MISCELLANEOUS
Member is calling in upset and states they want to speak with a 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
Member called because 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
Florida Member calling to see if we can help with mileage trip override.
KA 4524 - Medicare Member - 2026 Non-Emergency Medical Transportation (NEMT) – SafeRide and MTM (A2C)
Member calling in to advise they completed their healthy home visit.
KA 4509: Medicare Member – 2026 Healthy Rewards: Aetna and Allina Health | Aetna Programs
Member 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 doctor called and said my authorization was approved, no need for the grievance anymore."
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
Member was released from incarceration 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 Extra Benefit 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."
KA 3586: Medicare Member - Locating the Plan Number (Plan #)
"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"
Member's daughter is calling in about a frustrating interaction she had with a representative from CVS OTCHS, she is not listed on the account. [2 part answer]
KA 3109: Medicare Member: Grievance: Part C Medicare Organization Determinations and Grievances Decision Tree
KA 3123:Medicare Member: Appointment of Representative (AOR) Form
Member states, " I got an MRI last month, and the claim was denied, so now Im being billed, I'm not sure what happened but my doctor 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 OR
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
Member calling in to advise they will be having a procedure with the code and would like to know what the benefit cost-share would be.
KA 3318: Medicare Member - Call Handling -Quoting Benefit Information Steps
You make an outbound call to CVS OTCHS and need to document the activity completed in the call.
KA 3658: Medicare Member: Call Documentation
Member is calling because the standard 30-day TAT for an appeal will jeopardize their health.
KA 2825: Medicare Member: Expedited Appeals Call Handling
Member states, "I submitted my fitness receipts in April, can you check the status of my refund?"
KA 2778: Medicare Member: Member Reimbursements
Member is calling in regarding application status.
KA 3584 - Call Handling Application Status
Member is calling in asking about a benefit that would cover a new cane.
KA 4518: Medicare Member: 2026 Fall Prevention Benefit
"Hi _____, i'm calling on behalf of my mother, she fell last night, she's ok but the ER doctor advised she needs a wheelchair, can you help me with this?" [2 part answer]
"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)
Member calls about denial of continued services in a Skilled Nursing Facility (SNF) and does not agree and would not like to be discharged.
KA 3003: 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
D-SNP QMB Member calls because their podiatrist is charging them $36.16 for their last visit and won't see them until it is paid.
KA 4519: Medicare Member - 2026 Dual-Eligible Special Needs Plan (QMB, QMB+, SLMB+, FBDE, SLMB, QDWI and QI)
"I called last month, I can't 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, "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." [2 part answer]
"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
KA 3704: Medicare Member – Confidentiality: Level 1 vs. Level 2 Information