ComplaintsforHealth Alliance Medical Plans, Inc.

• Initial Complaint

  03/21/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  My daughter, ***** (I am her mother), who has Type 1 Diabetes, is in college in Colorado. Before she left, I phoned Health Alliance--our health insurance provider, to ask for a list of endocrinologists in the Fort Collins area who would be covered. They gave us the name of Dr. ****. Each time ***** has had a medical appointment with Dr. ****, Health Alliance has refused to cover it and I have appealed. Each time they have covered it after the appeal has gone through. Now they have written to say they will not cover any future visits. Just to reiterate: Health Alliance gave me the name of this doctor and told me she was covered on our extended plan (I signed ***** up for the college plan), and now they declare that they will, henceforth, not cover this doctor? I have explained all of this in a letter to Health Alliance. I respectfully ask the Better Business Bureau (who has accredited Health Alliance in the past--I saw the BBB plaque when I was in their office) to intervene and request that Health Alliance cover the doctors they themselves suggested we turn to for medical help. Thank you so much.

  

  Business response

  04/03/2024

  Thank you for the opportunity to respond to Ms. ******** complaint.

  Since ***** is in our Student Extended Network Program, she would use our ***** ****** extended network of providers while away at school in Colorado.  After reviewing the complaint with several of our internal departments as well as ***** ******, we have determined the cause of the issue. This issue was created because this provider was incorrectly not included in the ***** ****** online directory. ***** ****** indicated that there was a directory update on 03/11/24 that impacted the directory flag for Dr. **** at **** ***** ** ****** ************* in Fort Collins, Colorado. They have confirmed that the provider is participating and will re-enable the directory flag.

  Additionally, Health Alliance's Claims Department has taken steps to remedy the issue to ensure future claims are adjudicated appropriately through this extended network system. The previous letter indicating future visits will not be covered is inaccurate.

  We apologize for any inconvenience this may have caused. 

  Customer response

  04/04/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. Thank you for helping me to receive a fair response and a fair adjustment. I understand that Health Alliance will henceforth cover Dr. **** for my daughter. Thank you. 

• Initial Complaint

  06/27/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  We have contacted Health Alliance several times regarding the fact that we cannot find a local--within 30 miles--dentist who accepts the ***** ****** PPO that is bundled in with the health plan for our kids. All the dentists listed as being "in network" no longer accept this insurance. We purchase our health insurance plan through **********.*** as we are self-employed and pay over $20,000 in premiums every year. Please see our first correspondence with Health Alliance below. Thank you. Mar 15, 10:29 AM Topic: Eligibility (Effective/Termination Dates, Add/Remove Dependents). Hello, My wife spoke to your representative, ******, earlier today regarding the pediatric ***** ****** benefits through our Health Alliance POS plan. He was very helpful and went above and beyond trying to solve our issue. However, we have learned new information and would like to make someone at Health Alliance aware. Per ***** ******, we have searched for participating providers on their website. The ***** ****** rep said that we need to choose a provider that lists ***** ****** PPO. We have done this, but when we call the providers, they are saying that they no longer accept the "Pro" version of the PPO and only accept "Premier." Apparently the version of the ***** ****** PPO we have through Health Alliance is "Pro" only. The dentists offices have mentioned that this is a corporate decision. Our current dentist said they received notice on March 1, 2023 that "Pro" is no longer accepted. Another dentist we called stated that they will no longer accept "Pro" as of May 1, 2023. This seems to be a trend, and we are left wondering: WHO CAN WE GO TO within a reasonable distance from our home? This seems to be an issue best suited to higher management, and I ask that someone from management contact us please. We pay a lot of money for our Health Alliance plan and expect the benefits to be active for the term of the policy. Thank you, ****** * ****** ******* ************

  

  Business response

  07/05/2023

  Thank you for the opportunity to respond to Mr. ********* concerns. Health Alliance partners with ***** ****** to provide dental benefits for this member’s plan.  ***** ****** is held to state mandated network adequacy requirements for their product and maintains those requirements. 
  
  Health Alliance reached out to ***** ****** with the list of dental offices Mr. ******* contacted to review his concerns.  ***** ****** provided us with the following information:
  
      All but one of the offices noted by the member are with ********* Clinics.  *********** business model no longer supports the PPO standard that ultimately provides our members the      greatest cost savings, so they have moved to our ******* network only.  While ********* is moving to ******* only, we recently (in March) added 3 PPO locations through *******        Health Clinic. They have 2 offices in Champaign and 1 office in Urbana.  
  
      While we are always actively recruiting Central and Southern IL area providers, there are ample PPO options in the Champaign/Urbana area to service members.  
  
      ***** ****** provided a list of 5 offices in Champaign, 2 offices in Urbana, and one in Tolono.
  
  We also conducted a search on ***** ******’s website. We searched within 50 miles of Gibson City for the ***** ****** PPO product. It does appear to have some providers in the Bloomington area as well as Champaign/Urbana. 
  
  We reached out to Mr. ******* on 6/28 and shared the information that ***** ****** provided.  He has indicated he will be following up with the providers.
  
  We understand that the member would like compensated, however, as the pediatric benefits are embedded in their plan and premium there is no method to facilitate this request.  Additionally, as there are providers available and since ***** ****** continues to meet their network adequacy requirements we do not agree compensation is warranted.

• Initial Complaint

  02/28/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  2/28/23 ANY AND ALL OF MY HEALTH INSURANCE TERMED & ENDED 12/31/22 WITH ***** HEALTH ALLIANCE. PER MARKETPLACE 834 ESCALATIONS REF# ****** AND MARKETPLACE REPRESENTATIVE ******. THE MARKETPLACE INSURANCE ************ CONTACTED ***** IN WRITING BEFORE 12/31/22 AND TOLD HELATH ALLIANCE I WAS NOT GOING TO HAVE ***** AS MY INSURANCE CARRIER FOR 1/1/23. HEALTH ALLIANCE ************ SHOULD NOT MAIL ME ANY PREMIUM BILLS FOR 1/1/23 AND 2/1/23. FURTHERMORE, SO WHATEVER 1/1/2023 & 2/1/23 PREMIUMS ***** IS TRYING TO BILL ME IS FRAUD BECAUSE ALL OF MY PREMIUMS/BILLS ETC HAVE BEEN PAID WITH ******HEALTH ALLIANCE FOR 2022, 2021, AND 2000 ETC. MY NEXT STEP IS TO REPORT ******HEALTH ALLIANCE TO THE ATTORNEY /INSPECTOR GENERAL'S OFFICE AND INSURANCE COMMISSION IF ***** DOES NOT CORRECT THEIR PREMIUM BILLING MISTAKES ASAP!!! I ALSO SENT AN EMAIL TO HELATH ALLIANCE MANAGERS. ******************************** and *********************************

  

  Business response

  03/03/2023

  Thank you for the opportunity to review and reply to *** ******** complaint. The Marketplace dictates all eligibility rules for members on Marketplace plans.  This means we are required to follow all effective dates and termination dates provided by the Marketplace via the **** system.  We have received two notifications from the Marketplace for this member for plan year 2023.  We received a request from the Marketplace on 01/12/2023 to reinstate this member.  This is why this member was effective.  Then on 02/25/2023 we received a request from the Marketplace that stated this member should not have coverage and that we should terminate them. We processed this termination immediately, but it was processed after billing ran.  The next statement the member receives from us should be reconciled and should reflect a $0 balance and show she is not effective for plan year 2023.
  

  Customer response

  03/07/2023

   I am rejecting this response because: HEALTH ALLIANCE REPORTS FALSE INFORMATION WAY BACK LAST YEAR HEALTH ALLIANCE RECEIVED WRITTEN NOTIFICATION FROM ME AND MARKETPLACE THAT MY ***** COVERRAGE WOULD END 12/31/22 AND ***** WAS NOT CHOSEN AS MY HEALTH INSURANCE FOR ANY OF 2023 PERIOD!!! ***** NEEDS TO STOP THEIR FALSE BILLING FOR FOR 2023 ETC BECAUSE i DON'T OWE ***** ANY MONEY & DO NOT TRY & REPORT TO CREDIT BUREAU BECAUSE I HAVE NOTIFIED THE CREDIT BUREAU ALSO ABOUT ***** FALSE BILLS. IF NEEDED, I WILL REPORT ***** TO THE ONS COMMISSION & ATTORNET GENERAL'S OFFICE...

  
  

  

  Business response

  03/14/2023

  As indicated in our 3/3 response, we agree that *** ****** does not owe any outstanding premiums for her Health Alliance policy, and that her policy terminated effective 12/31/2022. *** ****** should receive a statement from Health Alliance, mailing on 03/20/2023, showing that any balances outstanding for plan year 2023 were adjusted and her outstanding balance is $0. Since *** ******’s coverage terminated on 12/31/2022, any claims or services received after that date would be denied as not covered and this member would need to submit them to her current insurance carrier.
  This is not a “false billing” situation. As mentioned in our 3/3 response, we are unable to terminate Marketplace plans without direction from the *** via the **** system. When we received notification from the *** to terminate *** ****** effective 12/31/22, received on 02/25/23, we processed it immediately. If it would be helpful to BBB, we are happy to provide screen shots from the **** system that would illustrate when the termination notice for *** ****** came in. We have not reported anything to the credit bureau for this member, as she has no outstanding balance to report. *** ******’s complaint references potential escalation to external commissions and/or offices. Health Alliance remains willing to cooperate in partnership with the BBB and/or any other commission or office with whom *** ****** would like to partner to bring resolution.

  Customer response

  03/16/2023

  Better Business Bureau:
  I have reviewed the response made by the business in reference to complaint ID 19512182, and find that this resolution is satisfactory to me. BBB please have ***** health alliance give me screen shots of **** 12/31/22 stating ***** isn’t my health insurance carrier. Also, have ***** health alliance notify *** that I have no outstanding money owed to health alliance. *** Medical
  

  

  Business response

  03/23/2023

  We have attached the **** case from the *** showing *** ******** coverage terminated with Health Alliance as of 12/31/2022. *** ****** also had a gap in coverage with Health Alliance between 05/01/22 and 06/01/22. Her provider may be billing her for claims for services received during that gap in Health Alliance coverage.
  As indicated in our previous response, as *** ******** coverage with Health Alliance ended on 12/31/2022; due to this she would need to submit claims for services received after that date to her current insurance carrier. She would need to work with her current insurance carrier to resolve any outstanding claims after 12/31/2022. Health Alliance is not responsible for payment of claims incurred after a member’s termination date, or during a time that a member does not have coverage with us.
  As part of a previous BBB Consumer Complaint #********, we made significant efforts to resolve balances due with ***, which we determined must have due from when *** ****** was covered by another plan between 05/01/22-06/01/22.  *** ****** did not engage in our request through the BBB response to provide additional information on the outstanding balance.        
  We do not discuss member’s premium balances with providers or carriers.  As indicated in our previous response, her premium balance owed is $0 and her premium statement reflecting a $0 balance was mailed on 03/20/2023.

• Initial Complaint

  11/20/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  HAVE HEALTH ALLIANCE AS MY MEDICAL INSURANCE CARRIER AND THE FOLLOWING MEDICAL IN NETWORK BILLS NEED TO BE PAID TO *** ******* ***** PROVIDERS BY HEALTH ALLIANCE: $812.11, $171.94, $148. I SHOULD NOT RECEIVE ANY MEDICAL BILLS WHEN I HAVE ***** AS MY MEDICAL INS. IN ADDITION, THERE SHOULD NOT BE ANY NEGATIVE CREDIT BUREAU REPORTING ON MY BEHALF EITHER. I HAVE ALSO COMMUNICATED THIS TO HELATH ALLIANCE REPRESENTATIVE ***. BBB PLEASE ASSIST.

  

  Business response

  11/29/2022

  Thank you for the opportunity to discuss this member’s concern.
  On 11/18/22 we received a call from this member. She stated she received multiple billing statements from *** ******* ***** that she thought should be paid by Health Alliance. 
  The following amounts are what the member is stating she is being billed for:
  
  $812.11
  $171.94
  $148.00
  
  When we asked for clarification about the billing and for her to provide the dates of service, she stated no dates of service were on the billing statements from **** To assist the member, we called ****  They reviewed the member’s account they were able to match the amount owing of $812.11 on her October Statement. *** was able to confirm that the charges had been billed and that Health Alliance had paid on the claims.  The dates of service were from 06/29/22 through 09/28/22.  The balance that was showing owing was members copay/coinsurance responsibility. They also noted that for the month of May, the member had a lapse in coverage with Health Alliance and had **** ********** ****** for those dates of service. Per *** member also owes copays for services during the month of May 2022.
  
  *** was able to match the amount owing of $171.94.  They confirmed that the charges had been billed and that Health Alliance had paid on the claims. The billing received for member in the amount of $171.94 was for dates of service 3/3/2022 – 3/4/2022.  The total billed amount was $51,405.25.  The member’s copay/coinsurance responsibility was $171.94.
  
  *** and Health Alliance were unable to locate the last amount $148.00 that member has received a statement for. 
  
  On 11/22/2022 we made call out to member and attempted to explain that we can send her a copy of her EOB’s showing her responsibility for the above listed dates of service and that we would also need more detailed information to be able to assist with the charges being billed for $148.00. The member stated that *** should be billing her insurance instead of billing her and hung up the call.
  
  We will send the member copies of the EOB’s for the dates of service we were able to identify, but we can only show what members responsibility was for and can’t comment on what the member has or has not paid to the facility for services rendered.  If member would like to provide us with more details regarding the $148.00 charge we would be happy to assist with that charge.

  Customer response

  12/01/2022

   I am rejecting this response because:
  
  *** STATES THEY SENT *****-HEALTH ALLIANCE MY IN-NETWORK MEDICAL BILLS FOR $812.11, $171.94, AND $148 TO PAY. *** ALSO STATES THAT THE ACOUNT NUMBERS ARE ON ALL THE ABOVE-MENTIONED BILLS. SO, ***** NEEDS TO PAY THE BILLS BECASUE I WON; T AND WILL BE REPORTING HALL TO THE OFFICE OF INSPECTOR GENERAL, INSURANCE COMMISSION, AND HREALTHCARE MARKETPLACE BECAUSE I PAY THE MARKETPLACE AND *****-HELATH ALLIANCE FOR INSURANCE.

  

  Business response

  12/08/2022

  Thank you for allowing us to review and reply to this member’s concern.
  As previously explained, we made several attempts to assist this member with their concerns. Her claims were processed appropriately and according to her plan.
  The balances of $812.11 and $171.94 are amounts owed after Health Alliance processed her claims. These amounts are her copayments, coinsurance and/or deductible. This cost sharing responsibility is clearly illustrated throughout all of her member materials, such as her policy, description of coverage and SBC documents.
  We contacted *** again on 12/1 and are still unable to locate a bill with a member responsibility totaling $148.00. We would be happy to assist with any questions or further review if the member would like to provide us with more details regarding the $148.00 bill.
  In order to ensure this member has a full picture of how her claims have processed, we have mailed her Patient Profile documents from 01/01/2022-04/30/2022 and 06/01/2022-11/30/2022. These documents outline items included on the members EOB, such as the following:
  Date of service
  Provider Name
  Procedure Code
  Billed amount
  Allowed amount
  Copay amount
  Not covered amount
  Deductible amount
  Withheld amount
  Net amount
  
  We are happy to help this member with any questions, but thus far our efforts to assist her have not been well received.

• Initial Complaint

  11/17/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was a health alliance member for almost 10 years. Due to a job resignation, I was preparing to lose my coverage. When I called Health Alliance to confirm the last date of coverage on 6/29/22, the customer service representative told me that my last day of coverage was on 6/30/22. I clarified by asking her if she indeed means tomorrow and she confirmed. As a result, I enrolled in the first health care coverage I could find until I was able to go on my spouse's insurance. In reality, my health alliance coverage did not end until the end of August, and I spent over $600 on the other coverage unnecessarily and due to Health Alliance's error. After many phone calls and many months of back and forth, Health Alliance was unable to agree to pay me back the money I spent on the other coverage. I was clear that that was the only way I would be satisfied with the situation, and they refused. The solutions they offered to the problem would have been untimely and costly, and I rejected their offers several times. I will not be satisfied until I am reimbursed for the extra, unnecessary, coverage that I paid for due to their error.

  

  Business response

  11/23/2022

  Hello,
  
  We appreciate the opportunity to address ***** ********* concerns.  We agree on 06/29/2022 we advised *** ******* that the policy would be terminating on 06/30/2022. This was a misquote and we have provided education to the representative involved.  On 07/24/2022 we received notification from the member’s former employer that her termination date should be 08/31/2022.
  Between 07/01/2022-08/31/2022 we continued to receive and pay approximately $2000 in claims. 
  
  When the member contacted us with her concerns we made every effort to resolve her concerns.  Unfortunately, she was unwilling to allow us to extend effort to reprocess claims under the new plan or coordinate coverage in any way.  As this member obtained a limited indemnity plan it is presumed it would not have provided the same level of coverage for the processed claims, which would result in overall higher out-of-pocket expenses for this member.   
  
  Please let us know if there is further clarification we can provide.

*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. ↩