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Group Health Cooperative of South Central WI

Phone: (608) 251-4156 Fax: (608) 828-9333 View Additional Phone Numbers 1265 John Q Hammons Dr, Madison, WI 53717 https://ghcscw.com/


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Description

This company is a member-owned health care co-op insurance service for individuals, employer groups and Medicaid recipients. Primary medical care delivered through 5 clinics in Dane County with in-patient treatments provided at Madison area hospitals.


BBB Accreditation

A BBB Accredited Business since

BBB has determined that Group Health Cooperative of South Central WI meets BBB accreditation standards, which include a commitment to make a good faith effort to resolve any consumer complaints. BBB Accredited Businesses pay a fee for accreditation review/monitoring and for support of BBB services to the public.

BBB accreditation does not mean that the business' products or services have been evaluated or endorsed by BBB, or that BBB has made a determination as to the business' product quality or competency in performing services.


Reason for Rating

BBB rating is based on 13 factors. Get the details about the factors considered.

Factors that raised the rating for Group Health Cooperative of South Central WI include:

  • Length of time business has been operating
  • Complaint volume filed with BBB for business of this size
  • Response to 4 complaint(s) filed against business
  • Resolution of complaint(s) filed against business


Customer Complaints Summary Read complaint details

4 complaints closed with BBB in last 3 years | 1 closed in last 12 months
Complaint Type Total Closed Complaints
Advertising/Sales Issues 1
Billing/Collection Issues 3
Delivery Issues 0
Guarantee/Warranty Issues 0
Problems with Product/Service 0
Total Closed Complaints 4

Customer Reviews Summary Read customer reviews

1 Customer Review on Group Health Cooperative of South Central WI
Customer Experience Total Customer Reviews
Positive Experience 0
Neutral Experience 0
Negative Experience 1
Total Customer Reviews 1

Additional Information

BBB file opened: June 17, 1998 Business started: 03/01/1976 in WI Business started locally: 03/01/1976 Business incorporated 03/13/1972 in WI
Licensing, Bonding or Registration

This business is in an industry that may require professional licensing, bonding or registration. BBB encourages you to check with the appropriate agency to be certain any requirements are currently being met.

These agencies may include:

Wisconsin State Office of the Commissioner of Insurance
P.O. Box 7873, Madison WI 53707-7873
http://oci.wi.gov/oci_home.htm
Phone Number: 608-266-3585 state wide 800-236-8517
Fax Number: 608-266-9935 for general office

Type of Entity

Cooperative Association

Business Management
Dr. Mark Huth, MD, Executive Director/CEO Mr. Al M Wearing, Chief Insurance Services Officer
Contact Information
Principal: Dr. Mark Huth, MD, Executive Director/CEO
Business Category

Insurance - Health Insurance Services Clinics Consumers Cooperative Organizations Insurance Companies All Other Insurance Related Activities (NAICS: 524298)


Customer Review Rating plus BBB Rating Summary

Group Health Cooperative of South Central WI has received 0 out of 5 stars based on 0 Customer Reviews and a BBB Rating of A+.

BBB Customer Review Rating plus BBB Rating Overview

Additional Locations

  • 1265 John Q Hammons Dr

    Madison, WI 53717 (608) 251-4156 (608) 260-3170

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BBB Customer Review Rating plus BBB Rating Overview


BBB Customer Reviews Rating represents the customers opinions of the business. The Customer Review Rating is based on the number of positive, neutral and negative customer reviews posted that are calculated to produce a score.

Customer Review Experience Value
Positive Review 5 points per review
Neutral Review 3 points per review
Negative Review 1 point per review

BBB letter grades represent the BBB's opinion of the business. The BBB grade is based on BBB file information about the business. In some cases, a business' grade may be lowered if the BBB does not have sufficient information about the business despite BBB requests for that information from the business.
Details

BBB Letter Grade Scale

BBB Rating Value
A+ 5
A 4.66
A- 4.33
B+ 4
B 3.66
B- 3.33
C+ 3
C 2.66
C- 2.33
D+ 2
D 1.66
D- 1.33
F 1
NR -----
Star Rating scale

  Average Score
5 stars 5.00
4.5 stars 4.50-4.99
4 stars 4.00-4.49
3.5 stars 3.50-3.99
3 stars 3.00-3.49
2.5 stars 2.50-2.99
2 stars 2.00-2.49
1.5 stars 1.50-1.99
1 star 0-1.49

BBB Customer Review Rating plus BBB Rating is not a guarantee of a business' reliability or performance, and BBB recommends that consumers consider a business' BBB Rating and Customer Review Rating in addition to all other available information about the business. If the BBB Rating is NR then only Customer Reviews are used for the Star Rating.

Complaint Detail(s)

7/27/2015 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: I work in Madison at the ** ****** ******* and have Group Health Cooperative as my family health insurance. My diabetic son ******, **** ** ******* ** *** ********* ****** ** ***********. During a bout of the stomach flu at school on 3/31/14, he went to the emergency room at Aurora Health Care in Milwaukee. A few days later on 4/3/14, he had to go in again for an IV. His stomach was not absorbing food properly and he had another diabetic sugar low. We contacted GHC as they request when a patient is seen out-of-area. Per my policy, an emergency office visit is $75 each visit which is paid to the hospital and GHC then pays the rest.I sent Aurora Health 2 checks for $75 for each visit. I assumed GHC was going to pay the entire difference and that would be the end of it. GHC did make a payment to the hospital but it was not the full balance. What I was told later is that GHC and Aurora do not have any agreement between each other and Aurora would not negotiate on the cost of the emergency office visits. Aurora then started billing my son in December, 2014 for that difference which was $2611.80. I called GHC to get them to take care of this amount. I was told that GHC now uses a company called *** to deal with these situations. I then had to call a Scott S******* at ***. He said the first thing I have to do is file a dispute letter for each appointment. This would prompt Aurora to negotiate the balance or write it off entirely. I was assured by him that 99 times out of 100, the hospital would just write off this balance. He e-mailed me 2 separate dispute letters and I sent them to Aurora. Got another bill in January, 2015. Called Scott. He said not to worry. They will be writing it off soon. And even if they sent my son's account to collections, the laws now would not allow Aurora to report this debt to the credit agencies. Got another bill in February. Called Scott. Same story again. If they sent the account to collections it wouldn't appear on his credit report. If it got sent to collections, GHC would pay that balance immediately. Received a bill in March and April. Called Scott. Same thing. Be patient. In May, my son received a letter from the State Collection Service for $1364.98, half of what the original balance was. Called Scott. He said now my son had to call State Collections and negotiate further and get the bill lower and then GHC will pay it. That was enough. I called GHC and talked to a Victoria. I told her that this is a terrible way to do business. GHC needed to negotiate with Aurora a long time ago and get this balance paid. My son is in collections. She asked what the amount was and I told her. She said she would talk to her boss and see if GHC would pay it. She called me back and said they would pay it off. I said does everyone in this situation go through this same crap. She said yes but there aren't that many. They just started using this *** company a little more than a year ago. I said would you like this if this happened to your son? She said well it doesn't get put on his credit report. I said that my son has got one more year of school in Milwaukee. What if he gets sick again and has to go to the hospital. Will he have to go through this all over again? Victoria said yes. I said this is an awful way to do business and I wanted to file complaint with GHC. I talked to another woman and voiced my complaint. This would go to a Sarah, Victoria's boss. After telling this woman my complaint, she said that this collections notice wouldn't be on my son's credit report. I told her my diabetic son is now worried about going to an emergency room when he is sick because he will be sent to collections again for something GHC should have paid for in full to begin with.

Desired Settlement: In the future, GHC should stop using this kind of business practice or method to settle an obligation they have to their customer. GHC should negotiate with Aurora and any other hospital if necessary and then pay that balance off in full for the patient. This balance was always GHC's responsibility and should be taken care without having a patient sent to collections.

Business Response: This letter is in response to the complaint that was filed on June 19.201 5. We understand that
one of our members disagrees with Group Health Cooperative of South Central Wisconsin's
(GHC-SCW) handling of a claim for service. We have been in contact directly with member to
address his concerns.
I assure you that we strive to administer our health plan benefits as accurately, equitably, and
fairly as possible. We make every effort to collaborate with our members and their providers to
fully understand the clinical needs of our members while effectively administering the benefits
of the plan. In this situation, our Claims Department and our patient advocacy partner have had
ongoing discussions with this member regarding the resolution of this claim. You have also been
collaborating with our patient advocacy partner in an effort to resolve these charges with the
provider amicably.
Mr. **********, thank you for allowing us to respond to this complaint. Though the claim was
ultimately resolved, we certainly regret any inconvenience or misunderstanding in this matter.
Please feel free to contact me directly if 1 personally may be of further assistance or clarification
in this matter

Consumer Response:

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

   The response from Group Health Cooperative does not address the complaint at all. In my initial complaint, I described to you the entire process that GHC makes you go through in order to pay my son's claim. ***, the GHC advocacy partner, did help with letters to the hospital but after that, they advised us to not pay anything and wait for the hospital to write off the balance or be sent to a collections agency. When the balance was finally set to collections, *** then wanted us to negotiate further to lessen GHC's financial responsibility. Steering a patient to collections and possibly hurting their credit in order to lessen their financial responsibility is a rotten way to do business. No decent company would do that. My son is diabetic and going to school in Milwaukee one more year. If he gets sick again and has to go to an emergency room, GHC said we would have to go through the whole process again to get the claim paid. And, we just received a bill from the hospital for $1246.82. GHC said they paid the balance of the claim but they obviously did not. This is an awful way to treat a customer. I paid my son's portion of the claim. GHC needs to pay the rest in a timely fashion period without putting a patient into collections. 

[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

******* ********

 

 

Business Response: This letter is in response to the complaint that was originally filed on June 19, 2015. We
understand that our member expressed additional concerns subsequent to our initial response to
your office. We understand that our member continues to disagree with Group Health
Cooperative of South Central Wisconsin's (GHC-SCW) handling of a claim for service. We had
been in contact directly with the member to address his concerns.
The member's recent correspondence indicates that GHC had failed to pay a balance on a claim.
Upon further review and upon following up with the provider, we confinned that the provider
did in fact receive the payment that we had remitted for services. We suspect that the provider
may have submitted a bill to our member prior to posting the payment received from ***.
Consequently, if the member did remit payment to the provider, then he should be owed a refund
from the provider. We've been having ongoing communications with this member about the
claim, and we're certainly happy to continue to address any additional questions or concerns
directly with the member.
Mr. **********, thank you for allowing us to respond to this complaint. Though we encourage
our members to seek care from providers who are within our network of contracted providers, we
understand that it is sometimes necessary for our members to receive care from non-contracted
providers. We strive to collaborate fully with the provider and member in effectively and
efficiently resolving these types of claims. We certainly regret any inconvenience or
misunderstanding in this matter. Please feel free to contact me directly if I personally may be of
further assistance or clarification in this matter

2/19/2014 Advertising/Sales Issues | Complaint Details Unavailable
9/24/2013 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: On July 18, 2013 I received correspondence from State Collection Services Inc. stating that I owe Group Health Cooperative $40.00. I am disputing this correspondence for numerous reasons: (1) I am a current member of Group Health and health care insurance is deducted every two weeks. (2) Every month I receive a zero balance invoice stating I do not owe money for any services. (3) I have never been notified of any payments due (as stated in item #2); (4) I have a 100% credit rating never paying a bill late. I am very upset that this firm has not contacted me and has turned this minute amount over to a credit collection agency which could damage my credit rating. I would like this amount removed from my records; I request that this collection agency be notified and if this is reflected on my credit report I will file a complaint with every known regulatory agency that exist State and Federal.

Desired Settlement: That these false allegations be removed from my record; that the collection agency be notified and the record be removed.

Business Response:

BBB of Wisconsin, Inc.

***** ** ********** ***

********** **  *****

August 23, 2013

RE:  Case #:  *******

Dear Better Business Bureau of Wisconsin,

We are responding to the above complaint received from your office via email on 8/20/13, and in the mail on 8/23/13.  Group Health Cooperative of South Central Wisconsin (GHC-SCW) reviewed this Consumer’s desired resolution of removing the charges in the amount of $40.00.

We will respond to each of the consumer’s points below:

1.       The consumer is correct when stating to be a current member of GHC-SCW.  This coverage is purchased through the consumer’s employer.  For which, this member states a certain dollar amount is deducted every two weeks.  This deduction they speak of is NOT administered or collected by GHC-SCW.

2.       We are unsure as to what the consumer is referencing regarding an invoice with $0.00 balance as it is not our practice to mail patient statements which have a $0.00 balance. 

3.       GHC-SCW has mailed four patient statements which included the above mentioned $40.00, to the consumers address, for which we verified is the same address that was given by this consumer, to the Better Business Bureau of Wisconsin, regarding this complaint.  These patient statements were dated 2/28/13 for $40.00; 4/4/13 for $40.00; 5/4/13 for $40.00; 6/8/13 for $60.00 (for which the $40.00 mentioned above is added with another $20.00 outstanding amount).

GHC-SCW also mailed two Explanation of Benefits, regarding this owed amount on 2/7/13, and 2/8/13.  The Explanation of Benefits is not a bill but it notifies the member that there is a Member Responsibility for a certain Date of Service.  Then the Patient statement is mailed. 

GHC-SCW made two attempts to contact this consumer via the phone on 3/28/13 and 6/27/13 to discuss the amount due.  However, there was no answer and no answering machine to leave a message.

4.       GHC-SCW does not have information related to this consumer’s credit rating, so we cannot verify the consumer’s statement of having 100% credit rating.  However, there have been five past amounts due to GHC-SCW that were sent to State collections dating back to 2003. 

GHC-SCW will not be removing this $40.00 amount from state collections, and with the information provided to you above, there are no false allegations made by GHC-SCW to rectify.   GHC-SCW Member’s always have the right to file a grievance within GHC-SCW, by contacting Member Services Department at ###-###-####.

Thank you for allowing GHC-SCW the opportunity to respond with the facts surrounding this complaint.

Sincerely,

**** *****

GHC-SCW Member Services

Consumer Response:

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID *******, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

To date, I have not received any correspondence from Group Health; I pay all copayments and pharmacy bills via credit card.  I will reference each charge with the appropriate credit card and provide the information to you.  I am at work during the day and Group Health has that number; if they really wanted to discuss these charges with me.

I have just contacted GHC and discovered that they charged me $20 for three missed appointments claiming they notified me .  As God is my witness I was not aware of any such charges; if I showed up for my appointment it would have only been a co-payment of $10 so why would I pay $20 to miss the appointment.  I have just paid the criminal charges via Visa and I expect this to be removed immediately,  they are lying, coniving criminals to assess these charges and not make me aware.  I pay all my invoices.  Surely there is a government agency that enforces laws against criminal acts such as this and I intend to pursue this matter with that agency.

Regards,

****** *****

 

 

Business Response:

BBB of Wisconsin, Inc.

***** ** ********** ***

********** **  *****

September 13, 2013

RE:  Case #: *******

Dear Better Business Bureau of Wisconsin,

We are responding to the additional concerns this consumer has regarding the case listed above, which was received on September 5, 2013.  Group Health Cooperative of South Central Wisconsin (GHC-SCW) reviewed this consumer’s additional concerns and request to remove charges the consumer recently paid to collections.

As noted in our previous letter, GHC-SCW mailed four patient statements to the consumers address.  GHC-SCW did not receive returned/undeliverable mail from these four mailings to the consumer.  GHC-SCW made two phone attempts to reach the consumer regarding these invoices and charges in question to notify them of the fact that they were being sent to collections.  GHC-SCW stands firm that these charges will NOT be removed.

The consumer has a new concern with a recent charge of $20.00, mentioned in their recent letter.  GHC-SCW reviewed this consumer’s concern and this charge is for a missed appointment on 5/10/13.   Our automated telephone system made a call on 5/8/13 to remind this consumer of their upcoming appointment for which our records documented that this consumer answered this call that was delivered to the phone number given by the consumer to reception at the time of scheduling.  The department that the appointment was scheduled has a small fee for missed appointments and cancels that come in within 24 hours of the appointment.  Had the consumer arrived for the appointment a co-pay would have been collected for the services according to their benefits.

This consumer signed the 1 page Rights, Responsibilities, and Informed Consent form on 12/10/12, which explains in great detail these charges(this form is good for 1 year and will expire on 12/10/13 and a new signature will be required of the consumer).  See that portion from this form below (I have omitted the department name for HIPPA reasons):

Appointments and Telephone Reminder Calls:  For _____________ (dept. name) services to be helpful, it is very important to keep appointments.  If you are unable to keep a scheduled appointment, please contact GHC-SCW at least 48 to 72 hours in advance.  This allows us to offer the appointment to another member.  If you cancel an appointment less than 24 hours in advance you may be charged a “No Show” fee of twenty dollars ($20.00).  GHC-SCW routinely reminds all patients of upcoming appointments using an automated telephone system.  If you do not wish to receive a ___________ (dept. name) reminder call, please tell the receptionist at the time of scheduling each appointment that you do not want a reminder all.  Please understand that declining a reminder call applies to the __________ (dept. name) provider you are seeing for that visit only.

 

GHC-SCW has billed appropriately, and will not be reconsidering the billed charges.  If the consumer would like to discuss this further with our Medical Billing Department or our Member Services Department they can do so by calling ###-###-#### and asking for either of the departments.

 

Thank you for allowing GHC-SCW the opportunity to respond with the facts surrounding these concerns.

Sincerely,

**** *****

GHC-SCW Member Services

9/16/2013 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: I didn't think it would come to this, so I did not document exact dates, but I know GHC has this information. I went to a free skin care screening clinic and was told, with a sense of urgency, that I needed to schedule an appointment ASAP with dermatology for removal of this wart. That was failure #1. I was encouraged to do something that would cost $$$ rather than first be advised for an over-the-counter option. I had the small common wart for over a decade, so I'm not sure why it was an issue anyway. I called in to GHC to inquire further. Now I was told different info. I was told that my primary could do it. I happened to have my annual physical coming up (those visits are covered under my health care plan) and they said the doc could just do it then, FREE OF CHARGE. This all made perfect sense. I am a healthy woman and my appointments only take about 1/2 of the allotted time, so it made sense there would be extra time for a quick treatment. The treatment took less than 1 minute, and didn't work. But I could look past that it doesn't work (although still upset I was never advised to try over the counter...so I feel deceived by the skin care docs and their advice to see a derm doc asap), but I was told it would be free. I ended up getting a bill for $144 and some change. I went through the dispute process, and was denied. I am a good customer that pays all my bills on time, but in this situation I was deceived, and I do not feel it is right that I was charged $144. It did not take extra time and resources even. If it had, I may be more willing to pay, despite the wrongful nature of this whole thing.

Desired Settlement: I would be willing to pay $20 of this. That is what it would cost to do an over the counter treatment (or less). I believe this is fair, since I was never given that advice, but since have found out that would be the first place to start. At home. I would expect GHC in good faith to remove this bill from my account. They would not be at a loss for services, and I would be treated fairly as a consumer and human.

Business Response:

BBB of Wisconsin, Inc.

10019 W. Greenfield Ave

Milwaukee, WI  53214

August 23, 2013

RE:  Case #:  *******

Dear Better Business Bureau of Wisconsin,

We are responding to the above complaint received from your office via email on 8/20/13, and in the mail on 8/23/13.  Group Health Cooperative of South Central Wisconsin (GHC-SCW) reviewed this Consumer’s desired resolution of removing the charges, except for $20.00 that the Consumer is willing to pay, from the charges accrued from an appointment on 05/08/13, for the amount of $124.95.

Our records indicate that the consumer did contact GHC-SCW on 4/22/13 at 2:17 pm, inquiring if the procedure could be completed during a future appointment that was already scheduled for an Annual Physical with the consumers Primary Care Physician on 5/8/13.  Our records indicate that an LPN that works with the consumers Primary Care Physican replied back that the treatment could be done at the future appointment.  Our records also indicate that there was no question from the consumer regarding cost for the procedure, nor was there a response from GHC-SCW that this procedure would be FREE OF CHARGE. 

Please Note:  This procedure is billed separately than the Annual Physical because it is not part of an Annual Preventive Health Exam.  However, GHC-SCW was able to accommodate the consumer’s request.

The procedure was completed on 5/8/13 as requested and was billed appropriately according to the consumer’s benefit plan. 

Our records indicate that the consumer made a contact to the Member Services Department inquiring on costs for services the day AFTER the appointment when the procedure was completed, on 5/9/13 at 7:58 am.  The Consumer asked about the cost of the procedure that was completed the day before, and was given a price range for services that were done or ordered at that appointment and what the future charges could be due to the consumers benefit plan.

The consumer purchased a Benefit plan that has Maximum Out of Pocket amounts that need to be met prior to having no patient liability for services, which is why this procedure processed with a patient liability.  This consumer receives a Benefit Summary within her renewal packet annually, this explains the benefit plan.  The most recent renewal packet was processed, and sent to the consumer on 12/19/2012.

Our records show that the consumer filed a grievance with GHC-SCW regarding this complaint on 7/16/13.  The GHC-SCW Member Appeals Committee reviewed this grievance on 8/13/13.  It was determined that this procedure processed correctly to this members Benefit plan, and denied this members request to waive these charges accrued from the requested procedure.

GHC-SCW will not be removing the patient responsibility for the remaining balance of $109.95. 

Thank you for allowing GHC-SCW the opportunity to respond with the facts surrounding this complaint.

Sincerely,

**** *****

GHC-SCW Member Services 

Business Response:

BBB of Wisconsin, Inc.

10019 W. Greenfield Ave.

Milwaukee, WI  53214

September 13, 2013

Re:  Case #:  *******

Dear Better Business Bureau of Wisconsin,

We are responding to the consumer’s clarification question received 9/5/13, regarding the above mentioned Case.  Group Health Cooperative of South Central Wisconsin (GHC-SCW) has records of the consumer contacting our Receptionist on 4/22/2013 at 12:57 pm for which a clinical message was recorded and sent to the Consumer’s Care Team as a referral request for an appointment within our _________ Department (because of HIPPA requirements, I am not able to disclose certain information), for a treatment.  This message also mentions that the consumer offered information to the receptionist about a future appointment with their Primary Care Physician (PCP) on 5/8/13, and may get treatment done at that time.  On 4/22/13 at 2:17 pm a nurse contacted the consumer back and was notified that the treatment can be done at the appointment with PCP.  There was no discussion regarding costs within either of these contacts, nor was there a question raised by the consumer of home care possibilities.

This consumer has the Preventive Care benefit, which means they do receive one annual physical examination per year for which the consumer does not incur patient liability.  If there are any other services/treatments/procedures done during that appointment, they are appropriately coded separately on the claim, and are processed according to the consumer’s benefits.  This treatment is not considered to be part of the preventive care benefit for which did incur patient liability, accurately.

GHC-SCW will not be removing the patient liability for these services.

Thank you for allowing GHC-SCW the opportunity to respond with clarifying facts surrounding this concern.

Sincerely

**** *****

GHC-SCW Member Services

Consumer Response:

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID *******, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

I am fully aware of my plan, yet if I am told something can be done on a routine AND COVERED office visit, then I would think it would all fall under the same terms. So I am not disputing GHC's facts of this all. What I can't let go of is the fact that when I saw the dermatologist during the free skin-screening clinic, I was told I "had to immediate" see dermatologist to get this taken care of. This was false information. Had the receptionist not been knowledgeable enough to inform me my primary could take care of this, I would not only have beem charged for a worthless procedure, but also for the doctor's time. I am fighting this based on principal! Dermatology never presented options, but made something not even worth treating, into an urgent situation, and this was not the case. So again, I fully understand my plan and I pay my bills, but this situation was not handled properly by GHC, which is why I am still disputing this.

Regards,

**** ********

 

 


Customer Review(s)

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Customer Reviews Summary

1 Customer Review on Group Health Cooperative of South Central WI
Positive Experience (0 reviews)
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