MISCELLANEOUS
Member is calling in upset and states they want to speak with someone else/supervisor?
KA 3037- Individual Caller Request to Speak with Supervisor/Escalated Calls
Member states " This is ridiculous, Aetna has agents who are always placing me on HOLD HOLD HOLD and never come back, what kind of service is this!"
KA# 3109: Medicare Member: Grievance: Part C Medicare Organization Determinations and Grievances Decision Tree
MM called to say they have not received their reimbursement check for their eyewear that was mailed on 4/23/2026.
KA# 3002: Medicare Member - Medicare Stop Pay and Reissue Check (HRP Claims)
Member is calling in because they received a letter due to loss of Medicaid.
KA- 3672 Dual Eligible Loss (Recertification) of Medical Coverage
Member calling to see if we can help with mileage trip override in Florida
KA 4524- Medicare Member - 2026 Non-Emergency Medical Transportation (NEMT) – SafeRide and MTM (A2C)
Where would you go to see a list of capitated providers for Capitated vendors?
Wiki Tool
MM states " I filed a grievance yesterday, I was very upset at the agent who had no fault in this, I feel bad because today my dr called and said my auth was approved, no need for the grievance anymore. "
" Thank you for calling us back to withdraw the grievance you filed yesterday. I will be more than happy to assist with this"
KA# 3101: Medicare Member: Withdrawing a Grievance
Member calls in about claim cost share not matching EOC
KA# 3914: Medicare Member: How to Handle Claim Issues
MM was released from incarnation 10 days ago and wants to know if they can enroll into a new plan?
KA# 3220: Medicare Member: Incarcerated Member
Member calls to request rollover for their OTC EB Card
KA# 4458: Medicare Member: 2026 Individual Aetna Medicare Extra Benefits Card Over the Counter (OTC) Benefits
Member states "My doctor is asking me for a group number, I don't know what that is or where to find it, I'm not in a group so its confusing"
"I understand insurance details can be confusing, Ill be more than happy to provide you your group number and where to locate it for future reference"
KA# 3586: Medicare Member - Locating the Plan Number (Plan #)
Short notice transportation could not be accommodated because MM has a vehicle accommodation due to medical reasons. MM is upset the trip cannot be scheduled. Email sent to CM for additional resources. Grievance is filed. EB Card wallet explained. Is this a nFCR Grievance?
No it is not
KA# 3109: Medicare Member: Grievance: Part C Medicare Organization Determinations and Grievances Decision Tree
MM states " I got an MRI last month, and the claim was denied, so now Im being billed, Im not sure what happened but my dr says it should be paid because he got plan approval"
"Thank you for calling us to bring this to our attention so we can assist, I know how concerning bills can be. I'll be happy to look into your MRI claim and see how we can make this right"
KA# 3149: Medicare Member - How to Send a Claim to Rework via GPS
KA# 2816: Medicare Member - How to Send a Claim to Rework via HRP
HMO member wants to know if she can switch plans?
KA# 2806: Medicare Member: NextGen Medicare Plan Changes
FL member calling to find a INN cardiologist in their area. What KA would you follow to see if PCP is capitated?
KA -4059 Florida Medicare -Evolent Soeciality Services (Oncology, Cardiology, Cardiac Surgery, and Hematology)
Anytime you're reaching out to the contact for more info by making an outbound call, sending an email, correspondence, fax, or form outside the company.
KA# 3658: Medicare Member: Call Documentation
Member is calling because the 30- day standard TAT for an appeal will jeopardize their health. Which Ka would you follow?
KA-2825: Medicare Member: Expedited Appeals Call Handling
What are 2 benefit types for member reimbursements?
KA# 2778: Medicare Member: Member Reimbursements
Member is calling in regarding application status
KA 3584- Call Handling Application Status
Member is calling to report they have completed their healthy home visit.
KA- 4509: Medicare Member – 2026 Healthy Rewards: Aetna and Allina Health | Aetna Programs
"Hi _____, im calling on behalf of my mother, she fell last night, she's ok but the ER dr advised she needs a wheelchair, can you help me with this?"
"I'm sorry to hear our member fell, glad she's ok. I'll be more than happy to assist with the benefit to get MM a wheelchair."
KA #4222: Medicare Member: Call Communication Skills
KA #4492: Medicare Member: 2026 Durable Medical Equipment (DME)
MM calls about denial of continued services in a Skilled Nursing Facility (SNF) and does not agree.
KA# 3003:
Knowledge
Medicare Member: Fast Track Appeals: Quality Improvement Organization (QIO) (Commence Health or Acentra Health (formerly Kepro)) Appeal Rights: Skilled Nursing, Home Health Care Agency, Comprehensive Outpatient Rehabilitation Facility
QMB MM calls because their podiatrist is charging them $36.16 for their last visit and wont see them until this is resolved
KA# 4519: Medicare Member - 2026 Dual-Eligible Special Needs Plan (QMB, QMB+, SLMB+,FBDE,SLMB, QDWI and QI)
"I called last month I cant remember the date, but I told the agent I wanted to cancel my Aetna plan, it was not active yet. I went to my PCP this morning and they told me I am now enrolled with Aetna as of May 1st. Can you help me understand why? "
"Thank you for calling us to address your cancellation issue. I'll be happy to take a further look into your cancellation request from April"
KA# 3518: Medicare Member - Cancellation of Enrollment
Caller states "Im so frustrated, every time I call I have to put my dad on the phone so one of you can speak to me. He's 89 years old, he can barely talk. I just want to know what he is supposed to pay to see his neurologist. "
"I'm sorry to hear that, I can definitely assist in providing the cost share for a specialist on your dads plan. I will also discuss your options so that you wont have this issue on future calls, when calling about your dads account"
KA# 3701: Medicare Member - Call Handling - Viewing/Requesting Authorization for Release of PHI Form / Appointment of Representative Form / Power of Attorney