Reviews

Review Details

• Review fromJoseph F

  Date: 05/08/2025

  1 star
  How come care plus no longer has an advocacy group for people who can't get care plus to help. How come Advent Medical is no longer giving echo cardio grams at 10 of there hospitals, to out patients, but making patients go to ***** or zephyrills to get them done.These are the care plus numbers I have dialed 1 267 525 979

• Review fromRobert F

  Date: 04/06/2025

  1 star

  Robert F

  Date: 04/06/2025

  Horrible! For a year I've been trying to. get som home health care to do light housekeeping for me which I'm unable to do. A month ago they called me and said someone else would be calling me to set it up. Have received no call.The only reason I keep this company is because of the debit card and that the Dollar General store near me takes it. Other than that, I would have dumped them long ago.

  CarePlus Health Plans, Inc.

  Date: 04/18/2025

  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.
  
  Please note according to our records, the member was enrolled into our CareNeeds Platinum (HMO D-SNP) H1019-146 for the 2024 benefit year and is also under the same plan for the 2025 benefit year. Unfortunately, this plan does not cover ****************** (PHC) that covers a $0 copayment for a minimum of 3 hours per day, up to a maximum of 42 hours per year for certain in-home support services to assist individuals with disabilities and/or medical conditions in performing activities of daily living (ADLs) within the home by a qualified aide (e.g., assistance with bathing, dressing, toileting, walking, eating, and preparing meals).
  
  Furthermore,we reached out to the office of primary care physician (PCP) Dr. ******** ******* who advised us member was last seen in the office on April 16, 2025,has an upcoming appointment on July 13, 2025 however there are no requests on file of member requesting a PHC referral from the office. Member can reach the office for any assistance at ************ Monday Friday 8:00am-5:00pm.
  
  Additionally,we reached out to our ************************** who advised there are no records of communication prior to June 2024. On July 9, 2024, the CarePlus *************** nurse made first contact however the member was uncooperative and refusing assistance with a provider change request or medical needs. On July 23, 2024 the member expressed the need for additional home assistance and was referred to the support *************** team while awaiting a response from the long term care (***) program. Follow up attempts were made on July 30, July 31,August 2, August 5, and August 14 with the support *************** team providing continued assistance.
  
  In ************************************************************************************************** requesting a call back. Available programs for the members need include home health aide services which require PCP request with justification and additional hours through the *** program which must be coordinated between the *** provider and the PCP.
  
  Moreover,we reached out to our *************** department who advised us that the member was first contacted on May 17, 2024 regarding a potential request for home health assistance through the Comprehensive Assessment and Review for *************** Services (CARES) program. Initially the member was transferred to *************** where they were educated about the *** application process but declined to proceed due to the anticipated processing time. The member believed their CarePlus plan would cover ****************** without an application.Follow up calls on June 13, 2024 and July 19, 2024 were made with the member eventually agreeing to apply for the *** program. A referral for the assessment was completed and was scheduled for July 31, 2024.
  
  In 2025 the member was contacted again on March 19 as part of the *** campaign. They requested a call back due to a medical appointment but the follow up was missed. Contact was reestablished on April 14 2025 and the member reapplied for the *** program. It was discovered that the member had missed the prior year's assessment, so a new appointment was scheduled for April 17, 2025.
  
  The ******** long term program is available to eligible individuals offering home and community-based services for those 65 or older or adults with qualifying disabilities requiring nursing facility level care. Social service assists with the application process, coordinates assessments and helps manage waiting lists. They also support benefit renewals to ensure continuity of care.
  
  Lastly,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.
  
  Thank you for alerting us about this issue. We value our relationship with our members and take all complaints seriously.

• Review fromPamela T

  Date: 03/04/2025

  1 star

  Pamela T

  Date: 03/04/2025

  This is the absolute worse plan I have ever experienced! Call and get the run around. Will not approve meds that are prescribed by physicians! Claim they never received paperwork or order! ***!

  CarePlus Health Plans, Inc.

  Date: 03/14/2025

  I am writing in response to the inquiry you submitted to CarePlus on behalf of ******* *******.  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.
  
  Based upon our review, on January 2, 2025, the beneficiary contacted CarePlus and was assisted by a *************** Representative in requesting a coverage determination on his behalf for the medication, ************ 1/62% gel pump under *** *********. This request was denied on January 3, 2025, after receiving the documentation from the beneficiarys provider Dr. *** **** under ******** Part D because the information we have does not tell us what condition the drug above is treating (their diagnosis). The ******** rule in the Prescription Drug Benefit Manual (Chapter 6, Section 20.4) says a drug is covered when the use is reasonable and necessary for treatment of an illness. We look at the two major drug guides to decide if the use is accepted (reasonable and necessary). These drug guides (compendia) are called the Drugdex Information System, and the *********************************** Drug Information (AHFS-DI). A diagnosis will help us decide if the drug can be covered under the beneficiarys Part D benefit.
  
  Pursuant to the beneficiarys 2025 Evidence of Coverage for CareFree Platinum Giveback (HMO) Chapter 5 Using the plan's coverage for Part D prescription drugs, for certain drugs, the beneficiary or their provider need to get approval from the plan before we will agree to cover the drug for the beneficiary. This is called prior authorization. This is put in place to ensure medication safety and help guide appropriate use of certain drugs. If the beneficiary does not get this approval, their drug might not be covered by the plan. Please be advised that once we create an Episode of Care (***) and fax to the medical doctor, it stays open for 14 days to receive a response. Once a response is received, we will make a decision in 72 hours for standard requests and 24 hours for an expedited request.
  
  Furthermore, on January ******, the beneficiarys provider Dr. *** ****, submitted an appeal request appealing the denial of the *** ********* requested. This appeal was denied on the same day as we agree with our initial coverage determination. We cover this drug when our criteria are met. The unmet criteria are: the beneficiary has had one of the following: documentation of two morning serum ************ levels (total or free) that are below normal ranges, taken at separate times, prior to treatment; or documentation of a serum ************ level (total or free) that is less than or within the reference range for the lab, when already on treatment. This decision was from CarePluss Preferred ************ Products Pharmacy Coverage Policy at **************************.
  
  Additionally, on February *******, CarePlus received additional information from the beneficiarys ************ Physician (PCP) Dr. **** ********. Therefore, we reopened and reviewed the additional information received. Unfortunately, we still agree with the original decision.
  
  Moreover, if the beneficiary does not agree with this decision, they have the right to ask for an independent review (appeal) of our decision. If the beneficiarys case involves an exception request and the physician or other prescriber did not already provide the beneficiarys plan with a statement supporting the beneficiarys request,their physician or other prescriber must provide a statement to support the beneficiarys exception request, and the beneficiary should attach a copy of this statement to their appeal request. If the beneficiary wants to appeal CarePluss decision, they must request their appeal in writing by mail or electronically within 65 calendar days after the date of this notice.  The beneficiarys must submit their written request to the independent reviewer at one of the following addresses:
  
  Standard ****************************************************** Reconsiderations
  P.O. Box 44166
  **********************-4166
  
  For Mail sent by courier such as ***** or UPS:
  C2C **************************
  Part D Drug Reconsiderations
  ******************************************************br>************, *******; 32202
  
  Fax Numbers:
  For Standard Appeals: **************
  For Expedited Appeals: **************
  
  Lastly, please be advised if beneficiaries have any questions, they can contact our *************** 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, the beneficiaries can always leave a voicemail after hours, Saturdays, Sundays, and holidays and we will return their call within one business day.
  
  Thank you for alerting us about this issue. We value our relationship with our beneficiaries 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 ************** ext.1466697. 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.

• Review fromLiza Z

  Date: 12/02/2024

  1 star

  Liza Z

  Date: 12/02/2024

  The company does not deserve any stars. I have been filing grievances for the past year regarding a LEP penalty. The company canceled my insurance because the mailing address was used as the coverage area not the primary home address that never changed. They said I moved. I never moved I updated my information and provided them a "mailing address." I was never sent any documentation that they were going to cancel my insurance. I found out 3 months after they canceled me at the eye doctor. What's crazy is the **** over the phone kept telling me that i had active insurance but my carecard at the time was not active. Why i kept calling members services. I kept asking them why is my card not working? That's when the fifth rep gave me the correct information that i had no insurance. I had to reactiviate the coverage than they sent me a LEP enrollment penalty. No forms to appeal they said they sent the forms. I told them I had Part D coverage with the VA since 03. I sent them documents for proof. They continue to send penalties every month for over a year. Getting multiple different stories. You need to go through ********. ******** says go to careplus. Careplus says go *************. There is no way to leave messages with c2c. Careplus employees failing to provide accurate information multiple grievances and spoke with multiple supervisors. I now need to wait over 3 weeks to get something in writing regarding a form that i had coverage. I will continue to stay on top of this cause they keep billing me these penalties and no longer want anything to do with this company and how long this is taking to handle this problem

  CarePlus Health Plans, Inc.

  Date: 12/13/2024

  Dear Better Business Bureau:
  
  I am writing in response to the inquiry the beneficiary submitted to CarePlus on behalf of **** M. *********. We have researched the concern and identified the following:
  
  In regard to the beneficiary's concerns against the CarePlus associates who did provide accurate information over the phone, these 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.
  
  In addition, we reached out to the CarePlus ********************* and requested a review of their records. They informed us that the beneficiary was disenrolled from CarePlus effective May 1, 2023, because CarePlus did not receive a response to the letters that were mailed to the beneficiary requesting them to call the plan and confirm their address. On October *******, CarePlus received a notification from the ****************************************** (CMS) advising that the beneficiary may be out of the service area. Per CMS guidelines, the beneficiary was mailed the required letters, and any responses were tracked for six (6) months. The beneficiary did not contact the plan to confirm their address during that time period, and therefore they were disenrolled from the plan. The first letter was sent to the beneficiary on October 22, 2022, notifying them that they may be residing outside of the plans service area - and that they would be disenrolled six months from the date of the letter. A reminder letter was mailed on January 23, 2023; and the final letter was mailed on April 10, 2023. On May 4, 2023, a letter was mailed to the beneficiary confirming their disenrollment with the effective date of disenrollment: May 1, 2023.
  
  According to our records, the beneficiary is currently enrolled in the CarePlus CareOne Plus Health ************************ (HMO)H1019-001 policy effective August 1, 2023. On July 10, 2023, the health plan received an enrollment application on the beneficiarys behalf, and it was processed with an effective date of August 1, 2023. Please be advised this application was forwarded to CMS for processing and the beneficiarys enrollment application was accepted by *** on July 12, 2023. On August *******, CarePlus Health Plans received a notification from CMS advising of a creditable coverage change with an effective date of August 1, 2023.Subsequently, on August 23, 2023, CarePlus Health Plans received a notification from CMS advising that a new enrollment penalty was accepted with an effective date of August 1, 2023.
  
  In addition, the CarePlus ********************* reported that the beneficiarys monthly Late Enrollment Penalty (***) amount is $1.00 effective August 1, 2023. According to their records, a letter was mailed to the beneficiarys residence on July 13, 2023, advising that the beneficiary did not have creditable prescription drug coverage that met ********* minimum standard. The letter stated that if the beneficiarys records show that the beneficiary had prescription drug coverage from May 1, 2023, to August 1, 2023,the beneficiary can avoid paying the monthly penalty by returning the enclosed form to CarePlus Health Plans, Inc. ******************************************* or by calling *************** at ************** to provide information by August 12, 2023. On July 21, 2023, a final notice letter was mailed to the beneficiarys residence requesting proof of prescription drug coverage be submitted by August 12, 2023. On August 23, 2023, the ********************* mailed a letter to the beneficiarys residence informing the beneficiary that starting August 1, 2023, the beneficiarys new premium will include a late enrollment penalty of $1.00 per month. According to ********'s records, the beneficiary did not have creditable coverage for 3 months from May 1, 2023, to August 1, 2023. The beneficiary was advised that the beneficiary can submit a reconsideration request within ************************************************************************************************************************************** ******** may not consider the request.
  
  Furthermore, the ********************* informed us that the *** is sent to CarePlus directly from CMS, and the beneficiary must request a reconsideration to the contracted ************************* (***):***************************** The Late Enrollment Penalty is an amount that is permanently added to a beneficiarys monthly Part D premium. This accumulates when a beneficiary goes 63 days or more without credible prescription drug coverage. A Creditable coverage is a prescription drug health insurance (coverage)that meets a minimum set of qualifications established by ***. The Late Enrollment Penalty is assessed by ********. The *** is calculated by multiplying 1% of the ********************************* times the number of full, uncovered months without prescription drug coverage. The final amount is rounded to the nearest $0.10 and added to the beneficiarys monthly Part D premium.
  
  Please be advised, if the beneficiary would like to reconsider their ***, the beneficiary must send a signed reconsideration request to the ***: ****************************. The request should include any supporting documentation and may be submitted to:
  
  ******************************
  Part D *** reconsiderations
  P.O. ******************************************
  Fax: **************
  Toll free customer service: **************
  Web portal: ****************************************
  
  Lastly, please be advised if beneficiaries have any questions, they can contact our *************** 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 ****** addition, the beneficiaries can always leave a voicemail after hours,Saturdays, Sundays, and holidays and we will return their call within one business day.
  
  Thank you for alerting us about this issue. We value our relationship with our members and take all complaints seriously.

  Sincerely,       
  
  **** *******
  Supervisor
  Grievance/Appeals Department

• Review fromAldo C

  Date: 10/30/2024

  1 star
  EL PEOR SERVICIO DE LA HISTORIA. Pongo una ******** porque no hay menos. Pero es terrible. Tengo ********* y en agosto me cambi de Aetna a CarePlus, la peor decisin de la vida. Desde entonces lo **** que he tenido son ****************** Tengo que estar en el telfono prcticamente todos los das y no encuentro solucin. Dependiendo de la persona que responda el telfono, la situacin ******.Necesito un CPAP, la cual yavena usando por casi un ao hasta el cambio de proveedor. Obviamente, Aetna me exigi la devolucin de la mquina y desde entonces empez mi calvario. Primero era porque no recibian los estudios y notas completas, lo cual el empleado que respondia mi cuarta llamada siempre confirmaba que estaba completo. El nuevo proveedor del **** tambien me llamo y me dijo que debia esperar porque no tenian en inventario. Desde setiembre estamos hablando de un lado a otro y hasta ahora nada. Cada vez que llamo a preguntar el status del envio del nuevo CPAP me dicen que no tienen ningun requerimiento, o que esta incompleto, o que la orden expir. Luego me dicen que todo esta bien. He recibido **** una carta de ****************** (el suplidor del CPAP) con autorizacion para el despacho y hoy que llamo a ********* nuevamente me dicen que no tienen nada y que debo empezar con el requerimiento nuevamente. Mi mdico primario dice que corro riesgo de infarto por la falta del **** y quiero dejar constancia en este medio por si algo me llega a pasar. Por favor, tengan mucho cuidado con esta compaa.

• Review fromAlexys R

  Date: 09/30/2024

  1 star

  Alexys R

  Date: 09/30/2024

  Worst insurance ever. Everyone who works there are very unprofessional, all in their feelings with attitude problems. No one has a clue on how to do their job and procrastinate on every need of the patients. I would never ever use this insurance nor refer them to anyone. If I could I would give them -5 stars. I've been waiting since July 7th for a denial letter for a skilled nursing service. I've been trying to get reauthorized and here I am September 30th and still have yet to receive it in order to take it to my other insurance to see if they will pay. Everyone keeps giving me the runaround and no one knows what they're doing and all they have is excuses. Please stay clear and far away from this insurance plan because you will ultimately regret it such as I have. If I can boycott them I most definitely would. Don't say I haven't warned you. This is definitely fair warning.

  CarePlus Health Plans, Inc.

  Date: 10/11/2024

  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:
  
  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.
  
  As per the Centers for ******** and ***************** (CMS)guidelines, CarePlus Health Plan has 14 days to make a determination for a standard authorization request and 72 hours for an expedited authorization request. When an authorization is approved, the beneficiary's ************ Physician (PCP) has access to the submitted authorization through a delegated portal. In the case of an expedited organization determination, the beneficiary receives a phone call. If CarePlus is unable to reach them, a voicemail is left, and/or a letter is sent notifying them of the decision. The denial letter is mailed to the beneficiary the same day it is generated.  If the authorization is denied, the beneficiary has the right to appeal the decision within 60 days of the date of denial.
  
  According to CarePlus records, on July *******, the beneficiary contacted CarePlus and was assisted by a *************** Representative with opening an expedited authorization on his behalf for Home Health Care (***)services. This request was denied under authorization 15420839**** on July *******, because CarePlus contacted the office of the beneficiarys ************ Physician (PCP) Dr. ********* *********-********* to discuss his case. However,CarePlus did not receive the **** consent, an order, and the clinical information required for the request. CarePlus contacted the beneficiary and left a voicemail advising of the authorization denial and educating on their appeal rights. On August 3, 2024, we mailed a denial letter to the beneficiary with appeal rights. Additionally, per the beneficiarys request, we have mailed the denial letter again on October 2, 2024.
  
  In addition, on September 30, 2024, the beneficiarys PCP,Dr.*********-*********, submitted an authorization for *** with Registered Nurse (RN) visits this authorization request (15583909****) was denied on October 1, 2024, because CMS guidelines state that for an enrollee to qualify for *** services or a home health aide (HHA), the beneficiary needs to be confined to the home, be under the care of a physician, and receiving services under an established plan of care that is periodically reviewed by the physician.The beneficiary must also be in need of skilled nursing care on an intermittent basis, or physical therapy or speech-language pathology, or have a continuing need for ********************. CarePlus reviewed the information received from **************************** (IHCS), CarePluss delegated provider for *** services, which indicates that the beneficiary does not meet the ******** criteria for ***, because he receives daily ***** care/maintenance under ************ Insurance. The clinical information did not indicate that the beneficiary requires additional skilled care at home. Please be advised that the decision to deny this request is based on: Centers for ******** and ***************** (CMS) - 100-02-******** Benefit Policy Manual - Chapter 7 -Conditions Patient Must Meet to Qualify for Coverage of Home Health Services,Section 30. On October 4, 2024, CarePlus mailed a denial letter to the beneficiary with appeal rights.
  
  Furthermore, the beneficiary has the right to appeal our decision.The beneficiary has the right to ask CarePlus Health Plans to review our decision by asking us for an appeal within sixty days of the date of the denial notice. We can give the beneficiary more time if they have a good reason for missing the deadline. They may file an appeal by mailing their request to:
  
  CarePlus Health Plans,INC.
  P.O. Box 277810
  *****************
  Fax: ************
  Email: ******************************************************************************
  
  Please note that upon receipt of the beneficiarys appeal they will receive a decision in writing as expeditiously as their health requires but no longer than sixty calendar days.
  
  Lastly, the Grievance and Appeals Representative attempted to contact the beneficiary on October 2, 2024, and October 9, 2024, to offer further assistance; however, we were unable to reach the beneficiary. Since the beneficiary expressed having a negative experienced with CarePlus Associates because of concerns with inappropriate behavior or attitude, these allegations were forwarded to the appropriate department/leaders for investigation. Please be advised that all review findings are confidential and not subject to disclosure to our beneficiaries.
  
  Thank you for alerting us about this issue. We value our relationship with our members and take all complaints seriously.

• Review fromVIcki C

  Date: 07/15/2024

  1 star

  VIcki C

  Date: 07/15/2024

  PLEASE DO NOT USE THIS PLAN!! -Their average time to answer phones when called is between 15 & 30 min's. -Medical Group offices communication with CarePlus is sporadic and untimely. -Referral communications not accurate nor timely, causing delays in care Delays in care have the definitive potential to impact your health!DO NOT USE THIS PLAN!!!

  CarePlus Health Plans, Inc.

  Date: 07/25/2024

  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:

  As per the Center for ******** and ******** Services (CMS) guidelines, CarePlus Health Plan (CPHP) has 14 days to make a determination for a standard authorization request and 72 hours for an expedited authorization request. When an authorization is approved, the beneficiary's ******* Care Physician (***)has access to the submitted authorization through a delegated portal. In the case of an expedited organization determination, the beneficiary receives a phone call. If CarePlus is unable to reach them, a voicemail is left, and/or a letter is sent notifying them of the decision. If the authorization is denied,the beneficiary has the right to appeal the decision within 60 days of the date of denial.
  
  According to CarePlus records, on January 17, 2024, the beneficiary's ***, ***************************, submitted an authorization for office visits with gastroenterologist **************************, which was approved that same day under authorization number 14857490*PO for three visits expiring on January 16, 2025. Furthermore, on July 9, 2024, the beneficiary's *** submitted an expedited authorization for a colonoscopy and biopsy with ************** at *****************, which was approved on July 10, 2024, under authorization number 15367084*OS for one visit,expiring on October 9, 2024. CarePlus contacted the beneficiary and left a voicemail advising of the authorization approval and instructed them to contact CarePlus ****** Services or their *** for further information about the approved service.
  
  Moreover,the Grievance and Appeals Representative reached out to the office of *** ************************** and requested a review of their records. The office reported that they first received the referral request for the colonoscopy on July 2, 2024,and that it was submitted to CarePlus Health Plans for review and determination on July 9, 2024. The office received the approved authorization on July *******, and it was faxed to the specialist that same day. As per the office policy of **************, once they receive a referral request from a specialist,they will process and submit it to the health plan within 72 business hours.Once it is approved by the plan, they will fax it to the specialist. The office of ************** clarified that they were closed on July 4 and July 5 of 2024, for the holiday.
  
  Please note that the *** is responsible for providing routine health care needs and overseeing care. If the beneficiary requires certain types of covered services or supplies from network providers, they must obtain approval in advance from their ***, such as getting a referral. All communications with medical offices are conducted through the Provider ********************** and provider offices can always contact CarePlus Provider Services for assistance. For authorizations, all providers have access to submitting and receiving approvals via an electronic portal.
  
  Furthermore,a Grievance and Appeals Representative contacted the beneficiary on July 1******, to offer further assistance. During the call, the beneficiary advised that she only needs a colonoscopy and that she is currently scheduled to have it completed with gastroenterologist ************** on October 2, 2024. The Grievance and Appeals Representative offered to assist in finding a new gastroenterologist with an earlier appointment; however, the beneficiary declined as they preferred to have ************** perform the colonoscopy.Therefore, we contacted ******************************* office at *****************. They confirmed that the beneficiary is scheduled for a colonoscopy on October ******. Their records indicate that the beneficiary was previously scheduled for the colonoscopy on July 10, 2024. The office indicated that no sooner appointments were available. We inquired if they have a waitlist for cancellations to help the beneficiary get an earlier appointment, but they do not have one. Due to high demand, there is limited availability for these procedures. Some providers are scheduling appointments as far out as February.
  
  In regard to the wait of the call center, we apologize for any inconvenience regarding the expressed concern. We are currently experiencing higher than normal call volumes and are working diligently to resolve this issue. Wait times fluctuate throughout the week based on member demands. We appreciate their concern and sincerely apologize for any inconvenience caused.
  
  Thank you for alerting us about this issue. We value our relationship with our members and take all complaints seriously.
  
  Best Regards,

• Review fromJean S

  Date: 05/18/2024

  1 star

  Jean S

  Date: 05/18/2024

  I am currently sitting in the hospital for no reason except the companies they use for home health IV antibiotics are horrible. This admission is due to the fact that no one came or called until 5 days after discharge by which time I was so sick I had to be re admitted. This time I am ready for discharge but am sitting here because of failure to coordinate delivery of drugs. BEWARE!!!!

  CarePlus Health Plans, Inc.

  Date: 06/07/2024

  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:
  
  We contacted CarePlus's ******************************** and requested a review of their records. Following this review, they informed us that the beneficiary was discharged from East Bay Rehab Skilled Nursing Facility on May 10, 2024. The discharge plan, which included the administration of intravenous (IV)medications, was submitted to ************* Solutions (OHCS). On May 14, 2024,the beneficiary was admitted to ******************** at the request of their podiatrist and was discharged home on May 20, 2024. Home Health Care (HHC)services were arranged through ******************** Services (IHCS) and provided by ********************* with IV medications coordinated by OHCS and provided by Optum. CarePlus confirmed there was no delay in the beneficiary's discharge. All necessary arrangements were completed on May 17, 2024, but the hospital's case manager indicated that the beneficiary did not have a discharge order at that time and was awaiting a medication order for home use from the hospital's MD. Due to the late arrangements on Friday, weekend staffing could not be coordinated to support IV medication administration, resulting in the beneficiary's discharge being postponed until May 20, 2024. To ensure timely medication administration and avoid further delays, CarePlus maintained contact with the beneficiary's ******* Care Physician (PCP) office and the hospital's case manager via phone and email. They confirmed that both IHCS and OHCS received the discharge orders. Please note that CarePlus staff are available 365 days a year to support any barriers to hospital discharge that a beneficiary might experience.
  
  We verified that the Home Health Care order was sent to ******************** Services and authorized for the period from May 20, 2024, to June 19, 2024. This authorization included one Occupational Therapy (OT) evaluation, three OT visits, one Registered Nurse (RN) evaluation, six RN visits, one Physical Therapy (PT) evaluation, and three PT visits, all provided by ********************* Providence ********* informed us that the beneficiary refused the services on May 24, 2024.
  
  We also contacted OHCS and learned that they received an order on May 7, 2024, for the IV medications Ciprofloxacin and Daptomycin, which was staffed to *********** ************* on May 8, 2024. An order received on May 17, 2024, was canceled due to a duplicate request, and another order on May 19, 2024, was canceled due to the need for reauthorization. On May 20, 2024, OHCS received an order for the IV medication Merrem, which was sent to *********** ************** on May 21,2024. Finally, we contacted *********** **************, and the staff confirmed they received an order on May 9, 2024, which was not dispensed, but they did not have notes explaining why. They received a verbal order on May 13, 2024,but by the time they were ready to dispense the medication, the beneficiary had been admitted to the hospital. The most recent order, received on May 21, 2024,for Merrem and Daptomycin, was fulfilled for nine days starting that same day.They confirmed that orders are typically fulfilled within the same day or the following day.
  
  Additionally, a Grievance and Appeals Representative contacted the beneficiary on June 6, 2024,to offer further assistance. The beneficiary confirmed they had received the necessary services after hospital discharge and indicated that no further assistance was needed at this time.
  
  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.

• Review fromGary M

  Date: 05/07/2024

  1 star

  Gary M

  Date: 05/07/2024

  Careplus I suffer with in large prostate And all I need is a 5 mg tablet to help relieve inflammation and they have denied me. I've been on this medicine for 7 years and never have I been denied this medication. When I was denied by WellCare they asked for information for my doctor if ***** was medically necessary for me to have my doctor sent them the paperwork and they covered it now Care Plus asked the same thing. My doctor sent everything they needed and they still keep denying me and I need this medicine but they don't think about people. They just think about what goes into their pocket and if I can find a different insurance I would. I left WellCare to come to them because they was everybody was saying how good they were and it's not a fact Care Plus *****

  CarePlus Health Plans, Inc.

  Date: 05/29/2024

  Based upon our review a Grievance and Appeals Representative has investigated the beneficiarys case and addressed the concerns. According to our review:
  
  According to our records, we confirmed that the beneficiary contacted CarePlus on January 25, 2024, and indicated that he needed the non-formulary drug Tadalafil 5mg. A Coverage Request, under authorization number *********, was submitted on behalf of the beneficiary. This request was partially approved on February 1, 2024, with an effective date of January 1,2024, through December 31, 2024, as the drug the beneficiary requested is not listed in their preferred drug list (formulary). The preferred drug(s), the beneficiary may not have tried, are at least one 5-alpha reductase inhibitor (finasteride 5mg tablet dutasteride capsule) . The beneficiarys provider needs to give CarePlus medical reasons why the preferred drug(s) would not work for the beneficiary and/or would have bad side effects. Sometimes a preferred drug needs more review for approval. Additionally, some preferred drugs listed may be the same drugs with different strengths or forms . CarePlus may only require one strength or form of that drug to be tried. This decision was from CarePluss Non-Formulary Exceptions Coverage Policy.
  
  In addition, on April 22, 2024, the beneficiary contacted CarePlus and advised that he needed the non-formulary medication Tadalafil 5mg. A Coverage Request, under authorization number *********, was submitted on behalf of the beneficiary. This request was partially approved on April 22, 2024, with an effective date of January 1, 2024, through December 31,2024, as the drug the beneficiary requested is not listed in their preferred drug list (formulary). The preferred drug(s), the beneficiary may not have tried, are at least one 5-alpha reductase inhibitor (finasteride 5mg tablet dutasteride capsule) . The beneficiarys provider needs to give CarePlus medical reasons why the preferred drug(s) would not work for the beneficiary and/or would have bad side effects. Sometimes a preferred drug needs more review for approval. Additionally, some preferred drugs listed may be the same drugs with different strengths or forms . CarePlus may only require one strength or form of that drug to be tried. This decision was from CarePluss Non-Formulary Exceptions Coverage Policy.
  
  Furthermore, on April 25, 2024, the health plan received an appeal request from the beneficiary for the non-formulary exception denial for the drug Tadalafil 5mg. This appeal was denied on May 2, 2024, as the drug the beneficiary asked for is non-formulary (not on CarePluss list of preferred drugs). According to the pharmacy and therapeutics non-formulary exceptions coverage policy, the beneficiary must have tried and failed the preferred drugs, including at least one 5-alpha reductase inhibitor (finasteride 5mg tablet dutasteride capsule). Sometimes a preferred drug needs more review for approval. Additionally, some preferred drugs listed may be the same drugs with different strengths or forms. CarePlus may only require one strength or form of that drug to be tried. In addition, CarePlus attempted to contact the beneficiarys prescribing physician ********************* to conduct a peer-to-peer review; however, the health plan was unsuccessful. Therefore, because the beneficiarys prescriber has not explained to CarePlus why the preferred drugs have not worked for the beneficiarys medical condition and/or would have bad side effects the request for tadalafil 5 mg tablet 30/30 has been denied. This decision was from CarePluss Non-Formulary Exceptions Coverage Policy.
  
  If the beneficiary does not agree with this decision ,they have the right to ask for an independent review (appeal) of our decision.  If the beneficiarys case involves an exception request and the physician or other prescriber did not already provide the beneficiarys plan with a statement supporting the beneficiarys  request, their physician or other prescriber must provide a statement to support the beneficiarys exception request and the beneficiary should attach a copy of this statement to their appeal request.   If the beneficiary wants to appeal CarePluss decision, they must request their appeal in writing by mail or electronically within 60 calendar days after the date of this notice.  The beneficiarys  must submit their written request to the independent reviewer at one of the following addresses:
  
  Standard Mail
  C2C Innovative Solutions, ******************* Reconsiderations
  P.O. Box 44166
  **********************-4166
  
  Mail sent by courier such as ***** or UPS                    
  C2C Innovative Solutions, ******************* Reconsiderations
  ************************************************************************************************; 32202
  
  Standard Appeals Fax #: **************
  Expedited Appeals Fax #: **************
  Phone: **************
  
  Moreover, for non-covered drugs, new beneficiaries may receive a 30-day supply of non-covered drugs during their initial 90-day enrollment, which is known as a transitional fill. We confirmed that the beneficiary became effective on CarePlus on January 1, 2024. Therefore, we contacted ********* Pharmacy and confirmed that the beneficiary picked up a 30-day supply of Tadalafil 5mg on February 7, 2024, and a 30-day supply on March 7, 2024. The pharmacy indicated that on April 11, 2024, the beneficiary picked up a 15-day supply using a pharmacy coupon due to medication not being covered. 
  
  Lastly, 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 beneficiaries and take all complaints seriously and thank you for alerting us about this issue.

• Review fromLinda

  Date: 04/05/2024

  5 stars

  Linda

  Date: 04/05/2024

  I've had enough of careplus. The care essentials benefit is well documented as to covering pet supplies - but it doesn't at ******** Other companies plans do. The first time I called I was told they had been slammed with calls about it and the temporary solution was to shop at another participating store. That was early March and so far I've spent over $200 out of pocket as I have no way to get to another store. Now when I call no one knows anything about this and just shop elsewhere. Is this a government based benefit? What do we do? I'm sure there are a lot of us in this situation and I feel CarePlus should reimburse us as they are not living up to their documentation. Thank you for your help.****************

  CarePlus Health Plans, Inc.

  Date: 04/15/2024

  Based upon our review a Grievance and Appeals Representative has investigated the beneficiarys case and addressed the concerns. According to our review:
  
  We contacted ********, the CarePlus provider for the Spending Account Card benefit, and requested a review of their records. After said review, ******** advised that they have submitted a receipt request to ******* to verify the eligible items that were denied for the items that the beneficiary advised were being denied such as , Purina Cat **** Dry Cat Food Healthy Weight & Hairball Indoor Whole Grain Chicken (20 lb. Bag), Special ***** ***** Whitefish & Tuna Dinner **** Wet Cat Food (13 oz), Special ***** Turkey Flavor **** Wet Cat Food for Adult & Kitten (13 oz), Kit & Kaboodle Original Adult Chicken, Liver, Turkey, and ***** Fish Recipe Dry Cat Food (22 lb.), Purina Friskies Dry Cat Food, Seafood Sensations (16 lb. Bag), Purina Friskies Dry Cat Food, Surfin' & Turfin' Favorites (16 lb. Bag), and Purina Friskies Canned Wet Cat Food 32 Count Variety Packs - (32)5.5 oz Cans. ******** advised that if these eligible items were denied, they will be added to the Approved Product List(APL) and may take up to 30 days to process. ******** acknowledged that there were some known issues with pet food being denied at *******; however, this issue has been fixed and the beneficiary should not have any issues with purchasing pet food at *******. If the beneficiary is experiencing problems with the checkout process at the store, we recommend calling the phone number on the back of their card ************ for further assistance.
  
  In addition, the beneficiary can access the Healthy Benefits Plus website or download the mobile application to access various features to help them manage their Spending Account Card.With the *********************** Benefits Plus website and application, they can activate their card, check their card balance, view the card number, request a replacement,view transaction history, search for participating stores, and access email support. With the Healthy Benefits Plus application, they can receive notifications,show the barcode to make purchases without the physical card, and access the barcode scanner to scan items in store to verify if they are eligible for purchase.
  
  Pursuant the 2024 Evidence of Coverage for ********* Platinum Chapter 4 Medical Benefits Chart (what is covered and what you pay) , the beneficiary has a $250 monthly allowance on the CarePlus Spending Account Card and can be used to purchase groceries, personal care items , Over the Counter (OTC) health and wellness items , home supplies , household assistive devices, and pet supplies from participating retail locations. The card can also be used to pay for monthly living expenses (phone payments, rent/mortgage, utilities, internet, etc.) ,non-medical transportation costs (public transportation, taxi, Uber, Lyft,etc.), and pest control services. Unused funds expire at the end of each month.The card cannot be used to purchase alcohol, tobacco and vaping products,firearms, lottery or gaming tickets. This card is not redeemable for cash except as required by law. If the beneficiary has any problems processing transactions with the CareEssentials Card, they may contact Solutran at ************.
  
  Furthermore, we have included a list of locations in the beneficiarys area that are currently accepting the CarePlus Spending Account Card:
  
  CVS
  ************************************************************
  ********************************************************
  
  Dollar General
  ***********************************************************
  ***********************************************************
  
  *******
  **********************************************************************
  ***********************************
  
  Lastly, 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.