Complaints

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:02/17/2025

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  This TPA is terrible. They do not process claims in a timely manner or even at all. I still have items outstanding from 2024 even though I directly worked with representatives. I feel they are untruthful in stating that they dont get my claims from healthcare providers because I know theyve been submitted several times. Their EOBs are unlike ones Ive seen before and it basically feels like I have no insurance. I am worried my credit will suffer due to late medical bill payments because they continue to not process claims. I dont feel comfortable going to the doctor even if I need to because I have no confidence they will process or pay and I have no idea what it will cost. This company is either extremely incompetent or fraudulent or both. Unfortunately, this is the only the only health insurance my company offers so I have no choice. If you have a choice, do not go with this company.

  Business Response

  Date: 02/21/2025

  Thank you for bringing your concerns to our attention. We sincerely regret any frustration you have experienced with the processing of your claims. Providing efficient and accurate service is our priority, and we take all feedback seriously.

  We understand how important timely claim processing is, and we would like the opportunity to review your specific case to determine the cause of the delays. In many cases, processing issues can arise due to missing information from providers, claim submission errors, or coordination of benefits requirements. However, we are committed to working with you to resolve any outstanding concerns as quickly as possible.

  To ensure we address your situation promptly, please contact our customer service team at ************ with your claim details. We will conduct a thorough review and provide a clear update on the status of your claims. Additionally, we are happy to assist in clarifying your Explanation of Benefits (EOB) statements and addressing any concerns regarding provider submissions.

  We value our participants and appreciate the opportunity to improve your experience. Please dont hesitate to reach out so we can assist you further.

• Initial Complaint

  Date:01/16/2025

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I acquire a debit card to pay for medical needs for me and my son that is being diagnosed with ** so he depends on me , I try to put money on the debit card so I have it whenever I need it for him or for me for medical expenses HMA is the company name that sign up with for a saving medical expenses debit card,, now I dont have access to my money when I go to the medical offices pharmacy ************** Unless I use that Facilities they choose on their network they said, but that was not what I signed for because my son goes to ****** . Thats where I used to use the debit card ,but now I cannot I tried to cancel the card and get a refund. They told me i couldnt do that. They wouldnt give me information on no one that I can contact. They wont even give me the names of the people that I talk to, so I need help getting my money back because I wont change my sons hospital in order to use my own money. They told me I can cancel, but they will keep my money that I have already saved on the car that I signed up for so please contact me at the earliest convenience And let me know what to do how to proceed to get my money back. Thank you. I appreciate it youre help.

• Initial Complaint

  Date:12/06/2024

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  ******** customer service provided to providers. I am a ****** at a family practice and getting them to pay claims has been nothing but difficult. For one, the portal was impossible to sign up for that I had to email their customer service to be given access. Second, I have almost $1,000 in outstanding claims that I was able to look up in their system that were paid then taken back because they wanted a W9, but was not contacted regarding this. So I called their provider support line and was given a fax number, which failed x4. Calling them to get an updated fax number is taking so much effort than it should - being on hold for 1.5 hrs is crazy to me. Seems as if paying for their claims is not their number 1 priority. It will be on them when our office closes out to Verdegard insurance plans.

  Business Response

  Date: 12/13/2024

  Thank you for the opportunity to address this matter.

  After reviewing the details of this case, we can confirm that the providers claims were resolved as of November 8, 2024. Our team worked diligently to ensure that the required documentation was received and processed appropriately. Specifically, we confirmed that the W-9 issue was resolved on October 22, 2024, and the claims were successfully reprocessed shortly thereafter.

  Throughout this process, our Care Advocates have proactively reached out to Ms. ******* on several occasions to provide updates and confirm that no additional action was required on her part. We also left multiple voicemails requesting a callback to confirm that all concerns had been addressed. To date, we have not received any return calls or additional communication indicating unresolved issues.

  We believe this matter has been fully resolved and invite Ms. ******* to contact us directly at ********************** if she has any outstanding concerns or requires further assistance.

  Customer Answer

  Date: 12/16/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution would be satisfactory to me.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
  
  Regards,
  
  ********* *******
  
   
  

• Initial Complaint

  Date:11/03/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On 3/26/2024, I had routine labs done for my thyroid at Quest. On 6/27/2024 I turned 26 and was no longer covered by my insurance since it was my parents. I received a bill from Quest for those labs in March shortly after. In July I called Verdegard to resolve the issue and in checking my EOB, I found that they had never even processed the claim. The customer service *** told me they would expedite processing for me (after almost 4 months). In September I received another bill from Quest and an EOB from Verdegard. The *** stated they couldnt process the claim because they couldnt find my doctors NPI. I called Verdegard and offered to tell them my doctors ***. The customer service *** declined and put me on hold to call Quest, allegedly to ask them to ***rocess the claim. At this point my bill had been overdue long enough that I could not get more labs done at Quest, so now I wasnt just not getting coverage for services, I was effectively being denied care. Yesterday 11/2, I received a final notice in the mail from Quest threatening to go to collections and ruin my credit. So now I have the choice to give in and pay $588.10 that should not be my responsibility or have it affect my personal financial status while Verdegard continues to fail at processing a simple, straightforward, routine claim.

  Business Response

  Date: 11/12/2024

  Thank you for your message and for allowing us to review your experience. We apologize for the inconvenience you've faced and appreciate the opportunity to address it here.

  After reviewing your account history, we can confirm that you initially contacted us in August 2024 regarding the claim for your March lab work with Quest. At that time, we identified that the claim had not been processed due to missing information. Following your call, we took steps to expedite the claim, yet there were further complications when your doctors NPI was again missing from the claim form they submitted. Upon your follow-up in October,we reached out to Quest to request the resubmission of the claim with the correct details.

  We also want to note that our Care Advocates have reached out to you directly on multiple occasions throughout this process to provide updates and clarify any additional steps. Voicemails with these updates were left to keep you informed, though we have not yet received return responses from you. We hope these updates were helpful and assure you that we remain committed to open and responsive communication as we work towards resolution.

  Currently, we are working with Quest to finalize the claim processing, and we have requested that Quest pause further billing activities while we complete this process. We are committed to ensuring that this issue is fully resolved and that your coverage is accurately applied.

  We appreciate your patience and understanding, and we thank you for bringing this to our attention. Should you need further assistance or have any questions, please dont hesitate to reach out.

• Initial Complaint

  Date:08/12/2024

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Last week, I called our health insurance company (Hawaii Mainland Administrators) to ask about a claim that hadn't been paid, only to find out that now the company had a new name ****************** but it's also Verdegard) and that our policy had been terminated on July 1st.All of this was news to us - we'd received no notice that the company's name was changing, and no notice that our account was being terminated. No reason was provided for terminating and none of the customer service people I spoke could help. They kept saying, "We're just a third party."Now, our premiums were up to date and our account had been in good standing with them for over 2 years. In fact, our monthly premium was taken from our account on July 2, so we didn't even suspect anything was amiss. The amount of the premium was $797.50, and I believe that at the very least we should be paid back that amount for ********************* said couldn't help me because they were "just a third party," so I was connected over the phone to the "agency," which had no record of me ever existing. This was called USA Health Plans, though they said it would be ************ I called Aither back and went through the same runaround, several times. I called Enroll Admin, which is another third party that handles premium payments, but was informed that their voicemail box was full.Apparently, our health insurance was actually a trio of third parties who have all changed names and can't seem to help us resolve this issue. Hawaii Mainland Administrators became Verdegard, *********** became USA Health Plans, and Freemarket Administrators is now Enroll Admin. **************** kept bumping me to the next third party and no one could answer why we were terminated. We have been left with no health insurance for ourselves and our two children.Please note, this is a duplicate complaint against this company because they have two addresses.

  Business Response

  Date: 08/21/2024

  As of 12/31/2023, Verdegard Administrators, LLC (VAL)is no longer the claims administrator for this group health plan. Verdegard is not privy to *********** LP operations, enrollment processes, procedures,sales, or refund requests. Cancelation requests must be made directly to *********** LP Member Services at ************** M - Th from 8:00 AM to 5:00 PM CST F 8:00 AM to 4:00 PM CST.

  Aither Health is the third-party administrator for *********** LP. The group health plan has provided the below direct contacts:

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

• Initial Complaint

  Date:12/11/2023

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been dealing with this health insurance company since Feb. 23

  Business Response

  Date: 12/19/2023

  We wish to clarify that Hawaii Mainland Administrators,LLC (HMA) is not an insurance company. HMA is the third-party claims administrator for the group health plan serviced by Socios Buenos LP (SOCB3), whose services you participate in. HMA is not privy to SOCB3 operations, enrollment processes, procedures, sales, or refund requests.
  Concerning your complaint, HMA recommends that you reach out directly to SOCB3 at the below number regarding your benefits, eligibility,benefit limitations, and plan benefit exclusions. Cancelation and refund requests must be made directly to ****** Services at ************** M-T from 8:00 AM to 5:00 PM ET F from 8:00 AM to 4:00 PM.

• Initial Complaint

  Date:10/23/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I recently became a sole proprietor and found HMA online. I spoke with a representative and chose a health insurance plan which would be appropriate for my family. The first time and only I filed a claim was August 4, 2023. After confirming In-Network of all providers and the facility, my daughter underwent knee reconstruction. Even on the morning of the procedure due to confusion regarding another issue HMA was called and In-Network was confirmed. Now I have received an "Explanation of Benefits" from HMA stating that I owe the full amount to the facility and will also owe the full payment to the surgeon and anesthesiologist because the facility is out of network. HMA has refused any responsibility and states that I nor the facility were ever told that the surgery center was in network (basically accusing myself and the center billing department of being liars). HMA is a SCAM, when they told the center and myself of In-Network status we proceeded. Now showing to be out of network HMA can refuse all payments. HMA admits that the physicians are in network but has also refused their bill solely because the facility is out of network. The big summary is: Had HMA been truthful about network availability in the first place then I would have been able to find another facility if needed, but by telling me and the center that the center was in network when it wasn't allows HMA to pay nothing by contract.I see HMA has the same disclaimer for all complaints. My advice is to consider all of the negative feedback and the * rating by the BBB. I wish I would have looked here prior to being scammed. This is going to be a very expensive ****** learned. I hope to save someone else from the same fate.

  Business Response

  Date: 10/24/2023

  After reviewing our records and system, it appears that we do not have your name or contact information on file. We apologize for any inconvenience this may have caused. In order to assist you further and address your inquiry, we kindly request that you provide us with some additional details so that we can better understand your specific situation and offer the appropriate assistance.
  
  Please provide the following information:

  
  1. The participant's full name.

  2. The participants ID number.
  
  Once we receive this information, we will promptly look into your inquiry and do our best to assist you in resolving any matters. Your satisfaction is important to us, and we want to ensure that you have a positive experience with our organization.
  
  Thank you for your patience and understanding as we work to address your inquiry. We look forward to helping you resolve your concerns and providing you with the support you need.

  Customer Answer

  Date: 10/24/2023

  ***************************, *********

  Business Response

  Date: 10/31/2023

  We wish to clarify that Hawaii Mainland Administrators,LLC (HMA) is not an insurance company. HMA is the third-party claims administrator for the group health plan serviced by Socios Buenos LP (SOCB3), whose services you participate in. HMA is not privy to SOCB3 operations, enrollment processes, procedures, sales, or refund requests.
  As of today, October 31, 2023, our records indicate that your coverage is active,effective August 1, 2023, enrolled on the SOCB2 Panthera HSP3. This plan is a limited-benefit plan in which all claims received have completed processing and have been processed correctly according to your Schedule of Benefits (SOB) and plan design.
  Concerning your complaint, HMA recommends that you reach out directly to SOCB3 at the below number regarding your benefits, eligibility,limitations, and plan exclusions. All communication regarding your plan must be made directly to ****** Services for SOCB3 at ************** M-T from 8:00 AM to 5:00 PM ET F from 8:00 AM to 4:00 PM.

• Initial Complaint

  Date:08/08/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  In Jan 2023 I cancelled my insurance immediately and they still took $ ****** from my card. I called right away was assured I would receive refund by 1/15 than I was told by 1/31 since then I contacted them on numerous occasions and was told they are working on my refund. It it now Aug and I still have no refund. I don't know what to do.

  Business Response

  Date: 08/08/2023

   

  We wish to clarify that Hawaii Mainland Administrators, LLC (HMA) is not an insurance company.  HMA was the third-party claims administrator for the group health plan serviced by Consumer *************, LP,(CONSUME2), whose services you participate in. HMA is not privy to CONSUME2s operations and enrollment processes and procedures, sales, or refund requests.All refund requests must be made directly to member services ************** M-F from 9:00 AM to 6:30 PM ET.
  

  CONSUME2 terminated their agreement with HMA on 12/31/2022.

• Initial Complaint

  Date:07/05/2023

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Canceled a medical insurance policy on April 5 2023. The policy ran out may 31 2023. Company pulled ******* from my credit card for another 6 month policy on June 2 2023. I have been contacting them since the charges showed pending. I have spoken to ********, ******** and the (the boss of customer service) *******. ******* told my husband and I on June 20th that the money should be in our account one week from that day on the 27th, he said to call if it wasnt, we called on the 28th and ******* said that **** would be processing it and we should be notified in 2 days and not to call because they were handling it, we werent notified. I called today and the phone just rings busy. All the other numbers that *** called said they cant help.

  Business Response

  Date: 07/10/2023

  We wish to clarify that Hawaii Mainland Administrators, LLC (HMA) is not an insurance company.  HMA was the third-party claims administrator for the group health plan serviced by Consumer *************, LP, (CONSUME2),whose services you participate in. HMA is not privy to CONSUME2s operations and enrollment processes and procedures, sales, or refund requests. All refund requests must be made directly to member services ************** M-F from 9:00 AM to 6:30 PM ET.

  CONSUME2 terminated their agreement with HMA on 12/31/2022.

• Initial Complaint

  Date:06/20/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On January 2023, I was called by an agent who claimed to be from the Health Marketplace. I was looking to purchase health insurance and the agent informed me that this was an excellent option for me as it was a complete health insurance that was affordable and covered everything with the exception of maternity, substance abuse and mental health. That I would receive a **** form every year because it was compliant. However, when I actually needed to use the plan, nothing has been covered. I kept reaching out and if I called one number they provided me they told me nothing, absolutely nothing but 9 wellness office visits were covered, however, if the I called the second number provided they stated yes, everything was covered with the exception of above mentioned items. My providers even called and were told services would be covered but then when invoice was submitted, claims were denied. My providers consistently called and also got the run around with no clear or consistent answers. My health is now in jeopardy, I am suppose to have surgery and now I can't and am also swamped with thousands of dollars in medical bills because of this misrepresentation by this company. They sell it by the name First Health Network/Multiplan, AWAmember services, HMA LLC and Premier Health Solutions. It looks like they consistently change their name.

  Business Response

  Date: 06/21/2023

   

  We wish to clarify that Hawaii Mainland Administrators,LLC (HMA) is not an insurance company. HMA is the third-party claims administrator for the group health plan serviced by Socios Buenos LP (SOCB3), whose services you participate in. HMA is not privy to SOCB3 operations, enrollment processes, procedures, sales, or refund requests.

  As of today, June 21, 2023, our records indicate that your coverage is active, effective February 1, 2023,enrolled on the SOCB2 Panthera HSP9. This plan is a limited-benefit plan in which all claims received have completed processing and have been processed correctly accordingly to your Schedule of Benefits (SOB) and plan design.

  Concerning your complaint, HMA recommends that you reach out directly to SOCB3 at the below number regarding your benefits, eligibility,benefit limitations, and plan benefit exclusions. Cancelation and refund requests must be made directly to ****** Services at ************** M-T from 8:00 AM to 5:00 PM ET F from 8:00 AM to 4:00 PM.

  Customer Answer

  Date: 06/21/2023

   Member services were called at the ************  and I informed them of the situation, they stated that they would cancel my policy and issue a refund.  ******** ******* Services states that they are not liable that JB Health associates are at the ************** number.  It seems that they claim to work in conjunction on behalf of HMA LLC, one claims to be the limited services portion and the other the full service insurance yet no claims are approved, nothing has been paid to any provider.  My providers have called both numbers, one number tells them that nothing is covered other than office wellness visits, the other claims everything is covered but refuse to give any payment details or pre authorizations for any services needed.  They keep referring my providers to their contracts but will not provide any payment details.  My providers are fed up with the run around.  I am fed up with the run around.  It seems that the people you have representing you are nothing but con artists.  How can you play with people's health this way?  You take their money, refuse to pay when services are rendered and now I am out money I paid for what was told time and time again,  was a legit full service health insurance company and am now responsible for thousands of dollars of medical bills. I have phone call recordings, statements from my providers of the run around they received if the lies and entanglements that these two companies have said in representation of HMA LLC.  Now, I am in need of a surgery that I can't have because of all the lies, and deceitful actions of these companies. 

  Business Response

  Date: 06/23/2023

  We want to reiterate that Hawaii Mainland Administrators,LLC (HMA) is not an insurance company. HMA is the third-party claims administrator for the group health plan serviced by Socios Buenos LP (SOCB3),whose services you participate in. HMA is not privy to SOCB3 enrollment processes, procedures, sales, or refund requests through the following entities: ****** Services at **************, ******* Services, and JB Health Associates operations.

  As of today, June 22, 2023, our records indicate that your coverage is active, effective February 1, 2023.  As previously stated, youre enrolled on the SOCB2 Panthera HSP9. This is a limited-benefit plan in which all claims received are to be processed according to your Schedule of Benefits (SOB) and plan design.
  

  Regarding your complaint, HMA has mailed copies of your explanation of benefits (EOB) for all claims received by HMA as of June 22, 2023, along with a copy of your SOB.

  Customer Answer

  Date: 06/28/2023

  I am disputing this claim with the *** and the ******** of **** and Insurance Fraud with ********** as no one wants to take responsibility for this deceitful process.  There is an agent who calls you, claims to be from the Health Market Place.  He sells you an insurance plan which supposedly is 100% compliant.  Tells you that you have all these coverage  for which are later told you do not have when you try to claim them.  I was told that I was purchasing the absolute top tier with full coverage on all medical needs with the exception of mental health, maternity and substance abuse.  When I went in for a routine medical checkup, I received bad news that I need surgery.  I had blood work and testing done.  Nothing has been covered.  I am receiving invoices for thousands of dollars from providers that were originally told by supposed insurance that they were covered and then were declined due to services not covered.  If you call Premier Solutions you are told nothing is covered only 9 wellness check *** a year but no diagnostic blood work or testing.  Then you call JB Health and Associates who tell you that it is covered, they tell you that you have all sorts of coverage which are later revealed you don't have by HMA and Premier and that you have a two tier insurance plan that Premier is not aware of, yet they make you submit claims to HMA LLC. But all the claims come back as not covered.   JB Health and Associates supposedly works for, represents or is partnered with Premier Solutions and HMA LLC.  All three companies seem to be working together to scam innocent people out of hard earned money with false claims and promises.  All is great as long as you don't need any health services but as soon as you do, then everyone seems to throw blame to one another and you are left holding thousands of  dollars of bills.