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:02/29/2024

  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.

  I’ve been trying with proactive insurance since last year and I’m not getting anywhere with these people. My Doctor prescribed me some medication for my health and you have to be half near dead for this medication to be approved. I’m sick of going through this with this company. My A1C has to be a 6.5 or greater for the prescription to keep me from being Diabetic, they keep rejecting it due to those reason. I’m very sick. This is by far the worst experience ever. The customer service rep Taylor.W isn’t helpful. He’s rude and nasty. Don’t know how to talk to anyone. Refuse to let me speak to a manager after requesting one several times! I’ve never had to experience anything like this.

  Business Response

  Date: 03/06/2024

  Proact sincerely apologies for any
  inconvenience or frustrations this situation may have caused you. We
  have reviewed your concerns and the details of the data surrounding the medications
  you were attempting to process and the call that was mentioned from February 29th. We have reviewed the prior authorization
  history for the medications in question and below are our findings. The
  prescriber had attempted to request four different medications relating to your
  health needs. Unfortunately, all the medications that were requested by the
  provider were reviewed and denied by the clinical department. These were denied
  due to the lab documentation not meeting the established medication-specific
  criteria, as well as, FDA recommendations/ guidelines or the medication was
  listed as a plan exclusion according to your plan benefit. The prescriber did appeal one of the medication denials for an
  off-label diagnosis. However, this was still denied due to the following: “The
  Food and Drug Administration (FDA) has not approved this medication for use in
  treating your patient’s condition and the clinical information submitted by
  your office does not meet the criteria established for Off-Label Drug use, in
  accordance with the terms and conditions of the members plan benefit.” It was
  also notated that lab documentation still needed to be provided to support the
  criteria required. The phone conversation
  that was mentioned in the complaint from February 29th was pulled
  and assessed. On the phone call, the member was attempting to obtain
  information on the processing of her medications, the prior authorizations
  needed, and clarification for the denials. Our representative explained the
  clinical notes to the member on the denials and that the criteria was not met
  based on the FDA standards and plan benefit. The member requested to speak to a
  manager or Supervisor. It was stated that there was not one available at this
  time, and that a call back could be set up. The member did not approve of that
  answer and requested to speak to someone immediately. There was a long pause
  where neither party spoke, while the customer service representative attempted
  to locate a supervisor. After several minutes, he was able to connect with a
  supervisor and the call was transferred. We again apologize for any inconvenience and the representative’s demeanor
  on the phone call from the 29th. We hope that we will have the
  opportunity to regain your confidence in ProAct. We are 100% committed to
  providing the best customer service possible. If you wish to discuss this
  further, please reach out to our help desk at ###-###-####.

• Initial Complaint

  Date:08/01/2023

  Type:Billing 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.

  For the last five years I have repeatedly experienced difficulty with this company with regard to my son’s prescription medication, which is a non-preferred brand name medication. This company is unaware of their own procedures and policies for approving our access to this medication. They do not know how to process the letter of medical necessity for this medication which allows us to purchase the drug at a reasonable price. My son has now gone several months without his medication because they cannot (or will not) review the letter submitted by the physician and apply the necessity to my sons account. As a result, medication that would cost $4 per month (with a manufacturer coupon applied), costs $389 for a one-month supply. There is one person, Liz, who works there who has ever known how to assist us, but she has been promoted and I have been unsuccessful in getting my issue resolved. I cannot get any senior representatives to call me back and no employees who answer the phone can figure out how to solve this problem. I feel as though I am teaching them. My child is being denied access to necessary medication due to the incompetence of this organization.

  Business Response

  Date: 08/07/2023

  Our standard
  process here at ProAct surrounding brand name medications and potential DAW
  penalties includes the ability to submit a request through the prior
  authorization process to identify a brand name medication medically necessary.
  If found appropriate, the DAW penalty will be waived through this process. For
  this particular member, the standard process was initiated in May 2022 where
  the member was approved the brand medication as medically necessary which waived the
  penalty. This authorization expired on May 19, 2023. With no standard prior
  authorization edit associated with requested brand per the member’s plan
  benefit, the claim that was processed after the authorization expired paid
  through at the higher copay. At this time, we have initiated a new prior authorization
  request and are working with the provider to update the medically necessary
  need and will place the authorization once appropriate documentation is
  received.

  We truly understand the frustration and empathize with you on any inconvenience this may have caused. We hope to have the opportunity to regain your confidence in future interaction with ProAct. We are 100% committed in building a customer for life by providing the best customer service possible. If you have any further questions or concerns, please do not hesitate to contact us at **************. Our customer service representatives are available 24 hours a day, 7 days a week. 

  Customer Answer

  Date: 08/07/2023

  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. 
  Regards,
  
  ******* ***
  
  
  
  
  
  
  
  
  

• Initial Complaint

  Date:06/07/2023

  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.

  I obtained health coverage by ***** ****** Network via their *********** plan upon losing my COBRA coverage from my previous employer. Through this coverage I was forced to use ProAct. I paid for full coverage to take effect on May 1st on April 24th and discovered on May 10th that ProAct did not have me as an active member. I called my main insurance the following day (May 11th) to get further clarity and they alerted me that my information had never been shared with ProAct which was why I was not yet active, even though I should have been receiving full coverage. I was told that my information would be passed along to ProAct and that everything should be taken care of. I reached out to the insurance company again on May 31st and was informed that it took them 6 days before they passed my information along, and that ProAct still did not have me in the system. So at this point, I had paid more than $300 to receive full insurance coverage for the month of May and only received partial coverage. The company receiving my payments will not issue a partial refund, even though I never received full coverage as paid for.

  Business Response

  Date: 06/15/2023

  Although
  ProAct does administer the pharmacy benefits for Ms. ********* pharmacy benefit
  plan, we do require notification of eligibility from the third-party
  administrator. This notification was not received by ProAct until
  6/4/2023 at which time the member became immediately eligible.  ProAct has
  reached out to the entity responsible to pass the eligibility file to make them
  aware of this complaint. Requests
  for refunds, plan changes and cancellations are to be referred to the
  enrollment firm. The phone number is found on the back of each ID card. For
  this member and their questions regarding their enrollment or the benefits the
  plan covers, contact ************ or ***************@************.com.
  If you have any questions regarding claims, contact ************ or visit
  members*******.com as this member may be eligible to submit a direct member
  reimbursement to be refunded the amount of her May 21st prescription
  that was paid out of pocket.  We truly understand the frustration and empathize with you
  on any inconvenience this may have caused. 
  We hope to have the opportunity to regain your confidence in future
  interaction with ProAct. We are 100% committed in building a customer for life
  by providing the best customer service possible.