Complaints

This profile includes complaints for Aetna Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Aetna Inc.

  151 Farmington Ave Hartford, CT 06156-7003

• 

  Aetna Insurance

  7601 Ora Glen Dr Ste 200 Greenbelt, MD 20770-3641

• 

  Aetna Insurance

  7799 Leesburg Pike Ste 1100 Falls Church, VA 22043-2408

• 

  Aetna Insurance

  1301 Mccormick Dr Largo, MD 20774-5416

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  Aetna Inc.

  350 Springside Dr Akron, OH 44333-2435

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:05/05/2025

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On 4-22-25 I was checking the ****** ******** website and discovered that my drug plan with Aetna had increased the premium from, what started at $7 per month, is now in 2025 $40 dollars per month. I take no prescription drugs which is why I opted for a low cost plan. I also discovered that I was never notified about the change. I checked my email and had no message from Aetna in the fall of 2025. I did see messages from the two previous years. This denied me the opportunity to purchase different insurance during the open enrollment period. When I spoke with customer service they told me they offer no other plans, that they had consolidated the cheaper plan with the premium plan and converted it to the new plan. Everyone was notified via email of the change and since I missed the open enrollment period I will have to wait until October 2025 to change plans. This amounts to an additional $400 per year from my ****** ******** check, my only source of income. I am requesting a billing adjustment back to $7 per month since I never received notification and was denied the opportunity to change plans. Since this is how Aetna does business I will be switching plans as soon open enrollment period begns.

  Business Response

  Date: 05/06/2025

  **** *** ******* **********
  
  Please see our response to follow-up on complaint #******** for *** ***** ********* that was received by us on May 5, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you below.
  
  Upon receipt of the complaint, we immediately reviewed the member’s account. During our review, we have confirmed the plan received an online application through original Medicare’s website from *** ********* on November 19, 2021. This application was received as a request of enrollment into the SilverScript SmartRx Prescription Drug Plan (PDP) due to her being new to Medicare. *** *********’s application was approved by original Medicare and her ************ ******* PDP became effective December 1, 2021.
  
  The plan mailed *** ********* a confirmation of enrollment letter dated November 26, 2021. The letter states as of December 1, 2021, she should begin using ************ ******* (PDP) network pharmacies to fill her prescriptions. The monthly premium for your plan is $7.20.
  
  We show *** ********* requested to have her monthly premium payments withheld from the S***** ******** ************** ***** on November 21, 2021. We confirmed her automatic payments to be withheld from the SSA was approved and effective as of January 1, 2022.
  
  We would like to mention, we encourage our members to make well-informed healthcare decisions. The plan is required by Medicare to notify our members of any changes being made to their current plan. To assist with this, every year in the month of September we send our members an Annual Notification of Change (ANOC).  We encourage our members to read these documents as soon as they receive them to ensure that the plan is still right for them heading into the new year. This information is for them to review prior to the Annual Election Period (AEP), which takes places from October 15, through December 7, of every year. During the AEP, members may make plan changes. If they do not make any changes; they will remain in the same plan with any changes that were contained in the ANOC becoming effective January 1st. The enrolment periods are set by original Medicare and not by the plan. The information on how a member can end their membership with the plan is provided in their plan documents Evidence of Coverage plan booklet. All the members essential plan documents are located online at *******************************. This information can also be found in the Medicare & You 2025 handbook.
  
  We confirmed the member was mailed her ANOC notifications in 2021 and 2022. Beginning in 2023, the member’s account was set to receive plan documents including her monthly explanation of benefits statements, as well as the ANOC notification, via edelivery (email). The member would not have any emails received from us in the fall of 2025, as that is a future time frame. We have confirmed the member was emailed her ANOC documents in September of 2023, and 2024 calendar year. Sometimes these emails can be directed to their spam or junk folders within our member's email accounts. The ANOC includes information on the monthly premium cost changes, along with any other plan changes for the upcoming plan calendar year. The monthly premium plan changes from the time she enrolled into the plan up until current is as follows:
  
  In 2021, the ************ ******* (PDP) plan included a monthly plan premium of $7.20.
  
  In 2022, the ************ ******* (PDP) plan included a monthly plan premium of $7.00.
  
  On January 1, 2023, the plan name changed from SilverScript SmartRx (PDP) to SilverScript SmartSaver (PDP). In 2023, the SilverScript SmartSaver (PDP) plan included a monthly plan premium of $4.20.
  
  In 2024, the SilverScript SmartSaver (PDP) plan included a monthly plan premium of $5.20.
  
  On January 1, 2025, the SilverScript SmartSaver (PDP) plan was combined with our SilverScript Choice (PDP) plan. In 2025, the SilverScript Choice (PDP) plan includes a monthly plan premium of $40.20.
  
  Please know, Medicare will only allow members to disenroll at certain times during the year. From October 15 through December 7, members can join, switch, or drop a Medicare health or drug plan for the following year. Generally, members can’t make changes at other times except in certain situations, such as if they move out of SilverScript Choice (PDP)’s service area, want to join a plan in their area with a 5-star rating, or qualify for (or lose) Extra Help paying for prescription drug costs.
  
  What is Extra Help?
  People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If members qualify, Medicare could help pay for their drug costs, including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify won’t have a coverage gap or a Part D late enrollment penalty. Many people qualify for these savings and don’t even know it. For more information about this Extra Help, members can contact their local ****** ******** office, or call ****** ******** at ###-###-#### from 8 AM to 7 PM Monday through Friday. TTY users should call ###-###-####. Members can also apply for Extra Help online at ****************.
  
  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 *** ***** *********’s concerns.
  
  Sincerely,
  Marilyn
  Analyst, Medicare Executive Resolution Team

  Customer Answer

  Date: 05/06/2025

  
  Complaint: ********
  
  I am rejecting this response because: I did not receive an email from this company to my email address or in my spam or junk folders in 2024. I have checked all of those folderrs. HOWEVER, I stiil have the emails I did receive from this company in 2022 and 2023, regarding changes in the plan. I can't explain that but I was NOT notified of the changes in the cost of the plan, in time to make changes to my plan. Obviously, if I had received that email I would have made those changes. Maybe when the price of the plan has increased to more than five times what the patient was paying originally, a reputable company, who is really concerned about their patients, would make sure to make several attempts to notify them using various ways to do that. The Aetna plan I have as a supplement notified me by mail o fthe changes in that plan. I definetely feel that this was deliberate and as soon as I am able to change plans I will be leaving Aetna completely.
  
  Sincerely,
  
  ***** *********

  Business Response

  Date: 05/12/2025

  ***** ******* **********
  Re: BBB Rejection Complaint # ********:
  
  We have identified within your Better Business Bureau (BBB) case #********, for our member ***** ********* that she did not receive an email for her Annual Notice of Changes (ANOC) from SilverScript Prescription Drug Plan (PDP) to her email address for the plan year of 2025. Member states she checked her spam and junk folders, with no document found. Member also stated, she was not notified in time to review and make changes to the 2025 plan and feels this was deliberate. We understand how concerning this can be and we take your concerns very seriously.
  
  Upon the plan’s receipt of your BBB case, our Executive Resolution Team immediately reviewed *** *********’s account. During our review, we confirmed the plan received an online application through original Medicare’s website from the member on November 19, 2021. *** ******** application was received as a request of enrollment into the ************ ******* Prescription Drug Plan (PDP) due to her being new to Medicare. *** ********* application was approved by original Medicare and her ************ ******* PDP became effective December 1, 2021. 
  
  The plan mailed *** ********* a confirmation of enrollment letter dated November 26, 2021. The letter states as of December 1, 2021, the member should begin using the ************ ******* (PDP) network pharmacies to fill the member's prescriptions. The monthly premium for the member's 2021 plan is $7.20.
  
  We show *** ********* requested to have her monthly premium payments withheld from the S***** ******** ************** ***** on November 21, 2021. We confirmed *** ********* automatic payments to be withheld from the SSA was approved and effective as of January 1, 2022. 
  
  Annual Election Period (AEP), which takes places from October 15, through December 7, of every year. During the AEP, the member may make plan changes. If the member does not make any changes; shewill remain in the same plan with any changes that were contained in the ANOC becoming effective January 1st. Original Medicare sets the enrollment periods, not the plan. The information on how the member can end her membership with the plan is provided in her plan documents Evidence of Coverage plan booklet. 
  
  All *** ********* essential plan documents are located online at *******************************. This information can also be found in the Medicare & You 2025 handbook.
  
  We confirmed *** ********* was mailed her ANOC notifications in 2021 and 2022. Beginning in 2023, *** ********* account was set to receive plan documents including her monthly explanation of benefits statements, as well as the ANOC notification, via e-delivery (email). We have confirmed *** ********* was emailed her ANOC documents in September of 2023, and 2024 calendar year.
  
  At times, these emails can be directed to the member’s spam or junk folders within the member’s email account. The ANOC includes information on the monthly premium cost changes, along with any other plan changes for the upcoming plan calendar year.
  
  We understand that *** ********* stated she did not find the document in her junk or spam but we have confirmed that the ANOC was sent on September 2, 2024 at 14:45:55 and the email was read on September 13, 2024 at 15:44:11. The email was confirmed to be sent to the address of [email protected], which is what we have on file and per the member's original Medicare application.
  
  *** ********* was advised in the previous BBB complaint that on January 1, 2025, the SilverScript SmartSaver (PDP) plan was combined with our SilverScript Choice (PDP) plan. In 2025, the SilverScript Choice (PDP) plan includes the member's new monthly plan premium of $40.20.
  
  Please know, Medicare will only allow a member to disenroll at certain times during the year. From October 15 through December 7, you can join, switch, or drop a Medicare health or drug plan for the following year. Members can’t make changes at other times except in certain situations, such as if you move out of SilverScript Choice (PDP)’s service area, want to join a plan in the member’s area with a 5-star rating, or qualify for (or lose) Extra Help paying for prescription drug costs.
  
  Silverscript has confirmed that there are two Five Star Rated plans available in the member’s area if she is not pleased with her current plan. *** ********* can also apply for Extra Help to pay for her prescription drug costs with instructions below.
  
  What is Extra Help? 
  People with limited incomes may qualify for Extra Help to pay for your prescription drug costs. If you qualify, Medicare could help pay for your drug costs, including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify won’t have a coverage gap or a Part D late enrollment penalty. Many people qualify for these savings and don’t even know it. For more information about this Extra Help, you can contact your local ****** ******** office or call ****** ******** at ###-###-#### from 8 AM to 7 PM Monday through Friday. TTY users should call ###-###-####. You can also apply for Extra Help online at ****************.
  
  We want to thank you for the opportunity to address your concerns. We value your feedback and thank you for bringing *** ********* issue to our attention. It is through valuable input such as yours that we can improve upon our services and member satisfaction. We apologize for the inconvenience this may have caused you as our valued member.
  
  Sincerely,
   
  Melissa R.
  
  Analyst, Medicare Executive Resolution
  
  Medicare Complaint Team

  Customer Answer

  Date: 05/12/2025

  
  Complaint: ********
  
  I am rejecting this response because: I did not receive the email to my email address and like I stated in my earlier response, when changing a patient's insurance premium amount to more than 5 times the original amount a reputable company would make sure that the patient is notified by more than just a single email since it appears that sometimes emails don't get to the patient. And I I also stated in my previous response that Aetna supplemental insurance notified me by postal mail of a change in my premium amount. I also don't know how my notifications were changed to email only either. So like I stated in my previous response, I will be changing both of my insurance plans, drug and supplemental insurance with Aetna, as soon as I possibly can. I also plan on letting all my friends and family know exactly the kind of company Aetna is, untruthful, deceiving and unconcerned about patient's needs. Please don't cloud the next response with all the prior verbiage of how we got to this place we've reviewed that twice now.
  
  Sincerely,
  
  ***** *********

• Initial Complaint

  Date:05/01/2025

  Type:Product Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My ****** said I was covered for 3 months but I paid 4 months premiums. A call with AetnaCVSHealth on 3/7/25, call reference number listed in form below, with AetnaCVSHealth and ************ *********** confirmed that I would be receiving a refund of $72.42 and it while it would take approx 14-20 days to process I would in fact be receiving it. I've spent 4-6 calls and hours of my life trying to get this refund after it never showed up on time. Nobody was able to help. Today 4/30/25 I spoke with a supervisor and he said he has to call me back and get ************ *********** back on the line to discuss. Why? The matter was already resolved on 3/7/25. Why is it taking so long to send me my refund and why have I wasted so much time dealing with this. I have no confidence that I'll even get this refund. Hoping for some help from the BBB.

  Business Response

  Date: 05/06/2025

  **** *** ******* **********
  
  Please see our response to complaint #******** for ****** **** that was received by us on May 01, 2025. 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 Mr. **** concerns reviewed. It has been confirmed by our enrollment team that a termination file has been sent to Aetna directly from *** ******* *** ****** (****) reflecting the member’s coverage effective date of April 01, 2024, and the termination date of June 30, 2024.
  
  Our enrollment team has updated *** ****** termination to June 30, 2024, matching the records from ****. A refund was submitted to the member in the amount of $72.42 on May 06, 2025. The member will receive the refund in 3-5 business days.
  
  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 Answer

  Date: 05/09/2025

  
  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. The full refund was received on 5/7/25. I want to thank the BBB for their part in this process.
  
  Sincerely,
  
  ****** ****

• Initial Complaint

  Date:04/28/2025

  Type:Billing Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My name is *** ******. I am the spouse of ****** ****** and responsible for this bill. In August 27, 2024 my wife ****** ****** went to the ***** ****** in 1790 Scenic Highway, Snellville, Ga 30078 for Dental treatment. **** ****** ID *******. The bill of ($1203.75),,One thousand two hundred and three dollars and Seventy five cents was sent to Aetna insurance after treatment and over ten times WAS DENIED FOR NO REASONS . I went for the ***e treatment on August 01, 2024 and the bill was fully paid by Aetna. We are both insured by Aetna insurance ID #**** *****. The treatments that were done was scheduled over (2) two years before it was done. Several times I called Aetna with my wife on phone and put the Aetna Ofice online with The ***** ****** and the bill was not paid. Some of the several times that I called Aetna Insurance are September 09,2024, September 11, 2024, September 19,2024, September 27, 2024, October 06, 2024, October 21, 2024, November 11, 2024, November 27,2024, November 29, 2024, December 03,2024, March 03, 2025, April 06, 2025, and April 16,2025. ALL THOSE DAYS that we called AETNA INSURANCE, THEY INFORMED US THAT THEY WERE WAITING FOR MORE INFORMATIONS FROM ***** ****** IN ORDER TO PAY. THEY REFUSED TO PAY AS OF NOW. TWICE I ASKED AETNA INSURANCE TO SEND ME APPEAL FORMS TO APPEAL THEIR DECISONS. THEY PROMISED TO SEND THE APPEAL FORMS TWICE. INDEED TWICE THEY LIED AND DID NOT SEND THE APPEAL FORMS. (March 03, 2025 and April 16, 2025). The ***** ****** has written me over ten (10) letters harassing, threatened and demanding that I paid the bill that The Aetna insurance must paid as agreed. A COPY OF THE BILL ATTACHED. The manager at the ***** ****** REFUSED TO TREAT US and cancelled all our Dental appointments until we paid the amount owed. ALL I AM REQUESTING IS THAT AETNA INSURANCE PAID THE ***** ****** AS WE ALREADY PAID OUR CO- PAYMENTS. AND APOLOGISED FOR ALL INC.ONVENIENCES , We are retired and paid our insurances monthly.

  Business Response

  Date: 05/05/2025

  **** *** ******* *********:
  
  Please see our response to complaint #******** for ****** ****** that was received by us on April 29, 2025. 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 Ms. ******’s concerns reviewed. It has been confirmed that denial for the periodontal scaling and root planning for the upper and lower left and right quadrant were overturned. It was found that the claims for the services were reprocessed to allow the overturned services. The member is owed a refund from ***** ****** in the amount of $50.00. Ms. ****** will need to allow fifteen business days from May 01, 2025, for the provider to issue the refund.
  
  The services for the periodontal scaling and root planning for the upper left quadrant will remain denied as it was found not be medically necessary. We have confirmed that the member cannot be charged for this quadrant.
  
  A copy of the updated Explanation of Benefits (EOB) and resolution letter from the complaint ************* have been included 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. 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 Answer

  Date: 05/11/2025

  
  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.

  HOWEVER I STILL DEMAND AND APOLOGY FOR THE PAINS AND SUFFERINGS  AND WHAT I WENT THROUGH TO GET IT RESOLVED'

  AND THANKS TO THE BBB ORGANIZATION FOR YOUR EFFORTS AND ASSISTANCE.
  
  Sincerely,
  
  *** ******

• Initial Complaint

  Date:04/23/2025

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Aetna mixed up my paperwork with someone else's. They list a ***** ** ***** as the provider, and the date of service as 08/09/24. That is incorrect. The $21 amount is the right figure. I requested reimbursement for an aquatics class taken through the ********* ***** ** Recreation Department. It began on January 7, 2025. I filed an appeal. They sent me someone else's paperwork. My claim is not stale. I am a senior citizen. I had a bone disease in my shoulder. My mobility is limited in that arm. The aquatics class is in my opinion the most beneficial thing I can do for the arm and shoulder. I went to a gym for about 13 years.

  Business Response

  Date: 05/07/2025

  **** *** ******* **********
  
  Please see our response to complaint # ******** for *** **** ****  that was received by us on April 23, 2025.  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. Appeal *********** is pending good cause due to the date of service of the Explanations of Benefits (EOB) showing in the case.  It is not a different member.  We were able to find the correct EOB and are working with the Appeals’ Department to add the correct EOB, so the appeals can be worked.
  
  Even though you are appealing, the claim for the member’s reimbursement was correctly denied.  In 2024, the member had a direct fitness reimbursement.  In 2025, the fitness reimbursement is not longer available.  The member was sent the Annual Notice of Changes in September, and it states Fitness Reimbursement is not covered.
  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 *** ****** concerns. 
  Sincerely,
  Cindi D
  Analyst
  Medicare Executive Resolutions

  Customer Answer

  Date: 05/07/2025

  
  Complaint: ********
  
  

  The response was garbled. Aetna changed its reimbursement policy.  I accept their conclusion.  To resort to the vernacular, it is what it is.  I DO NOT WANT A DETAILED LETTER OF EXPLANATION.  Don't waste your time or my own.

  
  Sincerely,
  
  ***** ****

• Initial Complaint

  Date:04/23/2025

  Type:Product Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I requested a refund In Jan 25 for dental procedure for the amount of $2300.00 I have had customer department and then I spoke with someone in resolution department. I spoke with a Johnny and Chinni. I was told that the following check# *******, *******, *******, ******** for the amount of $2300.00. They also told me that a complaint form was sent out to me that I never received. My last conversation was on 042325 with someone who told me that the check was sent overnight and I should have received it on 042225. I am requesting my refund of $2300 immediately.

  Business Response

  Date: 05/06/2025

  Dear Mr. Stewart Henderson: 
  
  Please see our response to complaint # 23240201 for Ms. Bryna Spector, which we received on April 23, 2025. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you. 
  
  Upon receipt of the concern, we immediately reviewed the member’s claim details. We received the member’s dental reimbursement claim on, November 21, 2024. The payment in the amount of $2,309.33 was issued on December 2, 2024. When the member advised us that she has not received her payment, we stopped the payment and reissued a new check on, January 17, 2025. We were notified by the member again that she did not receive her payment. The payment was stopped and reissued again on, March 29, 2025. We are very sorry for the inconveniences this has caused. We want to advise that a stop payment and reissue can only be processed if a member has not received the payment within 45 days of the check issue date. Any request that was made prior to the 45 days could not be processed. The Executive Resolutions Team has submitted a new stop payment and reissue request on the member’s behalf. On May 2, 2025, a new check was shipped to the member via UPS Overnight, I spoke with *** ******* on May 2, 2025, and provided her with the shipment tracking id number. On May 6, 2025, I contacted *** ******* again to confirm that she has received her payment. 
  
  We understand that there is still some concern about where the member’s previous payments were sent. We have contacted our internal financial team to confirm that there were three checks sent to the address on file. 
  Here are the last three checks that were mailed to this member, excluding the one for this request. We have received data to confirm the following checks that were sent.
  Check Number: ********
  Ship Date: January 22, 2025
  **** First Class 6x9 Tracking ID: ******************
  
  Check Number: ********
  Ship Date: April 2, 2025
  **** First Class 6x9 Tracking ID: ******************
  
  Check Number: ********
  Ship Date: April 22, 2025
  **** First Class 6x9 Tracking ID: ******************
  
  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

  Date:04/22/2025

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On behave of a medical provider **** *** ******** ******* *** *********** tax # ********* - *** ******* ** * *** *** ***** ** *****. Physical Therapy Providers are all out of network. For the past year or so , Aetna is pricing claims incorrectly not based on patients policy which is R & C 80%. Aetna sends our claims to **** *******. When we call , it is confirmed the claim was under paid, that the pricing is incorrect and they sent for re pricing - but stated we need to provide a non contract with **** *******. We explain that there is none and if **** ******* is adamant about there being one, it is their responsibility to provide one, in proof of justifying this low payment. Claims are being sent back to review reimbursement, corrected pricing BUT we need to call 3 times every 30 days. NOT only this is against all laws but we as DRs need to call for 3 months just to get a payment for rendering service under patient policy !! this needs to be fixed

  Customer Answer

  Date: 04/23/2025

  we are out of network providers therefor we do not have any contracts with them 

  Business Response

  Date: 04/30/2025

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

  Please see our response to complaint # ******** for ***** ******* on behalf of **** *** *********** *** ******** ******* that was received by us on April 23, 2025. 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 this complaint is coming from a third party and is not coming directly from the provider group. We would need the business agreement between the third party and the provider group to continue with the complaint. This business agreement has been requested twice, from two different people and we have yet to receive the business agreement that states the provider group is giving the third-party permission to act on their behalf. The attached document to this complaint is not a business agreement and is not legible. The third party would need to submit the business agreement in order for this complaint to be reviewed.
  

  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

  
  

  Customer Answer

  Date: 04/30/2025

  Hello I work directly with the provider and the group. Not sure what business agreement is needed.

  
  Thank you

• Initial Complaint

  Date:04/21/2025

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I am a victim of healthcare fraud through the Healthcare Marketplace,having been signed up for a policy without my knowledge. The person committing fraud signed me up for Aetna *** Health, and we didn't discover any of this any months later attempting to file our taxes. We filed this case as fraud with the Marketplace,but it was ruled against me,because it was discovered an ambulance company when I was sick billed this insurance and got payment October 18,2024, hence it was felt since we used the insurance this wasn't fraud. The ambulance company was contacted and money was refunded to Aetna *** health on March 16th 2025. Healthcare Marketplace will not allow an appeal unless Aetna *** shows this money was refunded and allows an appeal to go forward. Ultimately the *** ***** *** **** ***** form invalidated. I have made numerous phone calls to Aetna *** call center and have offers of help,but no one has helped, plus the necessary communication doesn't go forward to the Healthcare Marketplace. I think they use a foreign call center and not scripted to handle this type of problem

  Business Response

  Date: 04/30/2025

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

  Please see our response to complaint # ******** for ****** ****** that was received by us on April 22, 2025. 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 has been determined that the member was showing active from August 1, 2024, through February 1, 2025. Only one claim was found for date of service October 4, 2024, the claim was paid to the provider on October 12, 2024. On March 6, 2025, we received a void replacement claim, this was done by the provider to void the original claim. The original claim was voided, and an overpayment was sent to the provider, on March 8, 2025, we recovered the overpayment. The original claim has since been voided and the overpayment was satisfied. The member never received an Explanation of Benefits (EOB) to show the claim was in fact voided because in this case only the provider would generate an EOB. A detailed letter was mailed to the member today so that letter can be used to show the Marketplace the claim was in fact voided out. The member should receive this letter by mail in 7-14 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. 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

  Date:04/21/2025

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been messaging you and calling Aetna since 02/07/2025 to try to resolve 3 bills that are outstanding with *****. I changed to and HMO in 01/01/2024. I believe this defaulted to Mercy Physicians and I called in 03/2024 to designate *****. The woman designated ***** and told me to let her know when I decide on a physician. I designated *** ******** and began treating with him on 05/20/2024. I have treated with ***** ever since. I have paid every copay from 05/20/2024 forward. I later received a message from ***** saying I owe $1,888.88. I immediately messaged Aetna and they said these claims were processed and I paid my co-pay and I owe nothing. ***** continued to say I owed them the money. I messaged Aetna again and they then told me that I had designated ***** ********* ******* ***** which was incorrect. There was some error at some point when my insurance defaulted to them and once I was made aware of this I immediately called Aetna and they said they corrected the mistake and back dated the designation so I would have no issues with bills being paid. I again was informed by ***** I owed this money. I then called Aetna, and on 03/12/2025 Marvin confirmed that I do not owe this money and that he was going to send the bills back for processing. I asked him to please call me on the Monday 03/17/2025 and he never did. I messaged Aetna and they said he called me and left me a voicemail. He absolutely did not call me nor did he leave me a voicemail as I have all records of missed calls and voicemails. ***** again insists I owe the money and it's now almost $2,000.00. I'm on the phone with Aetna right now and the woman said Martin submitted the bills (maybe only one of the three she can't tell) and that he called ***** and left a voicemail for them on 03/17/2025 then "washed his hands of this". He never called again to follow up with ***** and never called me. Please ask Aetna for messaging history and call history dated all the way back to 02/07/2025.

  Business Response

  Date: 04/29/2025

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

  Please see our response to complaint # ******** for ********* ****** that was received by us on April 21, 2025. 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 has been determined that the member did call to change her Primary Care Physician (PCP) on March 26, 2024, however, on that call the member services representative advised that the PCP she had selected was determined to be a pediatrician so the member could not use that particular provider, this is why the system auto assigned the ***** ********** ***** as the PCP. The member services representative offered to change the PCP to *********** ******, but the member stated she would call back after she had researched the provider. The member called back on November 13, 2024, stating that she thought her PCP had been changed already. The member services representative advised that per the notes from the March 26, 2024, call the member was supposed to call back to designate her PCP. The PCP was changed on November 13, 2024, and back dated to October 1, 2024, as *********** ****** Physicians. Outreach was made to *********** ****** billing department, Marie R advised that she would resubmit the claims to Aetna, this process can take seven to 10 business days to receive the new claims. After the new claims are received it can take up to 30 business days for the claims to be processed and finalized. Once the claims are processed and finalized the member will receive new Explanation of Benefits (EOB). Marie R also advised that she has placed a hold on the members account so that it will not go to collections while we get the claims processed and finalized.
  

  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. Biddle’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 Answer

  Date: 05/01/2025

  
  Complaint: ********
  
  I am rejecting this response because:
  I appreciate the response and this sounds promising, however, I have to reject the response at this time as I simply do not want this case closed until ***** has been paid.

  Sincerely,
  
  ********* ******

• Initial Complaint

  Date:04/21/2025

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I enrolled in an Aetna HMO plan through the *** for 2025. I researched carefully to ensure that my doctor was an in-network provider. Now, I am receiving notice from my doctor's medical group that as of April 1, 2025, Aetna will no longer include them for coverage. So, the plan that I specifically chose because my doctor was in-network is now NOT covering my doctor. If insurance indicates a provider is covered at the time of enrollment, they should uphold that contract for the enrollment period. I now have to try and find a new cardiologist and it is extremely difficult to establish. Aetna should be held accountable for this and reinstate coverage for my doctor.

  Business Response

  Date: 04/29/2025

  **** *** ******* **********
  
  Please see our response to complaint #******** for ***** ********** that was received by us on April 21, 2025. 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 *** **********’s concerns reviewed. Based on the review it has been confirmed that member was informed that her cardiologist, *** ***** ** ******* was out-of-network as of April 01, 2025, and any claims after April 01, 2025, would be the member’s responsibility. After further review, we have confirmed that Ms. ********** does not have any claims or referrals for *** ***** ** ******* or with ************ ******* ***** on her account.
  
  We have engaged with our network team and was informed that Intercoastal Medical Group’s contract was terminated on April 01, 2025, for business reasons. The provider’s group was sent written notices 120 days prior to the termed date to allow members time to locate an in-network provider.
  
  We have attempted to contact Ms. ********** on multiple occasions, by phone and email ******************** without any response. A detailed voicemail was left at the phone number we have on file. A list of in-network Cardiologist was sent to the member’s 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. 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

  Date:04/17/2025

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I had Aetna CVS Bronze S: ******* plan last year via ********** ***********. I had met my annual out of pocket expenses in August 2024 but Aetna refused to pay for these two claims. I called twice and both times the reps understood the issue and said they couldn't figure out why I had additional out of pocket expenses when I had met my Out of Pocket in August 2024. Both times they say they will call back with a resolution but NEVER did! How stupid is that of such a big company to pray on people? This is insane. I want my $50 back which I had to pay because the isurance refused to pay and refused to correctly reprocess the claims.

  Business Response

  Date: 04/21/2025

  Dear *** ******* *********:  
  
  Please see our response to complaint #******** for ****** ****** ******* that was received by us on April 17, 2025. 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. It has been confirmed that there was an overpayment of his 2024 accumulator by $100.00 in December 2024. The three claims associated with the overpayment were from the date of service December 14, 2024.

  We confirmed that all three claims were reprocessed. The claim details are as followed:
  Claim: EWPDHSMQN was reprocessed on April 21, 2025, billed total $90.05, Aetna paid $57.17, leaving a new member responsibility of $0.00.
  Claim: EVADHPF0B was reprocessed on April 21, 2025, billed total $377.10, Aetna paid $0.00, leaving a new member responsibility of $0.00.
  Claim: EHY2KK2R6 was reprocessed on April 21, 2025, billed total $170.00, Aetna paid $170.00, leaving a new member responsibility of $0.00.

  The member and the provider will receive the updated Explanation of Benefits (EOB) in 7-10 business days. 
  
  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Rosario’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