Complaints

This profile includes complaints for Rocky Mountain Health Plans's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Rocky Mountain Health Plans

  2775 Crossroads Blvd Grand Junction, CO 81506-8712

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  Rocky Mountain Health Plans

  555 Rivergate Ln Unit B-1-109 Durango, CO 81301-7470

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  Rocky Mountain Health Plans

  PO Box 10600 Grand Junction, CO 81502-5600

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:01/19/2023

  Type:Billing 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.

  RMHP is underwriting my healthplan from **************** ***. They are fraudulently representing my coverage in order to trick me into paying for medications they claim are covered. (a) They say the medication Zaleplon was rejected pending prior authorization, which my doctor submitted. They told my doctor it was accepted. The pharmacy re-ran the prescription, and they approved the medication automatically, charging me $5 on 01/17/2023. They are now denying they received the medication and are attempting to bill me over $70. I would not have purchased this medication if it was denied. (b) My asthma specialist prescribed Zileutin. They denied as being non-formulary, which my doctor's office appealed. They told my doctor they accepted the appeal, my pharmacy re-ran the prescription, and they told my pharmacy the prescription was approved. The co-pay is $351. However, via phone they are now saying the medication is NOT approved, and will send me a bill of over $700 **on top of** the $351 co-pay. I would not have purchased this medication if it was not approved. I filed a written complaint, which they have not repsonded to. I called three times. The first time they refused to tell me which medications were covered, then placed me on hold "to get a supervisor". After one hour the call disconnected. The third time I spoke to a supervisor. She gave conflicting information. When I asked how I can know what medications were covered, she placed me on mute and 20 minutes of silence later she hung up the phone. This is clearly intentional, illegal, fraudulent behavior. I have audio recordings to support these events, if required.

  Business Response

  Date: 02/21/2023

  RMHP responded to a DOI complaint the member filed on January 19, 2023. I've attached a copy of the letter that was sent to the member.  Here is a summary of the resolution.

  RMHP reached out to ******* pharmacy and spoke with **** on January 24, 2023. He verified that there was a claim processed for Zaleplon in which you paid $5.00 on January 17, 2023, a claim for Zileutin was also processed. The cost for that medication was $351.00, you did not purchase this medication. Both claims were processed under a *** pharmacy plan. You verified with the pharmacy that plan was incorrect, you are on a ******** ******* plan. The pharmacy voided the *** plan on your profile. RMHP shows that the prescription for Zaleplon ran January 23, 2023, the cost you paid was $9.67 for a 30-day supply. The pharmacy ran the prescription for Zyflo January 31, 2023, and you paid $40.00 for a 30-day supply. The prior authorization for Zyflo is approved for a year and will end January 31, 2024, as long as you are eligible for the ******** ******* plan.

  Please let us know if you have any other questions on the complaint. 

  Customer Answer

  Date: 02/21/2023

  Although the business has failed to explicitly accept liability for the $5.00 Zaleplon charge, and further they have failed to promise any changes for their refusal to address these issues internally in the future, I take their written comments to apply they are accepting responsibility for the $5.00 Zaleplon charge I ought not have been charged, and are acknowledging their failure to appropriately resolve this issue initially, and are promising to make necessary changes to treat their customers better.
  
  If and only if this is explicitly understood, then I accept their response.