ComplaintsforMeritain Health

• Initial Complaint

  06/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Meritain was my third-party administrator for health insurance coverage in 2023. In November 2023, I visited an allergist and they applied a skin patch test (date of service is 11/14/23). My insurance policy at the time very clearly stated the deductible only applies to hospitalization, but all labs/diagnostic tests, etc. simply required a small co-pay. Meritain took the position my deductible hadn't been met on the diagnostic test despite the clear policy language. I submitted a written appeal three months ago. When I didn't hear back, I called and spoke with a Meritain representative -- she unequivocally told me the claim was reversed in my favor and amount owed by me was $0. I asked when I would receive an updated explanation of benefits, and she said soon. After another month, I still hadn't received anything, so I called again. This time, the Meritain representative told me the original determination stood and my appeal was rejected. They could not give me any basis for why my appeal was rejected, despite clear language in the policy contradicting their determination. I waited on hold for 30 minutes to escalate my concerns, and then was hung up on. To date, I still have not received anything on my appeal submitted three months ago, and again, no one can explain to me why my appeal did not go through or why a Meritain representative initially told me my appeal was successful.

  Business response

  07/30/2024

  The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.

• Initial Complaint

  04/05/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unresolved

  More info

  Meritain Health is my Insurance Provider and ******** RX is their Prescription Drug Provider. For Some Reason even thought I've not had a lapse in coverage ******** is not showing that I have prescription coverage. This was discovered when trying to get a prescription for an illness filled When I contacted ******** on 4/2/24 they told me Meritain would need to update my policy information. On the same day speaking with a rep at Meritain he told me this would be done in 24 hours When I called back on 4/5 I was told Meritain does not do this and that I would need to send information to ********. When I called ******** they said this wasn't correct and I would need to consult with my HR dept. Bottom line , I'm currently without prescription drug coverage even though I paid for it.

  Business response

  04/09/2024

  The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing

  Customer response

  04/10/2024

  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.This does not address the issue with how Meritain is communicating this issue to ********...that is the heart of the complaint.  I know , Meritain knows that I have coverage.  I need Meritain to correct this information with their partner ********.  Until this is resolved I'm unable to get prescriptions filled and approved so this is a real time issue that requires immediate attention  Regards, ***** ******  

  Business response

  04/12/2024

  The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing

  Customer response

  04/15/2024

  Better Business Bureau:
   
  I have attached the Authorization for Release 
  
  Regards,
  
  ***** ******
  
  
  
  
  

• Initial Complaint

  02/13/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to a provider back in September and subsequently got a larger than expected bill from the Drs office. I spoke with Meritain or ******* health in December and they told me it was a mistake. They told me it would get corrected and I’d get a new bill from the Dr office. I then called them back over 50 days later and they then tell me the last person misspoke and the Dr was not in network. Very misleading.

  Business response

  02/16/2024

  The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.

• Initial Complaint

  02/13/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am writing to formally file a complaint regarding my experience with Meritain Health concerning the denial of claims and the inadequate support received from their customer service representatives. Throughout 2023, I maintained insurance coverage with Meritain Health, provided by my employer (Group # *****, Member # **********). I visited my PCP on 11/2/23, and subsequently on 11/29/23. It is crucial to note that I had already met my deductible for the year by the time of these appointments. Both claims for these visits were denied by Meritain citing that the services provided were not covered. - 11/2/23: CPT *****, amount denied $207 - 11/29/23: CPT *****, amount denied $318 I reached out to my PCP office on 1/10/24, via email to inquire if the visits were accurately coded. They confirmed on Jan 11th that the visits were indeed coded correctly. On 1/12/24, I contacted Meritain by phone to seek clarification on why the claims were denied. The customer service representative I encountered was unhelpful and provided no substantive information. I was advised to file appeals for both denied claims. As directed, I mailed appeals forms via certified **** mail on 1/12 (tracking below). - Tracking #1: ********************** - Tracking #2: ********************** I called Meritain on 2/13/24 at 2:04 pm ET to follow-up on the status of my appeals. The representative was unable to locate my account details, despite my provision of all necessary demographic and account information. Furthermore, my attempts to access my online account were unsuccessful, as it appears my account has been rendered inaccessible. The representative was unwilling to offer any further assistance. I now have an outstanding bill with my PCP for routine follow-up visits that should have been covered. Despite adhering to all requisite procedures and processes, I find myself unable to obtain any clarity or information from Meritain.

  Business response

  02/16/2024

  The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.

• Initial Complaint

  02/07/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have been denied payment to ******** ******** ******** for services on June 6, 2023 and June 26, 2023 as not being covered under the insurance. I have had continuous insurance through my employer form 10-1-2022 through present. The carrier is Meritain Health, and I am enclosing the denial EOB's and the Coverage verification. I have called the company multiple times and have not had the problem resolved. Please help with this.

  Business response

  02/12/2024

  The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.

• Initial Complaint

  12/14/2022

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Had surgery 8/27/2021 with a prior authorization to perform the surgery with Dr. S**** at **** *** ********. On the prior authorization it states Out of Network, Pay as In Network. The insurance company is trying to tell me that the hospital was out of network and so they are not paying that portion of the bill. When I call over and over they tell me they see what I am saying (I even provided a copy of the faxed authorization they sent to the hospital) and run it back through to be reviewed. However, it keeps coming back saying the same thing. I tried working with an ************* ******* ******** for billing but they no longer return my calls. The first time I spoke with them they said they see what I am seeing and even provided documentation. They told me they have been fighting it themselves. At this point, I am going in circles over and over with no one willing to help me and no one truly reviewing all the paperwork in the system when resubmitted for review beyond the Member Service Member that gets my call - otherwise they would see all the documentation.

  Business response

  12/16/2022

  Dear Sir or Madam,We are in receipt of your correspondence dated December 15, 2022 regarding the above referenced matter.There was no Personal Health Information Release Authorization attached with this request. Please be advised that we require a recent HIPAA Compliant Authorization signed by the member in order to comply with your request.Upon receipt of the duly executed authorization, we will forward our response to your inquiry. I have attached a copy of our standard Authorization for Release of ProtectedHealth Information for your convenience. Please forward the completed authorization to my direct fax number at ###-###-####Thank you for your attention to this matter.Sincerely,Shannon L******Legal Assistant

• Initial Complaint

  12/12/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Unresolved

  More info

  Husband was laid off in October. At the beginning of November, we filed paperwork to activate COBRA coverage for just me. Plan was activated, retroactive start date of Nov. 1. By the second week of November, I tried to fill an important medication at the pharmacy. Pharmacy says my insurance company denied my medication because my birth date is incorrect, and ID# is incorrect. Around Thanksgiving, I receive a new ID#, and update that with the pharmacy. We called twice the week before Thanksgiving to get Meritain to correct my birth date in their system. The Monday after Thanksgiving, pharmacy is getting the same error on my birth date (ID# works). We call Meritain again, and they lie and say they correct it (they don't). By Thursday, December 8th, my birth date is still not corrected, and we are told that Meritain corrected the birth date in house, but did not correct it with *** ********, who provide prescription benefits. It is "escalated" and we are assured will be done by Monday the 12th. We call today, the 12th to confirm that it is correct. They still haven't even reached out to *** ******** to correct the birth date. They have charged us two months' coverage ($1400) and I've had to use my emergency stash of my medication for the past month ($2000). I still cannot use the benefits I'm paying for. I ran out of my medication a month ago, and have been limping along since on emergency stash. I run out of my medication and start being unable to absorb nutrients from food in a matter of days. They are literally going to kill me instead of change my birth date. Fix it!

  Business response

  01/05/2023

  Dear Sir or Madam, We are in receipt of your correspondence dated December 19, 2022 with regards to the above referenced matter. We are unable to locate this individual in our systems with the information you provided in your correspondence. Further information is required to definitively determine if this person is or is not in our claims system. Information regarding the following is needed: group health plan name and number, full member ID number, subscriber name, and name of the employer. This information can be found on the individual’s Health Plan Identification Card. Please forward this information to my attention at your earliest convenience. Upon receipt of this information we will forward our response as soon as possible. Thank you for your attention to this matter. Sincerely, Shannon L****** Legal Assistant ****************************

  Customer response

  01/19/2023

  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.
  
  ***** was NOT the problem here. ***** created the COBRA plan, but Meritain was the issue. Meritain set my birth date incorrectly, refused repeatedly to fill my medication, and gave us the run around for weeks. This was, 100% Meritain's issue, as they were the ones who set my birth date incorrectly, denied my medication, and then lied to us for weeks.
  
  Meritain cost us money, and used up $1000 of medication I was supposed to keep in reserve. They are lying to you.
  
  Regards,
  
  ******* *****
  
  
  
  
  

  Business response

  02/02/2023

  Meritain Health
  300 Corporate Parkway
  Amherst, New York 14226
  February 2, 2023
  VIA Company Portal
  Better Business Bureau
  100 Bryant Woods South
  Amherst, NY 14228
  Re: ID No. 18561932
  ******* *****
  Dear Sir or Madam,
  We are in receipt of Ms. *****’ additional concerns with regards to the above referenced matter.
  As previously stated, this individual was a participant in an employer sponsored self-funded
  health plan (the Plan), which is governed by *****. The Plan is the ****** Commerce
  Employee Benefit Plan. Meritain Health, Inc. (Meritain) is the third party claims administrator for
  the Plan. Meritain Health is not an insurance company.
  I have confirmed that this was not a Meritain error but rather an error with the member’s pharmacy.
  The prescription request was being submitted under the member’s husband, ****** *****. The
  issue was resolved once the new member ID card was provided at the pharmacy. Ms. *****’
  COBRA coverage has since terminated as of January 1, 2023.
  Thank you for your attention to this matter.
  Sincerely,
  Shannon L******
  Legal Assistant
  

• Initial Complaint

  10/31/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have claims that have gone un-processed with Maritain health for approximately 6 months since the earliest of 5/10/2022 to todays current date 10/31/2022. Suspiciously this is also around the time that my deductible was met while they deny it is related. I have followed up monthly (or more often) with their claims and customer service departments, and received verbal confirmation, and run around that they are "running behind", each time that the necessary paperwork has been received but is in processing. The office providing the medical care has additionally submitted information in addition to our primary care physician which I am told is the only reason that I am not being billed directly, as they are also unable to get an adequate response.

  Business response

  11/16/2022

  The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.****** *** ********** ******** ********* ********* ** ************ *** ** ******** *** ** ******* ** **** ************** *** ********* ***** ******** ** **** *********** ** *** ***** ********** ************* ** ******* **** *** ********** ** * *********** ** ** ******** ********* ***************** **** **** ****** ***** ** ******** ** ****** *** **** ** *** ****** ***** *** **** ******** ****** ***** ******** ******* **** ********** ** *** ***** ***** ****** ************* *** *** ***** ******** ****** ** *** ** ********* ******** * **** ********** **** ****** **** *** ********** ********** *** **** **** ******* **** *** **** ******** ******** *** ** ** ** ****** *** ******** **** *** ******** ******* ******** ******* ********* *** ******* ********** *** ****** ******* *** ***** ********** ** ***  ***** ********** ****** ******* ******* ******* **** ******* *** ******* ********* *** ****** **** *** ************ ** **** ** ********* ********** *** ******* ******* **** ******** **** *** ******** *** *** ********* ***** ******* **** ********** *** ****** **** ** ******** ** *** ******** ***** *** *** **** ********* ** **** ******** 

• Initial Complaint

  09/29/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I used Meritain Health Flexible Spending card to purchase a $14.22 thermometer from a local pharmacy, who gave be a simple credit card receipt. Meritain asked me to submit receipt for IRS documentation purposes. I also submitted pictures of the product (front and back) But, because the receipt did not contain enough information, this was not good enough. Meritain put a block on our Flex Spending card, and are making it very difficult to remove the block. We need this credit card to make medical purchases. Meritain suggested I submit a reimbursement request form, and/or an Explanation of Benefits(EOB). I submitted the reimbursement form, but there is a maximum of 4 uploads. So, I can not submit the full pharmacy receipt (the online system will not allow it). Also, why would I submit an EOB for a thermometer? Meritain is refusing to remove the block from our Flex Spending **********, preventing purchases (after several calls to their Customer Service, including speaking with a Supervisor). I do have the option of paying the $14.22, but only by setting up my checking account in their online system. This process will "take 3 to 5 business days." I requested the card to be reactivated today, but Meritain is refusing. I am doing my part to get this matter taken care of (the local pharmacy has graciously provided me with a more detailed receipt). But, Meritain is not doing their part. In fact, they are creating more confusion, and more time and effort on my part. BBB, please help resolve this matter as soon as possible, thank you, *******

  Business response

  10/13/2022

  We are in receipt of your correspondence dated October 11, 2022 regarding the above
  referenced matter.
  

  There was no Personal Health Information Release Authorization attached with this
  request. Please be advised that we require a recent HIPAA Compliant Authorization signed
  by the member in order to comply with your request.
  

  Upon receipt of the duly executed authorization, we will forward our response to your
  inquiry. I have attached a copy of our standard Authorization for Release of Protected
  Health Information for your convenience. Please forward the completed authorization to
  my direct fax number at ###-###-####
  

  Thank you for your attention to this matter. 
  

  
  

  Customer response

  10/24/2022

  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. Please close this complaint, as the business finally did activate the needed Flex Spending account credit card (after a whole lot of time communicating). Regards, ******* ********* 

• Initial Complaint

  10/19/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I joined my new employer on 03/08/2021 under there EPO plan with Meritain (Aetna). I was initial in east coast. Later I moved to west coast in June 06/2021. My wife (dependent) then became patient with Obstetrix Medical Group (900 E. Hamilton Avenue, Suite 220, Campbell, CA - 95008) with first visit on 06/29. Obstetrix Medical Group then notified me that they would not be In-network with Aetna in first week of August. Within 1 week of notification, I applied for transition of care with Maritain to continue services for my wife with the same medical group, since we were in the middle of treatment and continuing there seemed to be the best option. We filed transition of care form on 08/12/2021 and sent it to Meritain for approval. On 09/03/2021, I got notified from Meritain that the transition of care was denied. Reason mentioned was 'Request for transition of care was received later than 2 months after the effective data of coverage' But the reason for there denial is not true

  Business response

  10/22/2021

  The Personal Health Information Release Authorization attached with this request is not compliant. Please be advised that we require a recent HIPAA Compliant Authorization signed by the member in order to comply with your request. Upon receipt of the duly executed authorization, we will forward our response to your inquiry. I have attached a copy of our standard Authorization for Release of Protected Health Information for your convenience. Please forward the completed authorization to my direct fax number at (716) 541-6695 Thank you for your attention to this matter.  

  Business response

  10/22/2021

  The Personal Health Information Release Authorization attached with this request is not compliant. Please be advised that we require a recent HIPAA Compliant Authorization signed by the member in order to comply with your request. Upon receipt of the duly executed authorization, we will forward our response to your inquiry. I have attached a copy of our standard Authorization for Release of Protected Health Information for your convenience. Please forward the completed authorization to my direct fax number at (716) 541-6695 Thank you for your attention to this matter.  

  Customer response

  10/28/2021

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, I received there communication in a separate complaint that I already made few weeks back. They have agreed to resolve this issue.
  
  Regards,
  
  **** *****
  
  
  
  
  

  Customer response

  10/28/2021

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, I received there communication in a separate complaint that I already made few weeks back. They have agreed to resolve this issue.
  
  Regards,
  
  **** *****
  
  
  
  
  

*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. ↩