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:10/30/2024

  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 had an injury that required surgery and Clearwater has not done there part with payment for the charges from the doctor, hospital, and physical therapist. In November 2022 I had surgery and paid my $2500 copay as instructed by Clearwater benefits by Planstin. They have repeatedly denied the claims sent by the hospital. I have exhausted my resources contacting people by email that will never call me to discuss. The bill is over $110,000 and I am about to be sent to collections due to this.

  Business Response

  Date: 11/04/2024

  To *** *****, 

  We have gone ahead and looked into your policy with ClearWater and see that we have some of the bills you mentioned but not all of them. In order for us to review further, we will be reaching out to you directly to gather more information so that we can ensure that we have all of the bills on hand to properly assess your policy. 

  If you have any further questions please feel free to contact **************** at *************.

• Initial Complaint

  Date:10/14/2024

  Type:Billing Issues
  Status:

  UnansweredMore 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.

  Every single claim I have had through Clearwater has taken months to get paid. I have had to follow up dozen of times for each claim, for both medical and dental. I have a claim from October 27, 2023 that still has not been paid although I was advised that it was being processed back in March. I did not realize it had not been paid until I just recently received a bill from the medical provider stating that their attempts to receive payment from Clearwater had been unsuccessful. This company is in the business of NOT paying claims! I only had insurance through them for one year because it was so bad. I have spent countless hours trying to get bills paid.

• Initial Complaint

  Date:05/15/2024

  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.

  Date of Incident: 5/2/2024 Member ID: ************ When I received my membership card, I noticed the phone number for Clearwater Benefits was incorrect. On 5/2/2024, I found the correct number and contacted them. I explained the issue multiple times to the representative, who did not understand. I requested a U.S. representative, which took several minutes. The new representative was initially rude but became professional after I expressed my dissatisfaction. She said the information on the entire card was incorrect and would order a new one. I asked for a phone number to contact an office in the ** and she gave me the same number I had called earlier. She claimed it was a U.S. office and that the previous representative was new, which I doubted since the representative had a difficult time transferring and came back to the line a couple of times telling me he was trying to transfer the call.Concerned about future support, I called on 5/7/2024 to cancel my membership. The representative was professional and informed me I needed to give a 30-day notice, ending my membership on May 31, 2024. I asked to speak to a supervisor, and she said she would forward my request.On 5/8/2024, *******, ************* Team Lead, emailed me, stating he would try to expedite my cancellation. He notified me later He was unable to.Due to the incorrect information on my card, the poor handling of my issue, and the unprofessional treatment, I cannot risk staying with Clearwater Benefits. Given these circumstances, I should not be charged for **** and a refund should be issued. No claims were submitted during our membership.

  Business Response

  Date: 06/17/2024

  Upon  investigating and reviewing ***************** communications we were notified by *************** on May 2, 2024 the Member expressed that the ** card does not have the correct information. Member advice she called ************ and she is not able to get assistance for network status. *************** was advised ************  is the Clearwater customer service number and ************ is the **** customer support line to check if the provider is in the network. In speaking to the agent, there was a language barrier and *************** requested to speak to someone U.S. Based. In speaking to the U.S. agent *************** was dissatisfied with the level of service provided, and requested to cancel her plan. The cancellation request was submitted and communicated on May 8, 2024.*************** was on Advance Clearshare 2500. This plan requires a qualifying life event with a 30-day notice. After *************** spoke with a supervisor, the exception was made to honor the cancellation with a termination date of May 31,2024. Mrs. ****** plan was terminated, the last draft occurred on May 5, 2024 for **** coverage.

• Initial Complaint

  Date:04/02/2024

  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 have had insurance with Clearwater benefits for about a year and a half. I went for a routine doctor visit and labs and Clearwater has not covered or attempted to reimburse any amount of my appointment. I have called and followed up 12+ times, once or twice a month asking for assistance on next steps for this. NOT ONCE did someone tell me that my labs were not covered! I submitted forms that different Clearwater employees asked me to do, I called back when asked. NO ONE told me this for over a year - this resulted in my medical bill going to the collections department because I was awaiting the Clearwater team to assist me on next steps. It was brought to my attention in January that someone on your team did not send an email to me noting this and therefore it went to collections. I was then informed to submit a form for a special case and that they would call the collections company and ask for me to put a hold on it since it was in error. It is not okay, for over a year Clearwater to not inform their consumer of ineligibility for a bill that resulted in a ding to my credit and now is at collections. Please advise immediately,

  Business Response

  Date: 04/11/2024

  Dear *******,

  Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced.

  I have reviewed the information that you provided and determined that the claims and needs denial that you received is correct according to the Basic ClearShare 2500 plan that you are on. The plan that you are on requires an annual maximum of $2500 to be met before the ******************** shares in your qualifying medical expenses.

  All qualifying medical expenses submitted after the annual maximum is met are shareable with the ******************** at 100%. There is no annual or lifetime limit. You will not need to pay the annual maximum again until your new membership year begins, based on your original effective date. Additionally, you are only responsible for the annual maximum once each membership year. 

  If you have any further questions or concerns, please do not hesitate to contact us.

  Sincerely,

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

  Senior Manager of Compliance
  Clear Water Benefits

  Customer Answer

  Date: 04/16/2024

  Complaint: 21520197
  
  I am rejecting this response because: Routine doctor visits / labs do not require a deductible to be met.  It is absolutely ridiculous that no one from Clearwater can explain why this routine visit isn't covered.  My husband did the same routine visit and labs and his medical bill was reimbursed a couple of months later.  I have called and followed up so many times asking for assistance on next steps for this.  NOT ONCE did someone tell me that my labs would not be covered.  I submitted forms that different Clearwater employees asked me to do, I called back when asked.  NO ONE told me this for over a year and this resulted in my medical bill going to the collections department because I was awaiting the Clearwater team to assist me on next steps.  It is poor practice to not inform your consumer of ineligibility and the fact Clearwater is still not covering this invoice is unacceptable.  Please advise immediately,
  
  *********************************

  Business Response

  Date: 04/22/2024

  Complaint: 21520197
  
  Dear *******,
  
  I have reviewed your information again and can confirm that the doctors visit and lab that you had were not coded as a routine checkup by your doctor. This was the reason that we were not able to approve your claim/need.
  
  We have gone ahead and made an exception for you this one time to approve the claim/need. The payment has been made directly to your provider and you should be receiving a receipt of the payment made within 72 hours of 4/22/2024.
  
  Please note that this is an exception and under normal circumstances this should not have been approved based on the coding of the visit by your doctor. If this type of situation happens again in the future, the claim/need will need to follow standard procedure and an exception will not be made for payment.
  
  If you have any further questions or concerns, please do not hesitate to contact us.

  
  Sincerely,

  
  *****************
  Senior Manager of Compliance
  Clear Water Benefits

  
  

  Customer Answer

  Date: 04/23/2024

  Complaint: 21520197
  
  I am rejecting this response because: I spent 1 calendar year, calling every other week to seek guidance for the next steps. Not once did a single employee notify me that my labs/visit was not covered. For over year, I called - told to do something/fill out something else. In addition, a representative from Boomy Health noted that nearly 10 months later, an email was subject to be sent notifying me that it was not covered, but that email 'accidentally' did not get sent and the lab company sent my bill to collections. When I called again in ******************************************* that it was fully denied - Boomy health told me to fill out a special case form and it would be covered. It is not about the coverage of the health care at this point, it is the fact that nearly 12 months of speaking directly to representatives, the company failed to inform their consumer the correct course of action. 
  
  Regards,
  
  *********************************