ComplaintsforCollective Health

• Initial Complaint

  07/12/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I am filing a complaint against Collective Health regarding their inconsistent handling of coverage for my medication, Vyvanse. Despite initially receiving authorization for a coverage exception and being charged $375 for a prescription in May, I am now able to obtain the same medication for $65, which is the expected copay under my plan. Collective Health has provided conflicting information regarding coverage, deductible application, and reimbursement, causing confusion and financial burden.Details:On April 10, I was informed by ******** from Collective Health that I could potentially qualify for a coverage exception and sent the necessary documentation to the managed pharmacy benefits provider, Prime Therapeutics.On April 21, I received a confirmation letter from Prime Therapeutics stating the coverage exception was approved,On May 12, I went to ********* Pharmacy to obtain my medication but I was charged $375 at the pharmacy instead of the correct cost of covered non preferred brand medications which is $65. I paid the cost and was told I should request reimbursement.Subsequent communications with ****** from Collective Health on May 23 indicated a technical issue was resolved, and I was advised to submit a reimbursement claim to Prime Therapeutics, which was denied citing deductible application.Prime Therapeutics and Collective Health confirmed in July that the medication is non-covered and subject to deductible, contradicting earlier assurances of coverage given the letter I received on April 21.On July 10, I reiterated my concerns to ******** from Collective Health regarding the sudden price discrepancy and requested clarification on changes in coverage between May and June.Desired Resolution:I seek reimbursement for the overcharged amount of $310 and assurance that future communications and claims will be handled accurately and promptly to avoid further confusion and financial burden.

  Business response

  07/16/2024

  Thank you for bringing this matter to Collective Healths attention. We would love the opportunity to address this matter/these concerns; however, due to privacy laws we are unable to discuss specific matters in a public venue.  If you are a current or former Collective Health member, please reach out to our Member Advocate team directly at ************. Thank you.

  Customer response

  07/16/2024

   
  Complaint: 21978422
  
  I am rejecting this response because:

  They should be reaching out to me, not the other way around. They need to assign a senior manager this case to review what went wrong and see it through to closure. 

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

• Initial Complaint

  06/06/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I had a bill 2 years ago and it was annual physical check, should be covered by my insurance company. But since I had two insurance, the insurance company needs me to submit both of them. I gave my both insurance information to collective health, they start to make mistakes, than submitting to my insurance company, they submitted to my husbands company. But they ensured me that this is processed and everything should be ok. So since the insurance didnt receive them, the hospital keep billing me. So I talked to collective health again, and she just kept saying there is no update yet. Then one day, I got a call from debt collection saying this bill was sent to them. So I immediately called Collective Health, ask whats going on, and only seems then, she started to talk to insurance again. So far, 2 years has gone by, and apparently they never talked to hospital billing department because they need me to call my hospital to give permission. OK, enough, 2 years is overdue for my insurance to reprocess it. And with 2 years of calling, waiting, **** going to debt collection I just paid it. Which should totally be avoided if they didn't make the mistake, if they actively taking care of it, if they tried to figure out what has gone wrong. But no, none of that.

  Business response

  06/11/2024

  Dear Consumer, 

  Thank you for bringing this matter to Collective Healths attention. Were sorry for any inconvenience you have experienced. 
  As Collective Health is required to comply with HIPAA confidentiality requirements, we cannot respond here to concerns regarding your personal medical claims history here. However, we will alert our response team to contact you directly about these concerns through our secure member portal. 
  
  Thank you, 
  Collective Health 
  

  
  

  Customer response

  06/11/2024

   
  Complaint: 21812416
  
  I am rejecting this response because I never received a call or email. Yes they asked me every time to confirm these information and I never received anything from them. Also, I give you every permission you need to discuss anything regards my health, anything prevent you from being able to discuss it. STOP using that as an excuse!!!
  
  Sincerely,
  
  *****************

  Business response

  06/20/2024

  Dear Consumer, 

  Were sorry for any inconvenience you have experienced. 
  

  As Collective Health is required to comply with HIPAA confidentiality requirements, we cannot respond here to concerns regarding your personal medical claims history here. However, we have alerted our response team to contact you directly about these concerns through our secure member portal. 
  
  Thank you, 
  Collective Health 
  

  
  

  Customer response

  06/20/2024

   
  Complaint: 21812416
  
  I am rejecting this response because I already gave you all the permission you need. You keep using HIPAA as an excuse and you blocks you from discuss it with me. You know the truth that you can't discuss about it with me is that you didn't do anything for 2 years and I had to pay for something I didn't need to pay for at all. You wasted my time and my money. You need to pay for the money to cover my lost. 
  
  Sincerely,
  
  *****************

• Initial Complaint

  10/02/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  The following providers have not been paid since April 2023. As well as my husband and I for out of pocket medical expenses.*********************** Marriage and ****** Services *********************************************************************** *************************** Boca Ortho and Sports ***************************************************************************************************************** ************ ****************/************************************* ************************** **************************************************************************************** ************ *****************************, PT Training Room ******************************************************************************** ************ **************************** ************************ ************************************************************************ ************ ***************************** (billing manager) **************************** ****************** ******************************* Practice Name ********************************************************************************* ************ ****** *************** ************, ******* - emergency room *********************** hospital, **************************************************** Children's hospital, *****, ******* (emergency care)

  Business response

  10/03/2023

  
  Dear Consumer, 

  Thank you for bringing this matter to Collective Healths attention. Were sorry for any inconvenience you have experienced. 
  As Collective Health is required to comply with HIPAA confidentiality requirements, we cannot respond here to concerns regarding your personal medical claims history here. However, we will alert our response team to contact you directly about these concerns through our secure member portal. 
  
  Thank you, 
  Collective Health
  

  
  

• Initial Complaint

  09/14/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 2/26/2022 I had a trip to the ** & received two claims. Claim (23390898-0000) was paid in 3 separate payments during 4/8/2022 - 5/6/2022. The money never made it to my provider from the collective health agency. So I was sent to collection agencies for two separate claims. One claim they reimburse me, bu this claim (23390898-0000) I still have not received a reimbursement. They keep telling me I will receive an update in 3 days but have not heard one word from the company. I call weekly to get an update, but they never have an update. I just want to be reimbursed for what I already paid them.

  Business response

  09/28/2023

  Dear Consumer, 

  
  Thank you for bringing this matter to Collective Healths attention. Were sorry for any inconvenience you have experienced. 
  As Collective Health is required to comply with HIPAA confidentiality requirements, we cannot respond here to concerns regarding your personal medical claims history here. However, we will alert our response team to contact you directly about these concerns through our secure member portal. 
  
  Thank you, 
  
  Collective Health 

  
  

• Initial Complaint

  06/01/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  During my time attempting to settle all of my recent medical debt, I unfortunately had to deal with Collective Health and their poorly monitored practices within my personal life. I was formerly covered under both Collective Health and Independence Health for my medical insurance, with Collective Health being the secondary coverage. Upon receiving treatment for an emergency kidney stone removal surgery, I was billed heavily for the procedure, with my primary insurance covering the majority of the billing, and Collective Health supposedly covering the rest. This procedure was on 12/24/21. Collective Health stated they would cover the remaining medical expense, marking their books with payment of said bill, only to never send the payment. Because of this lack of promised payment, the ***************** back into my responsibility without my knowledge, because of the absence of payment and organization by Collective Health. I was initially informed of this payment oversight because of my my bill being shared and sold to a collections agency the debt was sold to, because Collective didn't actually pay the bill it stated was fully covered, and paid. Presently (6/1/2023), I am still, and have been, waiting for this internal payment issue from Collective Health, that is entirely their fault, to be corrected. I was initially informed in August of 2022 (10 months ago, as seen in the attached screenshot). I constantly receive vague updates from various representative as Collective Health, stating there will be progress every week or two, until I discover there is constantly, hardly ever progress made. (Seem in the attached web portal communications screenshots)I have been seeking resolution of this monetary obligation and potential credit risk for nearly a full year, with constant worry of my personal financial credit declines due to Collective Health's poor practices and lack of drive to remediate their mistakes. Please help me become unburdened of the above financial debt I have wrongfully suffered for nearly a full year.

  Business response

  06/09/2023

  Dear Consumer, 

  Thank you for bringing this matter to Collective Healths attention. Were sorry for any inconvenience you have experienced. 
  As Collective Health is required to comply with HIPAA confidentiality requirements, we cannot respond here to concerns regarding your personal medical claims history here. However, we will alert our response team to contact you directly about these concerns through our secure member portal. 
  
  Thank you, 
  
  Collective Health 
  

  
  

*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. ↩