ComplaintsforUnited Group Programs

• Initial Complaint

  01/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Optimed health 1/21/24 $338 Optimed health 12/22/23 $335 I was promised a service that I never got . I was told me and my daughter were insured through this super wonderful plan. On there website is a list of pediatrician. When I used that list to schedule an appointment for my daughter not one of the doctors on the list were valid or they didnt recognize are even know who optimed was. I just wants a full refund because of the false promises I totally feel like this place is a scam.Customer service is not professional . Ive had two phone calls where Im on hold for 20+ minutes and then the call just ends ..on there end. Anytime I did get in contact with a person, they will say , oh well let me transfer you and then you get transferred to a dead end. *** spent hours trying to cancel my plan and get a refund, and it feels like theyre just teasing me at this point by tossing me around phone call to phone call. NEVER USE THIS PLAN. Also was told I would receive ID cards in the mail.. its been a month and I havent got them . I called and asked about it and they said just to keep waiting.Also I was told that when I started in December, my next payment would be in February and they charged me in January and really put me in a hole by not keeping there word .Because of them my daughter has been late on her doctors appointment . Im almost 8 months pregnant right now and because of them I dont even think Im insured and Im ready to a bill hospital bill anyday now .

  

  Business response

  02/01/2024

  Dear BBB,

  OptiMed is the billing administrator for the product sold to *************  The product was sold by a third-party Agency. 
  When a member calls to cancel their policy, our **************** Team is required to transfer the call to the third-party Agency that sold the product.  After transferring the call, our **************** Team emailed ************ a cancellation form.  The completed form was not received by our **************** Team.
  Correspondence from the third-party Agency was received on 1/24/24 to terminate the coverage, however the correspondence stated no refund was due.
  
  We are sorry to hear ************ is not happy with the product sold by the third-party Agency.  As the billing administrator, OptiMed confirmed ************ did not file a claim and a full refund was processed on 1/31/2024. Please see the attached refunds processed.
  
  $353. Refund for 12/20/2023 charges
  $338. Refund for 1/21/2024 charges
  

  We hope a full refund to ************ will be to her fullest satsifaction.

  Sincerely,

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

   

   

• Initial Complaint

  01/19/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I signed up for health insurance with Multiplan Optimed Health Insurance May 2022. During the initial conversation, I was told that routine doctors visits, prenatal care, lab work would all be covered. I have been paying on average $350 per month for 18 months. I recently did a routine Pap smear with labs and was charged over $800, with insurance paying $0. I then became pregnant and was then told they do not cover any doctors visit etc. I do not know how companies like these can get away with fraudulent acts such as this. I need my money back, I am now left with an amount of bills, when I was scammed over $6300

  

  Business response

  02/01/2024

  Good afternoon,

  We are unable to find a member by the name of ************ in our system.

  Could you please supply some additional information to help locate this member.

  Full first name

  Last 4 digits of the payment method used to pay their premium

  Copy of their ID card

  Once this additional information is received, it will be our priority to search for the member and investigate their complaint.

  Sincerely,

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

   

   

• Initial Complaint

  12/18/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On August 29, 2022 my husband and I started a health insurance policy through Optimedhealth. We found it through Heath.gov. The premium was a little high ($463.) compared to others wed looked at but no deductible and dental insurance were inferred. (No dental)My husband sees a urologist every 6 months we cleared him as a provider. We do not have other regular Dr. ********* September 2023 my husband had a check up with the urologist. Optimed paid nothing. When I called hospital billing they said when they submitted the claim optimed told them our coverage had been terminated. Optimed said we were never terminated and their explanation was 1st that billing lied, then they said to resubmit the claim. Billing said they would but since there was already one in the que that a new claim would get kicked out. Then, optimed said that they recently moved and claims were not sent to the right address. This happened on 3 different bills. We never missed a Payment=approx $7000. We could have paid these bills several times over with what we paid them. The outstanding medical bills total $949.00 still unpaid as communicating with optimed is going nowhere. Excuses. Solutions We do not have authority to complete. ie, resubmitting claims.Im frustrated but also worried that there are other, maybe older folks out there that are being taken advantage of. As getting answers and resolve is a merrygoround and misleading making you think they have done their job and everyone else has messed up or been dishonest.I want our claims paid as they stated they were covered. And I want people to know that this company is misleading and not trust worthy.

  

  Business response

  12/27/2023

  Good morning,

  We have received the complaint submitted and wanted to provide an update.

  ************** stated $994. in bills.  To date, we have received two claims for a total of $664. 

  Attached please find the EOBs for the two claims received.  Both claims have been forwarded to the Claims Manager for review. 

  The information provided to ************** was provided by an Independent 3rd Party Agent and not our direct Team.  We have reached out to the Agent as well.

  Thank you for your patience as we research and will respond as quickly as possible.

  Sincerely,

   

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

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

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

   

   

   

• Initial Complaint

  10/25/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I canceled my insurance on Oct 4, . I requested for them to return the balance. I called and several times I was sent to voice mail. I sent email to them and they finally replied with a denial of my claim.

  

  Business response

  11/01/2023

  Good afternoon,

  We have received the request to refund ********** for his November, 2023 premium.

  Attached please find confirmation for the processed refund.  It may take 5 to 10 business days for

  the refund to appear on ************** account.

   

  Sincerely,

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

   

• Initial Complaint

  10/05/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I Purchased health insurance through optimed Health. Effective date was 9/8/2023. Member ID: *********. I paid them ****** for the first months premium. For my husband and me. I was told that I can go on the portal and print out my insurance cards to use until they mail my documents for my policy, which included my insurance cards as well.About a week after, I went to my pharmacy to pick up my medication, gave them the insurance card only to be told that I do not exist in my insurance companies system, and that I should call the company directly. I went home, called them and kept calling them for several days and even Emailed them with no response from them. I need to cancel my policy and get a refund but I cannot find anyone that can help me. I feel that this may have been a scam and all I want is to get my refund back and move on.

  

  Business response

  10/12/2023

  ******************,

  We are sorry to hear you were not happy with the product purchased, or the level of service received.  We value our clients and the service we provide.  

  A refund was processed 10/12/2023 for:

  $235. for September premium

  $235. for October premium

  Please allow 5 to 10 business days for the refund to post to the credit card.

  Sincerely,

  OptiMedHealth Plan

   

   

• Initial Complaint

  04/05/2023

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  On March 7, 2023, representative *********************************** ************** sold us a health insurance plan after being directed to this company by the ** ********************** marketplace. As we went through the list of health concerns and issues, we were repeatedly assured by the sales agent that our doctors and healthcare needs were covered, and that we would be receiving all necessary documentation in the mail. As of April 5, 2023 we have not received one piece of documentation from the healthcare provider, and numerous phone calls and emails continue to go unanswered.There is much conflicting information on the company's website and calls to customer support simply get dumped into a callback queue (and the callback NEVER happens).

  

  Business response

  04/12/2023

  An email notification was received on 4/7 regarding a complaint filed with the BBB on 4/5 to the assigned ID #********.
  OptiMed is the billing administrator for the product sold to ID# ********.  The product was sold by a third-party Agency, by **************, who is an Agent for Capestone Benefit Group. 
  Per our records, a call was received by our customer service team on 4/5 requesting cancellation and a refund for the policy.  The cancellation form was emailed that afternoon.
  Optimed reached out to the Agent directly requesting a statement regarding the complaint.  A response was received from ****************, who is the head of the customer service team at Capestone Benefit Group.
  ****************, the first and only correspondence received was when the members spouse (sole plan holder) reached out requesting cancellation and a refund.  A cancellation email was sent.  ****** reached out again and spoke with the member and his spouse and walked them through the steps to completed the cancellation form and addressed any other concerns the member had.  The member was satisfied with the results and thanked him for his assistance.  The member was also provided a direct point of contact if further assistance in the future was needed.
  The cancellation request was received 4/12 and processed.  The member will receive the refund within 7 to 10 business days.

  Customer response

  04/12/2023

   
  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 as long as the money actually shows up in my account (see attachment) .I would like to add that the sales rep in question never returned our phone calls, the  and the first and only response we received from the company was the email request to cancel the policy on April 5, 2023 at 9:00PM. .   The rep we did finally get in touch with after calling the sales department directly (since calls to the 'help' desk only allow you to leave a callback number - which went unreturned) informed my wife (*******) that they were having 'sales issues' when pressed how the rep could have misrepresented the coverage claims.  We still have not received the schedule of benefits as promised when we signed up on March 7, 2023.

  On the evening of April 11, 2023 at 11:12PM I did receive an email from Optimed title 'Payment Receipt' showing that my refund was approved for the full amount of ******, but at the time of writing this email - the money still has not been refunded to the payment card listed.  The email (attached) also contains no transaction number or other reference to even verify the payment was actually made.
  

   

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

• Initial Complaint

  02/24/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I canceled my policy due to non activation by optimed. It was supposed to be activated on the 1st of January 2023. The company irefunded my premium on February 1st. Optimed stated it would 7 to 10 business days to appear in my account. It still hasn't posted to my account. I've contacted customer care, and they keep saying they've reached out to accounting. I've contacted the *** and still nothing. I just want my money back.

  

  Business response

  11/21/2023

  Good afternoon,

  A refund was originally processed for ****************** on 2/01/2023 (Please see attached receipt).  ****************** contact our CFO stating he had not received his refund.  Upon researching the refund, a service fault was found and a refund check was overnighted to ****************** and was received on 3/01/2023 (Please see attached email correspondence).  ****************** contacted our CFO on 3/05/2023 stating he received another check.  We requested he destroy the check.  Please see the attached email correspondence confirming ****************** destroyed the second check.

  Our apologies for any inconvenience to *******************

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

  Compliance Manager

   

• Initial Complaint

  05/23/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  May 10/22 Tuesday. I was looking for short term Health Ins until I return to work. I spoke with ********* from Optimed early that morning. I explained to him my situation. I need short term health ins to cover me until I get back to work. I'm currently on ******* comp for a shoulder injury. I told him that I already had all my yearly routine check *** (GYN, Eye and Primary check up, and blood work.) I needed Ins for any emergency care. He told me the best plan for me and affordable would be PHCS of **. It would be a month to month coverage and I could cancel anytime, it would cover Emergency , Rx regular appts and no change of DR.S. $380.80/ month plus $125.00 enrollment fee one time charge total $505.809. (Charged to my credit card, which I filed a complaint about this also.) He gave me my confirmation #HHA1738 and ID # ********* so I could get into patient portal. When I read the plan I decided that's not what I wanted. That same day in the afternoon 3:11 pm I called the phone # ********* gave me to get in touch with him. I spoke with ******, explained why I needed to speak with ********* and I wanted to cancel my Ins he sold me. I was told by ****** that he wasn't available and she was unable to help me because the information was not in the system since it was just done so she could not see what plan I was given. ****** told me I need to call back on Thursday (3 days later) and she would be able to see it. I called back Wednesday 5/ 11/ 2022 and again I got ******, ( ******** was not available or a supervisor) I told her several times I want to cancel this Ins she would speak to a supervisor and call me back. No call back.Thursday 5/12/2022 I called I got ***** ****** was not available or a supervisor. He told me after many requests to cancel and asked for a supervisor he would send me an email with a ticket # that is the process. I informed him he is rude and not helpful and I'm reporting this *** to BBB. **** found me a supervisor ***** refused to cx plan.

  

  Business response

  05/24/2022

  Good afternoon,

  We have received the complaint submitted by *********************. 

  There are multiple parties involved with this product and we have forwarded ****************** complaint to the Agency that sold the product to **************.

  As the **** we value all of our members and ****************** policy has been cancelled and a refund of 100% of her monies has been requested.

  Regards,

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

   

   

   

   

  Customer response

  05/24/2022

  I just checked with my credit card and no refund was sent. I will continue to check and once refund is applied I will respond. thank you *********************

*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. ↩