Complaints

This profile includes complaints for Allied Benefit Systems, LLC's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Allied Benefit Systems, LLC

  200 W Adams St Ste 500 Chicago, IL 60606-5215

  
• 

  Allied Benefit Systems, LLC

  200 W Adams St Ste 500 Chicago, IL 60606

  

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:03/21/2023

  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 February 2, 2023, I visited an Otolaryngology (Ear, Nose and Throat) physician at the **************** ********* ******************** after having a series of ear infections and severe ear pain for 6 weeks and based on recommendation from my primary care physician. Before the visit I confirmed with Allied Health that both the provider, physician, and facility my appointment was scheduled with were in network and covered. As outlined in my insurance policy, I expected a $20 copay for a specialist visit. When the claim was processed, it was denied because the diagnosis of TMJ joint disorder was not covered by the plan. There was no way for me to know that the visit and affiliated tests would lead to a condition that wasn't covered by my insurance or that the exact same test could have led to a different diagnosis that would have been covered by my insurance. Furthermore, I was not treated for the condition of TMJ joint disorder, it was only identified during the evaluation. I now have a bill for over $1,000 that the insurance will not cover and both my insurance company and the **************** admitted that there was no way for me to know that it would not be covered.I have spoken to my insurance company and the **************** multiple times and both continue to suggest that I call the other. Additionally, during one phone call with an Allied representative, I was told that the claims would not be covered because they were billed as an outpatient hospital visit rather than an in office visit, so the answers that I am getting don't even line up. I am looking for help coming to a resolution, as the costs affiliated with this visit were unexpected even after doing my due diligence ahead of the visit.

  

  Business Response

  Date: 04/04/2023

  *******,
  We have received your complaint which is currently under review.

  Thank you.

• Initial Complaint

  Date:02/28/2023

  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.

  02/24/23,02/28/23. On these dates I spoke with representatives of Allied Benefit Systems after multiple denied claims through caremark for pharmacy benefits over a 2 week period. I was told by the original representative that my doctor's ****** would need to complete a prior authorization form and that they would need to mark it as urgent and my claim would be reviewed and processed in ***** business hours after I advised I only had 4 daily pills left. Upon checking back with Allied on 02/28 I was told by the first rep I spoke with that they were escalating the case to be worked immediately and I could check back by end of day to make sure it had been communicated to the pharmacy after advising that I only had 1 pill left. Speaking with a rep and supervisor the same day as instructed I was told that was not the case and that they didn't even know if documents had been received and I could pay for this very expensive medication out of pocket with no other resolution being provided and that I would have to wait **** business days to be reviewed. I asked for corporate contact information and was only given an address of the building. This company that I have paid premiums for has now endangered my health and well-being and provided no urgent response to the predicament they created and seemed to have no concern. I have never in 7 years experienced these issues of receiving medication and been disregarded with no additional protocol to escalate and help me to remain healthy without missing several days if not weeks of doses possibly endangering my body's acceptance of this medication and the withdrawal issues that *** follow. Allied Benefit Systems seems to have no actual benefits or care for their clients.

  

  Business Response

  Date: 03/13/2023

  Dear ***************************** - Our team has investigated your complaint and provided the following explanation. After contacting Allied in response to receiving a rejection at the pharmacy for medication requiring retail authorization, Allied advised that in order to obtain the medication, to please complete the retail authorization form, submit completed form to Allied, and allow **** days for determination.  On 2/28/23 the Pharmacy Benefit Manager was contacted and communicated the medication requires retail authorization process review with Allied and when Allied received the follow-up call the same day, Allied sent the retail authorization review to Allied's pharmacy advocate for priority review. However, since coverage terminated on 2/28/23, the authorization determination was denied.  

• Initial Complaint

  Date:12/21/2022

  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.

  I had health insurance covered from Allied between January 1, 2022 and April 30, 2022. I have submitted claims for coverage via both certified mail and fax between August 2022 and December 2022. The representative told me my certified mail claims were received, but lost by them. The faxed claims were never located. I have had four or five calls to service reps to make sure my claims are received and processed with no resolution except being told to send in the claims paperwork yet again.

  

  Business Response

  Date: 03/14/2023

  Dear *********************:
   
  Our team investigated your complaint and confirmed the claims in question were received and processed.
   
  If you still have questions regarding this matter, please call Allieds ****** Services at ************.