Business Profile

Health Insurance

Oscar

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Complaints

This profile includes complaints for Oscar's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

101 total complaints in the last 3 years.
34 complaints closed in the last 12 months.

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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:05/12/2025
Type:Sales and Advertising 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.
They keep sending mail and correspondence but I didn't sign up for Oscar and I don't know how I got signed up.
Business Response
Date: 05/19/2025
*** *** ****

****** ******** ****** *****
***************************************************
************************

********* *** ********

Dear Better Business Bureau,

Thank you for contacting Oscar regarding the enrollment in a 2025 Oscar policy. In our members complaint, they state that they did not request enrollment in a 2025 Oscar policy and were unaware of the enrollment.

Upon investigation, we confirm that our members policy was enrolled through the federal health insurance exchange, referred to as the Federally Facilitated Marketplace (***). Oscar does not have any ability to make changes to our members policies if they are enrolled through the ***, without first receiving explicit instruction from the **** We rely on data sent to us electronically from the **** and when we receive notification pertaining to a members policy, we make the requested plan adjustment to reflect any information exactly as relayed in the data transmission.

As of the date of this response, Oscar has not received any information from the *** to terminate the policy. Our member may contact the *** directly at ************** to discuss the enrollment and termination of the policy.

Please note that due to the public nature of this forum, Oscar cannot share specific details such as HIPAA protected PHI information. This includes specific member accounts and financial information. If our member would like a more detailed response, we encourage them to contact Oscar directly for assistance.

We apologize for any inconvenience that this issue may have caused, and appreciate the feedback regarding our members experience. If our member has any questions about this information, they can contact our ************************** at ************ or *************************************************************.

Thank you,
****** **
Grievance Liaison
Oscar Insurance Corporation
Initial Complaint
Date:03/20/2025
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.
March 18, 2025 Oscar Health Insurance ATTN: Grievances/Complaints **** ******************************** ****** **** **************************************************************** ************ *************** RE: Grievance complaint, Member Number: ************* To Whom it May Concern:I am writing this letter as a grievance to showcase the unfortunate delay in my medical care due to the misinformation and disinformation as the result of Oscars careless and problematic communication between Oscar and my providers office. Because of the lack of care on Oscars behalf, this has caused an increase in pain and suffering. This was caused by a denial of pre-authorization for my upcoming epidural of the lumbar region. I will now highlight how Oscar has failed me as the insured. I have spent, in total, over 7 hours speaking with various departments within Oscars interweb of lines of communication. During these 7 hours, I have been hung up on, dropped calls, told different stories, transferred to incorrect departments, and received misinformation/disinformation. Oscar wants to blame the providers office for not following the correct process in the allotted timeframe, but I witnessed just the opposite. Sections that are in blue and italicized are notes from the providers office:2/05 at 11:29AM: Called Oscar Health@************ S/w JACK A said member is active from 01/01/2025 with no termination date, has a EPO PLAN, Provider is in network, In network benefits are covered 100% after COPAY$75.00, No DED, IND OP $1,100.00 MET$227.25. Also, *** stated for CPT *****, ***** / member authorization handled by OSCAR EVICORE @************ Ref#SERVICE-*********
Business Response
Date: 04/01/2025
***** ** ****

****** ******** ****** *****
***************************************************
************************

Complaint ID: ********

Dear Better Business Bureau,

Thank you for contacting Oscar regarding the denial of our members authorization requests. In our members complaint, they state dissatisfaction regarding the denial of their authorization requests for services. They further explain that this has caused pain and suffering as a result of their experience with Oscar Member Services.

Upon investigation, we have verified that an authorization request was submitted to Oscars clinical review partner, *******, on February 5, 2025. ******* denied the request based on a clinical review for medical necessity on February 7, 2025. The provider then submitted an appeal on February 7, 2025. ******* also denied this request on February 7, 2025, based on a clinical review for medical necessity. Please note, an external review was submitted to Oscar. As a result of the external review with further information submitted, the services were approved on March 21, 2025.

We sincerely apologize for any inconvenience this may have caused, and appreciate our members feedback regarding their experience. We want to ensure that we meet our members needs and we regret that their experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures.

Please note that due to the public nature of this forum, Oscar cannot share specific details such as HIPAA protected PHI information. This includes specific member accounts and financial information. If our member would like a more detailed response, we encourage them to contact Oscar directly for assistance.

If our member has any questions about this information, they can contact our ************************** at ************ or *************************************************************.

Thank you,
****** **
********* *******
***** ********* ***********

Customer Answer
Date: 04/08/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

[At no point in time did my grievance get mentioned. I know all the facts,but nothing in the explanation gives reason as to why I wrote this complaint to start! I want to know what Oscar is doing about the misinformation that was provided to myself and the doctors office several times within Oscar **** as well as ******* ****. Furthermore, what has transpired with the **** involved will prevent this from happening again. Will those agents be coached? I mean they do not acknowledge there was an error on their end, when clearly there were several in fact! They cant even say "We are so sorry this happened So yes, I was harmed, physically and mentally!]

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

****** ****

Business Response
Date: 05/29/2025
*** *** ****

****** ******** ****** *****
***************************************************
************************

********* *** ********

Dear Better Business Bureau,

Thank you for contacting Oscar regarding the denial of our members authorization requests. In our members complaint, they state dissatisfaction regarding the denial of their authorization requests for services. They further explain that this has caused pain and suffering as a result of their experience with Oscar ***************.

We sincerely apologize for any inconvenience that our members interaction with *************** may have caused, and appreciate their feedback regarding their experience. We want to ensure that our representatives properly address our members needs, and we regret that their experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures. Please note, authorization requests must be submitted by the provider and Oscar is unable to review or create requests without the provider first submitting the request.

Upon further investigation, we have verified that our member submitted a direct complaint with Oscar regarding these concerns. These complaints provide more detail about the concerns the member mentions as they disclose personal information.

Please note that due to the public nature of this forum, Oscar cannot share specific details such as HIPAA protected PHI information. This includes specific member accounts and financial information. If our member would like a more detailed response, we encourage them to contact Oscar directly for assistance.

If our member has any questions about this information, they can contact our *************** Department at ************ or *************************************************************.

Thank you,
****** **
********* *******
***** ********* ***********
Initial Complaint
Date:03/06/2025
Type:Billing 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 received a voice mail from Oscar welcoming me to their HMO plan. I have never before heard of Oscar and I certainly did not sign up for their plan. Ive had insurance through my employer for 44 years.Hopefully this is just a mistake , maybe they misdialed and got me. But if they did start an account or policy in my name, it is clearly FRAUD.. I have been unable to reach any Oscar agents thru there phone menu. Please have them contact me again by phone.
Business Response
Date: 03/07/2025
***** ** ****

****** ******** ****** *****
***************************************************
************************

Complaint ID: ********

Dear Better Business Bureau,

Thank you for contacting Oscar regarding a non-member receiving a voicemail from Oscar.

In the complaint, the non-member expresses dissatisfaction regarding receiving a voicemail from Oscar welcoming them when they do not have a policy.

Upon investigation, Oscar confirms that this non-member is not found in Oscars system. At this time, the non-member does not have any active enrollment or policy with Oscar.

Please note that due to the public nature of this forum Oscar cannot share specific details such as HIPAA protected PHI information. This includes specific member accounts and financial information. If our non-member would like a more detailed response we encourage them to contact Oscar directly for assistance.

If our member has any questions about this information she can contact our ************************** at ************ or *************************************************************.

Thank you,
****** *.
********* *******
***** ********* ***********
Initial Complaint
Date:03/05/2025
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 was never informed about this insurance company and the address on the insurance is not a valid address. I was informed medicine was charged through them when all my prescriptions was with my current healthcare insurance. They have no remorse for customers that unaware of things that they never where informed of a switch and confirming information before running anything through their company. How can you run prescription if you have no confirmation or contact with a person. I called in to get this situation rectified to the marketplace and the said they contacted the Oscar health and it is valid when I never lived at the address on file in over 2 years. I was unaware of the insurance. They are not giving customers no remorse or help to fix situations that they are unaware of and not trying to find a solution. All they can continue telling me to go to the market place when I continue fighting between both companies that I was never aware of this insurance due to me not living at the address on file so I don't know how they can run prescriptions when I never knew about the company until I filed my taxes. This is causing a burden on me. I have no receipts with their names on it at all.
Business Response
Date: 03/05/2025
***** ** ****

****** ******** ****** *****
***************************************************
************************

********* *** ********

Dear Better Business Bureau,

Thank you for contacting Oscar regarding the enrollment in a 2025 Oscar policy.

In the complaint, our member expresses dissatisfaction regarding their involuntary enrollment in a 2025 Oscar policy when they were previously enrolled with a different insurer.

Kindly note, the members policy was enrolled through the federal health insurance exchange, referred to as the Federally Facilitated Marketplace (FFM). Oscar does not have any ability to make changes to our members policies if they are enrolled through the ***, without first receiving explicit instruction from the **** We rely on data sent to us electronically from the ***, and when we receive notification pertaining to a members policy, we make the requested plan adjustment to reflect any information exactly as relayed in the data transmission. Oscar has confirmed that information was received enrolling the member in a 2025 Oscar policy.

However, upon further investigation, further information has been received terminating the members policy to have not been enrolled. At this time, the member does not have any active enrollment with Oscar.

Please note that due to the public nature of this forum Oscar cannot share specific details such as HIPAA protected PHI information. This includes specific member accounts and financial information. If our members would like a more detailed response we encourage them to contact Oscar directly for assistance.

If our member has any questions about this information she can contact our ************************** at ************ or *************************************************************.

Thank you,
****** **
********* *******
***** ********* ***********

Customer Answer
Date: 03/24/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

[Your Answer Here]
In 2024 I was unaware of your insurance and therefore I so called had claims that I never knew about due to my insurance was another provider. Therefore I have been told I used insurance for prescriptions that I never had acknowledged about when all my insurance was through United healthcare for medical insurance.

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

***** *******

Customer Answer
Date: 05/20/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

[Your Answer Here]

I have called in and talked to multiple people and nobody been able to explain how they allowed claims for medication go through on someone who never accepted or access their medical insurance

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

***** *******

Business Response
Date: 05/29/2025
*** *** ****

****** ******** ****** *****
***************************************************
************************

********* *** ********

Dear Better Business Bureau,

Thank you for contacting Oscar regarding the enrollment of our members ************************************************************************** an Oscar policy for the 2024 plan year. Furthermore, our member did not request claims to be submitted. They state that they are unsure why Oscar allowed claims to be submitted under the policy.

Kindly note, Oscar must process claims when they are submitted and is unable to refuse claim submission from a provider or pharmacy, even if a policy is terminated or not active. We have verified that at the time the claims were submitted, the 2024 policy was active as it was enrolled through the Federally Facilitated Marketplace (FFM). As stated in previous responses, Oscar is unable to remove these claims as that request has to be made by the provider.

Please note that due to the public nature of this forum, Oscar cannot share specific details such as HIPAA protected PHI information. This includes specific member accounts and financial information. If our member would like a more detailed response, we encourage them to contact Oscar directly for assistance.

We apologize for any inconvenience that this issue may have caused, and appreciate our members feedback regarding their experience. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures. If our member has any questions about this information, they can contact our ************************** at ************ or *************************************************************.

Thank you,
****** **
********* *******
***** ********* ***********
Initial Complaint
Date:02/27/2025
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 cancelled my Oscar plan 1.3.2025 I was told I would not be charged for the month of January because of this. They charged me for the month of January, February, and are now trying to charge me for March. And this new charge is OVER 10x what I paid for my plan initially (with less money made by me annually). When I try to call the line (3 separate occasions, Im playing keypad merry go round where the menu lists number associated with options, I click said options, and after 5-6, Im brought back to main menu, causing me to continuing going for minutes on end. My last attempt was 20 mins of trying any number to get someone on the line to no avail. This is insane. Ive cancelled almost 2 months ago, Im getting charged, and I cant even call someone about it?? And I can only CALL because my account was CANCELLED and I cant get into the app anymore because my account was cancelled.
Business Response
Date: 02/27/2025
******** *** ****

****** ******** ****** *****
***************************************************
************************

Complaint ID: ********

Dear Better Business Bureau,

Thank you for contacting Oscar regarding a member's experience with being charged for a premium on a cancelled policy.

During our investigation, Oscar has confirmed that the member was enrolled in a 2025 policy through the federal health insurance exchange, referred to as the Federally Facilitated Marketplace (***). Oscar does not have any ability to make changes to our members policies if they are enrolled through the ***, without first receiving explicit instruction from the **** We rely on data sent to us electronically from the ***, and when we receive notification pertaining to a members policy, we make the requested plan adjustment to reflect any information exactly as relayed in the data transmission.

Upon investigation, the member was enrolled in a policy starting January 1, 2025, which was then terminated by the *** for an end date of January 31, 2025. A premium payment was initially charged for the month of January but has since been returned. At this time, Oscar can confirm that a premium payment is not on file for the month of January.

However, the *** has not yet directed Oscar to retroactively terminate the January enrollment and as a result, there is an outstanding premium balance. If the member disagrees with their enrollment with Oscar and would like a refund of the January premium, we suggest contacting the *** directly to request any enrollment changes as we are unable to refund any premiums payments for the time that a policy is enrolled or active.

We apologize for any inconvenience that this issue may have caused, and appreciate you bringing this matter forward for our review. If our member has any questions about this information she can contact our ************************** at ************ or *************************************************************.

Thank you,
****** **
********* *******
***** ********* ***********
Initial Complaint
Date:02/25/2025
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 keeping getting letters from oscar health care even after explaining to them that i have never heard or singed up for health care insurance. when i spoke to them last month i was assured the policy would be cancelled and they had me speak to someone named ******** in the marketplace. during our conversation she told me that she sent this to be investigated. meanwhile i have been getting denied coverage from my actual insurance company. i called oscar back last week and they kept saying i needed to provide my bank account info in order to proceed, to which i replied i had already spoken to them and my policy was cancelled. they replied and said according to your account, based on my phone number only, they showed an active policy. i told them again i never signed up for them, they said they had a glitch in their system and to cancel id have to call back in 30 minutes and hung up. i notified my insurance company and they are investigating. i am receiving multiple letters of money owed and EOBs to which is a direct violation of my hippa rights.
Business Response
Date: 02/27/2025
******** *** ****

****** ******** ****** *****
***************************************************
************************

********* *** ********

Dear Better Business Bureau,

Thank you for contacting Oscar regarding the members enrollment in a 2025 Oscar policy.

Upon investigation, Oscar confirms the members policy was enrolled through the federal health insurance exchange, referred to as the Federally Facilitated Marketplace (***). Oscar does not have any ability to make changes to our members policies if they are enrolled through the ***, without first receiving explicit instruction from the **** We rely on data sent to us electronically from the **** and when we receive notification pertaining to a members policy, we make the requested plan adjustment to reflect any information exactly as relayed in the data transmission.

Oscar confirms that the *** has sent Oscar updated information terminating the members policy for no coverage for the 2025 plan year. Furthermore, Oscar confirms that the member is not responsible for any premium payment amount due.

We apologize for any inconvenience that this issue may have caused, and appreciate you bringing this matter forward for our review. If our member has any questions about this information she can contact our ************************** at ************ or *************************************************************.

Thank you,
****** **
********* *******
***** ********* ***********
Initial Complaint
Date:02/21/2025
Type:Service or Repair 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.
We are healthcare providers without access to a dedicated provider relations representative. Instead, we are forced to rely on offshore representatives who provide no clear answers or resolutions, leaving us stuck in an endless loop of misinformation. Our claims continue to be denied in error, yet we have no access to a U.S.-based representative who can properly investigate and resolve these issues. Despite these challenges, we remain committed to our patients, but the ongoing claim denials create unnecessary obstacles to delivering care.
Business Response
Date: 02/21/2025
******** *** ****

****** ******** ****** *****
***************************************************
************************

********* *** ********

Dear Better Business Bureau,

Thank you for contacting Oscar regarding the concerns expressed on behalf of our provider. We have researched this case and determined the following:

An Oscar contracted provider expresses dissatisfaction regarding Oscars Provider Relations representatives. The provider stated that their office is forced to rely on offshore representatives who provide no clear answers or resolutions. Furthermore, the provider advised that their claims continue to be denied in error and they have no access to a U.S.-based representative who can properly investigate and resolve their issues which creates unnecessary obstacles to delivering care.

We appreciate our provider for bringing this matter to our attention. Their feedback has been shared with the appropriate team for potential future improvements. Oscar has taken note of our providers concerns and forwarded their feedback so that coaching may be provided to the representatives involved. We want to ensure that our representatives appropriately and promptly address our providers needs, and we regret that their experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value feedback to continually help us improve our processes and procedures.

Due to the public nature of the BBB forum and the sensitive nature of this matter as it pertains to claims the Plan cannot provide details in this response. This is not an appropriate or secure forum to discuss claims issues in detail with the provider. Kindly note, we are responding in good faith with the limited information we can provide on a public forum. If our provider would like a more detailed response we would encourage them to contact Oscar directly for assistance so that we might disclose more detailed response in a non-public forum.

If our provider has any questions about this information or specific , we ask that they please contact our ***************** at *************

Respectfully,

****** *
Customer Answer
Date: 02/26/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because: This is not an acceptable response. I still dont have access to a US represetnative. The phone number you list is the same number i call and get the claims representatives that dont help . The response saying that they will better train their **** does not help with anything since that was my first point of contact. I will open a complaint with the insurance commissioner and see if they can help.

[Your Answer Here]

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

**** ******

Business Response
Date: 03/19/2025
***** *** ****
****** ******** ****** *****
***************************************************
************************
********* *** ********

Dear Better Business Bureau,
Thank you for contacting Oscar regarding a providers experience with Oscars Provider Relations Team. We have researched this case and determined the following:
An Oscar contracted provider expresses dissatisfaction regarding Oscars Provider Relations Team representatives. The provider stated that their office is forced to rely on offshore representatives who provide no clear answers or resolutions. Additionally, the provider advised that their claims continue to be denied in error and they have no access to a U.S.-based representative who can properly investigate and resolve their issues, which creates unnecessary obstacles to delivering care.
As stated in the previous response, the providers feedback has been shared with the appropriate team for quality improvement. We want to ensure that our representatives properly address our providers needs, and we regret that this experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value provider feedback to continually help us improve our processes and procedures.
Furthermore, as stated in the previous response, if the provider is in need with a higher level of support, they may contact our Provider Relations Team and request a supervisor. Our supervisors are U.S.-based and can assist with complicated issues. The provider may also request disputes for any claims in question. At this time, we have verified that the provider's concerns are being investigated further by Oscar representatives.
Please note that due to the public nature of this forum, Oscar cannot share specific details such as HIPAA protected PHI information. This includes specific member accounts and financial information. If our provider would like a more detailed response, we encourage them to contact Oscar Provider Relations directly for assistance.

If the provider has any questions about this information, we ask that they contact our ************************** at ************ or *************************************************************.

Thank you,
****** *.
********* *******
***** ********* ***********

Customer Answer
Date: 03/19/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and feel we are just going in circles. I was never able to speak to a US representative but will continue to appeal my claims and hope for the best.

Sincerely,

**** ******
Initial Complaint
Date:02/13/2025
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 am reaching out to you because I have attempted 4 times to reach out to ******************* Insurance by phone speaking with a different representative each time telling me they were going to elevate my claim and someone would call me but I dont hear back so continue to call with no answer and nothing being done . A agent falsely used my info without permission to sign me up for this insurance. I received a letter 1st ever in October 2024 . I called explained this is not me I have insurance through my work never had nor used or gave no one permission to sign me up this was fraud . The lady who is India took my complaint never called me back ask me to verify my info and told me the agents name whom I do not know and never gave permission for insurance. I called back a week later after hearing nothing back the voice of same lady said I had to call the Market place and file a complaint so I did speaking with a Rep . Days later I received a letter stating the insurance that was done in fraud had bn used but would not disclose where I expressed Ive never used it only my Bcbs which is through my employer and again this was fraud . This is a government insurance in which I do not financially qualify for because I make around ****** a yr and I did not apply . I called my doctors and my pharmacy to verify this coverage did not show or was ever used each place telling me no only bcbs showed and used Also Oscar reported to The Market place that it had been used so they the market place denied my claim with in days I received a tax 1095 form for ***** some thing dollars against my taxes for this insurance and a welcome member package I was very upset called again to explain this was insurance fraud and not me and I do not this agent who signed me up and never used it why was I having to pay even explaining I called confirmed with my drs it never showed or was used and now on top of it all they sent me a welcome new member package and I want to know why as this was reported fraud
Business Response
Date: 02/20/2025

February 20, 2025
Better Business Bureau (BBB)
***************************************************
***********************;
Complaint ID: ********

Dear Better Business Bureau,
Thank you for contacting Oscar regarding our members enrollment into an Oscar policy.
In the members complaint, she expresses dissatisfaction regarding her enrollment into an Oscar policy without her consent.
Kindly note, Oscar does not have the ability to make changes to our members policies if they are enrolled through the Federally Facilitated Marketplace (FFM) without first receiving instruction from the ***. We rely on data sent to us electronically from the **** when we receive an update about a members policy, we must adjust their policy to reflect the information as relayed exactly in the data transmission. Upon investigation of the 834 communications sent by the ***, our members policy has been cancelled at this time and if she has additional concerns regarding her enrollment, the *** can be contacted at **************.
Oscar sincerely apologizes for any inconvenience this issue may have caused, and appreciates our members feedback regarding her experience. We want to ensure that we meet our members needs and we regret that her experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures.
Please note, due to the public nature of this forum, the plan cannot share specific details such as HIPAA-protected and PHI information or specific member account and financial information such as specific policy details and dates. If our member would like a more detailed response, we would encourage her to contact the plan directly for assistance with submitting a grievance directly with the plan so that we might provide her with a more detailed response in a non-public forum.

If our member has any questions about this information she can contact our ************************** at ************ or *************************************************************.

Thank you,
*********** ********** * *******
***** ********* ***********

Customer Answer
Date: 03/10/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

I contacted the market place they contacted your business as they opened a case and your reply to them was that you found open claims at some point in 2024 against your insurance saying that I had used I have ask several times for these claims to be provided to me and your or no one has ever sent them as of this date as I have explained I never used your insurance as I had my own and unknowingly knew of your coverage nor did my providers or pharmacy . Market place would not open a fraud case as your firm stated this was used by me from may thru dec of 2024 which if false I never used your insurance . Again this is fraud . I have dealt with this for months now owning a ***** dollar premium I have contacted the marketplace they tell me to contact Oscar Ive contacted ocar they tell me to contact the marketplace place I just want this reported as fraud and not to be held responsible for something I didnt authorized or know about and feel I should not have to pay for a premium on insurance in 2024 or 2025 .

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

******** ******

Customer Answer
Date: 03/26/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved
i did contact The Market place to report insurance fraud as well as ocar insurance multiple time the market place opened a fraud cause but Oscar insurance would not accept it as fraud for 2024 of May says there were claim open and against the policy even after I explained multiple times I nor my providers ever used or submitted a claim with Oscar . The market place tried to help me but Oscar kept telling me they would investigate the claims of fraud and the claims for payment from May of 2024 and as of this date have not nor have they ever provided me with claims from my providers that I ever used this insurance as I have not nor was I aware I ever had it nor did my providers in the yr 2024 at all. So even after reporting it as fraud to the market place because of Oscar saying they would open and exculpate a fraud claim the market place closed my fraud cause because **** said it had been used by me at some point from May 2024 till just several months ago when I was made aware of this fraud . I have called and reached out to Ocar a total of 5 times until I opened a claim with the bbb since I was not being listened to by no one at Oscar Health and The market place could not do any further action because Oscar health said I had claims open and would conduct their own investigation and elevate my fraud claim So I am being charged for 2024 for insurance without my knowledge as well as open claims regarding this policy against my knowledge . I have a paper proving this from the market place after I had contacted Oscar health and the market place stating Oscar health had claims on this policy and disagreed with the case I opened for insurance fraud .

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

******** ******

Business Response
Date: 04/07/2025
***** ** ****
****** ******** ****** *****
***************************************************
************************
********* *** ********

Dear Better Business Bureau,
Thank you for contacting Oscar regarding our members enrollment into an Oscar policy.
In the members complaint, she expresses dissatisfaction regarding her enrollment into an Oscar policy without her consent.
Kindly note, Oscar does not have the ability to make changes to our members policies if they are enrolled through the Federally Facilitated Marketplace (FFM) without first receiving instruction from the **** We rely on data sent to us electronically from the **** when we receive an update about a members policy, we must adjust their policy to reflect the information as relayed exactly in the data transmission. Upon investigation of the 834 communications sent by the ***, our members policy has been cancelled at this time and if she has additional concerns regarding her enrollment, the *** can be contacted directly at **************.
Oscar sincerely apologizes for any inconvenience this issue may have caused, and appreciates our members feedback regarding her experience. We want to ensure that we meet our members needs and we regret that her experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures.
Please note that due to the public nature of this forum Oscar cannot share specific details such as HIPAA protected PHI information. This includes specific member accounts and financial information. If our member would like a more detailed response we encourage them to contact Oscar directly for assistance.
If our member has any questions about this information she can contact our ************************** at ************ or *************************************************************.

Thank you,
****** *.
********* *******
***** ********* ***********
Initial Complaint
Date:02/12/2025
Type:Service or Repair 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.
Good faith payments made to Holy Cross/Trinirty Health wating on Oscar Insurance to Assignment the payment for Medical procedures reciecved on 9/5/2023 totalling $ ****** Waiting for refund.Oscar finally said they were going to pay the claim after all the appeals and the final Maximus review ruled in my favor, It was a covered service by the plan and they must pay, The billed amount is $3716.00 from **********/ Trinity Health, ** **** **, Pain Management. They have paid all other previous claims for the exact same medical procedures except for the service date oif 10/25/2023 and I had to file the Appeals and go through the whole process and they were told it was a covered service and to pay and they in fact did. Dont understand why they are continuing to distract, delay and attempt to pay portions in addition to attemtping other unfounded reasons to try and not pay the claim. The person *** from the ************ even topld me over the phone that in late November 2024, they (Oscar Insurnace) Had mailed the payment out to **********/Trinity Health. Then checking in with the ************** at ********** Day after day after day, they never recieved the payment. Oscar was not being truthful. I still feel like a ping pong ball going back and forth being mislead, put off, delayed and played with, This has to stop. I have done everything that has been asked or requested of me from Day 1 and still there has been no finalization. Please help This is definetely abusive.
Business Response
Date: 02/19/2025
***** ********* ***********
***************************
******************
**************
*************************************************************
****************************

******** *** ****
****** ******** ****** *****
***************************************************
************************
********* *** ********

Dear Better Business Bureau,
Thank you for contacting Oscar regarding the concerns of our member.
In this complaint, our member states they made good faith payments to Holy Cross/Trinity Health totaling $600.00 and are seeking a refund.
Additionally, he states we have not been truthful in payments sent to the provider.
Our Grievance Team has investigated this complaint and found that no misinformation was provided regarding coverage or payments sent to the provider.
We have verified that we received a message from 1-800-medicare. Due to this, a Complaints, Grievances and Appeals Team liaison is currently investigating the mentioned claim. A response letter will be issued by our representative via mail to our member with more detailed information.
Due to the Health Information Portability and Accountability Act (HIPAA), we are not permitted to provide any details on claims or member information in our response to the Better Business Bureau.
We apologize for any inconvenience that this issue may have caused, and appreciate our members feedback regarding his experience. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures.
If our member has any questions about this information he can contact our ************************** at ************ or *************************************************************.

Thank you,
***** **
********* *******
***** ********* ***********

Customer Answer
Date: 03/07/2025
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. Holy Cross/Trinity Health Billing did recieve full payment ON 2/28/2025 for the 9/5/2023 claim from Oscar Insurance Company. I am still waiting to hear back from **********/ Trinity Health Billing as to when the payment will be completed and exactly how much of a refund I will be receiving. I spoke with the ************** today and I was advised that they would be in contact with me on Monday, March 10, 2025 with all the final details. Then the account will be settled and closed. .

Sincerely,

****** *******
Initial Complaint
Date:02/12/2025
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.
Oscar insurance likes to provide a list of in net work doctors who actually aren't in network. When I called a handful of drs that were listed on my in network available doctors, when I called that office I was told that that specific practice and/or that specific location which I needed to go to, weren't participating in network with Oscar insurance. When I've previously called Oscar to discuss this, the 'care team' that I'm forced to work with is comprised of low level educated persons who have ZERO experience in health care and aren't trained properly to be dealing with matters related to health. I've called Oscar before and the person I had to speak with on my 'care team' told me that the only resolution she could offer me was for me to hang up the phone and hopefully get another 'care associate' because she wasn't going to do her job. So why do I pay a monthly premium if I'm getting scammed by an insurance provider? What's the point of paying a monthly premium if my visits don't get coded correctly from the drs office, oscar hires inept and incapible people of doing a job, which causes me great amounts of time lost, lost money when I take off time from work, and bills being sent to me which I shouldn't have to pay for, even after I confirmed with Oscar and Advent about how much was going to be due. I'm tired of being scammed by both Advent health and OSCAR insurance. Both of these people have a requirement to offer their policy holders and consumers a good faith estimate which they don't adhere to and double what I owe. This is fraud and medical gaslighting. It doesn't help that NP ****** ***** gaslighted me into taking a test I didn't actually need and her whole office for charting fraud and refusing to fix my patient notes. OSCAR and Advent Health need to be stripped of anything they can do, because they obviously can't do anything correct except scam their policyholders. Do better and start training your people instead of stealing from me!
Business Response
Date: 02/19/2025
***** ********* ***********
***************************
******************
**************
*************************************************************
****************************

******** *** ****
****** ******** ****** *****
***************************************************
************************
********* *** ********

Dear Better Business Bureau,
Thank you for contacting Oscar with our members complaint regarding our provider network and their experience with ***************.
In our members complaint, she expresses dissatisfaction concerning the inaccuracy of our provider directory. She also expresses dissatisfaction concerning the level of service she received from *************** representatives.
We were unable to find this information in our records. Our records found that on January 3, 2025, she spoke with a representative regarding the accuracy of our care router regarding the network status of our members providers. The *************** representative attempted to assist our member in locating in-network providers that she was seeking. Our member declined assistance from our *************** representative and requested to speak to a supervisor instead.
We verify it is our policy to introduce a supervisor to a member if one is available within 5 minutes. If a supervisor is not available, it is our policy to inform the member that they will receive a call back from a supervisor when available.
We have verified that a supervisor did not contact our member or return her call. We greatly apologize for the inconvenience this caused and want to make sure our member receives the assistance she needs. We have escalated this issue to a supervisor to assist our member further.
We verify that on January 17, 2025, we requested our member to refrain from using verbiage considered abusive per our policy via a secure message. We verify that throughout her conversations with us, our member used verbiage considered to be inappropriate and we kindly ask our member to refrain from the use of verbiage considered inappropriate or offensive. We verify our employees have the right to disconnect a call if they are found to be using abusive verbiage.
Our member expresses dissatisfaction regarding the network status of providers in our care router. If a provider shows as in-network in our care router and the provider informs a member that they are out-of-network, we urge our members to contact *************** at ************ for assistance in this matter.
On February 11, 2025, we sent our member a message regarding an issue we found within our systems which may have caused her to see an incorrect cost-share for her deductible and maximum out-of-pocket limit. We were happy to inform our member that this issue was corrected on February 8, 2025.
We verify that our members time is valuable and acknowledge her dedication to speak with us about any existing issues there might have been.
If our member has any questions about this information she can contact our *************** Department at ************ or *************************************************************.

Thank you,
***** *.
Grievance Liaison
Oscar Insurance Corporation

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