreach was made to the member on October 21, 2024, at 09:30AM. On that call the member went over benefits for asthma and anxiety. Benefits for hypoallergenic bedding, deep carpet cleaning, and calming comfort collection was requested and submitted. A new case manager (CM) has also been reassigned to the member. The member was given the new CM contact information. New CM will also make outreach to the member today to introduce themselves to the member.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ******* 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
10/23/2024

Complaint: ********

I am rejecting this response because: I had a prior authorization sent in for ******** that was approved. However, they only approved 1 gram, and the medication is 29 grams. The *** pharmacy is saying they can't fill the prescription because the bottle comes in 29 grams. I have emailed, called, and been transferred several times, but haven't been unable to get a resolution for this, and I desperately need this medication. Please fix this as soon as possible. Thank you.
Business response
10/31/2024
**** ******* **********
Please see our response to complaint # ******** for ***** ***** that was received by us on October 23, 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 complaint, we immediately reached out internally to further research the member’s concerns. We reviewed the member’s call history and was only able to locate one call to the pharmacy on October 21, 2024. During the call, *** ***** was informed that a prior authorization was needed for the medication. In addition, we confirmed that the dosage on *** ******* prior authorization was updated to 29 grams on October 23, 2024, and *** pharmacy received a paid claim for the medication on October 24, 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,

Brittany F.
Analyst, Executive Resolution
Executive Resolution Team
Customer response
11/05/2024

Complaint: ********

I am rejecting this response because: I never received the benefits requested for:
Asthma Home Care - Deep Carpet Cleaning
Asthma Home Care - Hypoallergenic Bedding
Calming Comfort Collection - Anxiety
Business response
11/12/2024
Dear Mr. Stewart Henderson:

Please see our response to complaint #******** for ***** ***** that was received by us on November 05, 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 Case Manager Coordinator has spoken with him regarding his requested items. It has been confirmed that $150.00 has been added to the member's card for the asthma carpet cleaning. It was advised that the member can contact a carpet cleaner of his choice. *** ******* Case Manager was able to confirm that the light kit was order and is pending for a vendor. The hypoallergenic bedding has been ordered as well.

*** ***** can contact his Case Manager Coordinator 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 *** ******* 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
10/18/2024
Complaint Type:
Order Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I enrolled in coverage through the marketplace in July 2024 and paid several premiums, but Aetna never activated my coverage. Since my coverage was never activated, Aetna must return the premium payments I made to them. I am seeking a refund for the $1,073.03 I paid to Aetna in July and September 2024.
Business response
10/25/2024
**** ******* **********
Please see our response to complaint # ******** for ****** ****** that was received by us on October 18, 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 complaint, we immediately reached out internally to further research the complainant’s concerns. We confirmed that, on July 1, 2024, *** ****** enrolled into a plan with a monthly premium of $682.42. She made a payment of $390.61 on July 7, 2024, but it was less than the monthly premium, therefore the plan did not go into effect. On September 9, 2024, *** ****** attempted to make a second payment of $682.42, but the account had terminated due to non-payment. Moreover, as of October 23, 2024, *** ******** account is voided, and the refunds ($682.42 and $390.61) will be applied back to the original form of payment within 5-7 business days. An outreach call was made to *** ****** on October 23, 2024, to review the resolution.
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,

Brittany F.
Analyst, Executive Resolution
Executive Resolution Team
Customer response
10/25/2024

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
10/17/2024
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.
For the year 2024 I am associated with AETNA Medicare Advantage plan. Recently went in for a Colonoscopy, CT, MRI And PET scan. It has been determined that I have Rectal Cancer. My *** ******* at ***** *** ***** in ******** ***** ****** wish me to have surgery at the **** ****** in *********. The problem is AETNA does or will not authorize surgery at ****. I need AETNA to release the hold they have on the Advantage plan. This is a serious matter. The surgery is required before the cancer has a chance to spread and take my life. AETNA holding on to the plan and not allowing me to have the much needed surgery is not allowing me the medical services I need.
Business response
10/24/2024
**** *** ******* *********:

Please see our response to complaint # ******** for *** ******* **** that was received by us on October 17, 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. As of 2022, **** may be enforcing its policies differently and choose not to see members from Medicare Advantage plans with which they are not contracted. This would include Aetna.

Our understanding is that **** will continue to assess scheduling capacity on a case-by-case basis depending on a patient’s medical need and their resource availability. We encourage patients to call **** directly if they have questions or are interested in scheduling a visit.

As a reminder, even though the member has a PPO plan as outlined in the Evidence of Coverage (Chapter 3, section 2.3), out-of-network/non-contracted providers, such as **** Clinic, are under no obligation to treat Aetna members, except in emergencies.
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 *** ****’s concerns.

Sincerely,

Cindi D
Analyst
Medicare Executive Resolutions

Customer response
10/24/2024

Complaint: ********

I am rejecting this response because: First of all I do not know what information will be showing up in 7-10 business days(another delay). The reason I can not receive treatment is due to AETNA holding on and not releasing the account. My surgery should have been taken care by now. There is going to be a real serious problem here if the cancer spreads to where it untreatable. Action needs to be taken NOW!

Sincerely,

******* ****
Business response
11/04/2024
**** *** ******* *********:

Please see our response to complaint # ******** for *** ******* ****, which we received on October 25, 2024. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you. The previous grievance resolution letter was mailed on, October 24, 2024. This is the letter we advised the member will receive within 7-10 days in the previous response.

Upon receipt of the concern, we immediately reviewed the member's prior authorization history. We were unable to locate any prior authorization request for a procedure at **** Clinic. If the member has any direct contact information for **** Clinic, he can provide that to us for further review. Please note, there was an article published in February stating **** ****** will no longer set appointments with Medicare Advantage plans that are not contracted.

In the past, Aetna Medicare PPO members have been able to visit with **** ****** providers by utilizing their out-of-network benefits. According to a recent article, **** may be enforcing its policies differently and choose not to see members from Medicare Advantage plans with which they are not contracted. This would include the member’s Aetna Medicare Premier (PPO) plan.

Our understanding is that **** will continue to assess scheduling capacity on a case-by-case basis depending on a patient’s medical need and their resource availability. We encourage our members to call **** directly if they have questions or are interested in scheduling a visit. The member is enrolled in the Aetna Medicare Premier (PPO) plan. As a reminder, as outlined in the member’s Evidence of Coverage out-of-network/non-contracted providers, such as **** Clinic, is under no obligation to treat Aetna members, except in emergencies.

The member can advise **** ****** that they can contact the plan to obtain prior authorization for services by contacting our Provider Service team at ###-###-####.

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

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

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution
Initial Complaint
10/17/2024
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I purchased this Medicare Advantage policy with the understanding I had a fitness reimbursement value of $1200 for the year. Midway through the year I was advised the reimbursement was being significantly changed from what I had signed on for, eliminating many of the benefits I had anticipated. I have since called 4 times to ask for a list In writing of what is a reimbursable expense. (It is not published on their website or available to view on my account). I finally spoke with someone who promised to send it. 2 days later I receive by *** a form to use for claiming reimbursement- I have not yet received the list I requested. The year is running out and Aetna is stalling me out to be able to use some of any of this benefit. ( which they are discontinuing in the coming year),
Business response
10/22/2024
**** *** ******* *********:

Please see our response to complaint #******** for Ms. ***** ****** that was received by us on October 17, 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 reviewed the member’s account. We confirmed that Ms. ****** has called into the plan multiple times requesting a fitness benefit brochure to be sent to her. During our review we found errors made by our customer service representatives with the incorrect process they were using to send the request to have the fitness benefit brochure sent. We do apologize, and we have sent service improvement coaching’s to the customer service representatives’ direct supervisors, to allow for more training, and service improvement to better assist our members.

We have attached a sample copy of the fitness brochure to this response that the member has been requesting to be sent to her. In addition, on October 21, 2024, we requested a fitness brochure to be sent to the member. We ask that she please allow 7-10 business days to receive the hard copy of the brochure via USPS mail.

Please keep in mind, due to many consumer products available on the market today, there is no way to supply an exact list of approved and ineligible products to our members. This is why the plan supplies the general brochure and encourages our members to contact our customer service line when they question whether an item/product is approved, or not, for the fitness allowance benefit when they do not see the item listed in the plan documents provided to them.

Our customer service representatives utilize a spreadsheet of facts and questions (FAQs), when answering our members questions when they call into our customer service line to inquire about the fitness allowance benefit and as to whether an item/product may or may not be covered under the benefit. The FAQ’s is updated often. We have attached the most recent Fitness item guidance list that is used by our claims department of the covered and non-covered fitness benefit allowance items, this list was last updated on October 15, 2024. Please beware this item list is continuously changing and updated often which is why it is not made available for our members to view.

After further review of the members account, as the member has not submitted any claims into the plan requesting a fitness reimbursement for items purchased, we confirmed Ms. ****** has the full $1,200 fitness allowance to use until December 31, 2024. We also confirmed the current plan she is enrolled into is not offering a fitness reimbursement allowance for the 2025 calendar year.

Keep in mind, for the fitness reimbursement to be approved, the items must be purchased and used within the current benefit year. The member must complete and submit the fitness direct member reimbursement (DMR) form within 60 days of the date of purchase along with any required receipts, either online, fax or via mail.

The form can be found on ***************************, scroll down to "Get paid back for fitness items or services." Here the member can download, print, and complete the fitness reimbursement form. If the member does not have a printer, they can call our customers service line at the phone number on the back of their member ID card, and we can mail them the form. Once they have completed the form, gathered their itemized receipts and any supporting documentation, be sure to write their member ID on the top of each page being sent into the plan, they can mail the documents to the address on the back of their member ID card, or they can fax it to ###-###-####.

Please know, once all of the required information is received by the plan, it may take up to 45 days for the member to receive payment from the plan.

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 Executive Resolution
Business response
10/22/2024
**** *** ******* *********:

Please see our response to complaint #******** for Ms. ***** ****** that was received by us on October 17, 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 reviewed the member’s account. We confirmed that Ms. ****** has called into the plan multiple times requesting a fitness benefit brochure to be sent to her. During our review we found errors made by our customer service representatives with the incorrect process they were using to send the request to have the fitness benefit brochure sent. We do apologize, and we have sent service improvement coaching’s to the customer service representatives’ direct supervisors, to allow for more training, and service improvement to better assist our members.

We have attached a sample copy of the fitness brochure to this response that the member has been requesting to be sent to her. In addition, on October 21, 2024, we requested a fitness brochure to be sent to the member. We ask that she please allow 7-10 business days to receive the hard copy of the brochure via USPS mail.

Please keep in mind, due to many consumer products available on the market today, there is no way to supply an exact list of approved and ineligible products to our members. This is why the plan supplies the general brochure and encourages our members to contact our customer service line when they question whether an item/product is approved, or not, for the fitness allowance benefit when they do not see the item listed in the plan documents provided to them.

Our customer service representatives utilize a spreadsheet of facts and questions (FAQs), when answering our members questions when they call into our customer service line to inquire about the fitness allowance benefit and as to whether an item/product may or may not be covered under the benefit. The FAQ’s is updated often. We have attached the most recent Fitness item guidance list that is used by our claims department of the covered and non-covered fitness benefit allowance items, this list was last updated on October 15, 2024. Please beware this item list is continuously changing and updated often which is why it is not made available for our members to view.

After further review of the members account, as the member has not submitted any claims into the plan requesting a fitness reimbursement for items purchased, we confirmed Ms. ****** has the full $1,200 fitness allowance to use until December 31, 2024. We also confirmed the current plan she is enrolled into is not offering a fitness reimbursement allowance for the 2025 calendar year.

Keep in mind, for the fitness reimbursement to be approved, the items must be purchased and used within the current benefit year. The member must complete and submit the fitness direct member reimbursement (DMR) form within 60 days of the date of purchase along with any required receipts, either online, fax or via mail.

The form can be found on ***************************, scroll down to "Get paid back for fitness items or services." Here the member can download, print, and complete the fitness reimbursement form. If the member does not have a printer, they can call our customers service line at the phone number on the back of their member ID card, and we can mail them the form. Once they have completed the form, gathered their itemized receipts and any supporting documentation, be sure to write their member ID on the top of each page being sent into the plan, they can mail the documents to the address on the back of their member ID card, or they can fax it to ###-###-####.

Please know, once all of the required information is received by the plan, it may take up to 45 days for the member to receive payment from the plan.

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 Executive Resolution
Customer response
10/22/2024

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,

***** ******
Customer response
10/22/2024

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
10/17/2024
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.
Twice I have encountered payment issues from providers. 1. ********** ** ******* ********** ****** **** ** *** **** *** **** **** *** **** **** ****** **** ** ***** seeking payment and I had insurance.
Business response
10/22/2024
**** ******* *********:

Please see our response to complaint #******** for ******* ***** that was received by us on October 17, 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 have reviewed the member’s claim history and confirmed that the processed claims were applied towards her $3,500 deductible. However, for the denied claims, we show that *** ***** may have other insurance. Therefore, she must contact Member Services by dialing the number on the back of her member identification card, to update her coordination of benefits (COB). If the COB is not updated, the claims will remain denied and per the explanation of benefits (EOB), the member is responsible for the denied charges.

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,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
10/16/2024
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.
I left my previous employer on 08/07/2024, at which time I activated COBRA to cover my wife ********* **** *****. I made my Cobra payment to *** which started on 09/01/2024, which was received and activated at by ***. On September 4th, *** notified Aetna that of the Cobra coverage. However, Aetna failed to activate the coverage. On September 13th I called Aetna, and they said that they did not receive the information from *** to activate the coverage. On a joint line, Aetna called *** at which point *** confirmed the information was sent to Aetna. Aetna said the policy would become active in 7-10 business days. On September 27th I called Aetna again and was told that Aetna had not received the information from ***. We once again held a joint call with *** and they once again sent the necessary information to Aetna. On 10/2/2024 Aetna confirmed receipt of the necessary information from *** in writing (ticket number ************ and the subsequent email was provided to me from ***). On October 16th, the policy still did not show as active. I called Aetna and they once again said they had not received the information from *** even though I have their written confirmation of receipt. Their complete and utter failure in this matter has had direct and serious consequences for my wife's health as she is disabled without her treatment. I have diligently paid necessary premiums to ***, and *** has submitted the necessary paperwork to Aetna several times, yet Aetna still refuses to activate the policy that is paid in full. The case number that Aetna has provided me is *********
Business response
10/23/2024
Dear ******* *********:
Please see our response to complaint # ******** for ****** Addu that was received by us on October 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 complaint, we immediately reached out internally to further research the member’s concerns. We confirmed that the Consolidated Omnibus Budget Reconciliation Act (COBRA) plan is a spouse only plan and has an effective date of September 1, 2024. Since we do not have a signed authorization form on file for the member’s spouse, we cannot provide plan details. However, should *** **** have any questions regarding the plan, he can call the Member Services number on the back of his member identification card. In addition, we have reviewed the member’s call history, and the necessary feedback was provided to the representatives.
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,

Brittany F.
Analyst, Executive Resolution
Executive Resolution Team

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