Business Profile

Insurance Companies

AvMed, Inc.

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Complaints

This profile includes complaints for AvMed, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

31 total complaints in the last 3 years.
5 complaints closed in the last 12 months.

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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:12/27/2024
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.
For at least six months, I have been struggling with the approval of medication for treating my knees. According to **********************, this medication should be sent directly to my specialist for the injections. However, I am uncertain whether AvMed Health Plans (my medical insurance) or CVS Specialty Pharmacy, which I believe is part of CVS Health Corporation, is more responsible for this issue. I have contacted the pharmacy at least 4-5 times, including instances when the nurse from my doctor's office called on my behalf. I spoke with various staff members, including a supervisor (Ms. ******* and shared my sensitive information. Despite these efforts, I am still waiting for someone to approve and send the medication. Now, after the cancellation of the medication on December 12, 2024, without any explanation, I would like to know what is happening with these companies. I feel as though I, and possibly others, are being held hostage by this process.P.S. Transcription of the last message from phone ************** on 12/11/24 at 12:26 this is CVS Specialty Pharmacy calling for Mr. ******** my name is ****** I'm with the resolution team I'm calling regarding your account status we do need your medical insurance information if you could please give me a call back at ************** my name is ****** my extension is 150-1771 and I'm in from 8 AM to 4 PM Monday through Friday Eastern standard time if you do call after that timeframe please leave a message and I'll call you back the extension again is 150-1771 thank you and have a good day
Business Response
Date: 01/27/2025
Please review attached response.
Initial Complaint
Date:11/12/2024
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 a six night stay at the hospital with a diagnosis of cellulitis. Avmed denied my entire day and refused to pay for anything. When I spoke to customer service, they said the reason for hospitalization was a complication from a cosmetic procedure. My cellulitis was not caused by a cosmetic procedure. Cellulitis can be caused by any break in the skin, including fungal infection, which I did have at the time and shaving. my doctor at the hospital Wrote a letter stating essentially the same thing and states nowhere did he say the cellulitis was caused by the surgery. I filed an appeal that AVMed had 60 days to respond to. I called on day 59 and as per the woman on the phone there still was no decision. I called back days later and she told me it was denied today for the exact reason it was initially denied. I feel they did not look into the case at all, or read my letter from physician. Hospital is now hounding me for payment and insurance is giving me the runaround. They denied my claim for their assumption of my diagnosis which is not correct.
Business Response
Date: 11/22/2024
Please see attached response
Customer Answer
Date: 11/23/2024

Complaint: 22547176

I am rejecting this response because:
Please see the attached letter from the hospital. The hospital doctor states "The liposuction was appropriate to include in the history and medical record as the patient personally endorsed it during the history portion of her evaluation. In fact, in no part of my note do I state the infection was caused by the surgery. My final diagnosis was cellulitis of the right lower extremity"
Cellulitis can by caused by many things. I had an active fungal foot infection also shaved. The infection was not a complication of the surgery. AvMed assumed that was the cause to not take responsibility. They completely ignored the letter from the hospital. They also took more than the 60 days to respond to my appeal. The appeal had no new information and just stated the original reason for denial.
Sincerely,

****** ******
Business Response
Date: 11/26/2024
Please see attached response.
Customer Answer
Date: 11/26/2024

Complaint: 22547176

I am rejecting this response because:
PLEASE SEE MY PREVIOUS ATTACHED LETTER (TITLED NCH )SUBMITTED BY MY HOSPITAL DOCTOR STATING THAT MY INFECTION WAS NOT CAUSED BY THE SURGERY AS AVMED CLAIMS. UPON AVMEDS RESPONSE, YOU HAD IN "INPUT" FROM THE DOCTOR THAT WORKS FOR AVMED TO DETERMINE MY CLAIM BY STATING THE FOLLOWING.
"Medical Expert, Internal Rules, Guideline or Protocol:
In making this determination, the Health Plan consulted with an AvMed Medical Director, DO,
who is Board Certified in Emergency Medicine, and the *********** HMO Plan Medical and
Hospital Service Contract"
THIS DOCTOR IS NOT MY DOCTOR AND IS NOT RELATED TO MY CASE OR ME AT ALL. AV MED IS DENYING MY CLAIM DUE TO THEIR ASSUMPTIONS SO THAT THEY CAN NOT PAY FOR MY HOSPITAL STAY. THEY ARE IGNORING THE DOCTOR THAT WAS ACTUALLY TREATING ME AND INSTEAD GOING WITH THEIR DOCTORS ASSUMPTION. THIS IS UNJUST AND UNACCEPTABLE.

Sincerely,

****** ******
Initial Complaint
Date:07/08/2024
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.
On 12/13/2023 I contacted Avmed to discuss the dental coverage with Delta. To confirm my current dentist was in network with the plan. I was confirmed by all parties to then find out on 5/15/2024 that e information that I was given by two completely different people was incorrect. It actually took the agent I spoke with on 5/14 a while to actually see my dentist was in fact not in network. I paid out of pocket ***** for my cleaning for procedure code D1110. I have also been paying an additional fee for this dental and vision coverage I am not able to use because of this incorrect information I was provided. I did all of my due diligence and have been requesting to be reimbursed for my extra premium and my out of pocket expenses and to switch as of June 1st to the plan without the dental and vision coverage but have been denied with no explanation or contact from the healthcare marketplace.
Business Response
Date: 07/17/2024
Please review the attached response
Customer Answer
Date: 07/30/2024

Complaint: 21956721

I am rejecting this response because:
Avmed is claiming that iCARE and Delta dental are reprocessing claims and that is not the case iCare and Delta are contracted through Avmed which provides reimbursement to them I requested either to switch to a non dental and vision plan as I had last year and reimbursed for premiums paid or the ability to reimburse me out of pocket for these doctors for this year that I was told were in network
Sincerely,

***********************
Business Response
Date: 08/20/2024
please see attached response
Business Response
Date: 08/21/2024
please see attached response
Initial Complaint
Date:07/03/2024
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.
AvMed use to be the best insurance, and now, pretty horrible. I have to see a pain management doctor once a month. I have to direct pay BC there are no other pain management doctors within 100 miles. I have requested reimbursement with no results. I also believe that AvMed is not truthful about their services. I searched the AvMed web for Gastro doctors in my area of ***********. They provided 5 doctors. I contacted all 5 and none of them ever heard of AvMed or PHCS which is the holding company. Please help!
Business Response
Date: 07/12/2024
Please review the attached response
Customer Answer
Date: 07/23/2024

Complaint: 21937360

I am rejecting this response because:

Sincerely,

***********************

BBB: Thank you for response. I do reject AvMeds answer BC it is NOT truthful. I have NOT talked to anyone from the member engagement. They just sent my monthly statement rejecting my claims from ******************. They didnt have the courtesy to call me, or even email me through the AvMed Portal. As for the Gastro **** I had to FLY to ***** to see a doctor, BC I could not find a doctor in ************ My complaint was that no gastro doctor in ***********, that is on the AvMed member portal has even heard of AvMed or PHCS. Their response is total garbage. Did they even investigate my complaint? I will also file a complaint with the Florida Insurance Commission.
Business Response
Date: 08/04/2024
Please see attached response
Customer Answer
Date: 08/16/2024

Complaint: 21937360

I am rejecting this response because:

I reached out to Member Services. They stated that there is nothing that they can do and submit an APPEALS LETTER. I did submit the letter (email) and the service agent, who was very nice too, told me to email to a certain section. Of course, that section did not exist from the members portal, so I sent to 2 different sections and requested that it be forwarded to the proper section. To date, I have NOT received any type of response. In fact, AvMed has not responded to my last few emails, one email was for a document for submission. AvMed did not provide the document, nor respond back to me. When I asked the agent about the false information on the website, such as, why are providers listed when they are NOT AvMed providers and have never heard of AvMed or PHCS. I had to file a complaint with the **************************** since I feel that is fraudulent since I called 10 doctor's offices. That information was right from the AvMed Member Portal. Thank you for your help and attention. ***********************

Sincerely,

***********************
Business Response
Date: 08/26/2024
Please review the attached response
Business Response
Date: 08/27/2024
Please review the attached response
Customer Answer
Date: 08/27/2024

Complaint: 21937360

I am rejecting this response because:

It still seems like **************** from AvMed hasn't even looked at my complaint, or any documents dealing with my complaint. When I contacted the 10 doctors from the AvMed provider website, NONE of the doctors take AvMed, or PHCS. **************** is stating that if I said PHCS every doctor would accept the insurance, and all is good (I wish he was right). In fact, when I asked the providers about AvMed and they stated that they never heard of it, then I ask about PHCS. The 10 doctors do not take AvMed or PHCS. I have reported this alleged fraud to the ***************************** and I am waiting for a response.
AvMed has NOT sent me any emails in reference to this complaint. However, I did receive a letter stating that they received my appeal and I have to wait the 30 days. For that, I am grateful.
Sincerely,

***********************
Initial Complaint
Date:05/30/2024
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 purchased an insurance plan by AvMed through the insurance marketplace. I confirmed with a salesrepresentative prior to securing the plan that a particular medication I am already on would be covered under the plan. However, now after having paid for 2 months of insurance, my medication is not being covered. I received a denial letter. I spoke w/ a customer service representative on 5/30/24 about this. I was told that any inaccurate promises or representations made about the extent of insurance coverage was "on" the marketplace and not on AvMed. I feel mislead by representatives from AvMed. I would not have purchased this plan if I had been correctly informed that my medication would be denied. Their lengthy appeal process leaves me without my necessary medication for 30+ days.
Business Response
Date: 06/06/2024
Please see attached response.
Customer Answer
Date: 06/07/2024
The company did not respond to the complaint in total. The complaint is that I was told by a sales representative my medications would be covered. I was not told that I would have to go through months of trialing different medications in order to get the medication approved. I do not want to submit to unnecessary meddling in my medication management by an insurance company. I was misled prior to buying the insurance. I have appealed and if my appeal is denied I will discontinue payment as I am not going through medication trials prescribed by an insurance company and not my neurologist. Hope this helps.
Customer Answer
Date: 06/07/2024

Complaint: 21782243

I am rejecting this response because:
they did not respond to my complaint that the sales representative told me my medication would be covered. The sales representative did not inform me I had to submit to additional medication trials in order to have my medication approved. The sales representative did not inform me I had to prove the existance of migraines at a certain frequency in order to have the medication approved. Migraines cannot be objectively verified. That is basic medical science. Put simply, I was misled into purchancing an insurance plan under the guise that my medication would be simply approved not that I had to undergo medical experiementation with unsuccessful medications beforehand. Having to switch to less effective medications to prove my migraines will result in a loss of economic viability. The insurance company should compensate me for any missed time at work during forced medical experimentation. Their boilerplate response says nothing about the issues I have raised. Hope this helps.

Sincerely,

*************************
Business Response
Date: 06/14/2024
Please see the attached response.
Customer Answer
Date: 06/17/2024

Complaint: 21782243

I am rejecting this response because:
AvMed has effectively acknowledged that the consumer has been harmed by fraud. AvMed's position is that the "Market Place" is responsible for this fraud and yet AvMed is the company who has materially benefitted from the fraud. AvMed evinces no concern that sales representatives are misrepresenting their products to consumers to close a sale and instead encourages the consumer to reach out to the Market Place to resolve the issue. Yet AvMed is the entity lining their pockets on the back of sales fraud and hiding behind a different entity to do it.
The consumer encourages AvMed to take responsibility for the information circulating about their products on the "Market Place" as well. AvMed would do well to ensure that consumers are not mislead into purchasing their producs. The consumer now requests AvMed act in good faith by covering ONE refill of Nurtec to make right this issue. The consumer will be happy to "switch" to a plan that actually covers medically necessary medications.

Sincerely,

*************************
Initial Complaint
Date:12/14/2023
Type:Product 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 a surgery on Dec 18th that was scheduled on Dec 7th. The authorization was put in right away but Avmed has not responded despite numerous calls from the surgeons office. Ive already spent money on medical equipment and services for my recovery
Business Response
Date: 12/28/2023
Please review attached response
Initial Complaint
Date:12/05/2023
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 canceled AvMed 1/1/23 but they continue to card my bank account each month. When I call they tell me I am not in their system so they cant help me.
Business Response
Date: 12/06/2023
Please see attached response.
Initial Complaint
Date:10/03/2023
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 continue to get AvMed mailers to my address to a person named "*************************." This person has never lived at my address and is unknown to me. I attached a copy of the mailers arriving to my address and request this person be deleted to my address.
Business Response
Date: 10/10/2023
Please review the attached response
Customer Answer
Date: 10/11/2023

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:07/20/2023
Type:Delivery 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.
06/08/2023. As part of my Medicare benefits. prescription eye glasses are covered for $400. I visited my provider (aVMed) and placed an order amounting to $440. (Made a co-payment of $40. To data, 07/2082023 I have not yet received the glasses. Called at least 4 times, and each time I was told there was an error at the lab. This needs to be rectified ASAP. My user ID is ***********
Business Response
Date: 08/01/2023
Please see attached response.
Customer Answer
Date: 08/01/2023

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:04/06/2023
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.
We have being try to get paid by Avmed since 2020. We are providers for Avmed with many claims pending for payments, The reason why Avmed denied claims are not valid, we are in network and no need of authorisation on file.Some claims get paid and some others don't. we have contact many supervisors, ************************* and ******************************* and no one has been able to help us out. Our patients are getting upset that we don't want to take their insurance even if we are in network and we are supposed to take them. but since we are not getting the payments from Avmed we don't know how to move forward and we are seeking help to fix this issue and finally been able to provide the services to our patients.
Business Response
Date: 04/20/2023
Please see attached.
Customer Answer
Date: 04/21/2023

Complaint: 19904221

I am rejecting this response because: the information they provide is incorrect. Claims were denied due to no authorisation on file and we didn't need one since we are in network W/ PHCS Multiplan/Avmed. they keep giving me the same reason and is incorrect, this is what we have trying Avmed to understand. So far we have only received some payments towards 2020 and 2021 claims, and some are paid at the wrong amount. It takes us a lot of time having to call Avmed and go over this claims, specially since Avmed will only help with 4 date of services per call, then we had to make several calls to fix this issue thats has been going on since 2020. I myself had spend around 4 to 5 hours daily calling on all the claims to be sent to be reviewed is not like Avmed is doing it them self. If I don't bring this to them this money will had never been collected and they hold my payments since 2020.

Please advice on how to move forward on the still outstanding claims.

Sincerely,

*************************************
Business Response
Date: 05/04/2023
Please see attached response.
Customer Answer
Date: 05/05/2023

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, I am glad that finally someone is helping us out after 2 years of us trying to get this issue resolved.

Sincerely,

*************************************

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AvMed, Inc. is NOT a BBB Accredited Business.