Complaints

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

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Payer Matrix, LLC has 4 locations, listed below.

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• 

  Payer Matrix, LLC

  1400 N Providence Rd Ste 5000 Bldg 2 Media, PA 19063-2072

  
• 

  Payer Matrix, LLC

  3608 Preston Rd Ste 250 Suite 250 Plano, TX 75093-8608

• 

  Payer Matrix, LLC

  9200 Indian Creek Pkwy Ste 560 Overland Park, KS 66210-2017

• 

  Payer Matrix, LLC

  1400 E Newport Center Dr Ste 207 Deerfield Beach, FL 33442-7705

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:05/24/2024

  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.

  Payer Matrix not communicating with Benecard pharmacy in timely manner for me to get my medication. Payer Matrix has a lawsuit against them because others claiming misleading info about being enrolled in financial assistance programs. Payer Matrix has told same thing to me, delaying me in getting needed medicine.

  Business Response

  Date: 06/12/2024

  
  SENT VIA E-MAIL AND
  BBB RESPONSE PORTAL                                                                         June 12, 2024
  *****************************
  BBB Serving ******************* and
  ********************
  **************************************************************************************; 17102
  *************************************
  
                                      Re:      Complaint ID  *******
  
  Dear ******************:
  
  
  Please accept this letter as Payer Matrixs response to the above-referenced complaint filed with the BBB Serving Metro ************* and Eastern Pennsylvania.  The complaint was filed by an employee of one of Payer Matrixs customers, ********************* (Complainant).  The allegations in the complaint reveal Complainants misunderstanding of the role Payer Matrix plays in her ability to obtain access to her prescribed medication.  We believe a brief summary of the Payer Matrix business model will help clarify the role Payer Matrix actually serves in this process as well as confirm that Payer Matrix has fulfilled all of its obligations to its customer and to Complainant.
  
  ********************* clients are employer-sponsored self-funded health plans such as *********************.  These self-funded plans are responsible for managing and funding the costs associated with their employees and their dependents (the members of the self-funded plans) medical and pharmacy claims from both company and members contributions.  These self-funded plans, however, ultimately assume the financial risk for the costs of their members carewhich includes absorbing the impact of any high-priced claims. Self-funded plans therefore spend a lot of time focused on their plan design in an effort to achieve potential cost savings that will help mitigate the risks and to ensure that there is enough money available for all memberscare.  
  Given the substantial financial risks that specialty medications such as Dupixent (the drug at issue here), and their exorbitant price tags pose to self-insured plans, there is significant pressure to reduce the costs and impact associated with specialty medications.  One way self-funded plans have been doing this is by carving out (some or all) specialty drugs from their plan benefit to ensure their continued financial viability. While these plans have been forced to make the difficult decision to exclude certain specialty drugs, they still want to ensure that their members who rely on these drugs, such as the complainant, have effective assistance in trying to access these medications.
  This is where Payer Matrix comes in and works with patients whose self-funded health benefit plans do not offer coverage for the specialty drugs they have been prescribed.  ********************* is one such plan that has chosen not to provide coverage for Dupixent, the drug Complainant is seeking to access.  Payer Matrix has been working with *********************, on behalf of Complainant, to identify and apply for alternate sources of funding. In this case, we have identified an assistance program called Dupixent ****** and are in the process of working with Complainants health care provider to complete the application seeking access to the Dupixent ****** financial assistance program.  Complainant should meet the insurance requirements of this patient assistance program because she does not have available coverage for Dupixent.
  In the meantime, while waiting for Complainants application to work its way through the Dupixent ****** review and approval process, Innovate ********** has approved an exception to the plans non-coverage of Dupixent, and approved coverage on three separate occasions 4/1, 4/30, and most recently,on 5/29.  Complainant has experienced no delay in getting her medication as she awaits acceptance into the Dupixent ****** assistance program. And Payer Matrix has fully complied with its sole obligation to assist Complainant in gaining access to this alternative funding source.
  Sincerely,
  *****************************;       
  VP Operations

• Initial Complaint

  Date:01/18/2023

  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.

  Payer Matrix contacted me regarding a specialty drug, *******, that I had been receiving through ********/***** health insurance. Payer Matrix explained they were contracted by the payer of the ******************** health plan to find alternative sources to pay for the specialty drug. I was accepted into the ***************** assistance program. I am unable to get any information from ***************** other than my application is in process. Payer Matrix does not return my calls. I am supposed to take this anti-viral medication daily. I am now out of the medication. Why is this happening? I am paying for the *************** insurance.

  Business Response

  Date: 07/12/2024

  Please see attached response.