ComplaintsforAetna Inc.

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Initial Complaint
10/16/2024
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.
Dear Aetna Appeals Department, I am writing to formally appeal the recent decision to process the claim for my wisdom teeth extraction under my health insurance instead of my dental insurance, which has resulted in an unexpected charge of $1,197. This decision was made without any prior notification to me or my oral surgeon, despite the initial claim being submitted under my dental insurance. The procedure in question is a dental procedure by nature, and both my surgeon and we understood it would be processed as such. It is unjust for me to be billed such a significant amount without any notification or explanation of this change beforehand. This unexpected financial burden is something I cannot afford, and I was not given the opportunity to make provisions or discuss alternatives prior to receiving this bill. sy I respectfully request that you reconsider this decision and reprocess the claim under my dental insurance, as initially intended. Please consider the impact of this decision on my financial situation and the lack of communication that led to this oversight. I appreciate your prompt attention to this matter and kindly request that you review the claim as well as the circumstances that led to this billing issue. I have attached paperwork showing that claim #***** was initially processed under my dental insurance without any issues. However, claim #***** was later created under my healthcare plan. Why was this claim not processed under the same plan? It seems unreasonable to mix and match policies, switching to the healthcare plan at the last minute, leaving a portion uncovered. As someone who processes claims for a living, I would never handle a claim in this manner. It would be like diagnosing a vehicle issue under one contract, then switching to another contract for the repair and telling the customer, "Sorry, it's not covered on this contract—you have to pay." This approach is unethical and needs to be corrected. Sincerely, **** *** ****
Business response
10/23/2024
**** ******* **********

Please see our response to complaint #******** for **** *** **** 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 member’s concerns we immediately reached out to investigate. We found that the member’s dental plan covers oral surgery when it’s not covered, in whole or in part, under the member’s medical plan. The medical plan covers oral surgery that is medical and dental in nature. Current Dental Terminology (CDT) codes that are defined as surgical are labeled as medical-in-nature or dental-in-nature by the ******** ****** ***********, and are not subject to review or redefinition by the member’s plan(s).

The member’s initial consultation was not surgical and was therefore not considered under the medical plan and simply covered by dental when it was submitted. Aetna policy does indicate that when the consultation is submitted with surgery, and the surgery is covered under medical, that the consultation and related services would also be covered under the member’s medical plan. However, we will not reprocess the member’s consultation claim to pay under medical at this time.

We reviewed the member’s contact history. We did not find a call or email from the member or the provider inquiring about the coverage for the service before it was rendered. We did not find a predetermination request for these services. Our plan documents, provided to the member when they enroll in the plan and available on the Aetna Member website, disclose the coverage that applies to the relevant plan.

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,

William B.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
10/15/2024
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 am a small business owner and, as such, have a health insurance plan through the marketplace. in August I updated my estimated income through the marketplace to accurately determine my federal subsidy. When my updated enrollment was sent to Aetna on 8/16, it was mislabeled and misrouted. This resulted in the termination of my coverage, effective 8/31. Aetna acknowledged their error, but my coverage has not been reinstated. I just got off the phone with both the marketplace and Aetna. They are now saying it will be two more weeks before they can even begin reinstating my coverage. I have been without coverage for almost two months now. I am a single-income, self-employed woman with multiple medical conditions requiring specialty care and maintenance medications. I am a mental health professional and find myself on the precipice of a mental health crisis of my own. I have filed a grievance with Aetna, along with a complaint to the ********* ********** (case ******). Nothing has changed.
Business response
10/22/2024
**** *** ******* **********

Please see our response to complaint #********for *** ***** ********* that was received us on October 15, 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 consumer’s concerns. Our Enrollment, Eligibility, and Billing (EEB) team previously submitted a service request to release the complainants file and correct the enrollment. This service request was escalated and the enrollment now reflects as active.

Due to the complainant not having access to her plan for the month of September the premium has been written off. The October premium has also been prorated for the days that the complainant did not have access to the plan. The plan is currently in good standing and paid through 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.

Sincerely,

Phalyn C. |Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
10/15/2024
Complaint Type:
Customer Service Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Aetna Claim ID: ********* On June 4th I had bloodwork drawn for hereditary cancer screening. Prior to the bloodwork being drawn I spoke with an Aetna care advocate 3 separate times to figure out what my out of pocket costs would be (if any). I spoke with Nicole 3 times, she advised me which CPT codes to use to ensure the testing would be covered & there would be no out of pocket costs as the testing was deemed medically necessary. I followed up with her several times to ensure the information she was telling me was accurate & there would be no billing surprise. The medical claim has since been denied as "no prior authorization form" was completed, however, when I spoke with Nicole, never once did she mention that I needed this form. I filed a 1st level appeal (#*************) which was denied. I have filed a 2nd level appeal & am pending a decision. However, I am absolutely appalled by the support I have received as I cannot rely on my insurance to advise me with correct information on my benefits. I spoke with another Aetna advisor, Kevin, and he said they could not provide me proof of my prior conversations with Nicole. He also said that there is "no allowance for incorrect information." I find this completely unacceptable because if I can't trust an advisor to give me correct information on my medical benefits before a service then who am I supposed to trust. I went above & beyond trying to take the necessary steps before getting my service (which I'm sure not all people will do) & I am still the one who gets stuck fighting with my insurance company 4 months after my date of service because I was told incorrect information. How am I, the policy holder, supposed to know what's needed beforehand, that was the reason I called in the first place, to make sure any pre-requisites were completed BEFORE the date of service. I should not have to pay anything as I did everything I was supposed to ahead of time and was still told incorrect information.
Business response
10/18/2024
Dear Mr. *********:
Please see our response to complaint #******** for ***** ******* that was received by us on October 15, 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 reached out internally to have the member's concerns reviewed. Based on the review, we confirmed that the member's provider is in-network with their plan. Based on the providers contractual agreement with Aetna, they should not be billing the member. We confirmed that a representative from both Aetna's Member Advocate Team and the Account Team are working directly with the member and their provider to resolve the situation.

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,

Lisa B | Analyst, Executive Resolution
Executive Resolution Team
Customer response
10/24/2024

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
10/14/2024
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 purchased an Aca healthcare plan from Aetna, according to my plan, blood work is a covered item subject to deductible, in network discounts and out of packet. On 09/27/2024 I went to ***** **********, an in-network lab facility to get my blood tests done that were ordered by my PCP after my annual wellness visit. I received my EOB from Aetna, showing the full amount for the blood work classified as “pending or not payable” with a denial code M15 (Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed). When I called Aetna’s customer service, I was first told that they already paid my PCP for the blood work and when I asked will my PCP reimburse the lab their answer was yes, later I was told by another agent that they will reprocess the claim. I have not received any new EOB. My PCP did not collect my blood samples, she did not perform the labs. My blood work was a separate procedure completed by ***** ********** ( a separate provider) on a different day of service than my PCP visit and within a different place of service so I don’t understand as to why my laboratory appointment would be bundled with my annual wellness visit resulting in denial code M15, subjecting me to full, out of network charges of $587.41 unpaid to ***** **********.
Business response
10/16/2024
Dear ******* *********:
Please see our response to complaint # ******** for ****** ********* that was received by us on October 14, 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 ***** billing, a representative named Hava J verified that the member has a $0 balance on this claim, it was paid under capitation. Several outreach attempts were made to discuss the findings with the member were unsuccessful. A detailed voicemail left that if the member had any further questions or concerns, that the member can reach out directly to **** * at the number she provided. An email was also sent to the member on October 16, 2024, the member can reach out to the email address provided as well.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *********** concerns. 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
10/11/2024
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 was under ************ **** ***** insurance from 4/2021 - 2/2024. In march 2024, I changed to Aetna health insurance as my primary plan. After switching to Aetna, Aetna incorrectly contacted ************ **** ***** and told them I was covered by Aetna during the time period of 4/2021 - 2/2024. As a result, ************ **** ***** has retroactively withdrawn appropriate payment for my medical services during this time and I am now being charged as a result of Aetna's mistake.
Business response
10/15/2024
**** ******* **********

Please see our response to complaint #******** for ***** ******* that was received by us on October 11, 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 verified that the member became effective with Aetna on February 25, 2024. We reviewed the member’s call history and found two calls discussing eligibility. On August 26, 2024, the member called Aetna stating we sent her prior carrier, **** ***** **** ****** ******, a letter advising she was under an Aetna plan since April of 2021, which is incorrect. The Aetna representative called **** and spoke with Joe who stated he sent a note to have their coordination of benefits updated. On September 30, 2024, Julia from **** called Aetna to verify the member’s eligibility. The Aetna representative correctly advised Julia that Ms. ******* and her children have only been under an Aetna plan since February 25, 2024, to present.

Furthermore, the plan sponsor liaison contacted **** on October 11, 2024, and spoke with Sharon who advised they show **** as primary from April 1, 2021 – February 25, 2024. However, the claims are still denying requesting the primary explanation of benefits (EOB). The plan sponsor liaison also spoke with Rebecca from **** who advised that she sent the member’s claim back to be reprocessed as primary with ****, and due to their claim volume, it can take at least three weeks for completion.

We confirmed that we do not show where Aetna has ever sent **** a letter stating we were primary for the member’s plan. **** has been told three times now that the member did not have Aetna coverage prior to February 25, 2024. We also created a letter (document control number ************) which shows the date *** ********* policy began, and we faxed a copy to **** on October 11, 2024. Should the member have any questions or concerns regarding her claims, she must contact **** directly.

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
10/10/2024
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.
On Oct 9,2024, my PCP ** *****, sent a script to *** for ************ 6.25 mg cough medicine for my asthma flare-up. Aetna has held up processing and releasing this medicine claiming it has *******. I went to the *** Pharmacy it does not have *******. Upon returning I phone Aetna to inform them spoke to a Miss G** on 10/10/2024 at 8 AM phone number ###-###-####. She did inform there is no ******* but still needs authorization to process. She could not give a reason for this. Now I have to pay out of pocket because they will not release it. Thank you for your time, **** *******
Business response
10/16/2024
Dear *** ******* **********

Please see our response to complaint # ******** for **. **** ******* that was received by us on October 10, 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. ************ requires a prior authorization. This can be found on page 79 of the formulary. Our plan requires the member or the physician to get prior authorization for certain drugs. This means that the member will need to get approval from us before you fill her prescriptions. If you don’t get approval, we may not cover the drug.

The reprehensive form Aetna correctly advised the member that a prior authorization is required.

When the complaint was sent, there was not an authorization for the prescription filed. A prior authorization was approved on October 14, 2024. The authorization is valid from January 1, 2024, to December 31, 2024. The member can go to your pharmacy to have them reprocess the claim. If the pharmacy is not able to reimburse the member for the difference, she can submit for reimbursement. 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
This is still not resolved with Aetna. I am in dispute awaiting the final decision of Aetna. So if need me I will open another BBB. **** *******
Business response
10/24/2024
*** ********* **** *** ******* ********** ** *** ********* *********

Please see our response to complaint # ******** for **. **** ******* that was received by us on October 24, 2024. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the complaint, we reached out internally to view the **. *******'s concerns. We understand that your complaint is about needing a prior authorization for her medication ************ *****************-6.25/5ML which you felt did not need a prior authorization. We understand how frustrating this can be and we take our complaints very seriously.

Upon receipt of **. *******'s complaint, we reached out internally to view her concerns. The medication ************ *****************-6.25/5ML does require a prior authorization.

The form from Aetna correctly advised **. ******* that a prior authorization is required. This can be found on page 79 of your formulary listing.

Our plan does require the member or the physician to obtain a prior authorization for certain drugs. This means that the member is required to get an approval from the prescription drug plan before you fill the prescription. If you don’t obtain the approval, we may not cover the drug.

When the original complaint was sent on October 10, 2024, there was no authorization on file for the prescription drug request.

A prior authorization was approved on October 14, 2024. The authorization is valid from January 1, 2024, to December 31, 2024. **. ******* can now go to your pharmacy to have them reprocess her claim. If the pharmacy is not able to reimburse her for the difference, then she can submit a member reimbursement claim form.

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,

Melissa R.

Analyst
Medicare Executive Resolutions
Initial Complaint
10/10/2024
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 waited a while to file a compliant because I thought the ** department at Aetna had just made a mistake, but it has now become a disgusting pattern. I ask that you look into my account for the ** denials for yourself. For context, I take medicine daily for my episodic migraines. I had been on all step-therapy options, *******, and was currently on Nurtec with my previous insurance. My doctor submitted multiple charts leading to 2 ** denials. The second ** denial incorporated all necessary information, but it was denied and I was recommended ******* as an alternative to *******. In addition, it was denied on a weekend when they reached out to my doctor during an obvious time when they were closed and requested more information. This is medical malpractice with the close-out date being Saturday, and with the denial recommending the same medicine which was being denied. I need these medications to live a life with dignity, but since they understood that was a major mistake and approved my doctor's appeal, I did not file a compliant. Fast forward to today when another one of my medications, one that I've been on for 6 years, has been denied twice. The name of the medication is ********************************* tablets, and it's been used for the treatment of my breakthrough migraines for the past 6 years. At first, my doctor needed to submit more charts, so they did. The second denial came saying they needed even more charts, so my doctor did it again. Now, as of today, I have been told they won't approve Butalbital (using the first word of the medication for short) for breakthrough migraines because the *** only approved it for tension headaches. I take a different medication which increases tension headaches as well. You'd think a review would involve that with a Medical Director, but apparently not at Aetna. None of this makes sense and it's been the worst experience with healthcare in my life. That was 1/2 of the original complaint submitted.
Business response
10/11/2024
Dear ******* *********:
Please see our response to complaint # ******** for ****** ******** that was received by us on October 10, 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 letter of medical necessity provided only stated the member has tried plan preferred drugs and they did not work. There is no documentation or office notes indicating plan preferred drugs and when. The member was mailed a denial letter and the next steps were outlined in that letter.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ********’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *******************************.
Sincerely,
ShaCarra B.
Executive Analyst, Executive Resolution Team
Initial Complaint
10/09/2024
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.
As a member of the Aetna health plan, I have not been able to find ONE provider that is accurately depicted on their member portal. Either the member search is limited with two or three names, or the names that ARE listed, are not part of the practice nor the correct phone number. While I have encountered this issue many times before, today- while trying to locate a pediatric oncologist for my daughter, the search provided me with a *** ******* * ****** ** *** *** **** *** ** ********** ** with a # ###-###-#### only to call and be told, they do not have a Dr. by that name under their list of practicing physicians. I then call ******** ******* *****, listed as having hematologist-oncologists at ###-###-#### only to be told, that the number I called is a nursing home and not the correct number. The amount of premiums paid to this insurance company and the lack of proper member information afforded to their members is not adequate business practices. They are running a business that is fraudulent in its business practices by not providing members with the most up to date information needed for follow up care.
Business response
10/18/2024
**** ******* *********:

Please see our response to complaint #******** for ******** ********* that was received by us on October 09, 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. We requested a knowledgeable representative to contact the member and spend the time necessary to find a participating pediatric oncologist. We reported the issues that the member had in finding a participating provider. Aetna’s provider directory is updated daily, Monday through Saturday. Our participating providers are contractually obligated to keep their information up-to-date with us, and to notify us when they wish to terminate their participation. Aetna strives to keep this information updated, and internal changes are automatically updated to the directory.

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
Customer response
10/21/2024

Complaint: ********

I am rejecting this response because:
This is clearly inaccurate. As stated in my complaint, even the PHONE NUMBERS to providers are inaccurate. As a consumer, I am calling ‘providers’ listed on the provider list and the phone numbers do not even belong to those providers. This is a false misrepresentation of the information afforded to your members. In addition, you have provider groups with multi-specialists only to be informed when calling that they do not have those specialists within their practice.
I have been a nurse for 10 yrs and prior to that, I worked in the insurance industry for many years, including as a provider credentialing specialist. Your portal is inaccurate, misleading, and it is a waste of consumers time to have to call 10 phone numbers before finding ONE provider with correct information.
Aetna clearly needs to do better at ENSURING that the information provided to their members is up to date and they are failing at this task.

Sincerely,

******** *********
Business response
10/31/2024
**** *** **********
Please see our response to complaint #******** for ******** ********* 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 our internal contacts for their review and assistance. We requested a knowledgeable representative to contact the member and spend the time necessary to assist them with locating participating providers. We confirmed our representative attempted to reach the member and left two voicemail messages for them asking for a return call. We confirmed our representative emailed the member with a list of participating pediatric oncologists in her area.
We submitted a ticket to our network team letting them know the following provider: *** ******* * *****, at *** *** **** ****, in ********** ** ***** with a telephone number as: ###-###-#### is incorrect, as well as the information for ******** ******* ***** at ###-###-####. Aetna’s provider directory is updated daily, Monday through Saturday. Our participating providers are contractually obligated to keep their information up-to-date with us, and to notify us when they wish to terminate their participation. Aetna strives to keep this information updated, and internal changes are automatically updated to the directory. Members can self-report any incorrect information on their Aetna® member website on the Find a Provider page. We confirmed the member can also contact Member Services at: ###-###-####, and our representatives have a workflow they follow for reporting incorrect information listed on our website.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *********** concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at: *******************************.
Sincerely,

Lisa B | Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
10/09/2024
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.
Refusal to Provide an Estimate: Before agreeing to proceed with services, I repeatedly requested an estimate for the anticipated costs. Despite my requests, the company refused to provide a clear and transparent estimate, leaving me in the dark about the potential expenses. Overcharging: After the services were rendered, I was charged significantly more than what was verbally implied by one of their representatives. This overcharge came as a shock, especially since I had no proper estimate or breakdown of the costs beforehand. Misleading and Conflicting Information: Throughout the process, I was given different and often contradictory information by various representatives. For example, one representative informed me that the procedure would be covered by my insurance, while another later stated that it was not. This inconsistency caused immense confusion and resulted in the company refusing to cover the expenses as initially suggested. Twisted Information to Legitimize Denial of Coverage: It has become clear that the company provided twisted information at every stage to make it appear legitimate not to cover the expenses, despite assurances to the contrary before the procedure. This manipulation and misleading conduct are unacceptable and have caused significant financial strain. I believe the company has acted dishonestly by providing conflicting information, refusing to offer a proper estimate, and overcharging me for the services. I am seeking resolution in the form of a refund of the overcharged amount and a formal apology for the lack of transparency and professionalism throughout this process.
Business response
10/11/2024
**** ******* **********
Please see our response to complaint # ******** for ****** *********** that was received by us on October 9, 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 phone call from October 7, 2024, was pulled and reviewed. On that call accurate information was given to the member, based on the information the member provided. The representative did not refuse to provide an estimate, the representative reached out to the estimate team to get an estimate for a Computed Tomography Scan (CT scan). Although the member did not know what type of CT scan he was having and did not provide any procedure codes, the representative did all that she could to assist the member based on the facility information that was provided by the member. Per the estimate team, the only information that was available for the ********** ** ******** ** ******* ******** was that we would pay 41.20% of the billed charges. The member provided limited information, which was also a hinderance on providing the best results. There is no claim on file so we cannot confirm what the member will be billed, or how the provider billed the claim. The representative also advised that CT scans require a prior authorization through *******.
Price estimates are estimates of what the member can expect to pay. However, this is not a guarantee of coverage, and should not be used a guarantee of payment or coverage. Once we receive the claim that the provider billed the price estimate may change based on several factors. The location, the procedure codes billed, how the provider bills the claim, and the member plan benefits all go into account when processing a claim. Attached to this is a cost estimator tool for the member.
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
10/11/2024

Complaint: ********

I am rejecting this response because:

Sincerely,

****** ***********
Initial Complaint
10/09/2024
Complaint Type:
Sales and Advertising Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I keep getting solicitations from them, have called plenty of times for them to remove my address. I'm not of medicare age but some how my information was retrieved illegally by this company. Remove my address from your system. It has gotten out of hand now.
Business response
10/11/2024
***** ******* ********* *** ********* **********

It is our understanding that *** ******* is inquiring about getting solicitations from Aetna and he wants his address removed from our system. *** ******* is not a member and is not Medicare age and wants the mailings stopped.

Upon review, we confirmed he does not have a plan with Aetna. We have added *** *******'s demographic information to our Do Not Call and Do Not Mail List.

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

This request can take up to 30 days to complete, therefore please wait the full 30 days before submitting another request. We do apologize.

The member will receive a detailed Medicare Resolution response via email.

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,

Melissa R.

Analyst, Medicare Executive Resolution

Medicare Complaint Team
Customer response
10/14/2024
I hope this is the last time i have to inquire about this. I tried resolving previously SEVERAL times by calling first.

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ComplaintsforAetna Inc.

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