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Denver & Boulder, Colorado

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Consumer Complaints

BBB Accredited Business since 10/24/2005

Health Choice One, Inc. (Headquarters)

Phone: (720) 200-2825Fax: (866) 763-1086

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Customer Complaints Summary

7 complaints closed with BBB in last 3 years | 0 closed in last 12 months
Complaint TypeTotal Closed Complaints
Advertising / Sales Issues5
Billing / Collection Issues2
Problems with Product / Service0
Delivery Issues0
Guarantee / Warranty Issues0
Total Closed Complaints7

Complaint Breakdown by ResolutionAbout Complaint Details

Complaint Resolution Log (7)BBB Closure Definitions
09/17/2013Advertising / Sales Issues | Read Complaint Details

Additional Notes

Complaint Category: Sales presentation misrepresented the service

Complaint: refund on a health plan that was purchase.
May 2013 I purchased a health plan through Healthchoiceone agency. I specifically informed them I was needing health coverage for myself and daughter. I was in the nursing program and I have to have health insurance and my daughter in going to college she is 18yrs old. We are rarely sick so we don't need much coverage I inquired several time for the plan to include office visits (minor cough and cold aches and pains that require a doctor's visit) and once a year well woman visit for us. Also I requested something inexpensive that would cover my needs. When I was explained of the coverage I continued to ask was the well woman visit covered I was informed by the company representative yes. I scheduled a doctor's appt for me and my daughter. It took a month for us to get in; the appt was scheduled for Aug 5th. Prior to the appt the doctors office called and informed me the insurance doesn't to cover the well woman visit over the age of 16 yrs. I felt I was misinformed of the coverage by the agency. the doctor is a provider on the plan. I intern call the health plan verification dept they confirmed the visit would not be covered so they gave me the number to the agency. The first time I called I got directed to several different people. Finally I research my emails the agency representative who I purchased the policy through I left a voice message and email with is ****** *****--- ************************** informing her of my unhappiness concerning the plan and I would like a refund. I specifically requested and asked was this service covered and I was told it was. I feel I was misinformed the nature of the plan. If I was told the truth regarding the plan I would not have purchased it. I had already agreed to another plan through another agency that accommodated what I need but I rejected it based on the fact when ****** with Healthchoiceone ask me to read to her the other companies plan. Which I did she said she had a better plan that would cover that what was offered and what I was looking for an it was cheaper. I went with her plan and I was explained the plan and I did asked several time was the well women visit covered and again actually 2 different representative stated yes and one stated I would only be subject to the copay. The plan that I purchased is not beneficial for me. She offered me another more expensive plan which I cannot afford that will cover what I asked originally. I decline because there were and is other plan the can accommodate my request and is cheaper. I requested a refund based on the inaccurate information that was provided to me at the time of purchase. I was told I would not be refunded. I think they knew I would not have purchased the plan if they told me well woman visit was not covered. my ID ********** group ***** ***** *****-***** The first month payment was May $207.00 + $125.00 enrollment fee. June and July $207.00 totaling $746.00 I am They were not honest with me regarding the coverage I asked about and specifically need.

Business' Initial Response
To Whom it May Concern,
I am writing this response based on transcripts of the recorded sales calls between Ms. *****-***** and Health Choice One agent ************. Ms. *****-***** discussed the policy details in the morning with Ms.****** and applied for coverage later that day. The subject of wellness care and preventive coverage was only very briefly discussed during the morning call and it was only discussed as it related to Mammograms. The description Ms.****** provided was correct for the coverage of Mammograms.
When Ms.****** called Ms. *****-***** back to complete the application, very little was discussed about coverage details. There were questions that Ms. *****-***** had about cancellation and refunding of the premium if she changed her mind, but the conversation was limited to that and application questions and answers. Wellness and preventive care were not discussed until the application was completed and Ms. *****-***** was sent to a separate Health Choice One employee who then verifies the customers understanding of the policy benefits, exclusions, premium amounts and payment dates and details. During this process Ms. *****-***** was informed that the plan doesn't cover wellness except for well-child visits up to age 16 and Mammograms. When she was told this she said that was a problem and that she would like to speak to Ms.****** again.
When she returned to Ms.******, the explanation provided was not accurate about the wellness coverage provided by the plan. Ms.****** discussed the Mammogram coverage correctly again, but then explained that other services like pap tests and colonoscopies are covered, but subject to the plan deductible. Ms.****** did correctly explain that if she used a network provider that network discounts would apply for those services. Then ****** said that the $50 copay would apply for pap tests and that the charges for the lab work would be subject her deductible and she would have to pay them. Ms. *****-***** then asked if it was subject to the copay and Ms.****** answered "copay and deductible, yes ma'am.
After this explanation, the client agreed to go back to the verification department and complete the process with the verifier. The same disclosure about wellness not being covered except for Mammograms and well child up to age 16 was again read to Ms. *****-***** and she acknowledged that she understood by saying yes.
Health Choice One has a training program that explains each policy to agents and we had trained on this product approximately 45 days prior to Ms. *****-***** purchase because it was replacing another plan that was no longer available that had different benefits. We have had a rigorous verification system in place to prevent misunderstandings like this from happening. We have thousands of very satisfied customers that have a clear understand of their policy benefits and what they do and do not cover. Unfortunately, Ms. *****-***** is not one of those satisfied customers.
Health Choice One is going to request that the carrier refund the premium and application fee that Ms. *****-***** paid and we will take this complaint and apply some additional safeguards to ensure that this type of misunderstanding does not happen again.

Vice President of Sales

Consumer's Final Response
(The consumer indicated he/she ACCEPTED the response from the business.)
I am in acceptance of the response as long as it pertains to me getting a full refund in the amount of $746.00.

Thank you,

***** *****-*****

Complaint Resolution: Company resolved the complaint issues. The consumer acknowledged acceptance to BBB.

08/06/2012Advertising / Sales Issues
01/31/2012Advertising / Sales Issues
12/20/2011Advertising / Sales Issues
11/14/2011Advertising / Sales Issues
03/12/2012Billing / Collection Issues
12/29/2011Billing / Collection Issues

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