ComplaintsforAetna Inc.

• Initial Complaint

  12/13/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  • Incorrect processing of claims • Unethical Practices • Lack of communication and failure to respond • Failure to meet contractual obligations There are quite 10,000 claims and denials that have been identified there has been no resolve for these claims to be reprocessed and reimbursed to us for services that has been given to Aetna members. I am currently being ignored to Samantha T*******, Stephanie S****** and Kelly G**** regarding these issues however I would like to still converse and meet about issues with your North Texas region for Aetna, in particular your team members named Stephanie S****** and Benjamin V*****.

  Business response

  12/23/2021

  **** *** ****** ***********************
  
  Please see our response to complaint #******** for Mr. ******* ******** on behalf of Urgent Care for Kids, LLC that was received by us on December 13, 2021.  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 complainant’s concerns. We have confirmed that Senior Director, Samantha T*******, has been in contact with the complainant, regarding the claim issues for the facility. Ms. T******* will continue to work with the complainant to resolve the concerns. The complainant has Ms. T*******’s direct contact information for any follow up 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 Mr. ********’s concerns. 
  
  Sincerely,
  
  Jessica B.
  Complaint and Appeals Consultant
  Executive Resolution Team
  
  

  Customer response

  12/25/2021

  
  Complaint: ********
  
  I am rejecting this response because:
  
  Sincerely,
  
  ******* ******** Aetna has done nothing more with my complaint and continue to only perform lip service. There has been no resolution not even a plan to have one. Aetna has over 9 million dollars and over 20 months of patients unresolved in our system and have actively and successfully chose not to resolve. Thousands of Aetna patients are being affected and will have bills that should have been resolved

• Initial Complaint

  12/08/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had a call with one of their representatives in October as I was contemplating whether to sign up for ******** benefits, as I am of that age now. He stated if I was not going to sign up for ******** at this time that the fees for Aetna on plan I chose it would not be taken out of my checking account. I contacted the cancellation department first part of November, prior to 11-05-21 at ************ and asked them to cancel as I was not signing up for ******** yet. In checking my ***** ***** account yesterday, 12-07-21, I had seen where the fees were taken out by Aetna. They can not take out fees if I do not have a ******** plan. I am still getting insurance from where I work full time. This is not acceptable and I want to report this as fraud. They need to refund me the money they took out of my account. I DID NOT sign up for ******** yet.

  Business response

  12/17/2021

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

  Please see our response to complaint #******** for ****** ***** that was received by us on December 08, 2021. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

  We confirmed that there are no active accounts on file for Ms. *****, and it doesn’t appear that an application was submitted or processed on her behalf. The phone number that the member states she called to cancel her plan is to a Place called ‘The Affordable Insurance’ and it appears they are licensed to sale Aetna ********. As a result, we reached out to our ******** team for further review. Our ******** Analyst Sara M. will maintain frequent contact with Ms. ***** as she will be her point of contact until the concerns are resolved.
  
  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,

  Shay G.
  Complaint and Appeals Consultant
  Executive Resolution Team

• Initial Complaint

  12/06/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  this co. has lied to me many times and stolen from me $195 dollars by giving me that amount that i paid to a dentist and for reimbursement! right after i deposited this into my bank they sent them a stop payment on not just that one but the other one that they finally returned of $102 dollars that was another payment. when i contacted them this is what they have been doing and i am SOOOOO sick of it!!!!!!!! they have been jerking me around for months now and wont get off their buts and do nothing!!!!!!!! i have contacted ******** also, and they are doing about the same thing!!!!!!! i need my money back asap and i surely need your help now and i would truely appreciate that as i need my money just like everyone else. also, i have sent them several other reimbursements that they have not done!!!!!!!!!! please help me to restore my faith in God's help. thank you so much in advance!!!!!!!!!!

  Business response

  12/16/2021

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

  Please see our response to complaint ******** for Norma Gray that was received by us on December 06, 2021.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

  Upon receipt of the member’s concerns, we immediately reached out internally to our ******** department for handling. They responded today stating they were able to confirm the reimbursement checks having a stop payment placed on them due to them being sent to the wrong address. They also confirmed we received a reimbursement request on September 17, 2021, and that request didn’t have all of the information needed to process a claim. The Explanation of Benefits (EOB) was sent out on October 16, 2020 explaining this to the member. The documents we received shows that $115.50 was paid on April 15, 2020, to ************* ****** ******* and $128.02 was paid to Commwell Health of Ocean.CareCredit on July 30, 2020. The documents do not show what type of services were received. The member needs to submit detailed receipts for both dates so we can consider payment.

  The member will receive a detailed letter from our ******** department in the mail within 7-10 business days and that letter contains the reimbursement form. The member will need to complete that form and attach all necessary documents and return it to the address listed on the form.

  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,
  Destiny S.
  Complaint and Appeals Consultant
  Executive Resolution Team

  
  

• Initial Complaint

  11/23/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Aetna has been an absolute nightmare to work with for providers. I work in the billing department for ***** *********** *** ****** ******** and Aetna has been processing our claims under the group; rather than the individual provider. Many of our surgeons are not in network on an individual level and should be paid at out of network rates. Unfortunately, due to the lack of organization from individuals at Aetna, our claims are not being processed or paid correctly. Also, when they process claims with multiple line items, they are split into multiple segments which makes it confusing for both myself and the Aetna representatives if there are incorrect denials and I have to get them reprocessed. We have lost a lot of money due to this and it is completely unacceptable. I am asking that a representative from Aetna contacts me so I can explain these issues in further detail. Thank you.

  Business response

  12/08/2021

  Dear Dear Ms. ***********************

  Please see our response to complaint ******** for ***** Molnar that was received by us on November 23, 2021.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

  Upon receipt of the concerns, we immediately reached out internally to have those concerns reviewed. A ticket was submitted to our Network department for assistance. Based on the submitted ticket, a Network representative (James O.) reached out to ***** directly and requested an updated roster. James also advised the claims should be paying at the group level because there is a group agreement and all providers billing under that tax identification number (TIN) should all be processing the same way. James will continue to work with ***** to reach final resolution once she submits to him the updated roster.

  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,

  Destiny S.
  Complaint and Appeals Consultant
  Executive Resolution Team

  
  

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