ComplaintsforAcademic HealthPlans, Inc.

• Initial Complaint

  02/09/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I am a student at MUSC and covered under the student healthcare plan. AHP manages our BCBS of SC coverage. I had a baby in May and signed her up for coverage well within the qualifying event time. I paid the premium and assumed that my dependent would be caught up to my enrollment period. The payment only covered two months of coverage and my daughter was dropped from coverage with zero notification, which is illegal according to the Department of Health and ***** Services (*************************************************************************************************). The only documentation that showed a date ending coverage was the receipt of payment. I found out months later that she was uncovered when I received an outrageous bill for a basic check-up. I immediately contacted them in November and they basically said they'd be happy to get my daughter covered starting in January (the open enrollment). Keep in mind my coverage is still active and I have never missed a reenrollment period. When I brought up that there was no notice of dropping an infant from coverage they did not seem concerned in the least. After weeks of me contacting them and threatening legal action, they made an exception and offered to add her back onto coverage and to backdate the coverage. At this point, I had already rushed to get her onto my husband's healthcare plan and was incredibly disappointed at the lack of urgency. I also still had thousands of dollars in medical bills when she was uninsured that should have been a simple co-pay. Thankfully, my provider discounted some of the bills and adjusted it, but I still have a balance of $595 that I would like AHP to cover since if I had been notified she would have been covered during this time or I could have gotten her vaccinated at the health department for free.

  

  Business response

  02/11/2024

  She enrolled herself and not her child during open enrollment for fall 2023.
  On November 29th (ticket ******) we offered to allow her to add her child to coverage for fall. - Attached

  She declined. She said she had other coverage.
  
  (same ticket ******, her response)-Attached

   

   

  
  

• Initial Complaint

  01/30/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I purchased multiple coverages at once and was only given a receipt with the total charge, not an itemized receipt. I need an itemized receipt for reimbursement purposes. I have requested an itemized receipt multiple times over the course of weeks and still have not received one. I have only been permitted to speak to employees who do not have the authority to provide this, but that have constantly assured that they have escalated it to employees who can help me. It sounds as though none of those capable employees care to take the time to fulfill my request. I have not been permitted to speak to any of them directly. I have been provided the same non-itemized receipt multiple times, which leads me to believe that some employees may not even be reading my explicit request.

  

  Business response

  01/30/2024

  We apologize for the delay in producing the requested receipt. Your request had been forwarded for prioritizing a system enhancement for producing additional details. Your receipt was emailed yesterday (1/29/2024). Please note the receipt indicates the family purchase and as such, there is no additional detail as the product is priced as described by the plan.

  Thank you and our apologies for the delay.

  Customer response

  01/30/2024

  Complaint: 21217226
  
  I am rejecting this response because: There is a cost associated with the coverage for one individual. For example, what would be the cost for that individual without the addition of another dependent? 
  
  Regards,
  
  *************************

  

  Business response

  01/30/2024

  You are correct, there is a cost for student only coverage however, you purchase was for the family plan. The description should read should have said Family(2+) and is being corrected for future receipts. Since the coverage for Family (2+) is for all individuals, it is not possible to provide individual amounts. It would not be completely accurate but you could use student only pricing to get relatively close and those costs are available on the website *****************************************************************************

   

• Initial Complaint

  01/17/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I am filing this complaint in regards to AHP delay in transferring my enrollment to my insurance company AND lying to me about it on the phone. I need my antidepressant, I am in medical school, and we have a huge storm approaching. This is just unacceptable, this happened last year as well. They state 5 business days is how long it will take. I paid for this last Wednesday. I am utilizing this instead of utilizing the court system but I am not going to compromise my own health because of a company slowly moving sending my enrollment. My insurance company is Wellfleet. I have included my receipt here, and I want this taken care of today. I do not pay $1269 to deal with this pathetic behavior. I will also click the option on this BBB complaint that "I am willing to speak with the news/media."

  

  Business response

  01/18/2024

  The student submitted the order on 1/10/24 for the spring coverage.  The information was sent to ********* on Friday, 1/12/24, per the file schedule (Monday/Wednesday/Friday mornings).  Monday, 1/15/24, was a non-working holiday for ******************************** Day.  We expect Wellfleet to process enrollment within 5 business days; today is business day 3.  This morning we requested Wellfleet to pull and manually process this students enrollment urgently due to the need for medical care and treatment.  They completed that and confirmed active coverage.  An email was sent to the student earlier today to confirm coverage and provide the ** card.
  
  This student did submit multiple inquiries to us and different reps pulled those tickets to reply and as a result there is some duplicate communication between us and Wellfleet and us and the student. Ultimately, the coverage is active today with ** card in hand for the student. 
  
  On a related note, this student is sent email notifications to advise of the upcoming need to renew coverage if applicable.  These notifications are sent 30 days prior to the renewal date which was December.  Coverage ended on 12/31/23 for this student and the enrollment wasnt submitted until 1/10.  For this student,knowing he needs medication refills and that it can take 5 business days to show active coverage, seems he would be more motivated to submit the enrollment sooner.   We recommend not waiting until coverage has expired to re-enroll in the future.

  Ultimately, we are glad you were able to obtain the care you need and are always here to assist.

  Thank you!

• Initial Complaint

  12/12/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am a disabled student who receive ******** as my primary insurance and ******** as my secondary insurance. Despite the fact that my school - Southern ******** University ************ (****) - has my medical information already I was notified that I am now required to create an account with "**********************" and provide them with my insurance information OR ELSE I will be automatically enrolled in an insurance plan that I neither want, nor need, nor can afford. I believe that my rights are being violated here since forcing me to disclose my medical information OR ELSE be charged nearly a thousand dollars is literally extortion. I've never heard of a company that has even tried to charge a student for refusing to providing personal information before.

  

  Business response

  12/12/2023

  Thank for reaching out to explain your concerns. As the document you shared indicated, your student status requires that students have insurance and if they do not, they will be enrolled in the universities selected student health insurance plan. Additionally, the letter explains that if you have other insurance, you may submit a waiver showing that you have appropriate coverage in which case, you will not be enrolled in the student health insurance plan.

  Since you state that you have both ******** and ********* you need simply to submit a waiver in the time frame requested to avoid being enrolled in the student health insurance plan. Your waiver request can be submitted  for review and acceptance by going to ********************************

  In order to get the best support, please contact us through the "Get Help" link on the ******************************** website.

  Thank you,

  Academic HealthPlans

   

• Initial Complaint

  09/19/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  AHP shows my policy coverage as active, but BlueCross BlueShield has no record of my enrollment. I have requested a customer service callback to resolve the issue and have also spent hours on hold with no response. The on hold message always goes from saying my wait time is over 10 minutes to saying my wait time is 2 minutes, but, on multiple occasions, I remained on the line and could not reach a representative. Even after waiting almost 2 and a half hours, I cannot get a response. I still have not gotten a call back or any email reply.

  

  Business response

  09/20/2023

  Had a service agent call the student and left a message. When the student returned the call, he explained he was on hold for several hours over the past few days and was frustrated.  Yesterday he was on hold for 3 hours. I apologized and told him that was not how we wanted our clients experience to go.  He was able to retrieve the membership cards requested through the BCBSTX system showing he has active coverage.  He was very nice and said he would retract or comment on the BBB complaint that the issue was resolved.

  Upon further research in our support system, the students prior request for a call back was found from earlier the same day. A call was returned however, the student was not reachable.

  We know how valuable our student members time is and we strive to make the enrollment and access to benefits processes as simple and quick as possible. We apologize for the delay and inconvenience that resulted in this encounter and are working to provide the very best support as students enter into this busy fall season.

  We wish you all the best and thank you for bring this matter to our attention.

  
  

• Initial Complaint

  09/07/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I enrolled my two sons for my policy through AHP as a graduate student employee at at ***** University last week. I called my HR, and I my policy was activated immediately as we all needed medical care. This week and last week I have tried to contact AHP 7 times with no response. The wait times are hours, if you press 1 to get a call back, they don't call. I have to take my sick child to the doctor tomorrow and BCBS is waiting on a file from AHP to activate my kid's policy. I have to pay out of pocket on a master's student salary, then file for reimbursement. All of this has cost me time and money I don't have. The loss of work time will impact meeting my graduation milestones, and the money will cost me being able to pay my other bills.

  

  Business response

  09/08/2023

  Thank you for bringing your concern to us, we take every inquiry very seriously. Upon investigating your recent enrollment we find that there were two enrollments for the student, one performed by the student on 9/1 and one performed via list enrollment by the university on 9/5. The later enrollment cancelled the first enrollment, which included the dependents cancellation as only one enrollment can be active per enrollment period. The enrollment from the school was received on 9/5, processed and transferred to the carrier on 9/6; one day processing. 

  Our records also indicate that the student left one call on 9/5 at 11:17 am with our service line requesting a call back. A call back to the student was placed the same day for which the student did not answer and a voice message was left.

  AHP reset the dependent enrollments that were cancelled due to the double student enrollment on 9/7 and discussed the status of the enrollment and access to benefits that were now available for the student and both dependents.

  Under normal circumstances, please allow 3-5 business days for enrollments to be verified, approved, and processed by the insurance carrier.

  Thank you for giving us the opportunity to serve and we wish you all the best as you pursue your educational goals.

• Initial Complaint

  08/28/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I am a student currently enrolling for graduate school. For the past several weeks I have been fighting with AHP in order to have them accept my employer insurance rather than pay for their insurance through the university. Their website clearly states that that they require a copy of the front and back of my insurance card. I provided that on August 8th. They then changed their request, asking for a letter of coverage stating that my insurance coverage is currently active. I provided that documentation on August 15th. 10 days later on August 25th the rejected that documentation and now are asking for a multipage document of my entire coverage including ALL benefits and ALL exclusions. I called my insurance company, Community First Health Plans, and they are unaware of such a document existing.Over the past week I have taken time off from work to call AHP on multiple occasions. I have left my number with their call-back service three times. I have never received a call back and have never been able to speak with a representative. The deadline for acceptance of insurance coverage is September 15th but I have little hope that I will resolve this issue with AHP by then. I am now at risk of being charged an additional $1,315 or will be forced to withdraw from my graduate school program. This is a very simple issue and AHP has been the antithesis of helpful in reaching a solution.I will continue to call AHP but I have no expectations that I will receive any help from their business without escalating an organization like BBB.It is appallingly unprofessional to move goalposts on students like this in order to make a cheap extra buck.

  

  Business response

  08/29/2023

  According to our investigative research on the matter, the requested waiver has been approved. Below are the timeline of facts regarding the submission and approval process.

  The student provided documentation dated 8/15/23 confirming active coverage.  Documents currently in the waiver have 8/26 submission date.  This was either the first time the student submitted what we needed to verify coverage or they were submitted on 8/15 and rejected and then resubmitted on 8/25.  The waiver ahs been approved according to the latest proof of coverage submission.
  
  Chronology:
  8/8 - Student submitted waiver
  8/9 - AHP - Unable to verify via Zirmed. Requested LOC
  8/15 - Student submitted dont see what they attached, if anything
  8/25 AHP Requested full policy
  8/26 Student submitted documents sufficient to confirm active coverage and verify plan.

  We hope this helped explain the situation that was experienced and provides and explanation for the final audit result.

  Thank you for your patience in providing the required documentation.

• Initial Complaint

  08/18/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  ********* member ********* / AHP member id: ********. I paid for dependent coverage several days ago but dependents still show up as pending instead of active - no one calls back and no one answers the telephone after hours despite being #1 in the queue. Tried to use chat but that shut off as I was entering info and never reappeared again. I contacted the carrier and they are waiting for AHP to send a file showing dependent coverage has been paid and active. WANT: Dependent Coverage activated and some customer service would be nice too. Expect a lot more complaints about this company in the future. My dependents need medical treatment and providers will not schedule without active insurance in place.

  

  Business response

  08/20/2023

  Our review of the matter confirmed this student is enrolled in the ********* carrier system. The school added this student via the urgent add process rather than the normal enrollment process and timeline. After the student was added, the student purchased coverage for her dependents through the normal process.
  
  This coverage was active 48 hours after the urgent enrollment was completed for the student and dependents. The issue was the dependents did not get sent over for an urgent add. ********* has now received an urgent add request and has added the dependents, but their cards will not be ready until Monday. We can provide the dependent ID numbers that can be used until Monday.
  
  We were not able to locate any prior request for assistance by this student however, our customer service lead will reach out to the student and provide her with dependent ID numbers and a copy of her own card.
  
  Lastly, we do not get a notice to approve or review enrollments that are submitted directly to the carrier through the enrollment system when it is completed by a school admin but being notified there were concerns with an enrollment and ID cards gave us the opportunity to address the matter and ultimately provide the results the student was looking for.
  
  Please let us know if you there are any further questions or concerns.
  Thank you,

  Customer response

  08/21/2023

  Complaint: 20487042
  
  I am rejecting this response because: The explanation does not address the issues. To obtain dependent coverage, i was directed to the *** portal by link, I added dependents and paid the premiums. There is no option to mark as urgent or regular, nor should there have to be - cards should populate upon receipt of payment, or soon thereafter. The response does not adequately explain why No one answers the phone or chat. After being on hold for several hours when a message tells me I am number 1 in the queue leads me to believe that something is wrong with the customer service department.

  To their credit, the business did reach out since my complaint, and we will wait to see if those cards arrive or not
  
  Regards,
  
  *************************

  

  Business response

  08/22/2023

  Based upon the last comments, the student was contacted and the dependent enrollments were collected and provided to the plans insurance carrier. We apologize for the customer service connection issues but have every confidence that the coverage benefits being sought have been made available.

  We also want to provide assurance that while this is the busiest time of year for fall enrollment nd waiver processing, we understand your frustration and are working hard to be as responsive as possible to all inquiries.

  Thank you for your prompt and candid feedback

  Customer response

  08/22/2023

  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.

  We received our insurance cards yesterday. The nature of your plan is dependent coverage and I can appreciate how busy you must be at the beginning of a semester - this should be a regularly occuring event (twice yearly) and one that you should be prepared for. My family has received the cards we needed to to receive medical care, therefore we consider this matter resolved. We hope you can make service improvements in the future to avoid future complaints.
  
  Regards,
  
  *************************

• Initial Complaint

  08/15/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I am a medical student with my own insurance and I'm trying to wave my university health plan. I have had the same insurance for years and I've gone through this process multiple times. Although my insurance has not changed, and I provide the same information each time, my waiver requests get denied about 50% of the time.In the last few days I have submitted 3 waiver requests in response to incorrect denials from Academic HealthPlans. Although my insurance card and correct information was uploaded during the first request it was denied (the same exact info has been approved on other occasions) and I was asked to upload a separate document showing proof of coverage from my insurer. I uploaded that document and the waiver was again denied incorrectly and I received another request to upload the same document. I waited for over an hour yesterday to speak with a customer service rep via chat, and when I was finally connected with somebody they disconnected from the chat before providing me with any information. This morning I again contacted customer service via chat. I was connected with someone in less than *************************************************** a professional manner, she was unable to provide any assistance. My waiver deadline is in 2 days. If this isn't resolved I will be charged a lot of $ for insurance I do not need. I would also like to point out that on multiple occasions in the past when Academic Health lans have arbitrarily denied my waivers and extended the process right up until the deadline I end up with the University Health Insurance associated with my name, this prevents me from getting prescriptions filled since the pharmacy attempts to bill the wrong insurance. I would sincerely appreciate it if somebody at Academic HealthPlans could approve my waiver and explain to me why my waiver requests get denied 50% of the time despite the fact that my insurance hasn't changed and I always submit the same info???

  

  Business response

  08/15/2023

  Thank you for bringing your concern to our attention. After researching the sequence of events and the materials provided, the waiver request provided sufficient information to confirm with the insurance carrier that the provided benefits were sufficient to approve the waiver. Additionally, we found that additional training would have prevented the confusion you experienced and as such, we are enhancing our training program and taking steps to prevent this from occurring again in the future.

  Thank you again and our apologies for the delay in processing your request.

• Initial Complaint

  08/10/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  My daughter attends ******************* and has insurance under me. The insurance card with copays listed was submitted last year through their site and waiver for the school health insurance was accepted without policy requested or needed. This year the same insurance card was uploaded, which should be accepted for a waiver. Recently, after uploading her alternate health insurance card in July 2023, a third party company, Academic Health Plans, requested on 8/2/23 that she also needed to upload our entire health insurance policy. This is a privacy and possibly a HIPAA violation, as well as a conflict of interest on their part since it's in their best interest to not accept waiver, so they can sell/charge for their insurance. I have tried repeatedly to to call this company multiple times with being on hold for over an hour with no call back from a live person, only getting email with no reply contact email requesting the policy again. There is no email address to contact anyone. *************** with my lawyer and Better Business Bureau. The waiver should be accepted with the insurrance card already provided to the school. The number on the back of the insurance card verifies the insurance. Thank You,*****************************

  

  Business response

  08/15/2023

  Dear ********************,
  
  Please find the below response in regard to the above inquiry.
  
  ******************** submitted the waiver on 7/25/23 and it was approved on 8/14/23. Below is the timeline of events:

  
  7/25/23 ******************** submitted original waiver request with 2 copies of the back of the ** card. The auditor could not see the front of the ** card to see if this was an employer plan. Our clearinghouse was not able to verify this was an employer plan or marketplace plan.
  8/2/23 The auditor sent a request to ******************** requesting a full policy in order to determine if the policy met the requirements set out by the school.
  8/12/23 ******************** resubmitted the waiver with the Summary of Benefits
  8/14/23 The auditor reviewed the additional information and was able to approve the waiver. ******************** was advised the waiver was approved.

  
  Please let us know if you have any questions or need anything further.

*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. ↩