ComplaintsforMolina Healthcare of Wisconsin

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Initial Complaint
10/17/2023
Complaint Type:
Product Issues
Status:
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.
I was supposed to receive a refund after I cancelled my insurance on August 8. 2023.Molina Healthcare was supposed to send me a refund of $311.20 by August 10, 2023.I never received my refund. My bank sent information to Molina Healthcare indicating that no refund was submitted to my account for the amount of $311.20 for the month of August 2023. I have been trying to work with Molina Healthcare to get my refund. They are not cooperating and still, two months later have not refunded my $311.20. Molina has not given me a certificate of creditable coverage indicating the termination date of my insurance. I am frustrated and angry at their lack of customer service. I have called them over twenty times with no results or refund.
Business response
10/27/2023
We have been in contact with the member and are working through the issue with him to his satisfaction, to be resolved in the next week or two.

Thank you-
***************************
AVP, Wisconsin Compliance Officer
Initial Complaint
06/13/2022
Complaint Type:
Product Issues
Status:
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.
I chose to switch to Molina after constant problems with my previous insurance. As of today l called them and was given the runaround basically. My ID number is unknown. I have not received my card at all. They promised to insure me and yet here I am without a card and I have appointments yet this week.
Business response
06/17/2022
Good afternoon:
Molina Healthcare of Wisconsin, **** (Molina) values the opportunity to respond to the BBB of Wisconsins Request for Information regarding the complaint submitted by Molina member *****************************.

Molina examined the contents of the complaint dated June 14,2022, and conducted an internal review of the information provided by ***************. Molina is in contact with **************** and is working with her to fully resolve the concerns that she brought forward.
Thank you-

*******************
Compliance ******** ******************************
Initial Complaint
04/13/2022
Complaint Type:
Sales and Advertising Issues
Status:
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.
I had called Molina Healthcare about a discrepancy in information given: I had called to ask if a clinic was in-network or out- of network at the end of October. I was informed by the representative that the clinic I was going to make an appointment at was in-network. 5months later I had received an EOB (explanation of benefits) stating that the clinic I went to was Out-of-network. I called Molina on March 31st to work out the issue. The representative confirmed that the previous representative from October did in fact give me incorrect information. The representative on March 31st filed a complaint for me and said someone would be contacting me. On April 12th, I had a representative from Molina Healthcare call me about a HIPPA violation. I had not reported the issue nor do I know who did. On top of the terrible communication made by Molina, I am now worried that there has been a HIPPA violation made against me without my knowledge. These are the larger issues I have had with Molina. This grace **************** by representative on Oct 29th, not only could end up costing me thousands of dollars but has possibly lead to a HIPPA violation that I am not being made fully aware of.
Business response
04/21/2022
Good afternoon:
Molina Healthcare of Wisconsin, Inc.(Molina) values the opportunity to respond to the Better Business Bureaus Request for Information regarding the inquiry submitted by Molina member *******************************.

Molina examined the contents of the complaint and conducted an internal review of the information provided by ****************. Molina has been in contact with **************** and has successfully worked with her to fully resolve the concerns to her satisfaction that she brought forward.

Thank you-
*******************
MHWI Compliance Officer
Initial Complaint
03/15/2022
Complaint Type:
Billing Issues
Status:
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.
Please tell Molina of WIsconsin that I'm am tired of harassing mail telling me I owe them money. I have not had insurance since 2020. I tried to have them as my insurance in *** of 2021 but they never accepted my credit card payment so I have been trying to quit them since. (My credit card company reversed that charge.) I think Molina ignores the first month payment received so they don't have to cover new patient visits because they did the same to my son.They sent me a **** for $344 at the end of 2021 for *** through December. I had different insurance starting in August after not having any for ***-July because Molina wouldn't acknowledge my first payment. But they keep billing like the PREDATORS they are.I am now getting bills for 2022. On my February 'statement', they tell me I am past due. I have other insurance. I'm sure they scare plenty of people into paying.I will be eligible for ******** in July. So it would be illegal for me to try to have ACA insurance.Please tell them to leave me alone. I owe them nothing.
Business response
03/25/2022
Good afternoon:
Molina attempted to reach **************** by phone, however to date we have not received a response. A letter was mailed today to **************** informing her of our findings.
Thank you-
*******************
MHWI Compliance Officer
Initial Complaint
03/13/2022
Complaint Type:
Product Issues
Status:
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.
My Member ID with ********************** is **********. The claim ID in question is ***********. The date of service in question is 11/09/2021. The procedure is ***** - Hospital -Outpatient. The procedure received prior authorization from Molina. The *** dated 01/01/2022 (attached) showed that the allowed amount was $500.61, and that my Copay amount was $500.61 (with Molina paying $0 on the claim). $500.61 as a copay does not make sense when I look at my policy. On 2/10/2022 (10:28am CT), I spoke on the phone with ***** who could find no reason why Molina would pay $0 and I would have a copay of $500.61. ***** assured me that the claim would be reprocessed. My call was then transferred to what ***** said was the claims department but was actually a different company (a financial institution that processes ETFs for Molina). I called back Molina a number of times, but the representatives offered me no further assistance on the matter. After phone calls proved unsuccessful in further resolution, I emailed Molina. I received an automatic email response ensuring me that I would receive communication within 24 hours (attached), but I never received a response from Molina. The lack of follow through and direct communication from Molina is unacceptable. I request that the $500.61 be payed in full by Molina.
Business response
03/22/2022
Good afternoon:
We have reviewed the correspondence from **************** and have made attempts to reach her to further discuss via telephone without success. Consequently and to ensure closure, a letter of explanation will be mailed to her this week regarding the issues she raised.
Thank you-
*******************
Compliance ******** ****************************
Initial Complaint
12/03/2021
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Molina Healthcare Marketplace plans advertise that ******* ************* services are at no cost to its members yet they are continuing to deny claims as "out of network" saying that the doctor that responded to your request for a virtual visit was out of network. You as a member do not have control over who answers your request for a virtual visit. I called on 12/3/21 for one hour to ****** Services to ask for re-processing and was transferred three times to ******, **** and one other girl who was working from home. I listened to their chickens cackling into the phone, ****'s cat meowing into the phone and ****** say she can only take requests from providers to re-process claims. **** asked for our SSN's and I told her that she is working from home in an insecure location and that I would not provide that but would provide the ****** ID number and she would not help so I asked for her Supervisor and she hung up on me. Here is the link to their website where they advertise "no cost to you visits via *******":https://www.molinamarketplace.com/Marketplace/WI/en-us/Individual-and-Families/Services/virtual-care/Get expert care from the comfort of home from Teladoc, 24/7. As a Molina Marketplace member, you receive this benefit at no cost to you!DENIED CLAIM Example: Claim id *********** I expect this and all other denied claims for ******* services by Molina to be reversed from my account and all other Marketplace ******s. A full investigation needs to be preformed on their fraudulent advertised practices.
Business response
12/13/2021
Good afternoon:

Please be advised that Molina Healthcare of Wisconsin (MHWI) has been in contact with Ms. ***** We are currently working with her to fully resolve the concerns brought forward.

Thank you-

*******************
MHWI Compliance Officer
Customer response
12/14/2021
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

They have left me two voicemails to call them with NO details and that is it on 12/13/21 and 12/6/21. I have NOT and will NOT communicate via phone with them since they wouldn't resolve my issue via phone and made me file a grievance via certified mail in order to get claim re-reviewed. They need to respond in writing for legal purposes to myself, the BBB and the *** just like they made me provide my appeal in writing. I want proof in writing that claim was reviewed and re-processed as their words over the phone are not trustful. I also expect a full audit on all members claims on who else they did this to for Teledoc claims and those claims should also be re-processed. A class action lawsuit can be expected if all member claims for Teledoc are not reviewed and paid as advertised on their website. They advertise FREE Teledoc to their members and have denied claims stating the doctor that responded to the request for virtual visit was "out of network". As everyone knows, you do not have control over what doctor answers that virtual visit on Teledoc. Molina even provides the link to dial right in for your virtual visit on their member site. This is a fraudulent practice by Molina.

Regards,

***************
Business response
12/23/2021
Good morning:

Molina Healthcare of Wisconsin has reviewed the message from Ms. ***** Ms. **** has also sent a similar letter to the **** we are in the process of answering that inquiry today. In the interim, we have made attempts to contact Ms. **** and have left a voicemail for her but have been unsuccessful in reaching her. Recently, a letter was mailed to her on 12/18 that addresses her concerns.

Thank you-

******************* AP, Compliance, WI Compliance Officer
Customer response
12/23/2021
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

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.

I hope that in the future they implement a process to upload the Teledoc physicians into their system timely before processing claims and rejecting them as not in-network. They should also update their customer service representatives so that they know how to respond and get the claim reprocessed rather than tell the members they needed a prior authorization for a free service offered by Molina. I assume that all claims for other members were reversed and looked at as well.
The customer service from in-home employees at Molina has been completely unacceptable (answer calls from her chicken coop, allowing cat to meow into phone, etc) and asking for SSN while working in an insecure location is also not appropriate when you have a member id number.
Please fix your processes and customer service. A customer should never have to go to such lengths to identify a major breakdown in your system in virtual visit claims and customer service provided by ********************** **************** Representatives.
Thank you for your attention to this matter.

Best Regards,

***************
Initial Complaint
09/02/2021
Complaint Type:
Order Issues
Status:
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.
on January 6, 2021 I went to the Cancer and hematology Center of West Michigan. and had a Medical treatment of over $14,000. The cancer center has a Grant that picks up and deductible associated with the medication. This covers all but a few hundred dollars of my $8,550 out of pocket deductible. However, Molina decided to reverse, readjust, reverse, readjust...this bill. This caused other bills from later in the month and throughout the year be billed to me, that should be totally covered by the very first doctor visit through the year. I even had a letter from Molina telling me not to pay a bill for over $1700 from January 15 & 18th dated April. Then at the end of July I get another letter saying I did owe these bills. They need to go back, and do the right thing. that first bill From January 6th covered my total deductible for the year. I do not care what they do internally, paper shuffle... It does not involve me on my end. I am only responsible for that very first bill of the year
Business response
09/09/2021

On behalf of Molina Healthcare of Michigan, I am responding to the complaint initiated by a member on 9/2/21. Due to HIPAA requirements, we will not disclose personal health information (PHI) in this public response. Molina will have a dedicated representative directly contact the member to resolve this concern and answer any questions. Thank you for the opportunity to address this issue.

Thank you,

Sarah

Sarah DeCaussin CPC, CPHQ

Director of Compliance MI

Molina Healthcare, Inc.

947-622-1062
Customer response
09/14/2021
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Regards,

******* ****
Initial Complaint
08/18/2021
Complaint Type:
Product Issues
Status:
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.
I bought a policy from Molina on the healthcare exchange in 4/21. On 4/28/21 I followed an online link & made my 1st payment of $44.08. On 5/31/21 I tried to make an online payment and couldn't because I had no membership card/number. I called Molina on 5/31/21 & 6/1/21 & was told they were waiting to receive my information from the exchange & to check back in 2 weeks. On 6/19 I received 2 emails indicating that Molina had "received my application" & instructing me to make a payment. I called on 6/28/21 & paid $44.08. I was told my membership # would be generated in 24 hours. Called again on 7/7/21 & was told it would take 3-5 biz days to process. Called on 7/20 & 7/27 both times told it was "escalated to a *********** *** would hear back within the week. Paid $44.08 by phone on 7/27/21. Called on 8/18/21 was told it was "escalated to a supervisor in processing" on 8/16/21. Asked to speak to the supervisor, told they didn't have his name. Been 3 mos. I still can't use my insurance
Business response
08/27/2021

Dear **************:

Molina Healthcare of Wisconsin, Inc.(Molina) values the opportunity to respond to the Better Business Bureau of Wisconsins Request for Information regarding thecomplaint submitted by Molina member *****************************.

Molina examined the contents of thecomplaint dated August 18, 2021 and conducted an internal review of theinformation provided by ******************. Molina is in contact with ****************** andis working with her to fully resolve the concerns that she brought forward.

BBB Resolution
Ms. Spenceris currently active with no restrictions.

Conclusion
Thank youfor bringing the complaint to our attention. Forquestions regarding the letter, please contact Molina at **************.
Sincerely,
*******************
Associate *************** ** Compliance Officer
Molina Healthcare of Wisconsin, Inc.
Initial Complaint
07/09/2021
Complaint Type:
Billing Issues
Status:
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.
I have diligently and prudently paid $892 a month for healthcare with Molina, that amount was paid 4x (Jan-April) Then I became eligible for a premium reduction thru the American Recovery Act. Was told by my health advisor that the new premium for *** would be $211. Here is the key, Molina generated the *** invoice (for *** coverage) on April 2nd for the OLD amount of $892. My plan amount then changed about a week later and I paid the new lower amount of $211 near the end of April. I attempt dozens of calls to Molina debating this and asking for an "adjustment" My advisor has tried too. The first reason Molina gave was a "new computer system" and was assured it was be dealt with. I have escalated the issue and emailed in copies of credit card statements. I did this on **** and told it would be 3-5 days. Next I was told it was resolved but no reason or communication was made. Yesterday I had to send it all in again. Coverage is now terminated. I paid for July-$211!
Business response
07/20/2021
Hello:

This is to advise you that we contacted the complainant on July 14 and resolved his issues with his coverage with Molina.

We appreciate the opportunity to address this matter.

Thank you.

Sincerely,

*******************
AVP, MHWI Compliance Officer
Initial Complaint
06/01/2021
Complaint Type:
Customer Service Issues
Status:
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.
My husband was added onto our Marketplace Molina Healthcare beginning of May. I've called several times to obtain a medical card for him and also to see why he's not listed on the website when I go to my insurance page. He's covered according to the premium that they take out of my account, they obviously don't have an issue with taking payment. Also Marketplace says he's covered. I've called several times, and I receive the same information....they are updating their computer system. My husband has heart issues and is unable to make an appointment because Molina says he's not covered. As of today, I was on hold for an hour and 6 minutes, then transfered and hung up on. I'm attempting again, as of now, I've been on hold for 1 hour and 16 minutes. I suggest anyone looking to have coverage thru Molina, move on to another company.
Business response
06/10/2021
Thank you for the opportunity to respond to this inquiry.

Molina has verified and communicated to the complainant regarding coverage for her husband to her satisfaction and has mailed the necessary documents on June 1, 2021 as she requested.

Molina Healthcare of Wisconsin strives to support its members and providers with the highest quality of health care, deliveing business services with a commitment to excellence.

Thank you-

AVP, Wisconsin Compliance Officer

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