Complaints

This profile includes complaints for Merchants Benefit Administration's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Merchants Benefit Administration

  18700 N Hayden Rd Ste 390 Scottsdale, AZ 85255-6790

  
• 

  Merchants Benefit Administration

  13840 N Northsight Blvd Ste 101 Scottsdale, AZ 85260-3665

  

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:11/01/2024

  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 went to the New York State of Health. N.Y. *** I talked to the representative telling that I needed health insurance First Health, I told him I needed health insurance, he sold me a PPO 80/20 for $393.99 monthly, they took out $408.99, They sent me an ID card membership #********* OptiMedHealth. I went to use the card and it's not health insurance. I called up and they assured me yes I have health insurance. Went to their site and downloaded the benefits, it is a joke. I called and talked to supervisor and stated what transpired and he told me it is not that type of insurance. It is not a 80/20 PPO. This was completely a misrepresentation of what they told me I was buying

  

  Business Response

  Date: 01/29/2025

  Good Morning,
  First and foremost, I sincerely apologize for the delay in responding to your inquiry.

  After reviewing your account, it appears that you canceled the policy during the "look-back" period. This means the policy was never effective, and you should have received a refund by this date. If you have not yet received it, I will be happy to investigate the matter further.

  I regret that the policy did not meet your needs. This plan is a Limited Medical Indemnity Plan, which provides fixed reimbursements for specific services. It should not have been presented as an 80/20 PPO plan. While it does utilize the First Health Network, it differs from a traditional PPO plan in that it offers limited medical benefits.

  Please let me know if you are still awaiting a refund, and I will promptly look into the issue.

  
  Best regards,

  Theo|Director

  MBA Inc

• Initial Complaint

  Date:08/13/2024

  Type:Customer Service 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.

  purchase health ins through this organization and tried to cancel it. called and they said they had no record of me on their system and was transferring serveral times. Asked for the phone number they were transferring me to and tried calling that number and it said the number was no longer in service. I have received a benefit card from the company with member id. I would like to cancel this service.

  

  Business Response

  Date: 08/14/2024

  Dear **************,

  Thank you for reaching out to us regarding your concern. However, it appears that your request has been misdirected towards MBA, ***** Please note that MBA, **** does not engage in the sale, enrollment, or collection of premiums. Our role is strictly as the plan administrator, and we are responsible solely for processing claims.

  To proceed with canceling your policy, you will need to contact the agency through which you enrolled:

  Optimed:
  **********************************
  ***************************
  Phone: *****************
  Email: ******************************

  I regret that we are unable to assist you with your cancellation request, as it falls outside our scope of services. We appreciate your understanding in this matter.

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

• Initial Complaint

  Date:07/19/2024

  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.

  On 1/15/2024 I had started the process of having 5 crowns replaced. My dentist submitted a claim for $8,688.00 to MBA for NCD (member # *********) to cover the expense of this procedure. MBA has processed and reprocessed this claim 5 times and we are on the 6th time now. I have contacted them on numerous occasions on what the timeline and requirements for resolution are and I keep being given excuses as to why the claim in being reprocessed and that I need to give them ************************************************************************************************** the next week and a check would be issued. None of the statements they have made to me have come to fruition. We have escalated this to several supervisors for resolution and all I am told is they are escalating it with the back office (man behind the curtain I am assuming). I have also contacted NCD to get involved with the resolution of this claim and nothing has been resolved to this point. If someone can help get this claim paid immediately it would be greatly apperciated.

  

  Business Response

  Date: 07/22/2024

  Good Morning,

  
  Thank you for bringing this to our attention. Upon reviewing your claim for $8,688.00, we found that it was initially processed and paid to the provider on 05/28/2024. However, it appears that the payment of $4,181.00 did not reach the provider. We have since reprocessed the claim to reissue the payment.

  Your claim was delayed once due to incomplete Coordination of Benefits information we received from the provider. Once we received the necessary information, we proceeded without issue. The payment of $4,181.00 is now scheduled for processing and should be paid on Thursday, July 25, 2024. At no time did we attempt to withhold payment or request multiple pieces of information beyond the full payment details from your primary insurance. Your claim is currently in process for payment and was only temporarily delayed due to the initial incomplete information provided about your primary insurance.

  If you have any further questions, please contact us directly. There are no issues or concerns regarding the services rendered.

   

  Customer Answer

  Date: 07/23/2024

  I am not satisfied with the response that the check will be mailed on 7/25/2024 (yet another delay. According to the claims processor the claim was approved on 5/28/2024 and the provider or I have not seen any funds to this point. Once again this is a delay tactic this issue will not be resolved until the funds are in my hands or the providers. It should not take over 60 days for the funds to me issued once a claim is approved.

  

  Business Response

  Date: 07/23/2024

  ************, 

  While I understand you do not accept this process, it is the process we follow. I would like to clarify that we work with a separate payment company that processes claims for payment every Thursday. The payments are then issued the following day. Unfortunately, there is no alternative to this established process.

  I have thoroughly reviewed your claim and the associated payment. I can confirm that the payment will be mailed out on Friday and should be received by your provider via **** shortly thereafter. Once the payment is issued, I will be able to provide you with the check number for your records.As mentioned in my previous response, a payment was issued in May but was not received by your provider. We are required to send the payment directly to the provider as per the submission details of your claim for services.

   

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

• Initial Complaint

  Date:04/16/2024

  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.

  On December 27th I had pelvic pain and called Mandy ************ to sign up for an insurance where I would be able to go to the ** for care. He told me that he would sign his mother up for this insurance, and since I was doing it over the phone, I trusted him. He told me to wait till midnight and go. So December 28th I went to the **, ended up finding out I was pregnant, fast forward to January 13th I had to go back to the ** with abdominal cramping and had to go into emergency surgery for an ectopic pregnancy. Now, I did know maternity wasnt covered in my plan, however not once did I see that specialty. ***** told me ** visits and outpatient visits were covered, told me how many specialty visits I had and how many PCP visits I had and that 70% of everything was covered. He lied to me. At a vulnerable moment I trusted this company and they scammed me. Now I am getting billed 23k for a surgery I wish I never had to have. When I try to resolve with the claims department all they tell me is "your plan didnt have maternity." As if I chose to have to go to the ** with an ectopic pregnancy. I want my money back or Dec through March and I want at least the two ** visits covered.

  

  Business Response

  Date: 04/17/2024

  Good morning,

  I would like to respond more thoroughly however, I show your account is still active, are you wishing to terminate the account in addition to a refund request?   Please advise me of your response and I will be able to respond more appropriately. 

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

  Director of Claims & Provider/Member Services

  MBA, Inc

  Customer Answer

  Date: 04/17/2024

  I am trying to respond to them. 
  

  I canceled yesterday, and they told me I would get a confirmation email and I never did. Also whoever answered hung up on my face. 
  

  please cancel my policy 

  Customer Answer

  Date: 04/17/2024

  I am trying to respond to them. 
  

  I canceled yesterday, and they told me I would get a confirmation email and I never did. Also whoever answered hung up on my face. 
  

  please cancel my policy 

  

  Business Response

  Date: 04/18/2024

  Dear **********************,
  
  I sincerely regret any distress youve felt regarding concerns about being scammed, and I appreciate the opportunity to clarify the details of your insurance coverage from December 28, 2023, to January 24, 2024.
  
  Your MedFirst 1 plan, effective as of December 28, includes a 30-day waiting period for sickness claims, as detailed in your plan documents and the attached Breakdown of Benefits. Unfortunately, your Emergency Room visit on the plan's start date fell within this period, which concluded on January 28, 2024.
  
  Additionally, any claims filed after this period were not approved due to the use of a facility not covered under your plan. The MedFirst 1 plan offers limited medical coverage, including up to three primary care office visits with a $25 copay and a maximum of $150 per visit, one specialist or urgent care visit annually with a $50 copay and a maximum of $300, and an inpatient hospital benefit of $1,000 per day up to $5,000 annually.
  
  For services such as those scheduled through mytelemedicine.com, discounted prescriptions through BestChoice RX, and hospital bill reduction through Healthcare Ninja, I encourage you to contact them at ************** for potential bill reductions or elimination.
  
  Please note, your plan remains active in our records. It appears there may be an intention to terminate the policy along with processing a refund. Based on this, I have initiated the termination request. We have processed your refunds the last three were refunded to the credit card on file, and a check for the fourth is being sent to your home address. Please confirm if this meets your intentions.
  
  Thank you for bringing your concerns to our attention. We are committed to providing clear and helpful support. Please dont hesitate to reach out for further questions or assistance.
  
  Warm regards,

   

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

  Director of Claims & Provider/Member Services

  
  

  Customer Answer

  Date: 04/18/2024

  hi, thank you for the refund. 
  

  I wasnt told any of this over the phone with ***** when I signed up. He said I just had to wait till midnight and I would be all set for the *** Unfortunately I called in a time of need and was met with someone probably just trying to make a commission. **** as far as saying hed sign his own mother up for this insurance. I was told the 30 day waiting period would be for pcp/speciality, and that if I really needed to see my gyn they could always submit a claim and they could make an exception. I was also told when I called customer service that ***** ******* was covered. Seems like every person has a different opinion when it comes to the coverage and rules. What concerns me is the amount of people unsatisfied with the promises they are made by these agents for this company specifically. One ****** search and youll see how many people feel the same way. I will call my health ninja, thank you for that information, hopefully they can help because I have no idea where i am going to get 20k for a surgery that was completely out of my control. 

• Initial Complaint

  Date:08/03/2023

  Type:Customer Service 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 been a member of Multiflex Nationwide Dental plan for several years. While the coverage has been useful, I have had the worst experience with customer service. I have had trouble loggin into their website on several occasions and when I attempt to "recover my ID/password" it says my account is not found. When I call the number listed on their website, I get "number not found" error message. I tried calling MBA Merchant's Benefit Administration, a company affiliated with Multi Flex Dental, and only got to a recorded line trying to offer me some free prize. I would eventually like to cancel this plan once I can secure other insurance, but I can't get ahold of anybody. I am severely disappointed with the lack of ethics and integrity of this insurance company. I will never be recommending Multiflex Nationwide Dental to anybody.

  

  Business Response

  Date: 08/07/2023

  Good morning,

   

  I have checked our contact information and it is valid and does bring the caller to the proper line to connect.  Since, no account information was provided so I am unable to assist or have you contacted directly.

  The number that you should be utilizing is ************.  Our hold times are less than 3 minutes and there should never be a time when you cannot get through during normal business hours. M-F 8AM-5PM MST

   

  Kind Regards,

   

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

  MBA, Inc

• Initial Complaint

  Date:07/24/2023

  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.

  My family has used this insurance for preventive health for several years now, but ever since my son was born in September 2022 we have been put through the ringer by mba admin and their continuous refusal to accept any claims and pay our providers. We have had anywhere from 2-6 different claims filed for multiple visits since 10/2022 that are denied. When I call to find out the reason, I am told one thing and that will get fixed with the provider and itll be denied again. Ill call and be told a different new problem to fix. i have even called mba admin and then conference called different providers billing offices and the mba admin reps are unable to report why the most recent claims are denied. I feel they are being maliciously incompetent in order to continue to collect money and never pay out. This delay has earned them plenty of interest on my premium payments that I pay monthly and on time. This has become what feels like a part time job having to call them and go between them and different doctors offices trying to get my and ******************** covered. My pediatrician hasnt received a ***** from them despite providing all well care for my now 10 month old.

  

  Business Response

  Date: 07/25/2023

  Good Morning,

   

  I was unable to locate an account by the name or address provided. Please provide your Member ID and dates of service your are inquiring about so that I may better assist you.

   

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

  Manager, Claims & Member Services

  MBA, Inc

  Customer Answer

  Date: 07/25/2023

  
  Better Business Bureau:
  
  My member of is s678444022, the dates of service are 

  2/21/2023

  1/9/2023

  7/6/2023

  11/28/2022

  11/1/2022

  10/4/2022

  06/30/2023

   

  Regards,
  
  *********************
  
   

  
  

• Initial Complaint

  Date:06/29/2023

  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.

  On 11/08/2022, I had dental work done at Affordable Dentures and Implants. I have a primary insurance with my ******** (Humana) and a second plan with a outside insurance ( ************* Dental ****). I filed both insurance companies at the same time. Within a month of this filing; my Humana paid out their portion and even did a second payout with corrected information requested. It has now been 8 mths and my secondary insurance company (NCD) has not paid their portion. I have filed this claim 7 times. The fault the first few times were my fault because I didn't send in the correct information. After speaking with the claims department ( Merchants Benefit Administration, **** I sent in the requested information, without any results of payment. I was told they had not received the information and to resubmit it. I did this and sent the next 2 claims registered mail. Still no progress. Calling also a number of times. So now I'm told that the *** was not sent in . ( did send it in) but I resent it again, 2 more times. Now here it is almost July. I have contacted (MBA) again online and phoned them and was told it is still in processing. I have gotten agitated with them on several calls but have given ample time for them to correct this now that I have sent in so many corrected claims. I had to finance this and want to pay down on the bill. I just need their portion they owe. Plan is: ************* Dental **** and is administered by : Merchants Benefit ******* **** Claims add; P.O. Box ******, *******, **. *****. Phone # **************.

  

  Business Response

  Date: 06/29/2023

  Good Afternoon,

  Ms. ******** claim was received and not denied but sent for additional information requested from the member.  ********************* Explanation of Benefits did not match the lines billed to our company. In order for proper Coordination of Benefits to occur we require a complete EOB from the primary insurance that outlines the ************** billed, the amount paid, and if any service was denied, that it was not denied for any error but for coverage limits or availability.  

  ****************** is still withing timely filing guidlines of 15-months from the date of service.  However, in order to adhere to each states guidlines in relation to "over insurance" we must have a proper and complete Explanation of Benefits.  As she stated her claim was resubmitted for additional payments to her primary insurance we are in need of the corrected EOB to ensure we adhere to her policy and the guidlins set forth by the state.

  Kindly,

  ******** A owser

• Initial Complaint

  Date:05/10/2023

  Type:Product 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.

  REF: ID: ********** (Member ID)Since the beginning of May, I have been trying to cancel my Multiflex Dental to no avail. Here is a summary of what has transpired since May1:I have now called customer service ************** at least 5 times Each time I call I am told that there is a problem with the system or it is being updated, but they are working on it and that I should receive the cancellation form via email that day or in a few days. I never received an email.I did receive one email stating that my automatic payment was discontinued.The last call was 5/9 at 10:10 am est. Given reference # ****** and told email will be sent by the end of the day.Since the dental insurance has not been canceled, I am being charged the monthly fee which should not be.I called ************ - customer service Address: Multiflex Dental, ******************************************************************************* MBA Merchants Benefits is the administrator and at the same address is the admin

  

  Business Response

  Date: 05/10/2023

  Good Morning,

   

  Thank you for the opportunity to respond to the members concern. In review of the account notes, it is noted that on May 2, 2023 a caller, Bunny, requested the account be canceled and ther request should be sent to a supervisor.   In review of the account I will have the account canceled effective 5/1/2023.  ********************** should understand that any claims presented for consideration on after 5/1/2023 will be denied for no coverage.  If you have any additional questions please do not hesitate to contact me.

  Kind regards,

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

  Manager, Claims and Member Services

  Customer Answer

  Date: 05/10/2023

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution would be satisfactory to me.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
  
  Regards,
  
  *******************************
  
   
  

• Initial Complaint

  Date:11/23/2022

  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.

  Went to the dentist on August 15, 2022 and had a procedure. Went to file dental claim form 1. Someone there misspelled my last name and would not cover the claim. 2. Although it was on their end, I had to resubmit it after the last name was fixed. 3. resubmitted the claim and they denied it because the dentist wasnt named but per dentist, the money is to come to me only. It was rejected a third time and they will not give explanation why it is not being covered , every time I call they say hold and come back and say they cant hear me then theyre using the excuse again that my last name is still misspelled when it is fixed. This is a scam company! I want all my money back since I started in March, or at least have them cover my claim.

  

  Business Response

  Date: 11/28/2022

  Good Morning,

   

  The claim submitted in the complaint is the identical claim submitted in our system. This claim cannot be processed as thier is no TAX ID that is visible.  It appears to be blacked out.  While the payment can go to the member as it states in "AUTHORIZATIONS" the patient should  place their signature in Box 36 only.  The Tax ID is a requirement per the *** and the claim cannot be processed without it.  If a new claim can be submitted with the billing dentist information including the Tax ID and 'Box 36' signed the claim can be processed for consideration and any payments will go to the member. 

   

  Respectfully,

   

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

  Manager Claims & Member Services

• Initial Complaint

  Date:11/14/2022

  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.

  MBA is the third-party administrator for my insurance plan. I wrote a review earlier after MBA repeatedly lost my mailed in claims but would not accept electronic ones; once they were received, they were denied because of an incorrect address. I did as I was directed from the previous review, and we fixed the billing address issue. Several of the claims were paid, but the one from June only received partial payment. Its now November and is still unresolved. This claim had multiple denials in it, but my plan clearly states that all preventative vaccines are covered. When I asked about it, they told me that the coding was wrong, but it is not. They have been checked by the doctors office, and they are correct. They would be unable to submit anything different because the coding is correct. The *** MBA offered had little to no details explaining what was paid out, what was not, and why the claims were denied. It simply said vaccine or service not covered with no explanation as to which vaccine was covered and which claims were not. After months of working with them, they finally instructed me to go back through the process and file an appeal to dispute the claims. This has taken months and is still unresolved. Calling the hotline only results in no call backs and a lack of profitable information to resolve the issue. Going back through the processes will just take me back to step one, and Im now on the hook for a larger payment than if Id just gone with the self-pay option. Im extremely frustrated at the companys lengthy, drawn-out response to this issue and their unwillingness to quickly correct it. This was a routine visit with vaccinations and should not have incurred any billing issues as it was a standard claim.

  

  Business Response

  Date: 11/15/2022

  In order to assist or answer the complaint apprpriately I am in need of additional information.  The member number, the date(s) of service in question.  Without this infomration I am unable to determine what specifically the complaint is regarding.

   

  Respectfully 

  *****************************, MBA

  Customer Answer

  Date: 11/20/2022

  
  Better Business Bureau:
  

   

  The Member Number is S679192823 and the date of service is 6/17/2022.
  
  Regards,
  
  *******************************