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.
491 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:06/12/2023
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.
Aetna refuses to provide me with a listing of my required providers. I have urgent medical needs and can't get the help required because Aetna will not supply me with the providers that are needed and refuse to help. I have sent written, called and continued to get lied to at every corner. They keep stating on social media that they have provided me information which they have not in order to not look bad with their PR, but no service is ever provided.
Business Response
Date: 06/22/2023
**** *** ******* **********
Please see our response to complaint # ******** for ****** ********** that was received by us on June 12, 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 complaint, we immediately reached out internally for review. We confirmed that the plan sponsor liaison Gilbert S., contacted the member directly on June 13, 2023, regarding his concern. Gilbert advised that he emailed the member a copy of the requested information and he confirmed receipt of the email. Gilbert also stated the member indicated that he did not have any additional concerns and that he was satisfied with the assistance that Gilbert has provided. Please know, the member’s call history is being reviewed and the necessary feedback and coaching will be provided for service improvement.
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,
Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:06/12/2023
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.
On May 10, 2023 I had an appeal review with Aetna by teleconference. I was told to expect a decision letter within 15 calendar days of the appeal. I called Aetna 2x and they told me it was sent in the mail but I never received their response. I am asking they send me the decision letter so that I can proceed against them. I asked to send again, they would not. Thank you.
Business Response
Date: 06/12/2023
**** *** ******* **********

Please see our response to complaint #******** for ********* ******* that was received by us on June 12, 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 internally for review. The requested appeal resolution letter for case ************* has been attached to this BBB response.

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,

Marshell H.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:06/09/2023
Type:Billing Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Two dental visits on 2/23/23 and 4/3/23 - combined visits - $1000 was approved as per stated total dental benefit on Aetna Medicare Advantage website. However the dental business, ****** ****** in ************ *** has never received payment, even though the Aetna Customer Service attempts to convince that they have sent payment. They shared the Electronic fund transfer #, payment #, transaction#, and payment ID # ( two separate sets of payment numbers that total $1000). So this benefit of $1000 is my personal loss because I had to pay up front for dental services and will be reimbursed only after the dental office receives payment from Aetna. I personally have contacted Aetna by website "secure messaging" and by phone to "customer service" at least 10 or more times since April (I have all the documentation) and the dental office has contacted the "provider line" at least as many times as well. The phone calls result in multiple transfers to "someone else who can help" and no resolution is forth coming - sometimes getting transferred to a dead line just to get rid of me. The website secure message center responded to me that they sent the provider "proof of payment" (provider confirmed that they received) but this means nothing because no money is ever received by the provider / dental office! Aetna "customer service" are professionals at dodging the issue. I have requested to be transferred to a "supervisor" but this never happens. At this point I am at a loss on how to get this resolved. At this point I classify this as fraud until proven otherwise.
Business Response
Date: 07/05/2023
**** *** ******* **********

Please see our response to complaint # ******** for Mr. ****** *** that was received by us on June 23, 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 concern, we immediately reviewed the member’s claim history. We located two claims from ****** ****** ****** ***. The claims are from dates of service, February 23, 2023, and April 3, 2023.

Claim ID: ********* for Date of Service, February 23, 2023, was paid on February 25, 2023. Claim ID: ********* for Date of Service, April 3, 2023, was paid on April 5, 2023. We confirmed the payment information including the provider address and NPI number.

We have also reviewed the member’s call history to the plan. After listening to the call recordings on May 10, 2023, and May 11, 2023, there were multiple errors found. During the conference call on May 10, 2023, with the member and the provider, the representative failed to provide correct information about claims and how to access member portal online. The representative failed to transfer the call to the Provider Services team. On May 11, 2023, the member’s wife contacted the plan about the claim issues. The representative failed to escalate the concerns. We have taken the appropriate actions with the representatives for service improvements.

The member contacted our Internet Response team on May 16, 2023. As a result, of this conversation, there was a task request created to allow us to work with Houska Dental ****** *** (Small-town Dental) to track the payments we made to them. We have now confirmed that payments have been received by the provider. We are sorry for any inconveniences this has caused.

The member will also be receiving 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,
Jasmine W.
Analyst
Medicare Enterprise Resolution
Customer Answer
Date: 07/06/2023

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:06/09/2023
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.
We are a contracted provider with AETNA insurance and we have quite a bit of patients that have all levels of AETNA. We have over 60 claims ranging from 5/1/2022 to current 5/3/2023 that are outstanding with AETNA and even current claims that are being denied with multiple reasons. Our claims are being denied as incidental for office visits and labs, claims are being denied as experimental, administrative codes needing a qualifying service to be billed out and many more. Each time I call AETNA I am provided many different answers and empty promises. We have contacted to get claims reprocessed and then they are reprocessed AETNA turns around and does the complete opposite of what we need. They do what we need them to do and then they turn around and do something more to prevent any sort of payment. We are a ********** *** ******** practice that requires payment for treatments of our patients to continue. We have checked the credentialing of our physicians with AETNA and we are trying to get down to the bottom of the issues at hand. I really need someone from the Executive Resolutions Team to contact myself at ###-###-#### EXT *** or send me an email that I have provided. This has become very tiresome and out of hand. It SEEMS that AETNA is just denying claims and being untrustworthy with resolving our claims and making sure that we can get these taken care of.
Business Response
Date: 06/29/2023

**** *** **********
Please see our response to complaint ******** for ** ***** that was received by us on June 23, 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 provider’s concerns, we immediately reached out to our Provider Escalations department for review. Tiffani L. with our Provider Escalations team sent an email to ** ***** on June 27, 2023. Please work directly with Tiffani for claims concerns ranging from May 01, 2022, through May 03, 2023. Tiffani will need the list of claims and member information to effectively assist with getting the impacted claims reviewed for ********** ********** *** ******** **********.
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 your assigned point of contact, Tiffani L.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team
Initial Complaint
Date:06/07/2023
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 registered for health insurance on 02/23/2023 with Richard on phone number ###-###-####. He informed me at the time that my plan is called ***** provided by ***** ******. He provided his ext *****. After I received my card I noticed I was informed on a series on issues so I called back but was never transferred to Richard. I was told by agents on the phone-James,Maria that the term “limited plan”on my card means I do not qualify for substance abuse and pregnancy but everything else is covered. I provided my PCP at sign up day and was informed it’s covered but I was unable to use it at my Dr’s office and was paying out of pocket each time I saw him while continuing to pay my insurance premium. I made monthly payments as shown below: 03/23/2023-$302.40 03/27/2023-$267.40 04/26/2023-$267.40 05/27/2023-267.40. I have reached out more than 10times calling daily but did not get resolution. I requested for email to send my complaints but none was provided. I requested for my call to be transferred to a supervisor or a call back but none was done. The member ID on my card is ********. My card also shows benefits underwritten by *********** ******** I believe that I have been defrauded so I will like this resolved please.
Business Response
Date: 06/12/2023
**** *** ******* **********

Please see our response to complaint #******** for ******** ******* that was received by us on June 08, 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 internally for review. It has been confirmed that Ms. ******* will need to contact the correct insurance carrier, ****** ***** ******* ********* ******* at ###-###-#### for assistance.

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
Initial Complaint
Date:06/07/2023
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am writing to express my profound disappointment and frustration with the consistently poor customer service and misinformation provided by your company over the past year. The impact of your negligence on my daughter's mental health cannot be overstated, and I believe it is essential for you to be aware of the consequences of your actions. My 7 year old daughter, ***** ******, has been a policyholder with Aetna Health Insurance under me for the past 2 years. During this time, she has sought mental health services that are crucial to her well-being and overall quality of life. However, our experience with Aetna has been nothing short of a nightmare. I have encountered a series of problems that have had a direct and detrimental effect on my daughter's mental health, and I hold your company accountable for the distress it has caused. In light of the distress caused by your negligence, I request the following actions: Expedited resolution of my daughter's claim for clinical services, including a thorough review of the case, on supervisor assigned to the case, and fair reimbursement for the services received. Compensation for the emotional distress and potential harm inflicted on my daughter due to the extended delays and inadequate customer service. Assurance that Aetna will improve its internal processes and training to ensure consistent and accurate information is provided to policyholders in a timely manner. A written apology from Aetna for the anguish and inconvenience caused by the mishandling of my daughter's claim and the subsequent negative impact on her mental health. I trust that you will treat this matter with the seriousness it deserves and take immediate steps to address and rectify the situation. Failure to do so will not only reflect poorly on your company but may also compel us to explore legal avenues to seek appropriate resolution.
Business Response
Date: 06/13/2023

**** *** **********
Please see our response to complaint ******** for Charles ****** that was received by us on June 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, I immediately reached out to have the concerns reviewed. Per the review by the member’s plan team, they reviewed 9 phone calls and 2 online messages via the member’s website. Per review of those interactions, the member was provided correct information. Mr. ****** was provided information on how to submit claims for reimbursement as well as how to file for a network deficiency. He was advised the claims were submitted with missing information, such as the modifier was missing for the telehealth visit for the following dates of service (DOS): January 07, 2023, January 14, 2023, January 21, 2023, February 04, 2023, and February 11, 2023. The online messages had very descriptive information for the member to submit for the missing modifier. The member was advised that services prior to the network deficiency would be processed as out-of-network as they were not approved. The member was advised on June 07, 2023, the provider was missing from the network deficiency as only the group was listed. This could also be causing issues in the processing of claims. The plan team advised Ron M. will be the member’s single point of contact (SPOC) and his contact information is ###-###-####/***************. I was advised Ron will be making outreach to the provider’s office for billing verification. If Mr. ****** has any additional questions or concerns, he should make outreach to his Ron directly.
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

Customer Answer
Date: 06/14/2023

Complaint: ********

I am rejecting this response because:
We are still gathering the information that was just provided to us last week but we have yet to be reimbursed for almost one years' worth of claims. Does Aetna not question why it took 9 calls and 2 emails (over 5 months and at least 15 hours worth of phone time) to supposedly put us on the right track (which still remains to be seen until we receive reimbursement.) And the process to have out of network provider Covered at in network rate was not shared when initial claims were submitted. It took several phone calls and about 3 months before the process was explained and then told Aetna would only cover claims from Dec 2022 forward not going back to August 2022 when we were submitting claims and NO ONE from Aetna had explained the process. I actually want those claims to be processed for reimbursement as well since again, the error was on Aetna's inability to provide helpful, accurate and timely customer service.
This response feels as insensitive as the calls for months which is indicated 9 calls which would seem to say something is not happening correctly and each time, we called we were given different information 9 different times. Are the calls listened too?
Even in the statement no we are sorry you are experiencing this situation. Felt more blaming of the participant who does not know the language of insurance and has been polite on each call with understandable frustration.

Sincerely,

******* ******
Business Response
Date: 06/20/2023
**** *** ******* **********
Please see our response to complaint # ******** for ******* ****** that was received by us on June 15, 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 complaint, the member’s concerns were escalated to our Management team to have the calls screened for coaching opportunities. They confirmed that the Aetna representatives provided accurate information during each interaction with the member and/or his spouse. Please know that the member’s point of contact for this matter, Ron M***, spoke with Justin from PM Pediatrics BH, PC on June 16, 2023. Justin stated the member is listed in their system as self-pay and confirmed that they were completely unaware that Mr. ****** had a single-case agreement (reference number ************) approved with Aetna from December 5, 2022-December 5, 2023. Justin confirmed that he understands the claim submission process but because the member is self-pay, they cannot bill Aetna directly. Instead, they will explain to the member that going forward, they will need to submit reimbursements through their Aetna member portal and include the reference number. In addition, Justin verified that the root cause of the member’s claim issues is that they were set up with insurance and their billing office did not include the proper modifiers when billing for telehealth services.
We completely understand the member’s frustration with this matter. However, we are unable to reimburse claims received prior to date of service December 5, 2022, as they are not covered under the single-case agreement. Please know that dates of service January 7, 2023, January 14, 2023, January 21, 2023, February 4, 2023, February 11, 2023, March 12, 2023, and April 4, 2023, were all adjudicated on June 16, 2023, and a bulk payment was issued to the member on June 17, 2023. As a reminder, the member can view claim activity and his explanation of benefits (EOBs) when logged in through the secured Aetna member portal.
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,
Shay G.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:06/06/2023
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.
At the beginning of February 2023 I learned that I was pregnant and immediately called to set up insurance so that I could afford my doctor visits. As normal, the policy AETNA GOLD would not start until March 1st. Unfortunately soon after calling to set up the policy with the Marketplace, I had a miscarriage and no longer would need the policy. I called near the end of February to cancel the policy and did not make the first premium payment for the policy to begin. Fast forward to April 17th I found out that I was pregnant again and started the process of making sure I was covered by the time of my first appointment which was not until May 6th. I made my first premium payment on April 19th giving Aetna PLENTY of time to have received the payment and issue a member Id card. As of May 16th, after paying my first premium, then also having to pay uninsured prices for my first OB appt and blood work along with the prescriptions that were required due to this being a High-risk pregnancy, I was STILL NOT an active member with Aetna. I called several times a DAY for WEEKS, as I would be given different reasons, told different time frames for resolutions, never would receive a call back when told I would. The last lady I spoke with at Marketplace actually suggested I throw in the towel on the AWFUL company and switch to a different one. She went through and helped me to select a wonderful plan which had me covered with proof with 10 days of making payment. I expect a refund for the premium payment on April 19th. This company and experience has caused me not just money and time but it has caused me such emotional stress. The was by far the worst experience I have ever had with a company for ANY SERVICE.
Business Response
Date: 06/13/2023

**** *** **********
Please see our response to complaint ******** for ******** ********* that was received by us on June 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, I immediately reached out to have the concerns reviewed. Per the review completed, we found the following:
February 03, 2023 – ******** received the enrollment request from the Centers for ******** *** ******** ******** ***** for a March 01, 2023, effective date
On April 01, 2023 – the policy was cancelled for non-payment of the binder payment.
On April 19, 2023 – ******** received change transaction from CMS effective May 01, 2023. This was not a true special enrollment period add transaction.
On April 19, 2023 – payment received.
April 19, 2023 – ******** cancelled May 01, 2023, policy for non-payment of March 01, 2023, policy again. This was due to the May 01, 2023, change submitted not being a true special enrollment period.
May 08, 2023, reinstatement submitted but was immediately cancelled because of previous non-payment.
Based on the above timeline of events, calls were reviewed to identify missed opportunities and coaching was provided. A refund in the amount of $191.34 was issued on June 13, 2023, to the **** card used for payment. The reference number of that refund is ******. The Subject Matter Expert (SME) made outreach to the member to advise of the refund and advised the member to allow 3-5 business days to receive the refund. During that outreach, the member expressed being satisfied. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *********’s concerns.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team
Initial Complaint
Date:06/06/2023
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.
I'm prescribed a medication which is too expensive that insurance companies usually work with another secondary insurer to pay it fully for the patients. I've been using this medication for more than a year now. Last dose was supposed to be delivered two months ago. It was exactly the time when there was an open enrollment in my company and I only renewed the same plan. Because of that, the pharmacy called me to confirm the new plan is still covering the due amount of the medication. Since I wanted to be 100% confident I reached out to Aetna and the secondary Insurer, ******* (which is affiliated with Aetna) to verify they would pay and I would have no responsibility whatsoever. They confirmed and stated that it would be paid in full and I should not worry about it! Now, after two months the pharmacy let me know that the payment was rejected and I owe them a significant amount of money. When I reach out to ******* and Aetna they do not care and they are not even cable of handling the issue in a professional and proper way. They just put me on hold for hours and finally say "sorry, we cannot find your case!"
Business Response
Date: 06/13/2023

**** *** **********
Please see our response to complaint ******** for ***** ******** that was received by us on June 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, I immediately reached out to our Pharmacy department for them to review the medication and costs associated with the medication. Per their review, they advised the member’s plan has implemented ******* Rx in their benefit however, since the member’s plan is a High Deductible Health Plan (HDHP) with Health Savings Account (HSA), the member must meet the deductible before ******* Rx picks up. The claim was processed by Specialty Pharmacy on April 03, 2023, and the member cost share was $10,231.72. The claim applied $5,989.90 to the remaining deductible amount and then 30% of the remaining balance applied to the member’s coinsurance for a total of $4,241.82. The copay assistance picked up $4,000 of the member cost share which leaves a remaining balance of $6,231.72. The amount paid by the copay assistance program does not accumulate towards the member’s deductible or out-of-pocket maximum. The member is responsible for $6,231.72.
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 matter, please contact the Executive Resolution Team at [email protected].
Sincerely,
Destiny S.
Analyst, Executive Resolution Team

Customer Answer
Date: 06/13/2023

Complaint: ********

I am rejecting this response because:
The insurance (Aetna and ******* Rx) communicated with me at that time and assured me I wouldn’t be having any due balance on my end, which is why I went ahead and placed the order. Otherwise, I wouldn’t have ordered the medication.

Sincerely,

***** ********
Business Response
Date: 06/21/2023
**** *** ******* **********

Please see our response to complaint #******** for ***** ******** that was received by us on June 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 your request, we immediately reached out to our Pharmacy Management Client Service Team, who reviewed Mr. ********’s concerns. Based on their review our Pharmacy Team has made outreach to Mr. ******** and advised that the copay assistance only covered $4,000.00 for the Infosys Limited claim. The member was advised that the claim is being reprocessed and the Pharmacy Team will follow up with him once it is completed.

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

Sincerely,

Marshell H.
Analyst, Executive Resolution
Executive Resolution Team
Initial Complaint
Date:06/05/2023
Type:Service or Repair 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.
Brotherinlaw **** * ****** ** passed away May 15, 2022. ** probate authorized me to handle estate. He had not done taxes for many years and was on medicare w Aetna. I need **** ***** for taxes. Have called/faxed/mailed information to them. Been getting the run-around. They acknowledge they’ve received proper forms then mail me the same blank form to resubmit. They have my address yet continue to mail to his closed POBox which takes forever to get forwarded to me. One letter says feel free to contact them at number provided above. No number provided. I clearly stated to them in an email, which I never received a response to so do not know if they received it, that HIPAA has nothing to do with tax forms. It is a form that just states he had health insurance which the *** wants. If this was a HIPAA issue, the *** would not be asking for it. I have spent many hours and quite a bit of money chasing down something that should have been simple. At this point I would like to be reimbursed $100 and I still need the **** ***** for the years 2019-2022.
Business Response
Date: 06/06/2023
**** *** ******* **********

Please see our response to complaint #******** for our member Mr. Paul *****, that was filed by Ms. ***** ****** and received by us on June 5, 2023. Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.

Upon receipt of this complaint, we immediately reached out internally to further research the concerns.

We reviewed the incoming calls, from *****, on Mr. *****’s account. Our customer service representatives were correct when advising the Protected Health Information form is needed on file in order to speak with her in regards to her brother-n-laws account. Per Medicare Guidelines we are required to have a completed Protected Health Form (PHI) on file. The PHI form gives us permission to speak to someone other than the member regarding the members health or coverage benefits. Also, when forms are requested to be sent from the members account they go to the current mailing address we have on file for the member. We confirmed Mr. ******* mailing address on his account is listed as ** *** **** ********* ** ******

We confirmed we received the completed PHI form on March 10, 2023. The completed PHI form is listed under our internal document control number (DCN) ************. The document was sent to our HIPPA Member Rights Team to validate and add to the member’s account. On April 27, 2023, our HIPPA Member Rights Team mailed a letter to the member’s mailing address on file. The letter advises as follows:

We are in receipt of the Administrator paperwork you submitted appointing ***** ** ***** as Administrator. We’ve updated your file permitting us to share your Protected Health Information with them. This Administrator update will be valid upon the terms of the documents provided unless we receive written notice of revocation. If you change your plan in any way, you will need to contact Customer Service to update your request. If you have further questions, please feel free to contact me at the number provided above. Per my review of the letter the phone contact is listed as an email address of the case worker from the HIPPA Member Rights Team.

The plan confirmed in the goverment portal for Centers of Medicaid & Medicare Services (CMS/Orginial Medicare) that Mr. **** ***** ** was enrolled into a SilverScript Choice Prescription Drug Plan (PDP) with an effective date as July 1, 2020. The member had a $0 monthly premium for this plan. The termination date is listed as July 31, 2021. The SilverScript Choice PDP ended due to Mr. ***** enrolling into the Aetna Medicare Explorer PPO Plan, this plan became effective August 1, 2021. The member also had a $0 monthly premium for this plan. The Aetna Medicare Explorer PPO Plan reflects a termination date as May 31, 2022, due to the report of the member being deceased.

Please know, in late December through January, the Centers of Medicaid & Medicare Services (CMS) mails ****** notices to the following beneficiary populations for prior year tax purposes:
    All individuals under the age of 65 with Medicare Part A;
    Those who enrolled in Medicare Part A for the first time in the prior year; and
    Those who had Medicare Part A coverage for part of the prior year.

As seen in the Medicare & You Handbook, on page 22; section 1: Signing up for Medicare; It states as follows: If you have Part A, you may get a “Health Coverage” form (*** Form ******) from Medicare. This form verifies that you had health coverage in the past year. Keep the form for your records. Not everyone will get this form. If you don’t get Form ******, don’t worry. You don’t need it to file your taxes.

Please know for Medicare Advantage and Prescription Drug Plans, the plan isn’t responsible for sending out ****** ***** ** ***** forms. The member, or the members legal representative, would need to contact their local Social Security Administration office, or call the Social Security Administration at ###-###-####, for information pertaining to this **** form.

In response to Ms. ***** ***** requesting Aetna Medicare to reimburse her in the amount of $100, for her expenses, and time, she has spent trying to get the **** form, unfortunately, we do not offer monetary allowances.

The member's representative, *****, will receive a detailed Medicare Resolution Letter within 7-10 business days with this response.

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

Sincerely,
Marilyn G.
Analyst, Medicare Enterprise Resolution
Customer Answer
Date: 06/09/2023

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:06/04/2023
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have been trying to get a prescription filled since April 13th. The doctor submitted 2 prescriptions for medications I need to complete a frozen embryo transfer. I need the medications to be delivered by June 24. My insurance authorized the procedure on May 5 (authorization number: ************). Two medications were prescribed: ******* and **********. ********** has been ready to schedule for a while and I have been waiting for the other one to be ready. However, all of a sudden, on May 5, I got a letter from Aetna that my prescription for ******* had been denied as the recommended drug for the procedure is *******. ******* is exactly the medication that the doctor prescribed and I had been waiting for it for weeks! I contacted the doctor and was told they have no idea why ******* was ordered by *** ********. I called *** ******** on May 22 and was told that they needed information from the doctor. The doctor says that the information has been provided. Infertility is already a very stressful condition and this is negatively impacting my mental health as I have no tools for solving the situation with the doctor blaming the pharmacy and the pharmacy blaming the doctor. I can't go to a different pharmacy because my insurance forces me to go through ********. My expected solution is that the ******** contacts the doctor (C*** ********** **** **** ** **** ******* ** *****) directly and gets this prescription filled so that I can schedule delivery and be ready for my baseline appointment on June 28. I am abroad for work but I check my email and I receive updates from ******** on my email ******************** I can also be contacted at this number: **********.
Business Response
Date: 06/06/2023

**** *** **********
Please see our response to complaint ******** *or **** ***** that was received by us on June 05, 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 internally to have the concerns reviewed. Per the review of the precertification along with the pharmacy claims, I was advised the last claim for ******* was rejected on May 22, 2023 due to no precertification. The precertification was approved under Aetna pharmacy benefit from June 02, 2023, to June 02, 2024. A test claim was ran and it went through with no issues. For the **********, the test claim paid with no issue on April 19, 2023, and does not require precertification for coverage at this time. I was advised the member should be able to contact ***/******** Specialty at ###-###-#### to get the medications filled and scheduled for delivery. Additionally, I’ve referred the member to our Case Management (CM) program. A case manager would be able to assist the member with claims, precertifications, medication fills, and serve as a single point of contact for the member in which I believe would be helpful for Ms. *****.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. *****’s concerns.
Sincerely,
Destiny S.
Analyst, Executive Resolution Team

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