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

1,342 total complaints in the last 3 years.
492 complaints closed in the last 12 months.

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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:03/14/2025
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 have recently received calls as well as mail for Medical services. Aetna is my current insurance provider. Ive never authorized a third party to have access to my medical records nor my personal information. Also, I never was informed about a third party having access to my information. I feel very violated. Also the fact that my co-pays has went up without being informed is even more ballistic. I don't feel that my privacy rights have been upheld. I also feel that them not informing me of a co-pays increase prevented me the opportunity to seek an insurance company that would be in my best interest.
Business Response
Date: 03/24/2025
**** *** ******* *********:

Please see our response to complaint # ******** for *** ******* ********* that was received by us on March 14, 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. Evicore is a vendor that Aetna utilizes for enhanced clinical information. We are required to use them for certain procedures to be reviewed and approved. Per Aetnamedicare****, there is a document that advises Aetna is allowed to use the member’s information for preventative health, disease, case management, and care coordination.

The notification of the change of the member’s copays can be found in your Annual Notice of Change (ANOC) that was sent out on September 10, 2024 to the member's email on file. The ANOC is sent out in September so that the member can weigh her options of keeping the plan or changing a different plan in her area. Open Enrollment Period which runs October 15th to December 7th yearly. The document is emailed yearly so our members can better plan financially for the upcoming year.

Annual Enrollment runs from January 1, 2025, until March 31, 2025, where the member can make a onetime plan change that would start the 1st of the following month. The member can go to Aetnamedicare**** to view plans in your area. To see what plans are offered by other carriers in her area you can go to Medicare.gov or by calling Medicare at ###-###-####. The member can always contact her ***** ****** ********* ********** ******* ****** at ###-###-####.
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
Initial Complaint
Date:03/11/2025
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 had to get an MRI done. Date of service was 11/4/2024. My pre-paid card would not work in the Service Providers machine, so I had to pay with my credit card. So I went to Aetna to get re-imbursed for the $120 I had to pay the Service Provider. My claim was denied. I then appealed and and won on my payment claim 2/5/25. So I never got the reimbursement payment and called them again and they told me I only had to 3/1/25 to file a claim. I told them I didn't have to file a claim. I already had filed it previously. I had to call them several times (they won't call you back). So I finally got a manager in the Hartford CT Headquarter office named David. He reviewed it and said I had to file more paperwork if I want to get paid. I explained to him that I had sent documentation 2 or 3 times already. And he said, there's nothing else he could do. The phone number on my called ID from him was ###-###-####. So I tried to call him back at that number and it said I had to call the # that was on the back of my Medicare ID card. So I called Aetna again today to try and get his last name and contact info, but they said they are not allowed to give that out. There have been numerous phone calls made to them since 11/2024 through today with no satisfaction. Perhaps, there is also an agency that regulates insurance companies that I could report them.
Business Response
Date: 03/24/2025
**** *** ******* **********

Please see our response to complaint # ******** for *** ***** ******, which we received on March 11, 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 2024 plan details. The member was enrolled in Aetna Medicare Advantra Silver (HMO-POS) for the 2024 plan year. With this plan, members received an Aetna Medicare Payment Card. The benefit includes a $100 quarterly benefit amount (allowance) member can use to pay for cost share expenses for medical plan covered services such as physician visits, lab work, and vision and hearing exams. It may also be used to pay for additional visits for a plan covered service that has a visit limit.

We located the claim for date of service, November 4, 2024. The claim was accepted with a copay responsibility of, $120. We understand that the member had issues with his ******* card on the date of service. We contacted ******* (now *******) to address the member’s concerns. Unfortunately, the ******* benefit details for 2024 are no longer available. ******* advised that they did receive a reimbursement request for $120 on November 15, 2024. $120.00. On November 19, 2024, ******* sent a request for additional information. ******* asked the member to send the claim with the insurance Explanation of Benefits statement or an itemized bill. According to *******, the member called on December 20, 2024. The ******* Rep explained what information was needed for reimbursement. The member called ******* again on March 6, 2025. He advised that he submitted the requested information. At that time, the benefit for the 2024 plan year expired. The representative advised to re-submit the documents and it could be sent as an appeal. The member requested to speak to a supervisor. A supervisor was not available at the time. The representative offered a call back.

We received an appeal on December 30, 2024. The Appeals team reviewed the member’s request and decided to overturn the original claim decision. On February 5, 2025, the claim was sent back to the Claims Department to be reprocessed. Unfortunately, the request to reprocess and remove the copay was not clear. We have sent feedback to Appeals team for service improvement. The claim for date of service, November 4, 2024, has been reprocessed as of March 24, 2025. We have adjusted the cost share for this date of service. The claim details are below.
Date of Service: November 4, 2024
Claim: *********
Provider: *** ****** ************* ***
Billed Amount: $4,502
New Paid Amount $682.28
Copay $0

Previous Claim
Claim: *********
Provider: *** ****** ************* ***
Billed Amount: $4,502
Paid Amount: $564.69
Copay: $120

The plan will send an updated Explanation of Benefits statement to the member and his provider within 30 days. *** ****** can contact his provider to be refunded.

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

Business Response
Date: 03/24/2025
**** *** ******* **********

Please see our response to complaint # ******** for *** ***** ******, which we received on March 11, 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 2024 plan details. The member was enrolled in Aetna Medicare Advantra Silver (HMO-POS) for the 2024 plan year. With this plan, members received an Aetna Medicare Payment Card. The benefit includes a $100 quarterly benefit amount (allowance) member can use to pay for cost share expenses for medical plan covered services such as physician visits, lab work, and vision and hearing exams. It may also be used to pay for additional visits for a plan covered service that has a visit limit.

We located the claim for date of service, November 4, 2024. The claim was accepted with a copay responsibility of, $120. We understand that the member had issues with his ******* card on the date of service. We contacted ******* (now *******) to address the member’s concerns. Unfortunately, the ******* benefit details for 2024 are no longer available. ******* advised that they did receive a reimbursement request for $120 on November 15, 2024. $120.00. On November 19, 2024, ******* sent a request for additional information. ******* asked the member to send the claim with the insurance Explanation of Benefits statement or an itemized bill. According to *******, the member called on December 20, 2024. The ******* Rep explained what information was needed for reimbursement. The member called ******* again on March 6, 2025. He advised that he submitted the requested information. At that time, the benefit for the 2024 plan year expired. The representative advised to re-submit the documents and it could be sent as an appeal. The member requested to speak to a supervisor. A supervisor was not available at the time. The representative offered a call back.

We received an appeal on December 30, 2024. The Appeals team reviewed the member’s request and decided to overturn the original claim decision. On February 5, 2025, the claim was sent back to the Claims Department to be reprocessed. Unfortunately, the request to reprocess and remove the copay was not clear. We have sent feedback to Appeals team for service improvement. The claim for date of service, November 4, 2024, has been reprocessed as of March 24, 2025. We have adjusted the cost share for this date of service. The claim details are below.
Date of Service: November 4, 2024
Claim: *********
Provider: *** ****** ************* ***
Billed Amount: $4,502
New Paid Amount $682.28
Copay $0

Previous Claim
Claim: *********
Provider: *** ****** ************* ***
Billed Amount: $4,502
Paid Amount: $564.69
Copay: $120

The plan will send an updated Explanation of Benefits statement to the member and his provider within 30 days. *** ****** can contact his provider to be refunded.

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

Customer Answer
Date: 03/25/2025

Complaint: ********

I am rejecting this response because: I have submitted the documentation 2 or 3 times in the mail to Aetna already. I had contacted Aetna on 3/19/25 Case# ********* and was told a check would be processed to me in 30-45 days. On a previous call to Aetna on 3/11/25 and I was told they sent a payment from Aetna for $569 (which supposedly the $120 was included with that payment). I followed up with *** and they said they never received a wire from Aetna. The only other information was that the address for this wired payment on 3/14/25. Going back to the 11/4/24 letter, it said I won the appeal, but I still never got the money. Since Aetna made the payment to AHN, they were at fault, so I think they should debit *** for the $120 and send me the payment (that's if the payment went through. that *** denied getting). So why is it that they screwed up and they want me to jump through hoops to get the $120. Bottom line is they should send me a payment for $120 and they need to go back to *** and debit them $120 to them. Thank you.

Sincerely,

***** ******
Customer Answer
Date: 03/25/2025

Complaint: ********

I am rejecting this response because: I have submitted the documentation 2 or 3 times in the mail to Aetna already. I had contacted Aetna on 3/19/25 Case# ********* and was told a check would be processed to me in 30-45 days. On a previous call to Aetna on 3/11/25 and I was told they sent a payment from Aetna for $569 (which supposedly the $120 was included with that payment). I followed up with *** and they said they never received a wire from Aetna. The only other information was that the address for this wired payment on 3/14/25. Going back to the 11/4/24 letter, it said I won the appeal, but I still never got the money. Since Aetna made the payment to AHN, they were at fault, so I think they should debit *** for the $120 and send me the payment (that's if the payment went through. that *** denied getting). So why is it that they screwed up and they want me to jump through hoops to get the $120. Bottom line is they should send me a payment for $120 and they need to go back to *** and debit them $120 to them. Thank you.

Sincerely,

***** ******
Business Response
Date: 04/15/2025
Dear Mr. Stewart Henderson:

Please see our response to follow-up on complaint # ******** for *** ***** ****** which was received by us on March 26, 2025. After receiving this rejection, we promptly conducted internal research.
Our Executive Resolution Team has finalized the research, and I would like to share the results of the review with you.
We have confirmed in the member’s account, the claim for the services the member received on on November 4, 2024, at *** has been reprocessed. There was an error found in a previous appeal and the claim was reprocessed to remove the member’s cost share of $120.

We have received notification from *** that a refund of $120 was processed back to the credit card, which was used as the original method of payment on April 11, 2025. They recommend allowing 5-7 business days for the refund to appear in the member’s account.

According to the 2024, Evidence of Coverage, the member’s benefit for their emergency care was as follows:

Emergency care refers to services that are:
• Furnished by a provider qualified to furnish emergency services, and
• Needed to evaluate or stabilize an emergency medical condition.

Cost sharing for necessary emergency services furnished out-of-network is the same as for such services furnished in-network. The 2024 cost share was a $120 copay. Cost sharing is waived if they are admitted to the hospital within 24 hours.

The member also had the Aetna Medicare Payment Card. The Medical Expense Wallet provided a $100 quarterly benefit amount (allowance) that could be used to pay for cost share expenses for medical plan covered services such as physician visits, lab work, and vision and hearing exams.

The payment could not be processed through ******* as the copay amount exceeded the $100 allowance.

The member will receive the detailed Medicare response in the mail within seven to ten 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 concern.

Sincerely,
Jennifer
Analyst
Medicare Executive Resolutions

Business Response
Date: 04/15/2025
Dear Mr. Stewart Henderson:

Please see our response to follow-up on complaint # ******** for *** ***** ****** which was received by us on March 26, 2025. After receiving this rejection, we promptly conducted internal research.
Our Executive Resolution Team has finalized the research, and I would like to share the results of the review with you.
We have confirmed in the member’s account, the claim for the services the member received on on November 4, 2024, at *** has been reprocessed. There was an error found in a previous appeal and the claim was reprocessed to remove the member’s cost share of $120.

We have received notification from *** that a refund of $120 was processed back to the credit card, which was used as the original method of payment on April 11, 2025. They recommend allowing 5-7 business days for the refund to appear in the member’s account.

According to the 2024, Evidence of Coverage, the member’s benefit for their emergency care was as follows:

Emergency care refers to services that are:
• Furnished by a provider qualified to furnish emergency services, and
• Needed to evaluate or stabilize an emergency medical condition.

Cost sharing for necessary emergency services furnished out-of-network is the same as for such services furnished in-network. The 2024 cost share was a $120 copay. Cost sharing is waived if they are admitted to the hospital within 24 hours.

The member also had the Aetna Medicare Payment Card. The Medical Expense Wallet provided a $100 quarterly benefit amount (allowance) that could be used to pay for cost share expenses for medical plan covered services such as physician visits, lab work, and vision and hearing exams.

The payment could not be processed through ******* as the copay amount exceeded the $100 allowance.

The member will receive the detailed Medicare response in the mail within seven to ten 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 concern.

Sincerely,
Jennifer
Analyst
Medicare Executive Resolutions

Customer Answer
Date: 04/15/2025
I checked my charge card, but as of today at 4:40PM EST, it is ,not there. I will continue to check and advise if/when I recieve the payment. Thank you.
Customer Answer
Date: 04/15/2025
I checked my charge card, but as of today at 4:40PM EST, it is ,not there. I will continue to check and advise if/when I recieve the payment. Thank you.
Customer Answer
Date: 04/17/2025

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. I did see the credit on my credit card today. Thank you.

Sincerely,

***** ******
Customer Answer
Date: 04/17/2025

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. I did see the credit on my credit card today. Thank you.

Sincerely,

***** ******
Initial Complaint
Date:03/11/2025
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’ve had Silverscript for years. All of a sudden *** ******** raised my drug prices by a factor of about 10. It’s unconscionable. There is no legitimate reason to increase prices so dramatically. As soon as the next opening occurs, we will look for other options! Very dissappointed in ***!
Business Response
Date: 03/12/2025
**** *** ******* **********

Please see our response to complaint # # ******** for Mr. ***** ****** that was received by us on March 11, 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. The inflation reduction act made many enhancements to Part D coverages such as $0 cost-sharing during the catastrophic phase, elimination of the coverage gap and limiting the Rx OOP threshold to $2,000. These enhancements to the basic Part D plan will benefit many if not most Medicare beneficiaries but reduces the ability to design products with meaningful differentiation. Consequently, a decision was made to consolidate SmartSaver and Plus with our Choice PDP.

One of the changes in the member’s plan for 2025 is the deductible phase of Coverage. In 2024, the deductible of $280 only applied to Tier 2 through 5. In 2025, the deductible of $590 is for Tiers 1 through 5, except for covered insulin products and most adult Part D vaccines.

The notification of the change of the name can be found in the Annual Notice of Change (ANOC) that was sent out in September. The ANOC is sent out in September so that the member can weigh his your options of keeping the plan or changing a different prescription drug plan in his area. Open Enrollment Period which runs October 15th to December 7th yearly. The document is emailed yearly so our members can better plan financially for the upcoming year.

The member may apply for Extra Help which is federal funded by using one of these options should you need financial assistance:
1. Fill out the online application at **************************************
2. Call Social Security at <###-###-####, 8 a.m. to 7 p.m. Local Time, Monday-Friday>.
The member may apply for state assistance through State pharmaceutical assistance program (SPAP) at **************** 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
Initial Complaint
Date:03/09/2025
Type:Delivery 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 been trying for over a year to resolve an issue with receiving my EOB’s from ********/Silverscript in the mail. I have filled out the go paperless information on my profile in my online account. Also made many phone calls. Also spoke with their technical support staff and most recently with their member service support team. Every time I get of the phone I’m told “you’re all set you should no longer receive your EOB’s in the mail”. However I just received another one this past Friday. I called in on Monday to talk to members service support team, had to leave my name and number for a call back. Two days later still no call. I sent an email to the person I had communications with in December and January. The response I got was my survey was closed that I needed to call in. This has become extremely frustrating. I have been very patient trying to resolve this through the normal channels with no success. I’m hoping you can move this up to the next level as I’m starting to feel like they are not taking this issue seriously. Their is so much identify theft going on and this document has some information about me that I would rather not be left in my mailbox that could alternately be delivered electronically.
Business Response
Date: 03/20/2025
Dear *** ******* *********:

Please see our response to complaint # ******** for *** ******* *****, which we received on March 10, 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 communications preference. We confirmed that the member’s communications preference is set to paperless. We found that *** ***** has contacted the Customer Service team to express concerns about his Explanations of Benefits statements. The Customer Service team has set the preference correctly. The member’s email address and communications preferences are showing as accurate in our system.

The member’s concerns were sent to our Digital Communications team to be escalated. The Digital Communications team advised that the email notifications were flagged as undeliverable. The Centers for Medicare and Medicaid (CMS) requires the plan to send a paper copy of the Explanation of Benefits statement if the digital copy is undeliverable. The Digital Communications team contacted our print vendor for further assistance. The plan print vendor has advised that there was a system delay in retrieving the member’s email address from the plan. We have worked with the print vendor to fix this issue. The email address has been successfully updated with the print vendor. The member’s Explanation of Benefits statement notification will now be sent to you by email.

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

Customer Answer
Date: 03/21/2025

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.

Sincerely,

******* *****
Initial Complaint
Date:03/07/2025
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.
Basically, my Aetna policy is being violated. Aetna has refused to honor the benefit package that I have, despite my repeated attempts to straighten things out. I don't want to try and determine what causes them the confusion, but they do not have a good system going...especially for senior citizens. I have never dealt with anything like this before. My policy is the ***** ******** (PPO) # *********. The Vision Care benefit I have is this: one free routine eye exam/year and $150 eyeglasses reimbursement/year. I went to an in-network eye doctor (***** *****) for the exam this year on 1-2-2025. I also purchased through a two-for one offer four pair of glasses...first on 1-2-25, then again on 1-17-25. Again, all "in-network". My out-of-pocket expenses totaled $189: $39 for the exam and $150 for the glasses. This is what I am entitled to under my Aetna policy. (My glasses actually ran over the $150 limit, but by policy, that's my cost.) Aetna has wrongly interpreted my benefit package, and also wrongly labeled my purchases as "out-of-network". So, what can I do about it? I have tried calling their service number (1-833-570-6670) many times, I have sent them e-mail messages online to no avail, and even returned to the stores to attempt to resubmit using the Aetna card. Nothing has worked. Since 2022 I have never had a problem paying and then submitting to Aetna for reimbursement. This was how my insurance rep had directed me to handle vision care. My cost invested as stated is $189. Aetna has paid a total of $100.63 by means of three checks (see below). Their people have admitted I am entitled to the free exam and $150 for glasses, but that's as far as it goes. The $88.37 I'm rightfully owed doesn't begin to cover my time, gas, and headache this has caused. Seems to me that this is the Aetna way: to underpay on benefits and then try to discourage people from collecting. Please help??
Business Response
Date: 03/17/2025
**** ** *** *********** *** ******* **********

Please see our response to complaint # ******** for *** ******* ****** that was received by us on March 7, 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. The member’s plan allows for one routine eye exam per year at a $0 copay. The member had his eye exam on January 2, 2025, and the provider had the member pay for the routine eye exam up front. The provider is in network with Eyemed, and a claim was submitted by the provider and paid for by Aetna on March 4, 2025. We contacted the provider to inquire that the member should not have been charged for your eye exam. The provider advised us that they contacted the member on March 13, 2025, and he will be reimbursed for the eye exam.

We contacted the Claims’ Department to find out why the member was not reimbursed the full $150 for your glasses and were only reimbursed $89. The second request for the eyewear reimbursement was denied because only one pair of frames were covered.

The member has a right to appeal. Appeal *********** was overturned on March 13, 2025. The claim is being reworked so the member will get the additional $61 eyewear reimbursement. The member will receive a detailed Medicare Resolution Letter within 7-10 business days.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. ******** concerns.
Sincerely,
Cindi D
Analyst
Medicare Executive Resolutions
Initial Complaint
Date:03/06/2025
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.
Late last year while reviewing my medical insurance with Aetna I noticed I had a benefit of $600. I could use to purchase health related equipment . Then in November I received a letter in regard to an Aetna Extra Benefits card that I would not be able to use after 12/31/2024. I contacted Aetna and was told I had been receiving an extra $45. Each month uploaded to a card that I had not received. I explained to multiple representatives that I had not received this money and did not have a card. They agreed to send me a card for December with $45. On it that I must use by 12/31/2024. Representatives explained they would check with supervisors about sending me the remainder of the money I should have been receiving, total of $495. And I should hear from someone in a couple weeks. During this conversation I asked about the $600. Benefit for health equipment. The representative explained that I could purchase things like a bicycle, smart watch, etc. So I asked specifically, if I buy a smart watch I can be reimbursed? Yes, she replied and went on to explain it would take about 30 days to be reimbursed and I would have to complete a form on line and upload receipt. I purchased an ***** watch on 12/30/2024, completed the online form and uploaded the receipt. The form indicated it had received it and listed it as pending. After many calls with representatives telling me to give it awhile longer, give it till the end of Feb. Etc. Most recently 3/5/2025 I was told I would need to submit another form that would be mailed to me. This is just another stall tactic; they do not intend to reimburse me. According to my records they owe me $495.money I should have received in 2024 plus the 353.68 for the smart watch reimbursement $848.68. Seems like after *** bought Aetna everything fell apart.
Business Response
Date: 03/11/2025
**** *** ******* **********

Please see our response to complaint # ********for *** **** **** that was received by us on March 6, 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. The ******* ******* Extra Benefit program for 2024, can be found on page 11 of the Annual Notice of Changes that was mailed out on August 17, 2023.

We do apologize that the member was not able to utilize her full ******* *******s Funds, but the program with ******* *******s as of December 31, 2024, and we are unable to obtain any missed funds that was not used.

The member has a yearly or quarterly allowance and will pay upfront for qualified fitness activities and fitness equipment for the sole use by the member. The member will need to submit for reimbursement. The member can use this benefit to be reimbursed for a range of eligible fitness-related services, activities, and equipment. Wearable tracking device examples but not limited to:

1. ***** Watch (All models)
2. ******* Watch (All models)
3. ****** ***** Watch
4. ****** (All Models)
5. ****** Fitness Tracker
6. ***** **** *** Pro Outdoor Watch
7. Step Counter
8. ******* Watch
9. ******** smartwatch

Wearable heart rate monitor used for tracking heart rate during exercise or monitoring fitness activity levels during the day is covered.

With a reimbursement allowance, the member will pay upfront and send the required information to us to get paid back. The member will need to complete a fitness reimbursement claim form for each item and include an itemized receipt. Additional information may be required. See the fitness reimbursement form for details. The member must use the fitness reimbursement form. The member can find this online at *****************/reimburse to print. It will arrive in 7-10 days. The Fitness DMR form is also available on *****************, *********************************** and ***************.

Once the member completes the fitness claim form, she can mail to the medical claims address listed on the back of your ID card or you can fax it to ###-###-####. Be sure to make copies of what is sent to us.

Submit the reimbursement request within 60 days of the purchase date. While the member can request reimbursement at any time during the plan year, we encourage the member to file right away. All receipts must be submitted by the end of the plan year.

Once all required information is received and the request is approved, it may take up to 45 days to send payment via check.

If something has been denied, the member is able to submit a written appeal if she believes it should have been covered.

Per further research, the submitted your receipt for the fitness reimbursement to ******* *******s and not to Aetna. We were able to upload the receipt, but in order for Aetna to process your reimbursement, the member will need to fill out the claim form. The member will receive a detailed Medicare Resolution Letter within 7-10 business days.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ****** concerns.
Sincerely,
Cindi D
Analyst
Medicare Executive Resolutions
Customer Answer
Date: 03/11/2025

Complaint: ********

I am rejecting this response because: I did pay upfront for my ***** watch, I completed the online form, attached my receipt and have been told since January that they did receive it and it is still pending. Asking me to complete another form is just another stall tactic. What has happened to this company? The other funds that were never used should also be paid. What a horrible way to treat seniors! My guess is they will not even send me this new form they mentioned. I am not letting this go. Not sure what my next step is...maybe I need to contact ******** ******** office. Based on all the other complaints I have read perhaps there should be a class action law suit. At any rate I am so disappointed with Aetna and I will pursue this claim.

Sincerely,

**** ****
Business Response
Date: 03/12/2025
**** *** ******* **********

Please see our response to the rejection of our previous response to complaint #******** for *** **** **** that was received by us on March 12, 2025. Our Executive Resolution Team took a second look of the members concerns, and we would like to share the results of the review with you.

Upon receipt of the rejection, we confirmed in the ***************************** website the online form that the member mentions that she already filled out, for her ***** Watch fitness reimbursement request was to ***************. *************** was our vendor in 2024, for the extra benefits card.

The fitness allowance benefit is a direct member reimbursement through the Aetna plan, not through the vendor, ***************. The member would need to submit the fitness reimbursement form that is required by the plan. Once all required information is received and the request is approved, it may take up to 45 days to send payment via check. If the reimbursement claim would happen to be denied, the member is able to submit a written appeal. We have attached a copy of the fitness reimbursement form for the member’s convenience. We ask that she please complete and return the fitness reimbursement form as instructed on the form.

In 2025, Aetna no longer uses the vendor *************** for the extra benefit allowance. All the extra benefit cards through *************** were deactivated at the end of the calendar year, December 31, 2024.

After further review, we show the member requested a rollover of her extra benefits allowance on December 17, 2024, due to not being aware of her extra benefit card monthly allowance of $45 and not using the benefits January through November of 2024. *************** completed a review on their end on December 18, 2024, and closed her request as follows:

The ******* ******* Extra Benefit program information for 2024, was provided to the member in the Annual Notice of Changes for 2024. We have confirmed was mailed to the member on August 17, 2023, to her address on file as **** ********* *** ******* **** *****. The member’s plan included a $45 monthly benefit amount.

We confirmed the member was mailed an extra benefits card ending in 4441 on December 21, 2023. The member did not report the card lost or stolen until December 4, 2024. We confirmed a new extra benefits card ending in **** was shipped to the member on December 6, 2024. We show the member activated the new extra benefit card on December 17, 2024.

The 2024 plan benefits state that the monthly benefit amount will be available on the card the first day of each month. Be sure to use the benefit amount each month, because any unused benefit amount will not roll over into the next month. Important: Plan not responsible for lost or stolen cards or for fees associated with late utilities, rent, or mortgage payments.

*************** does not grant requests for fund rollovers for lost or stolen cards, or members forgetting/unable to use their card. When members stating they never received the extra benefits card is not a valid reason to ask for rollovers, as cards are mailed to the mailing address on file. The request for rollovers can only be granted if Aetna is at fault for the member not being able to use their funds. The members request for a rollover of the $45 allowance, for the months of January through November of 2024, has been denied.

Please know, the member will receive a formal 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 *** **** ****** concerns. We do apologize for the inconvenience this may have caused her as our valued member.

Sincerely,
Marilyn
Analyst, Medicare Executive Resolution
Customer Answer
Date: 03/16/2025

Complaint: ********

I am rejecting this response because:The card I received in December 2024 was for $45.00. I did receive and use this card. ******* *******s checked and the benefit of $45.00 for Jan. 24 thru Nov.24 was not used. If I had been aware of this money I would have used it. Please reconsider this decision as that money was part of my 2024 benefit package with Aetna.
I will complete another form for reimbursement for the ***** watch. Where do I get this form?

Sincerely,

**** ****
Business Response
Date: 03/28/2025
**** *** ******* *********:

Please see our response to follow-up on complaint # ******** for *** **** **** which was received by us on March 17, 2025. After receiving the complaint, we promptly conducted internal research.

Our Executive Resolution Team has finalized the research, and I would like to share the results of the review with you.

We have confirmed in the member’s account, that September 2023, the plan emailed a notification that the member’s 2024 Annual Notice of Change (ANOC) was ready to view.

The ANOC informed the member about the Extra Benefits Card coverage for 2024. It reads:

If the member is diagnosed with a chronic medical condition, they may be eligible for this benefit. See the Evidence of Coverage for more information and eligibility requirements. Extra Supports Wallet amount $45 monthly benefit amount (allowance).

Additionally, the plan mailed the Extra Benefits Card in December 2023. Unused funds do not roll over into the next month, nor the next year.

Regarding the Fitness Benefit, we found that according to page 53 in the 2024 Evidence of Coverage (EOC), the Fitness Reimbursement includes important information. The receipt and documentation must be submitted before the end of each year to be eligible for reimbursement. If the member needs assistance with the reimbursement process, they were directed to can call the Member Services phone number listed on the Aetna Member ID card.

The item the member purchased on December 30, 2024, was not submitted to the plan for reimbursement until March 7, 2025. This has been denied for timely filing and is not reimbursable. The member can file an appeal if you disagree with the claim status.

The member will receive the detailed Medicare response in the mail within seven to ten business days.

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

Sincerely,
Jennifer
Analyst
Medicare Executive Resolutions
Initial Complaint
Date:03/05/2025
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.
My policy was paid current and claim was processed incorrectly not processing my medication refill to the deductible and max out of pocket for my claim in January. I have spent several hours on the phone and been told multiple times I will receive call backs and escalations that have not been processed, not allowing me to fill my medication at the corrected amount and the correct out of pocket and deductible expenses to show on the app, website, or pharmacy.
Business Response
Date: 03/14/2025
Dear *** *********:

Please see our response to complaint #******** for ******* ******** that was received by us on March 5, 2025. Our Executive Resolution Team researched the member’s concerns, and I would like to share the results of the review with you.

Upon receipt of the complaint, we reached out internally to have the member's concerns reviewed. We confirmed that all Aetna individual family plan members have a 31-day grace period during which prescription claims will process at 100 percent member responsibility. Once the grace period expires, the member’s account is reviewed to determine how claims will process going forward. Please know, the grace period for *** ********’s plan ended on March 6, 2024. Since *** ********’s account is showing paid to date, all impacted claims between dates of service January 10, 2025, and March 6, 2025, were reprocessed to show the correct deductible and out of pocket amounts. All updates should now be visible on the Aetna member website, and *** ******** should receive a reimbursement of $279.78 in the mail within 7-10 business days. Additionally, the member’s call history is being reviewed and the necessary feedback will be provided.
We apologize for any difficulties and inconvenience this situation has caused. 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,
Herman M.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:03/04/2025
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 02/10/2025 Aetna Medicare sent me a letter(attached) stating that they are required to supply me with a temporary 30-day supply of one of my medications(*************). My next refill date is March 6, so I called them today(03/04/2025) and asked the lady, a senior facilitator, for my 30-day supply. I was told that they had already given me my 30-day supply on 02/06/2025. However, since I HAD YET TO RECEIVE THE LETTER on 02/06 and WASN'T EVEN AWARE they would provide me with a temporary supply, I paid for the 02/06 prescription out of my own pocket. I then asked her if I could get it instead on 03/06(my next refill date). She refused to do that.
Business Response
Date: 03/10/2025
Dear *** ******* *********:

Please see our response to follow-up on complaint # ******** for *** ****** **** which was received by us on March 4, 2025. After receiving the complaint, we promptly conducted internal research.

Our Executive Resolution Team has finalized the research, and I would like to share the results of the review with you.

We have confirmed that the issue pertains to reimbursement for a prescription.

The member is enrolled in Aetna Medicare Platinum PPO Plan which became effective on January 1, 2025.

The plan allows a one-time, temporary, “transition fill,” of a medication when switching to a new plan. A transition fill is provided to allow the prescriber time to submit a coverage determination request.

As of April 1, 2025, the member will no longer be eligible for the transition fill of medication and have it covered by the plan without an approved prior authorization on file.

As of writing this resolution, we do not have a claim on file for the transition fill. We have provided a prescription claim form with this resolution. If the member has made an out-of-pocket payment for a medication that may be covered by the plan, they can submit this form along with the pharmacy receipt. Pharmacy receipts are usually attached to the bag with the prescription or can be obtained from the pharmacy if you need another copy.

Mail the form and the receipt/s to the address at the top of the form. The plan will review the claim and benefits to determine if a reimbursement is allowable. Reimbursement amounts are determined by the cost of the drug and your cost share outlined in the plan benefits.

If the claim is processed and the member receives reimbursement for the prescription on February 6, 2025, that will be considered their one-time transition fill. Please note that he will not be eligible for another transition fill.

We have received a coverage determination request on December 6, 2024, for this prescription. It was denied due to the prescriber not providing the requested information.
On December 16, 2024, a redetermination was then initiated. It was denied as criteria was not met since we did not receive the information above from the prescriber. This case has now been forwarded to C2C Innovative Solutions, Inc., a Medicare Part D Independent Reviewing Entity. The member will receive their decision in the mail and information about the next steps.

According to the plan documents, there is no deductible for Aetna Medicare Platinum (PPO). You begin in the Initial Coverage Stage when you fill your first prescription of the year. See Section 5 in the Evidence of Coverage (EOC) for information about your coverage in the Initial Coverage Stage.

During the Initial Coverage Stage, the plan pays its share of the cost of your covered prescription drugs, and you pay your share (your copayment or coinsurance amount). Your share of the cost will vary depending on the drug and where you fill your prescription.

The plan has 5 cost-sharing tiers. Every drug on the plan’s Drug List is in one of 5 cost-sharing tiers. In general, the higher the cost-sharing tier number, the higher your cost for the drug.

The member will receive a detailed response in the mail within seven to ten 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 concern.

Sincerely,
Jennifer
Analyst
Medicare Executive Resolutions

Customer Answer
Date: 03/14/2025
I have submitted my prescription receipt to Aetna for reimbursement on Tuesday 03/11.
When they reimburse me as promised, I will close the case.
Thank you for your assistance.
Initial Complaint
Date:02/28/2025
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.
I have over 20 claims at this point on my insurance that are not me. I have contacted Aetna multiple times through different avenues since September of 2024 and have yet to receive any help. This is a HIPAA violation so I don't understand why they do not care to help fix this situation. They are willingly paying $1000's for someone who is not insured through them because I can't get anyone to HELP ME.
Business Response
Date: 03/07/2025
**** ******* **********

Please see our response to complaint #******** for ******** ***** that was received by us on February 28, 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 immediately reached out internally to further research the member’s concerns. We confirmed that one of our client advocates made outreach and has been in communication with Ms. ***** regarding this matter. Please know, Ms. ***** emailed a list of the claims in question and upon review, we found that the member’s name and date of birth matched, but the address is different. All claims have been sent back for rework to be voided out. Unfortunately, due to policy, the member identification number cannot be changed. However, the client advocate is working with the member to have a restriction placed on her account, and a special handling alert for claim processing will be added to her file. As a courtesy, we have also contacted all the providers’ billing offices and explained the situation to them. In addition, we have submitted this matter to our special investigations unit (SIU) for a thorough investigation. For continued assistance regarding this concern, the client advocate provided Ms. ***** with her direct contact information.

We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. ******* concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *******************************.

Sincerely,

Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Customer Answer
Date: 03/07/2025

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.

Sincerely,

******** *****
Initial Complaint
Date:02/26/2025
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 had a dental cleaning and xrays from a dentist **** ****** who is included in the Aetna Dental network. The work was all covered by the policy. After the visit, I was told that there was a problem with my insurance card and that I had to pay with my credit card until the issue could be straightened out. I did pay, and had the dental visit submitted to Aetna for payment coverage. I have called multiple times, with each call lasting 20-60 minutes. The last time I called (in December I believe) I was told the claim was successfully processed and a check was mailed, yet I have not been reimbursed. I am submitting this complaint because it is more painful than a root canal to deal with this insanely slow customer service process. The dental visit was 3/8/2024 at **** ****** DDS at **** ******* ******** ***** **** *** ***** Please pay me the $320 that I had to pay for this visit.
Business Response
Date: 02/28/2025
Dear ******* *********:
Please see our response to complaint # ******** for ***** ****** that was received by us on February 26, 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 the dentist **** ****** was paid in error. The payment should have gone to the member. The claim was reprocessed to allow the $177.00 to be paid to the member, the claim can take up to 30 days to process and finalize for payment. The member will be sent a new Explanation of Benefits (EOB) after the claim has processed and paid correctly. Outreach was made to the provider office, and they were advised that they were paid in error and that they owe the member $143.00. The office is closed until March 3, 2025, another outreach attempt will be made at that time. A detailed resolution letter was mailed to the member today February 28, 2025, the member should allow 7-10 business days for the letter to be received.
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,
ShaCarra B.
Executive Analyst, Executive Resolution Team
Business Response
Date: 02/28/2025
Dear ******* *********:
Please see our response to complaint # ******** for ***** ****** that was received by us on February 26, 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 the dentist **** ****** was paid in error. The payment should have gone to the member. The claim was reprocessed to allow the $177.00 to be paid to the member, the claim can take up to 30 days to process and finalize for payment. The member will be sent a new Explanation of Benefits (EOB) after the claim has processed and paid correctly. Outreach was made to the provider office, and they were advised that they were paid in error and that they owe the member $143.00. The office is closed until March 3, 2025, another outreach attempt will be made at that time. A detailed resolution letter was mailed to the member today February 28, 2025, the member should allow 7-10 business days for the letter to be received.
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,
ShaCarra B.
Executive Analyst, Executive Resolution Team
Customer Answer
Date: 02/28/2025

Complaint: ********

I am rejecting this response because:
This issue cannot be considered closed until I receive reimbursement for the payment I made in March 2024.
I hope that this matter can truly be closed and do appreciate the timely response to this complaint, after eleven months of calls to Aetna.

Sincerely,

***** ******
Customer Answer
Date: 02/28/2025

Complaint: ********

I am rejecting this response because:
This issue cannot be considered closed until I receive reimbursement for the payment I made in March 2024.
I hope that this matter can truly be closed and do appreciate the timely response to this complaint, after eleven months of calls to Aetna.

Sincerely,

***** ******
Business Response
Date: 03/07/2025
Dear Mr. ******* *********:

Please see our response to complaint #******** for ***** ****** that was received by us on February 28, 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. We have confirmed that the claim from the date of March 08, 2024, for Dr. **** ****** has been reprocessed to pay the member $177.00. The member would need to allow 5-7 business days for the arrival of the check.

***** at *** ******** office was contacted on March 05, 2025. It was explained to ***** that since they are an Aetna PPO provider, they are held to the Aetna PPO negotiated rate of $177.00. Per the Aetna PPO negotiated rate, the provider’s office would owe the member back $143.00 since they charge the member $320.00 on the date of service. ***** has agreed to refund the member the $143.00.

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
Business Response
Date: 03/07/2025
Dear Mr. ******* *********:

Please see our response to complaint #******** for ***** ****** that was received by us on February 28, 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. We have confirmed that the claim from the date of March 08, 2024, for Dr. **** ****** has been reprocessed to pay the member $177.00. The member would need to allow 5-7 business days for the arrival of the check.

***** at *** ******** office was contacted on March 05, 2025. It was explained to ***** that since they are an Aetna PPO provider, they are held to the Aetna PPO negotiated rate of $177.00. Per the Aetna PPO negotiated rate, the provider’s office would owe the member back $143.00 since they charge the member $320.00 on the date of service. ***** has agreed to refund the member the $143.00.

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

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