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:09/28/2024

  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.

  I get several calls a day from this company looking for a "seralene Brookes" (not sure of the spelling). When I answer and tell them they have the wrong number they just go "okay" and hang up. But then continue to call me. It's harassing, they call sometimes 6 times a day from different numbers. This has been going on for months.

  Business Response

  Date: 10/04/2024

  Dear Better Business Bureau:
  
  I am writing in response to the inquiry you submitted to CarePlus on behalf of ******* ******** We have researched the concern and identified the following:
  
  After completing a review of our records, we were unable to locate any calls made to or received from Ms. ******** Please note that on October 1, 2024, a Grievance and Appeals Representative submitted a request to stop all calls to Ms. ******** phone number. This request has been forwarded to the appropriate department for action. CarePlus will take all the necessary steps to cease all future calls.
  
  Thank you for alerting us about this issue. We value our relationship with our members and take all complaints seriously.
  
  Please feel free to call me if you have any questions or concerns regarding this matter. I can be reached at ****************************  For any questions or concerns, beneficiaries may contact *************** at **************; TTY: 711. From October 1 - March 31,we are open 7 days a week, 8 a.m. to 8 p.m. From April 1 - September 30, we are open Monday - Friday, 8 a.m. to 8 p.m. In addition, the beneficiaries can always leave a voicemail after hours, Saturdays, Sundays, and holidays and we will return their call within one business day. 

  Customer Answer

  Date: 10/16/2024

   
  Complaint: 22354241
  
  I am rejecting this response because:
   I am still receiving calls from your 305 number, your representatives are calling and asking to speak to "seralene ******". 

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

  Business Response

  Date: 10/25/2024

  I am writing in response to the inquiry you submitted to CarePlus on behalf of ******* ******** We have researched the concern and identified the following:
  
  After completing a review of our records, we were unable to locate any calls made to or received from Ms. ******** Please note that on October 1, 2024, and October 21, 2024, a Grievance and Appeals Representative submitted a request to stop all calls to Ms. ******** phone number. This request has been forwarded to the appropriate department for action. CarePlus will take all the necessary steps to cease all future calls.
  
  Thank you for alerting us about this issue. We value our relationship with our members and take all complaints seriously.

  Customer Answer

  Date: 10/25/2024

   
  Better Business Bureau:
  
  I still receive calls from this telemarketing agency from a 305 number.  I will block all calls from your 305 number because I'm done dealing with this.

  Careplus, force your customers to verify their cell numbers.

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

• Initial Complaint

  Date:09/03/2024

  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.

  Having same issues constantly with ***************** Constantly getting freeze **** sometimes no sound, pixelization constantly. They keep sending a repair person who always has a different excuse as to what's going on, and I am lied to that the problem has been fixed. A couple hours later.... same things happen again. And my bill is constantly going up in price and the problems never get fixed. I am disabled and live on a fixed income and my TV is my only source of entertainment. It's not fair to keep raising fees and never fixing the problems and than on top of all that, they lie to you that it's been fixed. I would love to get another cable service but ******** has the monopoly on service in our area and there is no other company in our area. Please stay clear of them. They constantly raise your rates to ridiculous prices. They are ROBBERS AND DO NOT RETURN THE SERVICES AS PROMISED.

  Business Response

  Date: 09/04/2024

  Greetings,

  This issue cannot be reviewed since it does not relate to CarePlus.

• Initial Complaint

  Date:08/02/2024

  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.

  This company keeps sending me unsolicited mail for ******** plans. I have called them and requested the stop sending to no avail. I will not ever use this company for insurance. I want them to stop sending mail.

  Business Response

  Date: 08/06/2024

  I am writing in response to the inquiry you submitted to CarePlus on behalf of *********************.We have researched the concern and identified the following:
  
  After a further review of our records, we were unable to locate any calls from *************. Please note that on August ******, a Grievance and Appeals Representative submitted a request to stop all mailings to Mr.Vronas address.This request has been forwarded to the appropriate department for action.CarePlus will take all the necessary steps to cease all future mailings.
  
  Thank you for alerting us about this issue. We value our relationship with our members and take all complaints seriously.

• Initial Complaint

  Date:07/09/2024

  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 have been fighting with Care Plus since September 2018 to get My teeth fixed. Care Plus told Me numerous times that I am completely covered for dentures and related work needed for dentures. I went to several of their participating dentists and every time told there are copays. I live on a fixed income and cannot afford the copay. I was told many times that I don't have copays by Care Plus. I have lost 13 teeth so far, the broken remains still need to be removed. I have requested numerous times for a list of provided coverage in writing and only recently received it after 5 year. ****** took over the dental plan September 1st of 2023. After multiple calls I recently received the paperwork from Care Plus. That took 11 months.

  Business Response

  Date: 07/19/2024

  Dear Better Business Bureau:
  
  I am writing in response to the inquiry you submitted to CarePlus on behalf of **************** Winzewort. We have researched the concern and identified the following:
  
  The beneficiary's allegations have been forwarded to the appropriate department/leaders for investigation. A full investigation will be conducted, and corrective action taken, if needed. Please be advised that all review findings are confidential and not subject to disclosure to our beneficiaries.
  
  According to our records, we confirmed that the beneficiary became effective with CarePlus on September 19, 2019. The beneficiary has made several requests regarding dental fee schedules and Evidence of Coverage (EOC). On September 28, 2021, the beneficiary requested a dental fee schedule, which was mailed on September 29, 2021. Subsequently, on October 21, 2021, the beneficiary requested a dental fee schedule, which was mailed on October 22, 2021. On March 3, 2022, the beneficiary requested a dental fee schedule, which was mailed on March 4, 2022. Furthermore, on April 19, 2022, the beneficiary requested a dental fee schedule and EOC, which was mailed on April 20, 2022. On March 17, 2023, the beneficiary requested an EOC and a dental fee schedule, these items were mailed on March 20, 2023. Lastly, on March 23, 2023, the beneficiary requested an EOC and a summary of benefits and were mailed on March 24,2023. We verified these plan materials were mailed to the beneficiarys address at *********************************.
  
  In addition, on April 8, 2023, ************************* ***** submitted a prior authorization request to Aflac Dental Solutions, CarePluss Health Plans former dental benefits coordinator. This request was approved under prior authorization number  20230408EMCD0119090 for D5214, mandibular partial denture - cast metal framework with resin denture bases (including any retentive/clasping materials, rests and teeth) , D5213,maxillary partial denture - cast metal framework with resin denture bases (including any retentive/clasping materials, rests and teeth), and D7210,surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated. This request was approved on April 8, 2023, with an expiration date of July 7, 2023.Aflac mailed a Notice of Approval of Request for Services was mailed to the beneficiary. However, there were no claims on file suggesting the beneficiary proceeded to complete these procedures with the provider.
  
  Based on the beneficiarys 2024 Evidence of Coverage for CareNeeds Plus (HMO D-**** Chapter 4 Medical Benefits Chart (what is covered and what you pay) for the Mandatory Supplemental Dental Benefit DEN459 dental services are covered in-network only at a $0 copayment until the maximum allowable benefit of $4,000
  is reached annually. The benefit can be used for most dental treatments such as preventive dental services including exams, routine cleanings, basic dental services, such as fillings, extractions, and major dental services, such as periodontal scaling, crowns, dentures, root canals,and bridges. The allowance cannot be used on implants or cosmetic services. The beneficiary is responsible for any amount above the dental coverage limit. All services must be received in-office from a participating, in-network, general dentist, or dental specialist (e.g., oral surgeon, endodontist, periodontist, etc.). Limitations and exclusions may apply, and any amount unused at the end of the year will expire. Please note that the dentist may suggest and help arrange for additional services not listed in this benefit schedule; however, any procedures received that either are not listed in this benefit schedule or exceed the benefit limitations listed in this schedule are not covered. The beneficiary is responsible for the costs of these additional services and will be charged the dental providers usual and customary fees, less any contracted discount. Submitted claims are subject to a review process, which may include a clinical review and dental history to approve coverage. For more information regarding dental benefits,the beneficiary may go to CarePlusHealthPlans.com/Resources to view the complete Dental Benefit Schedule for their dental plan.
  
  Please be advised that effective September 1, 2023,the Aflac dental network was replaced by the Florida Gold Plus Network,administered by Humana dental insurance company. Covered services continue to be aligned per benefit year. Therefore, on August 7, 2023, a Humana Dental Transition Letter was mailed to the member, explaining the transition, and providing the beneficiarys new dental ID. The beneficiary may use www.humana.com/findadentist to find participating providers under the new plan.
  
  Furthermore, a Grievance and Appeals Representative contacted the beneficiary on July 15, 2024. During the conversation, the beneficiary requested assistance finding a dental provider. For the beneficiarys convenience, we located three providers in the Humana Gold Plus network:
  
  ******************, located at *****************************************************.
  Phone: **************
  
  **************************, located at **************************************************************.
  Phone: **************.
  
  ********************************, located at ***********************************************************************.
  Phone: **************
  
  Thank you for alerting us about this issue. We value our relationship with our members and take all complaints seriously.
  
  Please feel free to call me if you have any questions or concerns regarding this matter. I can be reached at **************************. For any questions or concerns, beneficiaries may contact ****** Services at **************; TTY: 711. From October 1 - March 31, we are open 7 days a week, 8 a.m. to 8 p.m. From April 1 - September 30, we are open Monday -Friday, 8 a.m. to 8 p.m. In addition, the beneficiaries can always leave a voicemail after hours, Saturdays, Sundays, and holidays and we will return their call within one business day. 

  Customer Answer

  Date: 07/24/2024

  I am not good at using **mputers. Care Plus did not mention that ********* ***** did not fix My teeth because Care Plus owed Him $70,000 and did not pay Him. This was told to Me in person by ********* *****. Care Plus does not mention the other 4 dentists that I went to that would not do anything without ** pays, despite the fact that I was told numerous times that I was **vered.Human Gold started September 1st 2023. I called Care Plus numerous times and finally received the requested information last Friday. That is 10 months later. My mailing address is a PO. Box. The mail issues cannot be blamed on the local letter carrier. I am not satisfied with any of the excuses that were given. I am missing more than 10 teeth and have several broken ones in My mouth. I want My teeth fixed without any more excuses. 

  Customer Answer

  Date: 07/25/2024

   
  Complaint: 21960793
  
  I am rejecting this response because:

  Care Plus did not mention that ********* ***** did not fix My teeth because Care Plus owed Him $70,000 and did not pay Him. This was told to Me in person by ********* *****. Care Plus does not mention the other 4 dentists that I went to that would not do anything without ** pays, despite the fact that I was told numerous times that I was **vered.Human Gold started September 1st 2023. I called Care Plus numerous times and finally received the requested information last Friday. That is 10 months later. My mailing address is a PO. Box. The mail issues cannot be blamed on the local letter carrier. I am not satisfied with any of the excuses that were given. I am missing more than 10 teeth and have several broken ones in My mouth. I want My teeth fixed without any more excuses.
  
  
  Sincerely,
  
  ***********************

  Business Response

  Date: 07/26/2024

  Please see letter attached

• Initial Complaint

  Date:03/22/2024

  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.

  On November 24, 2023, I emailed the company to ask to be removed from their database because I was receiving junk mail for ****** and ***************************. They claimed that they would forward the email to the appropriate department. Nonetheless, they are still sending junk mail to my home for *******************************.****** and *************************** do not live here. Please delete my address from your database.

  Business Response

  Date: 04/01/2024

  Based upon our review a Grievance and Appeals Representative has investigated the Ms. ************ case and addressed the concerns. According to our review: we  confirmed  that the request to stop all mailings to their address was received on November 24, 2023, and subsequently forwarded to the appropriate department  for action. Our records indicate that all necessary steps have been taken to cease all future mailings.
  
  Please be advised if beneficiaries have any questions, they can contact our ************************** at **************;TTY: 711. From October 1 - March 31, we are open 7 days a week, 8 a.m. to 8 p.m. From April 1 - September 30, we are open Monday - Friday, 8 a.m. to 8 p.m.In addition, the beneficiaries can always leave a voicemail after hours,Saturdays, Sundays, and holidays and we will return their call within one business day.
  
  We apologize for any inconvenience they may have experienced. We value our relationship with our members and take all complaints seriously and thank you for alerting us about this issue.

  Customer Answer

  Date: 04/03/2024

   
  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:11/13/2023

  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 am a person with a lot of health is***s and this plan is the worst they left me without my medication am a disabled person with heart problems, psychiatric problems and I end ** in Emergency room,how unprofessional if something else happened to me I will *** the Careplus plan

  Business Response

  Date: 11/21/2023

  Better Business Bureau
  Reference: #********
  
  Based upon our review, a Grievance and Appeals Representative has investigated the beneficiarys case and addressed the concerns regarding their dissatisfaction with CarePlus Health Plans, due to the difficulties they experienced in obtaining their prescription medication. According to our review:
  
  Upon conducting a review of the beneficiary's account, we confirmed that the beneficiary's coverage with CarePlus Health Plans began on November 1, 2023, specifically under the ********* Plus (HMO D-**** policy. Our records indicate that on November 13,2023, the beneficiary reached out to the plan for assistance in obtaining a 30-day supply of 90 tablets, for the medication Hydrocodone-Acetaminophen ******, as prescribed by *********************** on October 5, 2023. After reviewing the beneficiary's prescription claims, we confirmed that the plan had initially rejected the medication, on November 13, 2023, due to exceeding CarePlus' set limit for opioid prescriptions when beneficiaries are new to the plan. For such cases, an exception review is required to proceed. In the meantime, while awaiting the review, the beneficiary has two options. The first is to collect an initial 7-day supply covered by the plan using their original prescription.Once this initial supply is exhausted, they can then obtain any future refills,but a new prescription will be necessary. However, we also found that the medication was being rejected due to the concurrent use of the requested drug Hydrocodone-Acetaminophen ****** and the beneficiary's Alprazolam 1 Mg Tablet.The combination of these two drugs presents a safety concern and requires the beneficiary's doctor to provide an explanation for why they need to be used in conjunction.Regarding exceptions, the plan will provide a response within 24 hours for expedited requests and within 72 hours for standard requests, once we have received the doctor's supporting statement. However, if the beneficiarys health requires it, we will provide a determination sooner. The beneficiary may refer to Chapter 9, Section 7.3, titled "Important things to know about asking for exceptions" in their 2023 Evidence of Coverage for ********* Plus (HMO D-****.
  
  Moreover, in an effort to assist the beneficiary, on November 13, 2023, a ****** Services Representative assisted the beneficiary by submitting a coverage request for their medication.The request was approved, and on November 14, 2023, an approval letter was sent to inform the beneficiary of coverage for Hydrocodone-Acetaminophen ****** MG 90/30. It is important to note that this authorization is valid until December 31, ****, and a new approval will be needed for the same medication in ****.Any changes to prescription coverage in **** will be communicated in advance.  Furthermore, a ****** Services Representative initiated an authorization request on behalf of the beneficiary for an office visit with pain management specialist ***********************. The request was approved on November 15, 2023, and is valid until February 9, ****.
  
  In addition, according to our records, a claim for Hydrocodone-Acetaminophen ****** MG 90/30 was processed and filled on November 15, 2023. We have verified with Medicine Shoppe Pharmacy that the beneficiary was able to pick up their 30-day supply of medication.
  
  In accordance with the beneficiary's 2023 Evidence of Coverage Chapter 5, our plan has implemented a *************** Program (DMP) to ensure the safe use of prescription opioids and other commonly abused medications. If a beneficiary obtains opioid medications from multiple doctors or pharmacies or has recently experienced an opioid overdose, we may collaborate with their doctors to assess the appropriateness and medical necessity of their opioid medication usage. Should it be determined, in consultation with their doctors, that their use of prescription opioids or benzodiazepines is not safe, we may impose restrictions on how they can access these medications. The limitations imposed under our DMP may include requiring them to obtain all prescriptions for opioid or benzodiazepine medications from specific designated pharmacy/pharmacies. As well as requiring them to obtain all prescriptions for opioid or benzodiazepine medications from specific designated doctor/doctors. Lastly, this could include limiting the quantity of opioid or benzodiazepine medications covered for them.
  
  Furthermore, on November 14,2023, a Grievance and Appeals Representative reached out to the beneficiary to provide further assistance with medications and medical visits. However, during the conversation, the beneficiary declined the need for any additional assistance apart from receiving their medication. Nevertheless, as the beneficiary indicated that they have many medical and behavioral difficulties,they were informed about the coverage of outpatient mental health care services. These services include mental health treatment provided by licensed professionals such as psychiatrists, doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, or other mental health care professionals who meet ******** qualifications as per relevant state laws. It is important to note that prior authorization requirements may be applicable. They were also educated that that CarePlus is a ******** Advantage Prescription Drug (MA-PD) Health ************************ (HMO) plan in which the beneficiaries and their ******* Care Physician (PCP) coordinate their health care services. For most specialist visits, their PCP must work with CarePlus to obtain a referral. A referral is an authorization from their PCP and health plan to receive care from a specialist. Please note that the timeframe for receiving a decision under Centers of ******** and ******** (CMS) guidelines is up to 14 calendar days for a standard referral request and 72 hours for an expedited request.
  
  Lastly, we received a notification from the Centers for ******** and ******** Services (CMS), advising the beneficiary will be disenrolled from the plan, due to enrolling in another ******** Advantage plan, effective December 1, 2023. A notification was mailed to the beneficiary confirming disenrollment If the beneficiary requires any further assistance after this date, they should contact their new insurance provider.
  
  Should the beneficiary have any additional questions, they may contact our ****** Services department at **************; TTY: 711. From October 1 - March 31, we are open 7 days a week,8 a.m. to 8 p.m. from April 1 - September 30, we are open Monday - Friday, 8 a.m. to 8 p.m. in addition, you can always leave a voicemail after hours,Saturdays, Sundays, and holidays and we will return your call within one business day.
  
  We sincerely apologize for any inconvenience you may have experienced and trust that we have addressed your concerns in full.

• Initial Complaint

  Date:10/20/2023

  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.

  Been asking for a new pcp for months now pcp is not providing my health needs I have been complaining about neck pain for over a year pcp has done nothing to help I have complained many times to care plus but nothing ever done

  Business Response

  Date: 10/30/2023

  Please see letter attached.

• Initial Complaint

  Date:09/30/2023

  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 was scheduled for heart valve replacement 10/02/2023 at ************** Health. Due to the nature of the surgery the auth had to be in surgeons office no later than 5pm. It was sent at 5:16 pm. Surgery was cancelled. I spent 3 hrs at hospital for pre op. Paid hospital ** pay. No body at care plus cared one way or the other. Very upset

  Business Response

  Date: 10/05/2023

  hello,

  please see attahced. thank you

• Initial Complaint

  Date:08/02/2023

  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.

  Im in ********** a ****** hospital for broken shoulder I have to be out in the street by 12 oclock noon that because your insurance they never give rehab center near to my home I am a 90 years old. Have no English speaker I need your help. I will be out in the street by 12 oclock noon today please I need your help soon is possible. Thank you.

  Business Response

  Date: 08/11/2023

  Please see letter attached.