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:04/14/2025

  Type:Sales and Advertising 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 asked for a quote from another insurance company they gave me a plan instead. I never approved of that I had two year left with this insurance company. I am pregnant and need to renew my insurance as soon as possible. I am disputing a fraud with the other insurance company what are the next steps I really need to see a doctor for my baby it is three months in. I cant stress this enough

  Business Response

  Date: 04/24/2025

  Please see attachment.

• Initial Complaint

  Date:04/03/2025

  Type:Order 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 am writing to file a formal complaint against Simply Healthcare for gross negligence and unauthorized actions that have led to the termination of my elderly mothers ******** coverage and long-term care *********** February, a Simply Healthcare case worker arrived at my mothers Florida residence. At the time, my mother, ***** ******, was on vacation in *******. I, her daughter and legal power of attorney, informed the case worker that she was temporarily out of the country and would be returning shortly. The case worker acknowledged this and left without any further discussion or request for documentation.Despite being clearly informed that my mother was only on vacation, the case worker proceeded to file a 2515 form with the State of Florida, falsely stating that my mother had changed her address to *******. This form was filed without my mothers knowledge, consent, or the authorization of her power of attorney which is a direct violation of procedure and a serious ************ a result of this two-minute visit and the case workers unauthorized actions, my mothers ******** and all associated healthcare benefits were wrongfully terminated. My mother is 80 years old, a stroke survivor, and suffers from a brain tumor and an enlarged heart. She is now left without medical coverage or access to critical care and medication due to Simply Healthcares negligence.I have contacted Simply Healthcare multiple times to resolve this issue, but I am constantly redirected, given conflicting information, and no one has taken the necessary steps to correct this serious error or resubmit her Florida address to the state. The lack of accountability and refusal to take corrective action is unacceptable.I respectfully request the Better Business Bureau to investigate this matter and take appropriate action against Simply Healthcare. I am seeking:Immediate reinstatement of my mothers ******** and long-term care benefits

  Business Response

  Date: 04/28/2025

  Please see attached response.

  Customer Answer

  Date: 04/29/2025

   
  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:01/20/2025

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I am writing to file a complaint regarding an issue I experienced with ********************** and Simply Healthcare related to my dental visit on January 15, 2024.********************** is listed as an in-network provider with Simply Healthcare. However, I was charged over $100 for my visit because Simply Healthcare allegedly advised the dental office of incorrect insurance coverage. This charge was unexpected and should not have occurred, as my plan fully covers the services I received.After the visit, I contacted Simply Healthcares customer service team, and they confirmed that the information provided to the dental office was incorrect. I was advised that the services should have been covered in full, and I should not have been charged anything.I am requesting that Simply Healthcare:Expedite the processing of the submitted claim.Provide an Explanation of Benefits (EOB) reflecting the corrected coverage and payment details.Reimburse me promptly for the amount I paid out-of-pocket.Additionally, I kindly ask that ********************** be educated about verifying insurance coverage correctly for future visits to prevent similar issues for other patients.This situation has caused me unnecessary financial and administrative stress. I appreciate your assistance in resolving this matter efficiently.Thank you for your attention.

  Business Response

  Date: 01/23/2025

  January 23, 2025
  
  Better Business Bureau (BBB)
  Attention: ****** *.
  *****************************************>12th Floor
  ******************
  VIA: BBB Portal
  
  
  Member: ******* ********* Sr
  Re: Dental Refund
  BBB File No.: 22833989
  
  Dear BBB:
  
  This is in response to your correspondence dated January 20, 2025, regarding the above referenced member.
  
  Due to federal laws pertaining to the Health Insurance Portability and Accountability Act (HIPAA)and the Protected Health Information (PHI) portion of it that went into effect April 14, 2003, we cannot relinquish information without proper authorization.  Therefore, we will be addressing the concerns in question and responding directly to ******* ********* Sr.
  
  I trust that the information provided will aid in resolving your concerns and want to thank you for the opportunity to assist you.  Should you have any additional inquiries, please do not hesitate to contact me at ******************************************************************************************************.         
  
  Thank you for your concern.

  Customer Answer

  Date: 02/05/2025

   
  Complaint: 22833989
  
  I am rejecting this response because: ************** still has not resolved my issue which contracts for Simply. I kindly request Simply contacts ************** directly to resolve the matter, then thereafter contact me.
  
  Sincerely,
  
  ******* *********

  Business Response

  Date: 02/07/2025

  February 7, 2025
  
  Better Business Bureau (BBB)
  Attention: ****** *.
  *****************************************>12th Floor
  ******************
  VIA: BBB Portal
  
  
  Member: ******* ********* Sr.
  Re: Dental Refund
  BBB File No.: 22833989
  
  Dear BBB:
  
  This is in response to your correspondence dated February 6, 2025, regarding the above referenced member.
  
  Due to federal laws pertaining to the Health Insurance Portability and Accountability Act (HIPAA)and the Protected Health Information (PHI) portion of it that went into effect April 14, 2003, we cannot relinquish information without proper authorization.  Therefore, we will be addressing the concerns in question and responding directly to ******* ********* Sr.
  
  I trust that the information provided will aid in resolving your concerns and want to thank you for the opportunity to assist you.  Should you have any additional inquiries, please do not hesitate to contact me at ******************************************************************************************************.         
  
  Thank you for your concern.
  
  ******** ********
  Grievance Analyst I
  Medicare Complaints, Appeals & Grievances

• Initial Complaint

  Date:12/18/2024

  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 am writing in behalf of my grandmother because I spoke to simply months ago and they never solved the issue and never followed up on it. Today I found out that the social worker told my grandma that I had answer God knows what question giving her a good rating and saying nothing was wrong. That is a lie! Simply never called me back to solve the issue and I never rated that ** or said I was happy with her work. That is the main reason I called simply, to say I was very unhappy with what she did to my grandma and simply never responded back. I am so upset about this, they seem to not care about the elderly and protect their bad employees. Simply sent my grandma a social worker to her home, who basically didnt explain what she was signing to her in a clear way and my grandmother signed. The social worker changed my grandmother from one plan to another causing my grandmother to loose benefits. My grandmother used to receive prepared meals everyday, because she cant cook and multiple times has left the stove on causing something she was making to burn because she forgets. She cant cook! Because of this social worker my grandmother lost that benefit that she had for years. She needs her meals, shes 81 years old. When she spoke to the *** the ** told her she wouldnt be receiving the prepare food anymore in a very dismissive manner. I also spoke to the social worker and she was rude and dismissive as if she does not care for the elderly or the harm she caused. She was at my grandmas house today and my grandmother refused to sign some papers, the ** told her that she would be sending the papers to me to read so I could see what she was signing. The ** also told her that if she did not sign she would loose ALL BENEFITS. How can this company allow for their employees to coerce of the elderly?I need someone from simply to call me to solve this issue, it is infuriating that a company that deals with the elderly does this. My grandmother does not want that ** anymore.

  Business Response

  Date: 12/27/2024

  We have attempted to obtain additional information from the consumer/complainant by leaving voice messages. Once the consumer/complainant provides additional info then the plan can better assist. The complainant/consumer can contact the plan's member services ***** for assistance.

• Initial Complaint

  Date:08/21/2024

  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 had selected Simply healthcare through the Florida Healthy Kids CHIP program for my child to being in June 2024. Part of the benefits for the health plan include a $50 school supplies card and $50 for **** plus a rewards card for completing health related tasks such as getting an annual exam. I have not been able to use these benefits because the rewards center has my policy as inactive. However, according to the health plan I am active and there are no issues with my enrollment. It has been a month of continued calls and follow up on my part attempting to correct the issue so that I can use the promised rewards. The health plan (simply healthcare) and the rewards center (CHIP) have been pointing fingers at each other no one one has resolved the issue of me not being able to access the included benefits of the health plan.I would change the health plan provider however, since we already completed at least 1 health related task with simply we will not be able to claim the rewards if we switch.I really want the health plan and the rewards center to be held accountable for correcting the enrollment status for the CHIP rewards. I have called 3x a week for the past 4 weeks with no resolution and several failed follow up and escalation attempts.

  Business Response

  Date: 08/30/2024

  Good Afternoon,

  There have been 4 attempts made to contact the consumer to obtain additional information in order to verify who the member is and provide assistance. At this time the consumer has not responded to the plan. If the consumer does respond to the plan's outreach attempts, we will be more than happy to assist.

• Initial Complaint

  Date:08/05/2024

  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.

  still refusing and now allowing us to see patients with simply health care plans. we are turning away lots of simply health patients everyday.

  Business Response

  Date: 08/16/2024

  Good Afternoon, Whomever filed this complaint listed one of the plan's Provider Relations representatives as the consumer/complainant which is inaccurate. At this time we are unaware who the true consumer/complainant is. They need to provider their information in order to further assist them.

• 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 was in a car accident on 01/19/2024 and went to ER with me and my kids and it was a misunderstanding about my medical bill which caused the provider to bill me instead of insurance which they are required to Pay if a person dont have any other resources

  Business Response

  Date: 07/19/2024

  This was resolved via the Grievances process as the member did not initially provide the health plan insurance to the provider. The provider was contacted and provided the insurance information. The member has already been informed of the resolution.

• Initial Complaint

  Date:06/14/2024

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Simply provides ******** services for my Mother (*********************). Simply case worker introduced the *** program for my wife to be reimbursed for the services she provides to my mother.Was told that I myself (******************) legal POA for my mother could not sign off on the hours that my wife provides care.

  Business Response

  Date: 06/24/2024

  Good Afternoon,

  Please see our attached response.

• Initial Complaint

  Date:05/13/2024

  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 medical provider and been trying to access simply health care network so we can help patients with simply health care. Simply health care has been giving us run around since Aug 2022. How medical provider suppose to practice when insurnace companies like simply health care put red tapes all over where provider can not get in network.

  Business Response

  Date: 05/24/2024

  Good Afternoon, Multiple attempts were made to contact the provider to obtain additional information and inquire what line of business the provider is interested in participating. After multiple attempts, the provider replied indicating they have been contacting the health plan since August 2002 attempting to participate with the health plan. The provider can submit a letter of interest the following ways:

  How to apply for participation
  If youre interested in applying for participation with Simply Healthcare Plans, Inc. (Simply) and Clear Health
  Alliance (CHA), weve added new functionality to the provider enrollment tool hosted on Availity Essentials to
  further automate and improve your online enrollment experience.

  Digital provider enrollment is currently only available for professional practitioners. Facility and ancillary
  providers, please submit a letter of interest to the address below:
  Attn: Provider Relations
  Simply Healthcare Plans, Inc.
  *****************************************************************
  

  The tool provides the below features:
  Apply and request a contract to enroll a new group of practitioners
  Monitor submitted applications statuses real-time with a digital dashboard
  The system pulls in all your professional and practice details from Council for Affordable Quality Healthcare
  (CAQH) ProView to populate the information we need to complete the enrollment process including
  credentialing, claims, and directory administration. Please ensure your provider information on CAQH is updated
  and in complete or re-attested status.
  The online enrollment application will guide you through the process, and a dashboard will display real-time
  application status. Youll know where each provider is in the process without having to call or email for a status.
  To begin the enrollment process, log onto Availity.com and select Payer Spaces > Simply and CHA > Applications
  > Provider Enrollment. If your organization is not currently registered for Availity Essentials, the person in your
  organization designated as the Availity administrator should go to Availity.com and select Register. For
  organizations already using Availity, your administrator(s) will automatically be granted access to the provider
  enrollment tool. Staff using the provider enrollment tool need to be granted the user role Provider Enrollment
  by an administrator. To find yours, go to My Account Dashboard > My Account > Organization(s) > Administrator
  Information.

   

   

• Initial Complaint

  Date:04/23/2024

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  my kid is unable to see his dr and the insurance company assigned to him refuses to help my 13 yr old seeing his primary care

  Business Response

  Date: 05/02/2024

  Good Evening,

  Due to federal laws pertaining to the Health Insurance Portability and Accountability Act (HIPAA) and the Protected Health Information (PHI) portion of it that went into effect April 14, 2003 we cannot relinquish information without proper authorization.  Therefore, we will be addressing the concerns in question and responding directly to the consumer. This consumer complaint was forwarded to our Grievance and ************* so that an analyst can speak with the consumer about his concerns.