Aetna Member Services Customer Service Issues

Dear Community, I have attached the paperwork from the dentist's office regarding my upcoming oral surgery and I am hoping for assistance in determining if it will be covered by medical or dental insurance. I have some additional inquiries: - What is the coverage for white fillings and to what extent? - How is something deemed medically necessary, and what occurs once it is recognized as such? - If a procedure is deemed medically necessary, will it be covered by medical insurance? - I am planning to get braces for a deep bite (malocclusion) which I read online could be considered medically necessary. Can you confirm this? - What will my Co-pay be for the orthodontist and oral surgeon? - What services are included in my monthly orthodontist visits for braces? Lastly, during my recent dentist visit, I saw online that it mentioned a possible $40 owed even though I was told everything was covered, and I did not need to pay anything at the office. I am unsure why there seems to be a discrepancy and would appreciate clarity on this matter. Thank you for your assistance. Best regards.

I am currently on short-term disability, and I recently received a denial letter citing the lack of medical records as the reason. I acted promptly to address this by visiting my doctor and ensuring that the records were sent on 11-13, within the 10-day deadline mentioned in the letter (by 11-16). However, as of now, it has been approximately 15 business days, and I have not received any updates. Despite my efforts to follow up with numerous calls, my claim still appears closed on the app. This situation is significantly impacting my life, and I am taking it very seriously. Your assistance in resolving this matter would be greatly appreciated. Thank you for your attention and understanding.

After a year of poor service, I'm frustrated that I still can't even sign up for a health club membership that's supposed to be free. I've been given three different membership cards, all with incorrect information, preventing me from seeing my personal doctor for the past year. I'm unwell, and it seems like Aetna couldn't care less. As soon as I can, I'll be canceling my Aetna plan and warning everyone I know about my experience.

I am reaching out about my daughter, Macie B., born on 4/6/04. She is under her father's policy held by Brad B., born on 9/26/79, SSN ending in [redacted]. Macie underwent oral surgery in July this year, and the claim has been denied. She also has secondary insurance through her stepfather with Blue Cross Blue Shield. Brad has already contacted you multiple times regarding this matter. I have received a bill for over $[redacted], even though both primary and secondary insurances should have covered the costs entirely.

On November 24, I received a prepaid Mastercard from Aetna with $[redacted] for food and utilities to spend by December 31. I tried to use it at HEB and Walmart, but it didn't work. After hours of trying, I had to leave everything at the store. The clerk mentioned around $[redacted] might still be available but when we tried, it showed only $2 left, causing stress and fatigue. I had to spend $[redacted] in 37 days which was challenging, especially with difficult experiences trying to use it for utilities. In July, I only received 1/3 of my OTC order and didn't get a response to my complaint via email or form. Today, when I tried accessing my account on CVS OTC, they said I wasn't a member, and after a long call with multiple people, it was confirmed that I am a member. The customer service was nice, but the system is nerve-wracking and frustrating. I hope these issues get resolved as it's frustrating to deal with.

Subject: Request for Evidence of Coverage and V.P.'s Contact Information I, Norm Odell with ID # G8C210105, have been attempting to obtain the Evidence of Coverage with my Name and ID #, reflecting the new premium of $30.90 for [redacted] from Aetna-SilverScript. Despite multiple phone calls, a survey, and letters, the document has not been received. The interactions with the Call Center staff, possibly in Mumbai, have been challenging, with supervisors transferring calls and causing further frustration. An English-speaking supervisor did offer some assistance. I have received the "[redacted] Annual Notice of Changes" and payment records for [redacted] but not the needed form letter. Requesting the name and mailing address of the V.P. for Customer/Member Services for further assistance. Kindly email me the requested details. Thank you.

When signing up for my policy, I selected my primary care physician, Dr. Ida Gagliardi at Family Health Center of SW Florida. However, when receiving my card, it listed Louise Cohen at Millenium Group instead. Despite numerous calls over the past month and speaking to multiple representatives, the issue remains unresolved. I have been assured that it would be escalated, but no callbacks or communication have been received. This has hindered my ability to get necessary referrals and prescriptions. I am considering going to Walgreens as a last resort. The confusion seems to stem from Dr. Gagliardi being incorrectly listed as a pediatrician instead of a family practice MD. Urgent assistance is needed in rectifying this situation.

TRANSPORTATION ISSUE: As an administrative assistant and transportation coordinator at Trueman Pointe Care Center in Hilliard, Ohio, today marked the 3rd unsuccessful attempt to arrange transportation for Ms. Carlson, an Aetna client with Client #[redacted]99 and a date of birth of 06/07/[redacted]. It is crucial for Ms. Carlson, a bariatric resident, to attend these appointments. However, each time a transportation company is arranged, they send the wrong size van despite being informed of her needs. I have spoken with Mike J. at MTM transportation, the third-party supervisor, but unfortunately, he did not offer a solution. I previously suggested sending Ms. Carlson via stretcher due to the recurring van size issue, but I was informed it was unnecessary as she can use an electric wheelchair. As this problem persists, I am escalating the matter by contacting the state and filing a grievance to address your company's inability to provide suitable transport for clients. Immediate follow-up on this issue is imperative.

I am seeking clarification on how to have a procedure conducted during my initial uro-gynecology specialist office visit recognized as "specialist, nonsurgical" by my Aetna Silver plan. The test in question assesses residual urine in the bladder after emptying and is standard for new patients. Even though Aetna deems it surgical, I assert it aligns with the AMA's non-surgical definition and is routine. Aetna's concierge line did not offer specifics beyond advising to resubmit. I am inquiring about the advisable modifier or approach to ensure coverage for this non-surgical, specialist test. Analogous to preventive modifier 33 for colonoscopies, I am looking for a coding method that distinguishes this procedure as non-surgical or routine when conducted by a specialist.