Complaints

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

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  Aetna Inc.

  151 Farmington Ave Hartford, CT 06156-7003

• 

  Aetna Insurance

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

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  Aetna Insurance

  1301 Mccormick Dr Largo, MD 20774-5416

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  Aetna Inc.

  350 Springside Dr Akron, OH 44333-2435

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  Aetna Inc.

  1825 Ayersville Rd Mayodan, NC 27027-8007

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:11/14/2023

  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.

  They refuse to honor the terms of my policy, and owe me money on a claim. The policy states that they will reimburse me for $1600 dental expenses at my choice of dentists, irrespective of being "in network" or any "negotiated" amounts. This allows me to go to a good dentist instead of one of their discount dentists. They have given me different explanations of why they will only pay a portion of the charges. One is that other people recieved a discount, therefore the charges don't qualify. Another is that the negotiated amount for treatment is less, therefore they will only pay that amount. Still another is that they reimbursed me for the amount I still owed on the date I submitted the claim, ignoring the amount that I had pre-paid. One more was that Medicare limited the amount they could pay. None of these make any sense, but "customer service" doesn't seem to actually read my complaints or respond with anything more than canned messages. I have attached the statement from the dentist, which shows the charges for work done in 2023 as of 9/28/2023. I submitted two claims (also attached), in which I only requested reimbursement for the woke done on two dates. This is itemized on the bill. It seems simple enough. But Aetna keeps making excuses. I have attached two different written "explanations of benefits". The others were made on the telephone. I have also enclosed the "Summary of Benefits" stating my policy dental benefits

  Business Response

  Date: 11/15/2023

  Dear Mr. ******* *********: 
  
  Please see our response to complaint # ******** for *** ***** ***** that was received by us on November 24, 2023.  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. We forwarded the member’s reimbursement request to the Claim’s Department.  The claim was reprocessed, and the member will be receiving an additional $155 refund.  Please allow up to 45 days to receive.
  
  We reviewed the web assistance you requested.  Correct information was given about being reimbursed based on what was submitted on the receipt. 
  
  We reviewed the call from October 10, 2023.  The representative incorrectly advised the member that he was reimbursed based on Medicare Allowable Rates.  The member should be reimbursed what he was charged up to the $1600 dental allowance he has.  A coaching was sent. 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 Ms.*****’s concerns.  
  
  Sincerely,
  
  Cindi D
  Analyst
  Medicare Executive Resolutions
  
  

  Customer Answer

  Date: 11/15/2023

  
  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 thank the BBB for getting Aetna to take this mattter seriously,   It is ONLY because of your involvement that Aetna finally reviewed what I sent them and corrected their reimbursement.   

  PLEASE NOTE:  I refute their face-saving contention that they calculated the amount based on what they were sent, implying that some additional infomation was needed.  I used trhe forms they provided, and sent the billing statement from the dentist FROM THE START. Several times I referred them to that same statement, and several times I got different people responding who gave me different excuses for not paying what they owed. It was NOT one person who needed coaching..    

  Proper claims handing - especially a sijmple reimbursement liek this one - should not require the involvement of the BBB

  THANK YOU.
  
  ***** *****

• Initial Complaint

  Date:11/13/2023

  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.

  On October 6 I was seen by my ENT specialist who performed a series of examinations in office and discovered a combination of anatomical malformations within my nasal and sinus structures that together make it nearly impossible for me to breathe normally. Request for authorization for a surgery was put through and summarily denied as Aetna apparently thinks breathing is not a medical necessity. When I called in to inquire about this decision I was given a lot of run around and internal procedure numbers as the reason for the denial. I was then given a list of tasks that I as the patient would need to do in order to attempt to appeal the decision. Aetna has made the process intentionally cumbersome so as to dissuade people from seeking the medical care they need as an unethical cost-saving attempt. What Aetna is doing is practicing medicine on me without my consent and without the licensure to do so. This surgery is really the last thing that I need before I'm back to a healthy and fully functional body for the first time in several years since I got sick back in 2019 and in their short-sighted grab for money, they'd rather deny the surgery than help me get better so that I don't need their services nearly as much. It's shameful. My Member ID is ********* and the request ID is ************

  Business Response

  Date: 11/14/2023

  
  Dear Mr. *********:
  Please see our response to complaint ******** for ******* ****** that was received by us on November 13, 2023.  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 Clinical team to have the prior authorization for surgery reviewed. Per clinical, the denial of the surgery is correct based on the information we’ve received. Per the notes within the prior authorization denial, it appears the computed tomography (CT) scan provided was over a year old and doesn’t meet the Clinical Policy Bulletin (CPB) requirements. Clinical advised the provider is still within the timeframe for a peer-to-peer review. A peer-to-peer review allows the member’s provider to speak with an Aetna Medical Director (MD) regarding the member’s condition and need for surgery. We highly encourage the member to speak with his provider about completing the peer-to-peer review process. Additionally, the member can appeal. However, if the member’s provider wants to participate in the peer-to-peer review, that must be completed prior to the member filing an appeal. After the timeframe for the peer-to-peer review has passed, that option is no longer available, and the only other option would be for the member to submit an appeal. I’ve attached the complaint and appeal form for the member’s convenience if he chooses to go this route. It will need to be submitted via fax or mail. The fax number and mailing address are both listed on the appeal form.
  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:11/09/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have Aetna *** insurance and ************ virtual is supposed to be at no extra cost. Every time I use it I have been charged 89.00. It is very unclear how to get this included service. There should be a link on your aetna *** website that takes you directly to it. The link you have makes me complete my insurance info every time and then ************ has no registration of that type of insurance. I want to be refunded the 89.00 that ************ charged me. Very frustrating. This is the second time this has happened and had to spend hours trying to get a refund. ************ acts like they have never heard fo aetna *** insurance on their website. I pay over 1200 a month for this insurance and I want you all to correct this for me.

  Business Response

  Date: 11/08/2023

  Good afternoon, 

  Please forward this complaint to the Hartford, CT BBB for handing. 

  Thank you

   

  Business Response

  Date: 11/14/2023

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

  Please see our response to complaint ******** for *** ***** that was received by us on November 09, 2023.  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 Individual and Family Plan (IFP) team for review. They advised ************ was contacted and an Explanation of Benefits (EOB) was sent through email to the clinic for processing. Once the EOBs are received, it will take 24-48 hours to reprocess the claims and 4-6 weeks for a refund check to arrive in the mail. The claim was processed correctly with a $0 member responsibility. The member should receive a refund in the amount of $178.00 for the two visits: date of service (DOS) October 20, 2023, and November 08, 2023. Our IFP team advised they contacted the member and she was made aware she will receive a paper check in the mail within 4-6 weeks and a follow-up call is scheduled with a Resolution Specialist in our IFP department in approximately five weeks from today.

  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 matter, please contact Member Services at the phone number on the back of the Aetna ID card.

  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

• Initial Complaint

  Date:11/07/2023

  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 am asking for a claim since april 2023 , its only $600 ish dental cost, i submitted everything to them alrady upto now no money check was sent to me, been workin as nurse paying for my benefits everything submitted but until now no check being sent to me, its been almost 6 months how long would it take for aetna to resolve this, i provided aetna all documents and still missing more which i don’t understand they accept payment quick but too slow to give a reimbursement for a service or refund

  Business Response

  Date: 11/13/2023

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

  Please see our response to complaint ******** for **** ****** ********* that was received by us on November 07, 2023.  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 Dental team to have the claims reviewed. Per the Dental team’s review, they advised that additional information and x-rays were requested from the dental provider who rendered the services to our member because that information is required but was not submitted with the claim submission. Unfortunately, we never received the requested information. Approval was granted for the claims to be reprocessed despite never receiving the requested information as a one-time courtesy. Both claims were reprocessed and a payment of $914.19 has been issued to the member via check. The member should allow 7-10 business days to receive that check via standard mail. The new claim numbers are *********** and ***********. An updated Explanation of Benefits (EOB) will generate on the next cycle.

  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *********’ concerns. 
  
  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

  Customer Answer

  Date: 11/13/2023

  
  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:11/07/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I had CANCER surgery and repair on Jan 24, 2023. Just to give a quick explanation of what is going on with the claim. The doctor billed Aetna for my **** surgery, which had two codes, the surgery code and the repair code. Aetna split the claim and made it two claims instead of one, so each code is now its own claim. This of course causes the claims to be denied. For some reason they are not correcting it and processing it as ONE claim with two line items. This is their error and should be corrected by them. I called Aetna and was on the phone with them and the doctor for over an hour where Aetna admitted fault and said they would address the issue and said claim shouldnt have been denied. All of Aetna's calls are recorded and I request they review the call and fix the problem. I've spent hours on the phone with them at this point and its getting out of hand.

  Business Response

  Date: 11/16/2023

  Dear ******* *********:
  
  Please see our response to complaint #******** for ***** ****** that was received by us on November 07, 2023.  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 Claims department to assist with our investigation. Upon review they identified an appeal on file, which completed its during the investigation, overturning the denial and allowing the denied code. The claim has been sent to be reprocessed and a new Explanation of Benefits should be available within seven to ten business days. We requested for the member’s calls to be reviewed and feedback given 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:11/07/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I had cancelled my previous Aetna plan, and re-enrolled under special enrollment because I lost my job. My previous plan had been listed as cancelled on the member website as well. After signing up for a new plan, I then called Aetna to make sure the the previous balance would not be rolled over to my new premium. I was assured by a health concierge that it would not, and that on November 1st my new plan would start and that the balance would only be $9.12. Today, on November 5th, I check my account to pay my premium and see that it is $95.51. I call to inquire why this is and explained how I was told no previous balances would be rolled over, because I had tried to cancel months earlier. No one could explain why a previous balance was rolled over after stating that it would not be. Unfortunately I can't afford this, which is why I had to get a cheaper plan in the first place. I asked for a supervisor but there was "none available" and that they would "try" to escalate. I would like this issue escalated and would like to speak to a supervisor who can tell me what is actually going on, instead of being passed to different concierges who tell me different things.

  Business Response

  Date: 11/14/2023

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

  Please see our response to complaint ******** for ******* Taylor that was received by us on November 07, 2023.  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 Individual and Family Plan (IFP) team for review. They advised the member’s account has been updated to show the previous balance owed was written off. The Enrollment Eligibility and Billing team indicated previous balance for the member has been written off and the coverage is paid through November 30, 2023. The 2023 coverage systematically terminates when the 2024 span is created but the member will still owe a December payment of $9.12. The IFP team confirmed the website now reflects the correct balance due of $9.12. IFP advised they reviewed the member’s calls and didn’t indicate any incorrect information being provided. However, the call review did reveal a callback request from a supervisor was never requested and coaching and feedback has been provided to the representative and his/her manager. IFP confirmed member outreach was made to update her on the plan premium and the current balance due and stated the member didn’t have any additional questions or concerns.

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

  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

• Initial Complaint

  Date:11/06/2023

  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.

  Aetna did not bill my claim correctly for service date 7/19/23. On the Explanation of Benefits it shows the physical therapy evaluation is going towards my deductible. When I contacted Aetna through their website, a representative stated that the evaluation goes towards co-insurance only. My co-insurance is a $25.00 copay. Aetna needs to rebill this claim to reflect what their agent stated to me.

  Business Response

  Date: 11/07/2023

  
  Dear Mr. *********:

  Please see our response to complaint ******** for ******* ******* that was received by us on November 06, 2023.  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 had the claim reviewed by the plan team for the member’s employer-sponsored health plan. Per the review of the claim, it was determined the claim is processed correctly. Aetna does not standardly consider evaluation codes as a modality or therapeutic procedure and they’re not subject to the short-term rehabilitation visit maximums. The evaluation would apply to the specialist benefit. For the member’s plan, the specialist benefit is 100% after deductible, no copay. The deductible is $2,000.00 with a coinsurance limit of $2,000.00 including all deductibles. The plan benefit for physical therapy (PT) is 100% no deductible after $25 copay for PT and 100% after deductible no copay for OT and 120 visit max per year for PT and OT combined which includes outpatient hospital, outpatient facility service and not included is chiropractic services (additional visits subjected to review for medical necessity).

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

  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

  Business Response

  Date: 11/07/2023

  
  Dear Mr. *********:
  Please see our response to complaint ******** for ******* ******* that was received by us on November 06, 2023.  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 had the claim reviewed by the plan team for the member’s employer-sponsored health plan. Per the review of the claim, it was determined the claim is processed correctly. Aetna does not standardly consider evaluation codes as a modality or therapeutic procedure and they’re not subject to the short-term rehabilitation visit maximums. The evaluation would apply to the specialist benefit. For the member’s plan, the specialist benefit is 100% after deductible, no copay. The deductible is $2,000.00 with a coinsurance limit of $2,000.00 including all deductibles. The plan benefit for physical therapy (PT) is 100% no deductible after $25 copay for PT and 100% after deductible no copay for OT and 120 visit max per year for PT and OT combined which includes outpatient hospital, outpatient facility service and not included is chiropractic services (additional visits subjected to review for medical necessity). If the member can advise when she was given the quote on how the claim would process and whether that was done over the phone or using the online member portal, we can review further to locate the potential misquote.

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

  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

  
  

  Customer Answer

  Date: 11/09/2023

  
  Complaint: ********
  
  I am rejecting this response because: it is not what I was told in the messaging section of Aetna's online portal. Aetna routinely denies claims in order to put money into the CEO pocket and cause unnecessary patient suffering. My MRI was scheduled in March and I had to suffer until June, when it was finally approved after 2 appeals + a higher-level independent review.  A patient should NOT have to go through all of this to get the care they need and deserve. Aetna charges high deductibles, so they should provide a high level of care and make sure the patients are receiving what their providers order in a very timely manner so the patient can be on their "road to recovery," instead of suffering and being in pain.
  
  Sincerely,
  
  ******* *******

  Business Response

  Date: 11/15/2023

  Dear Stewart *********:
  
  Please see our response to complaint # ******** for ******* ******* that was received by us on November 10, 2023. 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 have reviewed the member’s communication history via the Aetna secured messaging portal and were unable to find where the member reached out about her physical therapy benefits prior to the service being performed. However, we did find where the member reached out on August 20, 2023, and was advised that her claim was processed correctly. The advocate indicated to the member that the evaluation was applied to her deductible and the physical therapy was applied to her $25 copay. Unfortunately, we did not find where the member was provided with incorrect benefits. If the member can provide the exact date or a reference number for when she was given the quote on how the claim would process, we can review further to locate the potential misquote. In addition, regarding the member’s magnetic resonance imaging (MRI), our Clinical team confirmed that Ms. ******* did not have the appropriate documentation for the initial review or the level one appeal request. During both reviews, the required physical therapy notes were still missing. We later received the physical therapy notes and a request for a level two appeal. Please know, the medical director used medical judgement and current imaging criteria to approve the level two appeal.

  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

• Initial Complaint

  Date:11/03/2023

  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 have been suffering with constipation for years. My current medication has stopped working and my GI doctor prescribed a new medication which the insurance will not approved. I have had to take laxative and give myself enemas which is not healthy since I do take a diuretic and BP Medication and this can cause a low potassium from all the water loss and diarrhea involved with a laxative. I am now having my second CT scan for severe abdominal pain and constipation. The first one shows diverticulitis but is in conclusive since it am still blocked with stool and now need a second CT Scan. I have spent a large amount of money on going to doctors CAT scan co-pays and laxatives and I feel it is wrong that the insurance company will not approve. Med that the ** ***** will alleviate my constipation and pain. I am a registered nurse and I am so tired of the insurance company's controlling what medical treatment I am entitled to as a patient. I want to receive the medication called motegrity which the doctor has prescribed for me to alleviate my constipation. I can end up with a small bowel obstruction from the constipation and the diverticulitis resulting in a colostomy bag. I feel like suing Aetna. They are causing a hazard to my health . My doctor is ** ****** ** ********* *** He is amazing but his hands are tied due to the insurance company. So unfair they put t my health at risk

  Business Response

  Date: 11/09/2023

  Dear ******* *********:
  
  Please see our response to complaint # ******** for ****** ******* that was received by us on November 3, 2023. 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 medication in question is not covered without proof of medical necessity because there are eligible alternative medications that the member may take. We also confirmed that the prior authorization request dated October 30, 2023, was denied due to the member not having tried one of the alternative medications. On October 31, 2023, the member filed an appeal stating she has tried both alternative medications. During the review of that appeal, our Pharmacy Precertification team was able to obtain the additional information needed from the member’s prescriber and agreed to allow coverage for the medication in question. The medication is now approved from October 8, 2023 – November 7, 2024, and our *** Pharmacy team has received a paid claim for a $65 copay. Please know, both the approval letter dated November 7, 2023, and the appeal resolution letter dated November 8, 2023, were mailed to the member’s address on file.

  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: 11/09/2023

  
  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:11/03/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have Aetna Health Insurance for many years. My ID # **********. I have submitted a claim for services on 1/29/22, over a month ago to my primary health insurance, which at that time was ****** **** ******. ****** **** sent me a EOB and covered $7039. Aetna being the second insurance company fails to cover the final balance of $5446.25. Presently, I only have one health insurance which is Aetna.

  Business Response

  Date: 11/10/2023

  Dear ******* *********:
  
  Please see our response to complaint #******** for ***** ******* that was received by us on November 03, 2023.  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 Claims department to assist with our investigation. We reprocessed Mr. *******’s claim using the Explanation of Benefits he sent us. We reviewed his concerns regarding the delay in handling. We found his prior submission. It was received but not yet handled. We have provided feedback regarding the delay, and will investigate the root cause to ensure future submissions are not also delayed.
  
  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:11/03/2023

  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.

  Hi better Business Bureau, I would like to contest past payments due for July, August & September from Aetna Health Insurance and/ or the ***********. I had requested an escalation of this issue with Aetna, also the ***********, and my cancellation date of my policy on September 28th, 2023. My new employer, *******, started my new insurance with **** ***** **** ****** of ********, as of July 1st. I stopped paying Aetna and was under the impression they would no longer cover me. Below is attached a picture of my past due balance for May; this letter from Aetna is stating that my coverage is at risk and that I will lose my coverage with a due date of April 30th. I also copied below is the last payment I made in June from my checking account. I had talked to Aetna and the *********** as of September 28th about my cancellation and requesting the end of my payments get retro dated back to July 1st. Aetna referred me to talk to the ****** *****, they connected me to (Representative Amanda at ***********). When I talked to Amanda at the ***********, today November 2nd at 1:40 PM, she stated that Aetna is denying my escalation because of lack of communication on my part (calls and emails). I was also told by Amanda at the *********** that I would need to speak to Aetna about this matter, and that they had sent me a letter showing a denial and how to communicate further about an appeals process. I was also told that there was no way to communicate directly with anyone that she knew of except for the letter that had instructions for communication of an appeal. I have been through my records, and there is no letter that I have received from escalation with Aetna or the ***********. Both Aetna & the *********** make it hard to connect directly with someone to help me with this matter. Please help me in resolving this so that I don’t owe three months past due from July 1st and on. Aetna definitely implies as of May 4 that I will be canceled due to lack of payment.

  Business Response

  Date: 11/13/2023

  Dear Mr. ******* *********:   
  
  Please see our response to complaint #******** for ***** ****** that was received by us on November 03, 2023.  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 Ms. ******’s concerns. Based on their review they confirmed that the plan’s termination date is September 28, 2023, as a voluntary withdrawal after the member contacted the ****** *****. Ms. ******’s request for a retro-termination date of July 01, 2023, was denied per the ****** **** guidelines.
  
  Lisa from our Customer Service Resolution Team spoke with Ms. ****** regarding her concerns. Lisa advised that the member has an unpaid balance on her terminated policy for the months of August and September. A review of the member’s account confirmed that there are claims predating the September 28, 2023, termination date.  It was explained to the member to avoid claim reversals, she will need to resolve the outstanding balance due of $645.89.
  
  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 Team
  Executive Resolution Team