Business Profile

Insurance Companies

Aetna Inc.

Headquarters

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Complaints

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

Customer Complaints Summary

1,344 total complaints in the last 3 years.
491 complaints closed in the last 12 months.

If you've experienced an issue

Submit a Complaint

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:02/05/2024
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.
They automatically enroll you in part D Medicare without your authorization or knowledge and you must contact a number to opt out which is inexcusable. There is no reason for them to have individuals pay more than what they’re paying. I currently have Medicare plus I am paying coverage for it Insurance and now they want me to also pay more when they are practically paying nothing since Medicare A&B pays for majority of the cost of my health cost and they only pay whatever’s left over. And now they want me to pay more by enrolling in part D, this is unexcused. They should not enroll individuals especially senior citizens without first advising them that they will be enrolled , or if they even want the coverage. Instead they automatically enroll us and then ask us to call to opt out. What if the individual is sick and cannot get to a phone or has no one to support them. This is unexcused someone needs to correct this practice.
Business Response
Date: 02/15/2024
Dear *** ******* **********

Please see our response to complaint # ******** for Ms. ********* *******, that was received by us on February 6, 2024. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the concern, we immediately reviewed our internal system to locate Ms. *******’s plan. Our research confirms that Ms. ******* is not an Aetna member. It appears that she is a **** ***** **** ****** member. Therefore, the member will need to contact the appropriate business.

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

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution
Business Response
Date: 02/15/2024
Dear *** ******* **********

Please see our response to complaint # ******** for Ms. ********* *******, that was received by us on February 6, 2024. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the concern, we immediately reviewed our internal system to locate Ms. *******’s plan. Our research confirms that Ms. ******* is not an Aetna member. It appears that she is a **** ***** **** ****** member. Therefore, the member will need to contact the appropriate business.

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

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution
Business Response
Date: 02/15/2024
Dear *** ******* **********

Please see our response to complaint # ******** for Ms. ********* *******, that was received by us on February 6, 2024. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of the concern, we immediately reviewed our internal system to locate Ms. *******’s plan. Our research confirms that Ms. ******* is not an Aetna member. It appears that she is a **** ***** **** ****** member. Therefore, the member will need to contact the appropriate business.

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

Sincerely,
Jasmine W.
Analyst
Medicare Enterprise Resolution
Customer Answer
Date: 02/16/2024

Complaint: ********

I am rejecting this response because: my complaint was originally submitted in 2023 as you can see by the email attached that Better Business Bureau received it in November 2023. I did not receive your response till recently that Better Business Bureau was reviewing it and they placed a date of 2024.
Please make the corrections and please make sure Aetna complies with what they did not do for customers. Thank you.

Sincerely,

********* *******
###-###-####
Customer Answer
Date: 02/16/2024

Complaint: ********

I am rejecting this response because: my complaint was originally submitted in 2023 as you can see by the email attached that Better Business Bureau received it in November 2023. I did not receive your response till recently that Better Business Bureau was reviewing it and they placed a date of 2024.
Please make the corrections and please make sure Aetna complies with what they did not do for customers. Thank you.

Sincerely,

********* *******
###-###-####
Customer Answer
Date: 02/16/2024

Complaint: ********

I am rejecting this response because: my complaint was originally submitted in 2023 as you can see by the email attached that Better Business Bureau received it in November 2023. I did not receive your response till recently that Better Business Bureau was reviewing it and they placed a date of 2024.
Please make the corrections and please make sure Aetna complies with what they did not do for customers. Thank you.

Sincerely,

********* *******
###-###-####
Business Response
Date: 02/16/2024

Dear Mr. Henderson:
Please see our response to complaint ******** for ********* ******* that was received by us on February 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 Ms. *******’s concerns, we reviewed the account. The Aetna plan was terminated as of December 31, 2023. Aetna doesn’t enroll members into Medicare plans. Additionally, the member is enrolled in a **** ***** **** ****** (****) Medicare plan. Ms. ******* would need to contact **** regarding her enrollment in their plan. Aetna cannot see other carrier’s plans and member accounts.
I reviewed the dates of the Better Business Bureau (BBB) complaints as well and found the original complaint was submitted on February 06, 2024, and we responded on February 15, 2024. MS. ******* rejected our response on February 16, 2024, and we’re responding to that rejection on February 16, 2024. Complaints filed with the BBB are sent to us the same day and we’re required to respond within 10-calendar days. Therefore, the member wouldn’t have submitted a complaint to us via the BBB in December that went unanswered until February. However, if Ms. ******* filed a BBB complaint with ****, we wouldn’t be able to see that. Ms. ******* is no longer an Aetna member and needs to contact **** regarding any additional questions or concerns she has.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *******’s concerns.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team

Business Response
Date: 02/16/2024

Dear Mr. Henderson:
Please see our response to complaint ******** for ********* ******* that was received by us on February 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 Ms. *******’s concerns, we reviewed the account. The Aetna plan was terminated as of December 31, 2023. Aetna doesn’t enroll members into Medicare plans. Additionally, the member is enrolled in a **** ***** **** ****** (****) Medicare plan. Ms. ******* would need to contact **** regarding her enrollment in their plan. Aetna cannot see other carrier’s plans and member accounts.
I reviewed the dates of the Better Business Bureau (BBB) complaints as well and found the original complaint was submitted on February 06, 2024, and we responded on February 15, 2024. MS. ******* rejected our response on February 16, 2024, and we’re responding to that rejection on February 16, 2024. Complaints filed with the BBB are sent to us the same day and we’re required to respond within 10-calendar days. Therefore, the member wouldn’t have submitted a complaint to us via the BBB in December that went unanswered until February. However, if Ms. ******* filed a BBB complaint with ****, we wouldn’t be able to see that. Ms. ******* is no longer an Aetna member and needs to contact **** regarding any additional questions or concerns she has.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *******’s concerns.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team

Business Response
Date: 02/16/2024

Dear Mr. Henderson:
Please see our response to complaint ******** for ********* ******* that was received by us on February 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 Ms. *******’s concerns, we reviewed the account. The Aetna plan was terminated as of December 31, 2023. Aetna doesn’t enroll members into Medicare plans. Additionally, the member is enrolled in a **** ***** **** ****** (****) Medicare plan. Ms. ******* would need to contact **** regarding her enrollment in their plan. Aetna cannot see other carrier’s plans and member accounts.
I reviewed the dates of the Better Business Bureau (BBB) complaints as well and found the original complaint was submitted on February 06, 2024, and we responded on February 15, 2024. MS. ******* rejected our response on February 16, 2024, and we’re responding to that rejection on February 16, 2024. Complaints filed with the BBB are sent to us the same day and we’re required to respond within 10-calendar days. Therefore, the member wouldn’t have submitted a complaint to us via the BBB in December that went unanswered until February. However, if Ms. ******* filed a BBB complaint with ****, we wouldn’t be able to see that. Ms. ******* is no longer an Aetna member and needs to contact **** regarding any additional questions or concerns she has.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *******’s concerns.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team
Initial Complaint
Date:02/05/2024
Type:Customer Service 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 an aetna medicaid member I am not able to login to the website or the app at all. My user name is *******. I would like for aetna to fix the issue of me not being able to login.
Business Response
Date: 02/08/2024

Dear *** *********:
Please see our response to complaint ******** for ******* ******** that was received by us on February 05, 2024. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Upon receipt of the member’s concerns, I immediately reached out to our Website team and the Aetna Better Health (ABH) team. The ABH team confirmed there is no member portal for ABH Medicaid members at this time. The online member portal the member was trying to sign into, based on the screenshot provided, is for commercial plan members and doesn’t currently support the Medicaid line of business at this time. If the member needs assistance, he can contact ABH Member Services at the phone number listed on the back of his member ID card.
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,
Destiny S.
Analyst, Executive Resolution Team
Initial Complaint
Date:02/02/2024
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.
My neurologist has decided that I need an oral splint due to debilitating TMJ caused by Ehlers-Danlos Syndrome. Aetna has refused to cover this device which I very urgently need. The doctor's office was not able to submit for a Prior Authorization because they were getting a notification in their system that one was not needed. They decided to call Aetna to confirm coverage, and they spoke to a representative who told them that it would not be a covered benefit based on the procedure code that the doctor's office is trying to use. Based on my Summary Plan Description (see attached), this is indeed a covered benefit. I need this to be resolved as soon as possible. I cannot afford this without my health insurance. This is not a cosmetic or optional device. It is prescribed by an MD and not a DDS. Please see below for the email that was sent from my doctor's office listing their interaction with the Aetna rep. I have also attached my Aetna Member ID Card in case it is needed to find my account. Benefits per Aya @ AETNA TMJ is a covered benefit per rep ***** is a plan exclusion but per her reading of the benefit TMJ should cover physical therapy, trigger point injections, mouth appliance/splint which is limited to one, and surgery if appliance alone cannot result in functional improvement. I asked rep to clarify how it is showing it not covered and she said it says "no benefit for that code". REF# 6179745193 Kira Cormier, Practice Administrator *** ******** ****** **** * **** ****** ****** ***** *** ******* ** ***** *********************************** ***** *** * **** * ***** ***** *** * **** * ***
Business Response
Date: 02/08/2024
**** ******* **********

Please see our response to complaint #******** for ***** ******* ***** that was received by us on February 02, 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 Customer Service department. They reviewed the member’s concerns and contacted him. They explained that the plan does have coverage for a Temporomandibular Joint (TMJ) splint once every five years. They explained that the Current Procedural Terminology (CPT) code provided does not apply to the benefit, and provided the applicable cross-code from the Current Dental Terminology (CDT) codes. They assisted the member with a list of participating providers, as well as providing information to request a non-participating provider be covered at the participating level. The member’s calls were reviewed and feedback and training provided as appropriate.

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
Date:02/01/2024
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.
I received medical treatment on 9/28/2023 from ********* ********* ********. The claim was originally processed and an explanation of benefits was generated on 11/17/2023 by Aetna insurance, reflecting I would max my deductible and max my out of pocket maximum. According to Aetna the claim was reprocessed and a new explanation of benefits was submitted on 12/12/2023 reflecting a patient responsibility of $315. However, the hospital in question has not received any updated paperwork and now two additional claims have processed with Aetna not reflecting my maximum being reached. I have currently payed $1377 dollars over my $6400 out of pocket maximum. I have contacted Aetna medical concierge service by live chat 6 different occasions and by phone on 5 additional occasions. Each time was I was told I would receive follow up from the escalation or claims processing in 7-10 business days. I have been contacting since December 15, 2023 and it is now February and resolution or follow-up still hasn't been received.
Business Response
Date: 02/08/2024
Dear Mr. ******* *********:

Please see our response to complaint #******** for ******* ****** that was received by us on February 01, 2024. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Upon receipt of your request, we immediately reached out to our Claims Management Team, who reviewed Mr. ******’s concerns. Based on their review they confirmed that we have reprocessed the claim from ********* ********* ******** from the date of service September 28, 2023. The correct patient responsibility is $315.63.

Our team has reached out to the ********* ********* ******** billing office and spoke with Maria. We advised her of the correction made to the claim and the corrected patient responsibility. We attempted to reach out to Mr. ****** and left a voicemail with the updated claim information.

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,

Marshell H.
Analyst, Executive Resolution
Executive Resolution Team
Customer Answer
Date: 02/08/2024
I am going to accept the response as the Hospital is attempting to update the claim, now that Aetna has actually made contact. However, I have received no communications from Aetna. There was ZERO attempt to call me or leave me a message.
Customer Answer
Date: 02/08/2024

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. However, no attempt was made by Aetna to contact me as stated in the response.

Sincerely,

******* ******
Initial Complaint
Date:02/01/2024
Type:Customer Service 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.
ubject: Complaint Regarding Delayed Service and Lack of Communication I am writing to express my dissatisfaction with the service provided by Aetna *** Health through Covered **********. I purchased medical insurance, specifically the Bronze 60 HMO plan, with a start date of January 1, 2024. I received the Enrollment Confirmation (Order #******) from Covered ********** on December 27th after making the necessary payment in the first week of January. My frustration arises from the fact that despite numerous attempts to contact Aetna customer service, I was unable to reach a representative. The automated service repeatedly disconnected me, leaving me with no means of communication. Unfortunately, I never received any communication or documentation from Aetna in the mail. This lack of information forced me to switch to another provider, rendering my payment for the full month of January unnecessary. On multiple occasions, I needed to use the insurance, only to find that I had no documents, making it impossible to utilize the coverage. This situation has also affected my daughter's vaccination schedule, putting her health at risk. Surprisingly, it was only today, on January 30, 2023, that I finally received a mail from Aetna containing the insurance cards. Due to the delay and inconvenience caused, I am requesting a refund for the amount I paid for the month of January, which amounted to $847.31. I trust that Aetna *** ****** will address this matter promptly and take the necessary steps to prevent such issues in the future. Sincerely,
Business Response
Date: 02/12/2024
Dear ******* *********:

Please see our response to complaint # ******** for ***** ********* that was received by us on February 1, 2024. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Upon receipt of your concerns, we immediately reached out internally for review. We confirmed that the member signed up for a policy on December 30, 2023, through ************** and a confirmation letter was mailed to him on December 30, 2023, outlining the necessity of making the initial effectuating payment before any plan information would be issued. We also confirmed that the member made the initial effectuating payment of $847.31 on January 5, 2024, which took 3-5 business days to process. Once the payment was processed, the plan became active with an effective date of January 1, 2024, and policy documentation (including member identification cards) was mailed to the address on file. Per our policy, it takes at least 10-14 business days for mailings to reach members. Given this timeline, 3-5 business days to process the payment, then 10-14 business days to receive plan documents, receiving the plan information at the end of January is accurate. Please know, after making his first payment, the member had the option of contacting member services to obtain his member identification number. Member services would have also been able to assist Mr. ********* with the member portal which allows him to access digital copies of plan documents, including identification cards. However, we reviewed the member’s call history and were unable to locate any calls made to member services concerning this matter. Per Mr. *********’s request, his policy was cancelled on January 31, 2024, and a refund has been requested. The refund will be processed back to Mr. *********’s original payment method and can take up to 21 business days. In addition, a plan advocate attempted to contact the member to discuss the outcome of his complaint but was unsuccessful. Unfortunately, they were unable to leave a voice message as the option was not available. Should the member have any questions regarding this matter, he may contact member services by dialing the telephone number on the back of his member identification card.
Furthermore, the member will receive a resolution letter in the mail detailing the outcome of this complaint.
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,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Customer Answer
Date: 02/13/2024

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. I wait to see the refund credit back into my account.

Sincerely,

***** *********
Initial Complaint
Date:01/29/2024
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.
I have Aetna indemnity plan, basic. Am not getting any claims approved that are allowed. Two ER visits, not covering ANY claims submitted. Including covered expenses allowed. Customer service acts like they can't hear me and had to repeat numerous times about my information. Have not received anything for services covered since end of 2023 to now. 01/2024.
Business Response
Date: 02/01/2024
Dear Mr. *********:
Please see our response to complaint ******** for ***** ******* that was received by us on January 29, 2024. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Upon receipt of the member’s concerns, we immediately reached out to the plan team for ****** ********* members. Per their review, the claims have all been paid according to the policy. A breakdown of claims and the processing have been attached to this response for the member to review. Additionally, a review of the member’s call history was completed as well. The last phone call took place on January 26, 2024, and we pulled that call and listened to it. At the onset of the call, Mr. ******* was very angry and irate with our Customer Service Representative (CSR) and the call was not productive. Our CSRs are available and ready to assist Mr. ******* but it’s important that both parties are exhibiting behaviors that are productive and allow our CSRs a fair opportunity to assist. Based on the call reviews and the complaints filed by Mr. *******, it appears there may be confusion in the type of plan he’s on and how the plan benefits are designed. Our Voluntary team has made two attempts to contact Mr. ******* to discuss the plan design and how the plan’s benefits work and our attempts to contact him were unsuccessful. We encourage Mr. ******* to contact our Voluntary team at the contact information they left on his voicemail for assistance. I’ve attached the plan documents to this response for the member to review and reference in the future if needed. Per the plan’s design, Aetna pays to a certain dollar amount, as outlined in the plan documents, for the services provided and the outstanding balance would be the member’s responsibility. The plan also provides a Preferred Provider Organization (PPO) discount. If Mr. ******* has any additional questions or concerns, he should contact Member Services at ###-###-####. That phone number is also on the back of the member’s Aetna ID card.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. *******’ concerns. If there are any additional questions regarding this particular matter, please contact Member Services at ###-###-####.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team

Customer Answer
Date: 02/01/2024

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
Date:01/26/2024
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 1/16/24 I submitted a prior authorization request for medication I have already received a prior authorization for successfully in the past. My physician submitted the request on my behalf, with all of the medical history regarding WHY I need the authorization attached. On 1/24/24 I had received no updates on this so I called my physician. They said they had attempted to make the request several times but each time it was denied and they could not figure out why. Then I called Aetna, and they said my doctor had submitted NO paperwork evidence with my request and then the customer service agent started repeating what she told me only slower like I was stupid. (Let me reiterate that I have been taking this medication for a year because I have tried everything else and this is what works). I said I would call doctors office to confirm. Doctors office was adamant that they submitted all the required documentation (and I believe them because I have had this doctor since I started any medication for this disorder). I called Aetna again to which they again said that the prescriber only submitted one time, and gave me a number for them to call to do a verbal authorization. My doctors office then called and told me that they tried to use the number but Aetna told them that they had submitted and been denied too many times and now they have to go through an appeals process. (I thought they had only submitted once??) I am livid because either their system isn’t user friendly, it isn’t working or they’re lying. Those are the only options.
Business Response
Date: 01/26/2024

Dear Mr. *********:
Please see our response to complaint ******** for ****** ***** that was received by us on January 26, 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, I immediately reviewed the appeal under case number *************. Based on the appeal case notes, the Medical Director (MD) has overturned the appeal decision as of today approving the medication for 12 months effective January 26, 2024, through January 26, 2025. The appeal case states the member has a diagnosis of attention deficit disorder and documentation reflects the member is currently stabilized on ******* since July of 2022. Therefore, the decision has been overturned. The member will need to have her provider submit a new authorization prior to this authorization expiring to avoid a lapse in medication.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *****’s concerns.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team
Initial Complaint
Date:01/25/2024
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.
Im been wait aetna for a while i have two complains about my claims they denied. First claim is where the removed the provider i went to in few months and didnt give any headup resulting in claim going to collection agency. Second claim which clearly shows thats its in network but is denied without giving any reason.I called so many times to get that resolved but they keep going in circles all the time. I am so tired and so stressed out due to this.
Business Response
Date: 02/02/2024
**** *** ******* **********
Please see our response to complaint #******** for ****** ***** that was received by us on January 25, 2024. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Upon receipt of your request, we immediately reached out to our Customer Service Team, who reviewed Mr. *****’s concerns. Based on their review it has been confirmed that the claim from the date of service August 15, 2023, was reprocessed as a one-time exception to allow the services to be processed at the in-network rate. The member’s responsibility for the claim is now $5.00, which is his Urgent Care copayment. It was confirmed that the claim from the date of service January 22, 2024, was processed correctly. A referral from the member’s Primary Care Provider is required to be seen by specialist.

Mr. ***** has a right to appeal, the member has 180 days from the date her Explanation of Benefits is issued to file an appeal. Mr. ***** may call customer service at ###-###-#### or send a letter to the following address:

Aetna Appeals Resolution Team
** *** ***** ********** ** ******

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,

Marshell H.
Analyst, Executive Resolution
Executive Resolution Team
Customer Answer
Date: 02/05/2024

Complaint: ********

I am rejecting this response because:
January 22, 2024 i went only there after the PCP referral. They can check with the PCP also on this. They can also see there was a visit to pcp before thats just to get the referral.I was only able to make appointment because if the referral. Now due to this we are no able to proceed with the surgery which is becoming difficult and causing more issues.

Sincerely,

****** *****
Business Response
Date: 02/13/2024
Dear Stewart Henderson:

Please see our response to complaint # ******** for ****** ***** that was received by us on February 5, 2024. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

Upon receipt of your concerns, we immediately reached out internally for review. We have reviewed the member’s file and confirmed that a referral has not been received from the member’s primary care physician. An outreach was made to the provider’s office who advised the member was seen on January 11, 2024, upon which the referral request was placed on the same day. However, the provider’s office confirmed that a referral was not sent to Aetna, but they are in the process of submitting one. Should the member have any questions regarding this matter, he may contact member services by calling the telephone number on the back of his member identification card.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. *****’s concerns.

Sincerely,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:01/25/2024
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 filled a claim by following the process according to my supplemental plan. I followed through with multiple phone calls. I was told the amount of the funds I would receive. On multiple calls I was told my claim was approved. I received an email and called to inquire on the email and was told, I do not need to do anything else that I was approved and my claim was due to my by 1/25/2024. Today is 1/25/2024 and still no funds. I called and was told my claim is in the final steps of processing which is now proving that Aetna is lying. I am now being told mine is being released by this week and then will take additional banking days. Aetna DOES NOT follow through what is documented in their policies on their expectations to the policy holders. This company lies and does not stand behind their policy!!! They do not care the policy holder has hospital bills and they are trying to to tell me the critical illness plan takes a little longer, then why the heck does the policy have a guarantee of 7-10 business days A BUNCH OF LIES!!! BEWARE OF THE COMPANY
Business Response
Date: 01/30/2024
Dear ******* *********:

Please see our response to complaint #******** for ***** ********* that was received by us on January 25, 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 Aetna Voluntary department to assist with our investigation. They reached out to the member to advise the claims were paid on January 24, 2024, and payment issued directly to her bank account on file. The member confirmed receipt of the payment on January 27, 2024. Regarding the member’s call, we reviewed the recording and provided feedback and training as necessary.

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,

William B.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:01/24/2024
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.
Aetna *** for a reason that until now has not been justified they canceled my Aetna health insurance since I had an automatic withdrawal they denied me medical care at the *** ******* urgent care clinic due to the cancellation of the Aetna health insurance, I called the Aetna insurance asking That was what was happening and they informed me that it was due to lack of payments, I said it was a mistake because I had an automatic withdrawal. I went to the bank and explained to me that my health insurance had been canceled due to lack of payments, that the Aetna health insurance for some reason had not been debited from my account for 2 months but that the bank agent was going to do me the favor of helping me…. I told him that please I would appreciate it since I have intense kidney pain and that I need to be treated urgently! He called Aetna *** Insurance and explained that he would make the two payments at that time. The receptionist who was in the *********** was still giving him a hard time and did not want to accept the payment. The bank agent said that he had to process it and at the end of the day, after insisting, she accepted date 11/24/23 confirmation number *********. In the first instance, with what authorization they stopped debiting my bank account, there was always cash... that is a violation of my privacy, they abused authority and persecution and denied my social benefits. Second, I do not agree under any terms that my private information and my finances should be managed in any country other than the ***... That my bank account and my social benefits should be managed in another country, in this case from the ***********. It was not all that who made this medical insurance affiliated with the Health Market. Not satisfied with that. On 5/1/24 I had an appointment at ********* ** ***** for an ultrasound of my kidneys, I was with a full bladder ready for the exam when the receptionist told me that my Aetna *** medical insurance was canceled I told her to please call and he said that and they have told him that it is cancelled. I called the health insurance Aetna *** shares and they told me that I was active I told them to report to radiotherapy for my exam that because I had not updated it that I had renewed the co-treatment for 01/1/24 with Aetna and they could not put it at risk my health that I had kidney problems and that it was illegal what they were doing, discriminatory acts against me, very unethical bipartisan!!! Not the first time that I have problems with my social benefits, I use them when I need them, Mr. President Biden, I am also a caring American and I work very hard for my social benefits. It is not possible that your administration will not allow me to use my benefits. They put My health and integrity are at risk. I also have problems at the pharmacy. They won't let me pick up my medications. Why? Aetna *** has not made the updates
Business Response
Date: 02/08/2024
**** ******* **********

Please see our response to complaint # ******** for ***** ******** that was received by us on January 25, 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 internally for review. We confirmed that the delinquency in question was from the member’s 2023 policy, and it occurred due to nonpayment/payment irregularity. The member had an on-exchange policy with subsidies that allowed her to have a 90-day grace period of coverage. Therefore, her plan would not have terminated due to a one to two-month delinquency. The member set up auto pay on October 4, 2023, with the payments scheduled to withdraw on the 15th of each month. Please be advised the billing cycle was prorated. Therefore, the first payment drafted on October 15, 2023, was applied to September, the payment drafted on November 15, 2023, was applied to October and the member made a voice pay payment on November 24, 2023, that applied to November and December. Furthermore, the member was enrolled in a fully subsidized bronze 4 plan with Aetna for 2024 with a $0 monthly premium. We did not make any withdrawals in 2024 because there were no payments due.
We have reviewed the phone call between Aetna customer service, the member, and her bank, and it is documented that the account was not terminated just delinquent by one month’s payment. The Aetna representative correctly advised that customer service representatives are not able to take payments over the phone and provided the phone number to the automated phone payment line along with the necessary system identification number. The callers (member and bank representative) were transferred to the payment line and the payment was successful. Additionally, the member’s call history was reviewed, and the necessary coaching was provided to the representatives involved. Please know, the member’s plan was voluntarily terminated on January 29, 2024. However, prior to that, the member’s plan was active without any gaps in coverage. We also reviewed the member’s pharmacy claims and were unable to locate any denials due to the lack of coverage. Lastly, we confirmed that one of our member service advocates attempted to contact the member several times to address her concerns and answer any questions that she may have. However, the attempts were unsuccessful. Voice messages were left should the member want to return the advocate’s call. The member will also receive a resolution letter detailing her concerns in the mail.
In response to our ***** of offshore representatives, many businesses send functions to be handled offshore. In the event that functions are handled in this way it is always done only after taking into account any applicable laws around the practice.
Aetna is committed to being an inclusive health care company. Aetna does not discriminate on the basis of ancestry, race, ethnicity, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. ********’s concerns.

Sincerely,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Customer Answer
Date: 02/14/2024
Due to the lack of communication from Aetna with *** ****** who assisted me, he was his assistant, I was not able to get my Asthma inhaler medication because the *** pharmacy said that my Aetna insurance did not cover what *** ****** and the doctor had pre-written ****** said that Aetna insurance did cover it, I called the insurance again and the insurance told me that I had to change *** ****** for another medication that the insurance covers, I called and asked *** ****** to please pre-write me to a medication that insurance covers and he told me that I had to call Aetna at my insurance to give me a list of what medication I will need. It is really unacceptable that I have to deal with medication lists since Those are the doctor's functions, putting my life at high risk since on 11/02/2024 I had an asthma attack that I had to leave my job because I felt like I was dying.
Business Response
Date: 02/22/2024

Dear Mr. Henderson:
Please see our response to complaint ******** for ***** ******** that was received by us on February 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 member’s concerns, we immediately reached out to our Pharmacy department for review. Per Pharmacy’s review, they concluded the member was originally prescribed Dulera however, the claim for ****** rejected as non-formulary on January 08, 2024. The member was written for ************ **********) as the alternative to Dulera and that prescription was filled and the claim was processed and paid. The member never picked up the medication therefore, the claim was reversed. This issue is considered to be 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.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team

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