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:05/10/2024

  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.

  Sidecar Health has denied my knee surgery that I needed so I could continue working and supporting my family. They said I was dishonest when I renewed my policy with them in November of 2023 by not answering their application questions honestly. At the time I was 100% honest. I was not planning on having surgery. I had an injection in my knee in August of 2023 which they covered but in January of 2024 I was told surgery was the only thing that would allow me to continue working. I assumed since they covered the previous visit and injection they were aware of my knee issue. I had surgery in January of 2024 and they are refusing to pay for it. I have done an internal appeal, submitted all medical documents they have requested and they still continue to ask for the medical notes that have already been submitted 3 times.

  Business Response

  Date: 05/28/2024

  This member received full benefits for their knee surgery. Sidecar Health members pay providers directly for covered services and then submit a claim to Sidecar Health afterwards. Members are issued a Sidecar Health **** benefit card, which they can use to pay for servicesor they may use their own payment method. When members want to spend above the default limit on their Sidecar Health **** benefit card they must get reach out to us to increase the spend limits on the card. This member asked for the spend limits to be increased and submitted medical records related to the surgery. From our review of the records, it appeared the surgery might not be a covered benefit. Therefore, this members spending limit on their Sidecar Health **** benefit card was not increased. The member was still able to obtain the surgery and submit the final bills to Sidecar Health for review, at which time, we determined the surgery was covered and paid benefits accordingly.

  Customer Answer

  Date: 06/04/2024

   
  Complaint: 21594645
  
  I am rejecting this response because their explanation was not completely accurate.

  They FINALLY approved some of the medical bills I submitted after they denied the surgery multiple times, I have all the emails.  They made getting this surgery approved extremely difficult.  I understood they were not going to cover the entire surgery, that was never a complaint of mine.  Lets hope they cover the remaining expenses that have been submitted.
  
  

  Sincerely,
  
  ***************************

  Business Response

  Date: 07/07/2024

  Sidecar Health determined benefits for the surgery and paid them accordingly.

  Customer Answer

  Date: 07/11/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********.

  The way we were treated in this situation was not ok. I was told 6 times they were not going to cover the surgery and because I continued to fight it they finally gave in.

  
  Sincerely,
  
  ***************************

• Initial Complaint

  Date:02/01/2024

  Type:Product 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 paid Sidecar ***** via my FSA card. I have asked them for a receipt for my transactions, because my FSA company denied the *** they sent me for the charges. The *** does not match the amount they billed me, and that I paid them. I am not disputing that I owed them money and needed to pay them. They need to provide me with a receipt, or something that shows why I owed what I paid. I'm not really asking a lot here. I have NEVER made a purchase with out receiving a simple receipt. I'm not asking to cure cancer here.

  Business Response

  Date: 02/23/2024

  Sidecar Health allows members to pay for care at the point of service using a Sidecar Health **** Benefit Card. This member made a partial payment towards a covered service using their Sidecar Health **** Benefit Card. Upon adjudicating the claim, 100% of the benefit payable for the service was credited to the member and available for the member to withdraw as cash, which the member did. These funds were sufficient to cover 100% of the providers charge, without any out-of-pocket cost to this member. However, rather than use these funds to pay the balance of the amount owed to the provider, this member paid the balance through another use of their Sidecar Health **** Benefit Card. Had the member not withdrawn the funds previously credited to their account, ********************** would have used those funds to offset this second use the card. However, since the member had already withdrawn the funds, Sidecar Health had to charge the member for this second provider payment. The member is no net out-of-pocket in relation to the covered service. The funds withdrawn by the member actually exceed the amount later charged to the member for the second use of the Card.
  The explanation of benefits provided to this member for the covered service correctly shows no out of pocket cost to the member. There is no separate explanation of benefits for the charge Sidecar Health made to the member for the second use of the Sidecar Health **** Benefit Card.

• Initial Complaint

  Date:11/16/2023

  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.

  I purchased two insurance policies from Sidecar Health on June 25, 2023. The initial payment was ****** for my husbands and my policy. Each month we were billed $169 and $175 for the policies respectively. With Sidecar Health, the premiums are based on the amount of funds you want available to cover healthcare costs. For my husband and I, our policies provided $2500 for medical plus $500 for pharmacy, per policy. Sidecar Healths process is to have the patient ask for the cash price when care is accessed, pay for the care with their **** card, Sidecar pays their portion of the bill from your allotted funds, and they expense amounts over the allotted coverage to me; which I have always paid.In 4 months, I had ONLY used $360 of my allotted funds. My husband had NOT used any of his funds. Despite this minimal use of the allotted funds, which were available in response to the premiums we paid, I received an email saying that the policy would not be renewed next year because I was using the funds for medical care. In response, I requested that the policies be cancelled. It took three requests to finally get a cancellation. These were sent on 10/28, 10/29, and 10/30. This complaint and request for an investigation into Sidecar Health twofold. It is based on Sidecar Healths practice of threatening me with non-renewal for using the insurance for medical care AND their failure to cover their portion of two expenses: Expense #****** in the amount of $1,246.19 on 9/7 and Expense #****** in the amount of $130 for a GP visit on 10/20. Note that both of these were submitted and in progress prior to my request that the policies be cancelled. It is also important to state that they have charged my HSA the full amount of the lab expense which is in violation of the Sidecar agreement and process of claims. They should have paid a portion of this bill and have a specific process in place to ensure this. The $130 payment is pending but Sidecar lists the plan pays portion as zero; meaning that they have also deferred the full payment of this to me; which again is in violation of my agreement with Sidecar and their process. I am asking for a full investigation into Sidecars deceptive process of getting patients to purchase policies and pay premiums, only to penalize the patient for accessing the funds and/or not honor their portion of the legal agreement I signed when I purchased the policies.

  Business Response

  Date: 11/28/2023

  We appreciate the opportunity to address the concerns raised by the member regarding their experience with Sidecar Health. At Sidecar Health, we share with our members transparent and fixed Benefit Amounts for every medically necessary covered service.  We cover these fixed Benefit Amounts regardless of what the provider charges. Members can conveniently access these Benefit Amounts through the Sidecar Health member portal, ensuring clarity and openness in our coverage.
  
  Because the Sidecar Health Access Plan is a fixed indemnity plan, it is medically underwritten. The application for Sidecar Health Access Plan coverage asks whether the applicant has had certain medical conditions within the past five years. This member indicated they had not had any such conditions treated or diagnosed within the past five years. The Access Plan covers pre-existing conditions, unless they are undisclosed in the application.  Shortly after this policy began this member submitted claims for the diagnosis and/or treatment of certain underwritten conditions. We requested that she provide records from her physician showing when she was first diagnosed with this condition so we could confirm whether these should have been disclosed on the application. The member did not provide the requested records and her claims where therefore denied.
  
  Our commitment is to provide transparent, accessible, and quality healthcare coverage to our members. We remain dedicated to resolving any concerns and ensuring a positive experience for all Sidecar Health members. Thank you for bringing this matter to our attention, and we are available to address any further inquiries or provide additional information.
  

  Customer Answer

  Date: 12/14/2023

   
  Complaint: 20822412
  
  I am rejecting this response because: the response from Sidecar is false. The question asked during the application was whether I had any surgical procedures where the costs were outstanding. My answer was no because the surgical procedure I had was paid in cash and nothing was owed. I subsequently developed reflux, which required diagnostics and labs. This was unrelated to my surgery and should have been covered by Sidecar. I continued to provide the information that Sidecar kept asking for (at least 5 times) as they tried to avoid paying their portion of the bill. Eventually, I received a notice that they would not renew my plan next year and I, instead requested that the plan be cancelled immediately. Sidecar is a scam and should not be in business. This is especially true if they are unwilling to honor their agreements with customers.
  
  Sincerely,
  
  *****************************

  Business Response

  Date: 12/14/2023

  No part of the application asks whether the applicant had any surgical procedures where the costs were outstanding. The application does ask Have you in past 5 years been diagnosed with any of the following There then follows a list of 13 conditions. This member responded no for each of these conditions on the application. This member submitted a claim reflecting a diagnosis of one of these conditions. We requested that she provide records from her physician showing when she was first diagnosed with this condition so we could confirm whether these should have been disclosed on the application. The member did not provide the requested records and her claims where therefore denied. This members policy states Failure to assist Us in obtaining the necessary information when requested may result in the delay or rejection of Your claim(s) until the necessary information is received by Us. We reserve the right to reject or suspend a claim based on lack of medical information or records.
  

  Customer Answer

  Date: 02/02/2024

   
  Complaint: 20822412
  
  I am rejecting this response because: The response is inaccurate and as fraudulent as Sidecar's practices. I did not have any of the conditions listed at the time that I purchased Sidecar. I also did provide documentation of my diagnosis date as well as my complete medical history TWICE. However, Sidecar continued to ask for the same information that was submitted in an attempt to not honor their portion of the agreement. They also fraudulently and deceptively used my HSA to cover the entire cost of a bill for which they were responsible for a portion of. I have filed an *** complaint for the false claims and deceptive business practices, and I do hope that the *** investigates because I believe that there are many others who have been scammed by Sidecar, like me.
  
  Sincerely,
  
  *****************************

• Initial Complaint

  Date:04/30/2023

  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.

  I was covered by Sidecar insurance through Dec 2022. Sidecar has acknowledged that during this time I have had claims payable under this policy and that as a result I have an account credit of over $1,800.I inquired on multiple occasions in March about getting that credit paid back to me. Each time they have told me that it's coming on date x, but that date comes and goes and I have to reach out to them again only to be told to wait until another date at which point the check will be released. Now that we're in April, I have been told that they essentially don't know what to do because they close accounts 90 days after they are no longer active, so my money is in limbo and they have been refusing to release it (which they have said at least 4 times that it should have already been paid out).

  Business Response

  Date: 05/09/2023

  This issue has been resolved. Sidecar Health account credit was paid to this former member as an independent bank deposit on Friday, April 28th.  Email communications went out to the member on April 12 and April 27 including this information.

  Customer Answer

  Date: 05/18/2023

   
  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.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  Date:02/20/2023

  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.

  My billing information is inaccurate.I have spoken with multiple representatives from your company to be told i Would hear back to hear nothing.I would like to be contacted directly this is an issue that has gone on since December with no end in site.

  Business Response

  Date: 04/06/2023

  Sidecar Health member care has reached out on several occasions.  We also separately received a note from BBB that this complaint was resolved.

• Initial Complaint

  Date:09/27/2022

  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.

  On 9/2/2022, I purchased a health insurance plan that stated it included prescription drug coverage in its policy. The plan delay to start was 9/16/2022. On 9/23/2022, I obtained a prescription and brought it to my pharmacy. The pharmacist informed me that the error code she received stated that this was not drug insurance. The drug was not expected to be covered, however, Sidecar was expected to be a prescription drug insurance company which could provide the Group number, Bin Number, PCN, and ID number that produced the electronic message necessary for a denial of coverage. Because the numbers given did not represent a prescription drug insurance company, and instead represented a "savings card", the denial code was not valid and my prescription could not be denied. Without the denial, I was unable to use the manufacturer coupon which brought the drug form $1218 to $25 per month. Based on the false advertising and false statements in the policy made by Sidecar, I was unable to get my prescription filled. I had to obtain another insurer in order to do this. This caused delay in filling the prescription as well as $95 for the premium. I asked Sidecar for a refund of my premium two times in writing and was not issued a refund. I disputed the premium charge with my credit card company. I am in the 45 day waiting period to hear back from my credit card issuer, Citi. The next step will be small claims in California. To clarify what I am disputing, it is not whether a drug was covered, but whether in fact I was purchasing true and real prescription drug coverage. As the toggle button implies, you can decline or accept the prescription drug coverage for an extra $20. (See photo of plan comparison). However, come to find out, you are not paying for prescription drug coverage, confirmed by the error message the pharmacy receives that defines the difference between commercial prescription drug coverage and savings card. False advertisement.

  Business Response

  Date: 12/15/2022

  Business Response /* (1000, 5, 2022/10/31) */ Prescription coverage is included with all Sidecar Health Access Plans, but members can choose to exclude it when they enroll in coverage. For those that choose it, Sidecar Health does, in fact, offer drug coverage. Here's how it works: Similar to medical services, there is a fixed Benefit Amount for each drug, which members can look up on the Sidecar Health member portal. The member portal will also tell members what their portion is depending on the price that the pharmacist charges. Because Sidecar Health works differently than traditional coverage (Sidecar Health members price shop, comparing against the fixed Benefit Amounts vs asking what's "in network", for covered care), Sidecar Health provides members with resources to help shop and navigate. Our Member care team is standing by to help and we offer comprehensive FAQs to help them best access their prescription coverage, such as this article: ************************************************************************************************************ Sidecar Health pays benefits for prescriptions submitted to us by our members through our online portal or mailed to our mailing address. Our members purchase prescriptions and other services at point of sale using a Sidecar Health VISA benefit card or a personal payment method and then submit the documentation to us. This member did not submit any documentation for services while their coverage was active. "Without the denial, I was unable to use the manufacturer coupon which brought the drug from $1218 to $25 per month" is an unclear and incorrect statement. Because the Member's Access Plan includes drug coverage, it would have been inappropriate for a denial to be issued at the pharmacy. Sidecar Health cannot speak to how the manufacturer coupon in question works; however, it is our understanding that manufacturer coupons are frequently used by, and often intended for, people who do not have insurance coverage and would have no way of getting a denial. This seems to be an unfortunate case where the pharmacist has provided incorrect information on a number of topics, including the fact that Sidecar Health is "true and real prescription drug coverage." A quick call to our Member Care team would have been a great option to help this member find a nearby pharmacy within the Benefit Amount that is more willing to work with discount codes. The member states: "I asked Sidecar for a refund of my premium two times in writing and was not issued a refund." Sidecar Health has reviewed our records and confirmed that the member received a refund via check which she cashed on October 19, 2022. This review is for the Sidecar Health Access plan, which is built for flexibility. Sidecar Health also offers employer and ACA plans, which provide more robust coverage and additional major medical protections. Consumer Response /* (3000, 7, 2022/11/07) */ (The consumer indicated he/she DID NOT accept the response from the business.) Sidecar continues to state that offer prescription drug coverage however, what they are offering is a savings car similar to what you can get for free through GoodRX or other similar savings card companies. When you choose prescription drug coverage, as advertised falsely by Sidecar, what you really get is not that. I had called several times to their Member Services who did confirm they are a savings card. This was not an error by the pharmacist or by me. The truth is that the Eli Lilly manufacturers coupon is for people WITH insurance who have commercial prescription drug coverage. This is a term and condition of using the coupon. It is not uncommon as there are many free with insurance (that includes prescription drug coverage) coupons for certain drugs. This company continues to falsely advertise and needs to make clear in their offering that the coverage is NOT commercial drug insurance like what I have purchased with another company. I have another plan now with United Health One that does include real prescription drug coverage for $123. So, $28 more than I was paying with Sidecar. It did not trigger the "savings card only" response by the pharmacy system Express Script (this is not seen on the consumer end, it is only seen within the pharmacist's internal computer system, at every pharmacy). Eventually, Sidecar did issue a refund for my premium, thankfully and surprisingly. However, this doesn't make up for the month I lost while waiting to get what I needed medically. The wait was purely the fault of false advertisement by Sidecar. They do no provide commercial drug coverage. It is a Savings Card and the Visa Debit card is simply a cash advance by the company for you to then repay on your bill. Whoever is responding to my complaint is either ignorant or fibbing about their knowledge of how manufacturer coupons work as well as ignorant to the internal computer systems of pharmacies and how they work. They are also ignorant to the definition of commercial prescription insurance and thus causing the issue that I had. I purchased their insurance with the understanding that what they allude to in their advertisement meets the definition of the requirement by the drug manufacturer. A third party pharmacist who works for any pharmacy or a representative from Eli Lilly can confirm what I am saying here. Business Response /* (4000, 9, 2022/11/20) */ Sidecar Health is not able to address the specifics of this case in order to preserve member confidentiality. However, we can generally provide the following information about how our plan works. Sidecar Health provides comprehensive major medical coverage which includes prescription drug coverage. In order to determine coverage, Sidecar Health requires that a proof of loss or claim be submitted. Once such a proof of loss is submitted, Sidecar Health determines whether a prescription drug is subject to any exclusion or limitation. Because our members pay at the pharmacy and submit a proof of loss after, they may take advantage of the many discount programs that are available to consumers, such as GoodRx. Sidecar Health does not require the use of GoodRx or any other discount program, and use of such programs does not affect the member's coverage. The member may submit a proof of loss for determination of whether the prescription drug is covered for the diagnosis for which she may need the drug. Absent that, we are unable to provide a denial or blanket statement that the drug is not covered as it is a covered drug for certain diagnoses

• Initial Complaint

  Date:08/30/2022

  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 am a current customer of Sidecar Health and submitted several claims regarding an outpatient *************** repair at an outpatient ******* center. The total billed actual charges, minus cash payment discount, were $4991.43. Sidecar estimates coverage on their app at $7041. The company states that there may be some discrepancies between the amount they cover and actual costs, that was made clear and understood. However, when I submitted my invoice, complete with CPT codes for billing, I was told my benefit coverage amount was only $1587. While there may be some degree of discrepancies expected, an approximate 1/3rd coverage amount is not what is advertised or implied. As of this point, I have paid out more than the policy has covered, which is also not in line with what was advertised. Further, I had spoken with several representatives of the company who claimed that there was no limit, other than policy limitations, to what could be processed using their Sidecar **** card, I was surprised, on the day of my ******* that this was not the case and that it had a $2500 total limit, despite my policy having a $2 million limit. This company has engaged in fraudulent business practices as well as deceptive advertising and I would like the cost of my ******* and related services paid for in full. Further I would ask that they be consistent in their messaging rather than getting literally 5 different answers to the same question so that other consumers do not have to deal with this unprofessional and unethical behavior.

  Business Response

  Date: 11/15/2022

  Business Response /* (1000, 5, 2022/10/03) */ This member submitted a bill that lacked in detail which only had two codes on it and we asked him to submit more detailed records so we could get him all possible benefits. He hasn't yet followed through on that. We can't add codes to get him more benefits, but he can update his records to show the details on the care he received. We are, of course, reliant on the member for bills, and we recommend that he submit full medical records so that we can will pay every benefit we can derive from those. Consumer Response /* (3000, 7, 2022/10/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) There are only 2 codes for the procedure performed. Those codes are 49585 which, per their website carries an average cost of $7041. I am attaching screenshots from their website that show I am owed reimbursement. Failure to correct the matter will result in legal action. Business Response /* (4000, 9, 2022/10/26) */ The below feedback is in direct response to the comment, "Sidecar estimates coverage on their app at $7041. The company states that there may be some discrepancies between the amount they cover and actual costs, that was made clear and understood". Sidecar Health provides members with the Benefit Amount for each service incurred. In addition, in an effort to assist members in understanding what the total cost of an episode of care may be, Sidecar Health search results provide a break down by grouping common examples of procedures that may be billed together (an "episode of care"). When displaying estimate care search results for an episode of care, we include the following: 1) A disclaimer stating, "This example is for reference only - exact coverage may vary based upon the specific medical codes listed on your itemized bill." 2) There would also be a list of categories that may be included in each episode of care. These include multiple line items for services including provider fees, facility fees, prescription fees, equipment fees, and anesthesia fees. Each of those line items has medical codes associated with them. If those are performed and included in the itemized medical invoice, Sidecar Health would pay the Benefit Amount associated with each line item for covered care. Ultimately, the Benefit Amount paid is calculated using the medical invoice submitted. 3) To ensure members understand #2, above, Sidecar Health includes an additional disclaimer that states, "While the benefit amounts shown are accurate, services and procedures included vary from doctor to doctor. The below set of procedures is simply a common example. Ask your doctor what services will be included in your visit for the most detailed information on how much your plan will pay." Further, in response to the note, "I am attaching screenshots from their website that show I am owed reimbursement". The screenshots attached simply showcase there were two codes submitted, including the Sidecar Health Benefit Amount for each and what the provider charged. The Sidecar Health model works differently than traditional insurance and this difference is one of the reasons that our members love Sidecar Health. By shopping for care, and correctly estimating their benefits in advance of getting care, our members can get cash back by choosing providers who charge less than our Benefit Amounts. In our member education efforts, we emphasize that members can ask their provider before getting care to understand costs. To offer further assistance, given the member didn't reach out to us until after receiving care, we have offered a three-way call between the member and the provider to obtain more detailed information on the services rendered. Our Member Care team has been in touch with the member directly to coordinate this. This response relates to the Sidecar Health Access plan, which is built for flexibility. Sidecar Health also offers large employer and ACA plans, which provide more robust coverage and additional major medical protections.

• Initial Complaint

  Date:08/30/2022

  Type:Order 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.

  Sidecar Health is enforcing policies that are not stated in their indemnity plan. Because these polices were undisclosed, I was uninformed and now am being held responsible by not receiving full coverage of my claim. I called and spoke with a manager who even told me she could not find the polices they were enforcing in my plan. Yet she also told me they could not help me anymore with this case and that they would not be giving me full coverage for my claim. I feel this is extremely unfair since it was not my mistake as these policies were not disclosed. The policies that are being enforced are: 1. Before your dates of service you must have your annual max benefit changed. (This is confusing because Sidecar Health members have told me that I am able to change my annual max benefit at anytime so I didn't need to worry about not having enough to cover something. If I need to up it for more, I could just call them or change it online. At any time. Which i've now found out is not the case, it's only at certain times. But I also couldn't have known that since it's not in the indemnity. I'm fine with this policy, it's understandable. It's just that it wasn't disclosed.) 2. When/how claims go on your old policy vs. your new policy and on the basis of the date of service not when it's billed. ( Again this is not anywhere in the indemnity and has now led to a lot of confusion.) I attached photos of the pages in the indemnity where their manager said it best represented those 2 policies. If you read through them, they're not there. I also attached a screenshot of the email where that same manager I spoke with on the phone referred to those pages in an email. All I would like is for Sidecar Health to own up to their mistakes and make this situation right. I would like for my claim for be fully covered as it would have been if I was informed about these policies by them being included in my indemnity.

  Business Response

  Date: 01/05/2023

  Business Response /* (1000, 5, 2022/09/30) */ This was a misstatement case. We had to terminate her policy for lying on her application. Her complaint to *** isn't factual. We can not disclose her personal health information. Consumer Response /* (3000, 7, 2022/10/06) */ (The consumer indicated he/she DID NOT accept the response from the business.) ******* Health terminating my plan has nothing to do with my *** complaint. Although, I felt this too was misrepresented like their policies. I am working as we speak to get my inpatient doctor to update my diagnosis to what is correct and has been declared by a specialist outside of the facility. I'm doing this because this is what has been deemed in need of fixing (by your manager *******) in able to correct my terminated plan. Your application shows (see provided document) that I checked "no" for the question*********************************************************************************************************************. When I read this question I read it with the term in which it gave "hospitalizing". To be clear I have never been hospitalized ************************************** I was diagnosed**************** around six years ago, but was never once hospitalized for it. But this past year I was hospitalized **************************************. Once again, just to be clear, *************** I have a medical diagnosis ********* from a specialist which I tested for right before my last hospital stay and received the results during my stay. However, the doctors at my inpatient stay are in fact not ****** specialists. They are there to aid in the safety of patients and can't make larger*************** diagnoses without a specialist. This is what happened to me in the first place when before my last hospital stay my regular ************ referred me to see an ****** specialist because ****** wasn't something she could diagnose me with (she's not a specialist). During my stay at the hospital, I heard doctors have a similar issue with a woman struggling with what she believed ********* They also have medication classes we can take during our stay as a resource. There it was pointed out by the teacher that they don't talk about medication for ****** ******* because it's not something they focus on during hospital stays. My inpatient doctors told me many times, that my situation was more "complicated" in comparison to people they see regularly who are struggling with things like life issues ******************* I've had ********** listed as one of my diagnoses on my inpatient stay because in the medical world your diagnosis trickles down after originally being listed. In the same way you wouldn't just no longer have ******** on your medical record after being diagnosed with it. Usually, a new diagnosis is supposed to disprove a past one if needed as well, which is what my case is. I received my updated diagnosis of ****** or more specifically *** (****** *****************) before filling out the application and had this understanding of myself fully before filling it out. Therefore, for these reasons I did not feel I could answer "yes" to your question. Because nothing within that list applied to me. So please do not accuse me of lying on my application when the real issue is a lack of thoroughness in it. I have been completely complacent in working towards creating what ******* needs for this situation to work regardless of all these issues. I have had to deal with a lack of ****** health resources, since my plan has been terminated, due to these mistakes made by your company. All of this could have been completely avoided, in your application and policies, if ******* wouldn't have been so vague and careless with writing their documentation. As for the actual issue I'm addressing in my complaint, in which you have not replied to anything originally stated. So please re-read that if needed. And if you would like more evidence of what I'm claiming and even not from me, you can listen to my past calls with your team members. Specifically, the ones with your manager ******* where she had no answer to these non-existent policies. When I asked for specific clarification, she verbally agreed with me over the phone about the vagueness. Like I said, listen for yourself if you do not believe me. Please reply to the original statement this time. Thank you. Business Response /* (4000, 9, 2022/10/20) */ Your policy provides coverages for "a Covered Service incurred by You while coverage for You is in force under this Policy." (page 20 of your policy). A service is incurred on the date it is provided, not the date it is billed. Therefore, coverage is always provided in accordance with the provisions of the policy in force at the time of the date of service. If coverage applied the date a service was billed (as opposed to when it was incurred) then you would only have coverage for services if your provider billed you while the policy was in-force. The language in your policy ensures that you have coverage even if the provider waits to bill you until after your policy has expired. Because coverage is based on when the services are incurred, your coverage is based on the terms of your policy in force on the date of service. It is important to remember that these policies are not renewable (page 28 of your policy), so while you are able to purchase a new policy to avoid a gap in coverage between the end of one policy and the beginning of another, any services incurred while your old policy was in force must be adjudicated under the terms of the old policy, not the new one. That is why increasing the maximum benefits on your second policy did not affect the benefits available on your first policy. For the same reason, increasing maximum benefits on a policy would only apply to services incurred after the effective date of the benefit change because we have to adjudicate claims based on the terms of coverage in force as of the date the service is incurred. If the maximum benefits are increased after a service is incurred, we must still apply the maximum benefits in force as of the date of service. If the service is incurred after increasing the maximum benefits, then those additional benefits would apply to that service. I hope this explanation has been helpful in explaining why we cannot apply an increase in maximum benefits to a service incurred prior to the date of increase. Consumer Response /* (4200, 12, 2022/11/04) */ (The consumer indicated he/she DID NOT accept the response from the business.) Thank you for your response, but unfortunately this is still the same answer I have been receiving for months. Like I've stated before, these are the original pages in your indemnity plan I was referred to when I spoke with your manager ******* and asked where these two polices were stated (1. Before the dates of service your annual max benefit must be changed. 2. Claims are billed at the dates of service.). Once again, I asked her to clarify how these two specific policies fit into the same specific lines/pages (page 20) I am now being given again. She then stated they did not and that she apologized for all the confusion I had been through, as well as that she knew I was a thorough customer because I was someone who called often. She then stated that ******* would be taking the feedback from my case to help make changes from their end but that they could no longer help me with this specific matter from my end. From this I took: the policy's were not listed in the indemnity plan(this is why I never knew about them nor could follow them as I wanted to), ******* knows they are not listed, and ******* does not care that customers have to take the fall for their mistakes. Specifically why these answers don't truly verify your policies are: for example, you stated "Your policy provides coverages for "a Covered Service incurred by You while coverage for You is in force under this Policy." (page 20 of your policy).". When I read this all I read is 'my policy provides: a service that is covered by my policy and that is a recorded expense during the time in which I have coverage'. Or in even shorter terms, the plan I purchased. This is what I meant when I stated that these statements are vague. In no way would I believe anyone would understand specifically from this statement that: 'claims are billed at the dates of a service'. As for the second reference you made, which was to page 28, it states you cannot renew your policy (you must reapply for a new one at the end of each plan). This does not answer my question either. Which is, where does it state in my indemnity plan that you must have your annual max benefit changed before the dates of service. This was also an issue when I did have coverage because I had a ******* member give me what I now know is incorrect information over the phone specifically saying, "not to worry about changing my annual max benefit ahead of time as I can call anytime to change it, whenever I need it to be higher. Just up it when you need it!". This scenario of not having the specific policy for me to refer to has now led me to here. As I did thoroughly read my entire indemnity plan when I originally received it and have since re-read it numerous times due to these discussions, to make sure I understood it is the issue. I've also had other people read it to make sure I understood it. If it would have been in the plan I would have known it when I thoroughly read it originally, I would have followed it, I would have changed my annual max benefit ahead of time because I would have seen your policy, ******* could have made more money, my claim would have been covered, I would have never had to question it, I would have never called and been told incorrect information, and we would not be here right now. If it was just in the indemnity plan. I do not need the policies to be explained to me in this discussion as I have been told them several times now since having this issue. I just need ******* to show me specifically where these two policies are stated in my indemnity plan in which they are claiming they are. In which they are then claiming I would have known them and could have then followed them. Because if they truly would have been stated in my plan I would have just changed my annual max benefit ahead of time as I had been worried about originally months before. Once again thank you for your reply, but please send back the correct information this time (the specific writing in my indemnity plan in which these two policies are stated). And if you cannot provide a specific place in which these two policies are listed please fix this mistake by covering my full claim Expense ******** In which it would have been covered if these policies would have been included in my indemnity plan. Thank you.