ComplaintsforAdmin America, Inc

• Initial Complaint

  01/10/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  We paid for COBRA benefits December 29, 2020 for coverage to start January 1, 2023. Today is January 10th and we still do not have health coverage. We have called both our insurance provider and Admin America to have this resolved and still nothing. Our 3 yr son was not seen at a medical appointment today because our coverage is inactive. I called our insurance provider again and they advised that Admin America has not provided our payment to them. This is totally unacceptable as we still do not have any insurance. Admin America should not be providing ***** services as they seem not to be willing to put forward payments received to them.

  

  Business response

  01/12/2023

  Unfortunately, the ***** re-enrollment / re-instatement process can move very slowly for Qualified Beneficiaries for reasons out of Admin America's control.   Usually, delays like the one experienced here are the fault of the insurance carrier as I believe was the case here.  The circumstances that lead to this complaint are precisely why our communications to Qualified Beneficiaries warn that a reinstatement may not show as active at their health care provider for up to two weeks.  Admin America notified the ***************************** health insurance agent within one day of the Qualified Beneficiary's election of coverage and required payment.  At that point, our standard role in the reinstatement process was complete but of course once we were alerted to a delay in coverage reinstatement, we did what we could to help the customer and accelerate the process with the insurance carrier (who ultimately is the only party that can communicate active coverage status to health care providers).

  For reference, a timeline of the relevant events follows:  

  The customer who submitted this complaint elected and paid for ***** on December 29, 2022.   There is no dispute that she correctly completed that process at that time.  Our administrative system notified us regarding her election and payment the next morning (12/30/2022).  That day, a member of our ***** Department sent notice of the election to the client's group health insurance broker via e-mail, per the administrative instructions for that client. 
  
  On January 6, 2023, we were informed over the phone by the husband of the customer who submitted this complaint that the insurance carrier had informed him over the telephone that the coverage was still inactive. The same Admin America ***** Department representative who email notified the group health insurance agent's ****** about the reinstatement on December 30, 2022 followed up with the agent's ****** again via email that day.  Our representative was informed by the insurance agent's ****** that they had communicated the reinstatement to the insurance carrier the previous day (January 5).  Their expectation was that the coverage would show as active on Monday January 9.  Later in the day on January 6, the insurance carrier called our ****** to verify information about the reinstatement and our ****** provided the insurance carrier with documentation that they requested.
  
  On January 9, the same Admin America ***** representative proactively followed up with the insurance agent's ****** via email to verify that the customer and her son were showing as active under coverage.  It is important to mention here that our representatives do not have a direct link to the insurance carrier for this employer client's coverage so we must obtain such confirmations though the insurance agent. ************* agent committed to following up with the insurance carrier.

  The next day (January 10), the insurance carrier called Admin America again to verify ***** eligibility for the customer in response to a telephone call that the customer had made that day to the insurance carrier seeking coverage confirmation.  The same Admin America ***** representative that had been working on this case since the beginning was asked to once again provide the insurance carrier via email which she immediately did.
  
  The same day, a different Admin America ***** representative received yet another call from the insurance carrier seeking the same information as had previously been provided twice.  That ***** representative immediately sent the requested information to the email address provided by the insurance carrier's representative during that phone call.   In response to that submission of documentation, we received an email confirmation from the insurance carrier confirming the reinstatement with a notice that it would take 24 to 48 hours for all systems to update.  The representative from the insurance agent was copied on this confirmation and she in turn informed the customer and her husband that the insurance carrier had acknowledged the coverage reinstatement.
  
  Later that day, the customer called **************** directly to complain about the reinstatement process.  She originally spoke with the first ***** representative who had been working on her case but was transferred at her request to speak with our ***** Manager.   She expressed her disappointment that her coverage had not been immediately reinstated upon payment of her premium and that  her child was not indicated as having active coverage when she tried to take him to a doctor's ****** on January 6.   She also complained that we had never sent along her premium payment to the insurance carrier.   Our ***** Manager I tried to communicate the following points during that call:  because of the exact situation that was occurring here, our ***** communications indicate that it can take up to two weeks for reinstated coverage to show as active for health care providers, ultimately, we have to rely on the insurance carrier to actually complete the reinstatement, that regardless of how long the reinstatement takes, she would not experience a gap in coverage as her coverage would be reinstated retroactively to the date of her loss of coverage and we don't send collected premiums to the carrier (we send collected premiums to our employer clients who in-turn are back billed by the insurance carrier for the premiums as part of their next month's overall group health plan coverage bill.  In that call, our ***** Manager committed to the customer that she would once again follow up with the insurance carrier to gather any additional information that she could and to call the customer back.
  
  When our ***** Manager called the insurance carrier later on January 10, the insurance carrier representative confirmed that the customers coverage was still showing as inactive. Our ***** Manager provided that representative with the information from the previous email confirmation of coverage reinstatement that we had received from the insurance carrier earlier that day including the insurance carrier representative who had sent it and the time.  ************* carrier representative then indicated that she could see internal notes confirming that coverage was active but reiterated that it would take 24 to 48 hours for it to update through their systems. Our ***** Manager inquired if there was any kind of  override or something to update the customer to active status faster. ************* carrier's representative put our ***** Manager hold to speak with a supervisor but came back on the line and said "no".  However the insurance carrier's representative passed along that the customer could to have her health care provider call the insurance carrier's dedicate provider provider phone number.  She also provided a reference number that the providers could give to the insurance carrier's representatives. Those representatives would be able to use the reference number to see notes confirming coverage reinstatement even though the system would still show the customer as inactive for an additional 24 to 48 hours.  
  
  Our ***** Manager called the customer back and relayed the information about the dedicated provider phone number and reference number and also texted the information to the customer. 
  
  Later that day, our ***** Manager followed up with the insurance agent's representative.  At that time our ***** Manager was informed that they were also working on getting the insurance carrier to accelerate the reinstatement process.  At the end of the business day on January 10, the insurance agent's representative emailed our ***** Manager to confirm that the customer's coverage was now active, that the customer had been issued a new subscriber number by the insurance carrier and that the agent's representative had notified the customer of this latest development.

  Our ***** Manager sent a text to the customer to confirm that she had received the notice from the insurance agent's representative and the customer confirmed that she had.  

• Initial Complaint

  05/15/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have not received all necessary tax documents. Admin America will not return phone calls or emails.

  

  Business response

  05/26/2021

  Business Response /* (1000, 5, 2021/05/17) */ Contact Name and Title: **** ******** Contact Phone: XXX-XXX-XXXX Contact Email: ****@adminamerica.com An e-mail was sent to the consumer (at the address listed in the complaint) on 05/17/2021 to address his request and to provide him with a direct point of contact at Admin America for any follow-up concerns.

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