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    ComplaintsforAmeriben

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    Complaint Details

    Note that complaint text that is displayed might not represent all complaints filed with BBB. See details.

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    Complaint Status
    Complaint Type
    • Complaint Type:
      Product Issues
      Status:
      Answered
      AmeriBen sent a letter dated May 1st, 2023 re: an uncashed check for reimbursement of a Claim C234512949, date of service November 4, 2022, for *************************(son) for $248.92 requesting a signature and return *********************************** Letter was sent to ***************************(mother) and policy holder for insurance, signed and emailed to AmeriBen on May 9th at 10:37 MST. Called AmeriBen on June 7th spoke to *******, who explained that AmeriBen had not received letter, however the process could begin to resolve and current outstanding check ********** would be cancelled and new check would be issued and reference number was ********. Received call from AmeriBen on June 8th requesting call back regarding ********. Called back on June 13th and spoke to ********** re: request for call back. She explained that accounting claims there is not a signed letter and that they would need another. When I asked for accounting to directly email or provide confirmation of receipt that was not possible. Also, based on a conversation she had with a manager they are only in Letter C/D to resolve these issues and they **************** could not see whether an email had been received by accounting. They are currently receiving calls from others regarding this same problem. We are asking for the check to be sent to us for $248.92 in a form that can be confirmed by us so that we do not have to go thru hoops in order to get the money. This process is broken and AmeriBen has a responsibility to fix this not the person who should receive the money.

      Business response

      06/22/2023

      Dear Resolution Specialist:
      Thank you for the opportunity to respond to complaint #******** received from ******************* response to this inquiry AmeriBen would like to share the following information.
      AmeriBen received ************************** signed unclaimed property letter via email on Tuesday June 13, 2023. **************** should have received a return email acknowledging our receipt of her signed letter, and indicating to allow 4-6 weeks for the reissue process to be completed. AmeriBen strives to expeditiously address members inquiries and concerns    Again, we appreciate the opportunity to respond to the concerns raised.
      Sincerely,
      *****************************

      Customer response

      06/22/2023

       
      Complaint: 20180862

      I am rejecting this response because:  Ameriben only "found" the email with my signature after I filed the complaint with the BBB.  They were unable to find this email when I was on the phone with them on that date (not to mention the previous 4 calls with them) and only replied after they received the complaint from the BBB.  So yes, they do now claim they have the documentation to provide the check however until the check has been received by from Ameriben this complaint has not been addressed or taken care of by Ameriben.  Their record of complaints including mine shows they are not above board and will say what they need to without truly resolving the issues of the complaints.  In this case the resolution is the receipt of the check from Ameriben.

      When Ameriben can prove that the check has been mailed and received that is when this complaint will be considered resolved and not before.

      Sincerely,

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

    • Complaint Type:
      Product Issues
      Status:
      Answered
      In May of 2022 I contacted Ameriben about doing some lab work for an upcoming wellness visit I had with my doctor. I asked if it would be covered in full without any deductible or coinsurance. I was told by my health advisor via chat that if it were billing codes and diagnosis were all preventive it would be. I had my doctor ***** the lab work and submitted it to my health advisor at Ameriben, they had me have it changed to insure there would be no out of pocket expenses. I did this and I was told it looked good and I will not have any out of pocket chargers. Well they were wrong. I have over $300 out of pocket charges, all for very basic labs and they are coded as preventive and wellness. I filed an appeal which they lost. I filed a 2nd appeal which must have been denied without contacting me. I noticed that the claim was reprocessed with a new date now. But they never reached out to me to tell me why it was not being covered in full like I was told it would be. I have faxed more correspondence to them, which has been ignored. I have never received a let explaining anything from them. I send a certified letter to the corporate headquarters as well as the appeals department. I received return slips from the postal department, so I know they received them, but they have completely ignored me. They are forcing me to file a civil dispute in court just to get them to acknowledge me. This is completely unacceptable.

      Business response

      05/17/2023

      Dear Resolution Specialist:
      Thank you for the opportunity to respond to the complaint received from Mr. ********  In response to this inquiry AmeriBen would like to share the following information.
      AmeriBen reexamined the charges in question and the employer's plan document. Our records show that Mr. ******* enrolled in a qualified high deductible plan that provides routine wellness care at no cost sharing when the services fall under the recommendations of ***************** ************ Services Task Force (USPSTF). The hospitals claim submission was correctly coded and billed properly for a general adult medical exam without abnormal findings. However, the lab testing done does not fall under the USPSTF age,gender, or medical condition recommendation guidelines for the testing to be covered under the *************** 100% benefit level. The plan does provide coverage for routine wellness lab services that do not fall under the *************** benefit at the applicable benefit level for diagnostic lab services.Therefore, the routine wellness lab work provided was applied towards meeting Mr.******* 2022 deductible.
      AmeriBen strives to address members concerns and properly pay eligible claims. Please let me know if you require additional information from **. Again, we appreciate the opportunity to respond to the concerns raised.
       Sincerely,
      *****************************
    • Complaint Type:
      Service or Repair Issues
      Status:
      Resolved
      I purchased hearing aids for $5000 from an in-network provider on Aug 16, 2022. I filed a claim with Ameriben on Aug 16, 2022 with the form that was available to me on their portal. But that form did not request all the correct information (TIN abd NPI numbers) so the claim was processed as out of network. I called on Sept 14, 2022 and was told I needed to use a different form and she sent it to me. I was assured that the doctor was in-network and it wouldn't be a problem. So I submitted that form with all the necessary information that same day. Two months later they processed it as a duplicate claim instead of correcting the original claim. I have been trying since then to get the claim corrected. I get different information every time I call. I get assured that it is being processed only to call again and find out that it was never sent to claims. I call and am told it is still open with claims and I need to wait. Then I call back and I am told there was a reply but the person I called last time didn't tell me. I get told it will take a week, then two, then 30 days, then 45. ***** can contact claims or put me in contact with claims to resolve the issue. It has now been 7 months and I am still getting a run around. I simply want my claim processed correctly as in-network and the $2000 benefit I am eligible for reimbursed.

      Business response

      04/10/2023

      Dear Resolution Specialist:
      Thank you for the opportunity to respond to the complaint received from ****************. In response to this inquiry AmeriBen would like to share the following information.
      AmeriBen reexamined the charges in question and the employer's plan document.  This additional review resulted in an adjustment to reprocessed ****************** charges under the hearing aid benefit of the plan. A corrected explanation of benefits issued on April 6, 2023.


      Ms. ***********; self-submitted her claim without provider TIN/NPI information and thus the claim processed as out-of-network. Unfortunately, her claim resubmission which included the necessary TIN/NPI information denied as a duplicate. Generally, a contracted provider will submit claims through the appropriate network and thus avoid an incorrect application of provider contract status.


      AmeriBen strives to address members concerns and properly pay eligible claims. Please let me know if you require additional information from us. Again, we appreciate the opportunity to respond to the concerns raised.
       Sincerely,
       *****************************

      Customer response

      04/15/2023

       
      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 dispute their explanation as they did not address the terrible customer service that I recieved or the length of time it took to resolve the issues.  I am however, satisfied that they are paying the claim.  Thank you.

      Sincerely,

      *************************
    • Complaint Type:
      Product Issues
      Status:
      Answered
      On 8/8/22, I went to my OB/GYN for an IUD. Months later, I received a bill from the provider and Ameriben denied it because it was not an in-network provider. A quick search confirms that this provider is in-network. I still hadnt heard back by December, so I called again (Ref#********). *******, stated she would send it back and it would get fixed.I called Ameriben again on 2/6/23 regarding the status (Ref#********) and I spoke to *****, a supervisor. She stated on 1/9/23 the inquiry was received but there has been no response from a specialist. She said she would send an expedited request (email) and that I would hear back within **** business days. I assured her on the phone that if I didnt hear by then, I would call back.I still didnt hear back 3 weeks later, so I called again on 2/27/23. I mentioned the previous call with ***** and was told she would call me back later today. ***** called and explained that she had no update for me. She seemed slightly apologetic about not reaching out but immediately said that there is nothing she can do until 30 business days have passed. I then assured her that I would call in exactly 30 business days from 2/6/23. I also asked what if nothing is resolved and she said it may be written off, but she wasnt sure which makes me believe that we will cycle through this **************** again.This entire process is incredibly frustrating. I spend almost 1-2 hours calling every few months over this simple issue. I understand that Ameriben is a third-party to Anthem, but they need to have better procedures in place when not given a timely response. I also tried calling Anthem directly several times on 2/6/23, but they end up just referring you back to Ameriben.I have consistently been calling for the past 3 months about this and nothing seems to be getting done. Meanwhile the provider has sent the bill to collections. This is terrible service and Im writing this in hopes Ameriben actually does something about this now!

      Business response

      04/10/2023

      Dear Resolution Specialist:
      Thank you for the opportunity to respond to the complaint received from ******************. In response to this inquiry AmeriBen would like to share the following information.  Upon ****************** initial contact on October 27, 2022, regarding her service incurred on August 8, 2022, AmeriBen has been working with the network, inquiring as to why the provider displays as in-network however, the claim processed as out-of-network. We received confirmation directly from the network that the provider is contracted and considered in-network. 

      The network has indicated that the original issue was  related to the providers rendering license information not being captured correctly based on that specific claim submission.  I have verified that this  providers information has been updated in the networks system to reflect the correct contracting status,  so there should be no further issues with claim submissions.  

      ******************  claim has been reprocessed at the in-network benefit level, and an updated EOB issued on April 5, 2023.  
      AmeriBen strives to address members concerns and properly pay eligible claims. Please let me know if you require additional information from us. Again, we appreciate the opportunity to respond to the concerns raised.

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

    • Complaint Type:
      Order Issues
      Status:
      Answered
      Ameriben denied authorization for a medical study for my wife ordered by a spine specialist. The denial was by an Internal Medicine doctor, not a musculoskeletal specialist.In their denial paperwork it clearly states: RIGHTS AVAILABLE TO MEMBERS:"Your provider, or any other person you choose, *** appeal on your behalf. They *** also help you during the appeal process."As a physician with 4 medical boards my wife trusts me as her advocate.When I contact Ameriben they tell me I cannot make the appeal for my wife despite the clear language in their own patient rights statement. I will pursue this with their company as best as possible but need to make consumers aware of their nefarious business practices.

      Business response

      02/17/2023

      Dear Resolution Specialist:
      Thank you for the opportunity to respond to the  complaint received from ********************. In response to this inquiry AmeriBen would like to share the following information.


      ******************** was correctly informed that AmeriBen did not have a HIPAA authorization on file that would have allowed AmeriBen to speak to ******************** regarding **********************


      We apologize that ******************** was incorrectly told that he could not appeal on behalf of his spouse.  It is our belief that the AmeriBen representative confused the  Immediate Family Member plan exclusion with the Designation of Representation plan provision.


      Mr. ********* plan does afford the member/patient to designate  an authorized representative to appeal on their behalf. However, the plan does require an appropriately signed Designation of Representation form  as described  in the Important Information about your Appeal Rights section of the notification.


      AmeriBen strives to address member inquires or concerns as well as properly approve and/or pay eligible claims, while also adhering to the plan requirements.  Again, we appreciate the opportunity to respond to the concerns raised.

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

    • Complaint Type:
      Sales and Advertising Issues
      Status:
      Answered
      The website on Ameriben has a guideline for what they use to determine medical necessity that I have access to as a patient. I met the criteria on there guideline on their medical necessity. They denied it and they used a different guideline and not the one listed to the patients. They are being dishonest to the patients that go to the website to see if they meet medical necessity. I did appeal and they state they used a different guideline.

      Business response

      01/31/2023

      Dear Resolution Specialist:
      Thank you for the opportunity to respond to the complaint received from *****************************. In response to this inquiry AmeriBen would like to share the following information.


      The complaint does not specify the patient and/or denial specifics. 

      The provided authorization of release only consents to the release of ****************** information, however the only current medical necessity determination we have relates to ****************** spouse                                      for whom we do not have a release. In order to provide more detail in the BBB forum, we would need a release from the husband.

      AmeriBen strives to address members concerns and properly approve and/or pay eligible claims. Again,we appreciate the opportunity to respond to the concerns raised.

      Sincerely,

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

      Customer response

      01/31/2023

       
      Complaint: 18941468

      I am rejecting this response because:
      There is a HIPPA form on my husbands file regarding that I can speak on his behalf. This is regarding a his cancer high risk colonoscopy complaint which I can speak on his behalf.
      Sincerely,

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

      Business response

      02/06/2023

      Dear Resolution Specialist:
      Thank you for the opportunity to respond to the rebuttal complaint received from *****************************. In response to this inquiry AmeriBen would like to share the following information.


      AmeriBen does have a HIPAA authorization on file that allows AmeriBen to speak to ***************** regarding ****************. However, this HIPAA consent allows AmeriBen to communicate with *****************, not the BBB.  
      AmeriBen has received a new complaint # ******** from ***************,  which includes the necessary HIPAA consent.

      AmeriBen strives to address members concerns and properly approve and/or pay eligible claims.  Again,we appreciate the opportunity to respond to the concerns raised.

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

    • Complaint Type:
      Billing Issues
      Status:
      Resolved
      This is related to insurance billing for lab services provided to my son on 7/11/2022.Ameriben incorrectly processed the bill as Out-Of-Network, despite being with an in-network provider (Quest Diagnostics). Ameriben has admitted to this mistake. However, the ******************* hasnt been corrected and Quest is now reaching out to me for the entire bill amount ($52.87 -- showing no insurance coverage whatsoever). I should only owe $0.50, as can be seen on an identical lab work performed and billed on 6/7/22 (which was an identical $52.87 charge, and I only owed $0.50 once correctly processed).Every time Ive called, Ameriben has instructed me to call back in 4-6 weeksbut nothing changes. They now claim that it was AGAIN reprocessed incorrectly. Ive called them probably 15 times since July 2022.Appropriate resoluation would be for Ameriben to immediately remit payment to Quest directly. Ameriben should call and pay this bill today, so that I am not adversely affected by their continual errors. This is on the verge of collections and is approaching 8 months since the service was performed.

      Business response

      03/10/2023

      Dear Resolution Specialist:
      Thank you for the opportunity to respond to the complaint received from ****************** regarding a claim for his dependent. In response to this inquiry AmeriBen would like to share the following information.

      AmeriBen reviewed the claim for the July 11, 2022, date of service and has confirmed the provider of service as in-network. We adjusted the claim on February 16, 2023, issuing payment at the members in-network benefit level.


      AmeriBen believes the original issue was the result of the providers filing of the claim. An ancillary providers contract with the network has some specific filing instructions and these may not have been precisely followed.    


      AmeriBen strives to address members concerns and properly pay eligible claims. Please let me know if you require additional information from us. Again, we appreciate the opportunity to respond to the concerns raised.

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

      Customer response

      03/10/2023

       
      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,

      *******************************
    • Complaint Type:
      Service or Repair Issues
      Status:
      Resolved
      January 27, 2022, my PCP submitted a billing claim form for a new patient/office visit. Ameriben entered this visit in their system as an annual/ preventative exam which I am only allowed one of a year. I did not realize that this error had occured until my OBGYN well women visit on May 18, 2022 was denied. Thinking this denial was an error, it was resubmitted in august with ameriben stating I already had an annual exam and denying it again. By this time it was too late to submit and appeal so my doctors office submitted a corrected claim from new patient to established patient in an attempt to reopen to claim and allow for correction. Thinking this would be corrected I submitted an appeal for my OBGYN and was denied. Turns out Ameriben disregarded the corrected form and processed it as a new claim which resulted in them paying my PCP twice for the same visit. I have had multiple phone conversations with claim representatives (october, november, december and january) who promise that this issue will be resolved and as of January 13, 2022, there has been no resolution. Ameriben is refusing to acknowledge the error and keep denying my appeals and/or emails from reps trying to clarify the claims. My OBGYN is now wanting to send me to collections because I refuse to pay a bill that my insurance should cover.

      Business response

      01/24/2023

      Dear Resolution Specialist:
      Thank you for the opportunity to respond to complaint #********, received from **********************. In response to this inquiry AmeriBen would like to share the following information.
      AmeriBen re-examined the charges in question and the employer's plan document.  This additional review resulted in an adjustment to Ms. ********** claims.


      The original issue stems from the providers claim submissions.The initial claim for 1/27/22 was received on 2/4/22 with procedures/diagnosis that would appropriately apply to the annual exam 100% benefit. The claim for date of service 5/18/22 was received on 5/26/22 and appropriately denied as over plan *** for annual exam. The provider resubmitted the claim for 1/27/22 on 10/7/22 with a different total billed amount, a different procedure code and no indication that this was a corrected claim, thus, our system auto adjudicated the resubmitted claim as a new claim.


      In early January 2023, a request for review was received by our claims department via an email from the AmeriBen ************** Coordinator,which included a corrected bill for date of service 1/27/22. This email request resulted in the adjustment of both claims on 1/20/23; the 1/27/22 date of service claim has reprocessed under the normal plan benefit and the 5/18/22 date of service claim has reprocessed under the annual exam 100% benefit. The corrected explanations of benefit were issued on 1/24/23.  
      AmeriBen strives to address members concerns and properly pay eligible claims. However, we are required to apply the members plan benefits according to the providers submitted information. Please let me know if you require additional information from us. Again, we appreciate the opportunity to respond to the concerns raised.


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

      Customer response

      01/24/2023

       
      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,

      *****************************
    • Complaint Type:
      Service or Repair Issues
      Status:
      Answered
      They provided different reasons for claim rejection and stated to provider that my coverage was expired when it was still in service. They failed to change the rejection claim. They never followed up after multiple phone calls to rectify this issue.

      Business response

      12/30/2022

      Dear Resolution Specialist: 
      Thank you for the opportunity to respond to the complaint received from ****************. In response to this inquiry AmeriBen would like to share the following information. The assertion is that AmberiBen provided different reasons for claim rejections and that coverage had expired. ****************** employer used the services of AmeriBen, a third-party claims administrator, from June 23, 2019, to July 1, 2021. During that time **************** did contact AmeriBen regarding various claims and benefits. However, it was not until March 2022 that AmeriBen was contacted by **************** regarding claims in question. 


      AmeriBen has reviewed the claims in question and the employer's plan document that clearly delineates covered and non-covered benefits for its members. AmeriBen adjudicated the claims consistent with the claims as submitted by the provider and the terms of the employers plan document. At the time of claim denial, **************** was provided specific information regarding the claim in the Explanation of Benefits document she received. The information provided included both the reasons for the claim denial, that it was a non-covered benefit, and that she could appeal the claims determination. **************** did not elect to appeal the claims. Further, according to our records, **************** did not contact AmeriBen until after the claims period was closed.   

      While we appreciate that **************** is dissatisfied with the determination, it was not within AmeriBens control to change the terms of her coverage, nor how the services were billed by the provider. Unfortunately, at this time AmeriBen is unable to reopen the claims as the employer is no longer with AmeriBen and further, based upon the information we received, the claims were properly adjudicated.  

      AmeriBen strives to address members concerns and properly pay eligible claims. Please let me know if you require additional information from us. Again, we appreciate the opportunity to respond to the concerns raised.  

      Sincerely, 
      **************************;


      Customer response

      01/02/2023

       
      Complaint: 18572677

      I am rejecting this response because:

      I contacted Ameriben when I received notice that the claims were not paid due to them being incorrectly billed as family therapy. These bills were sent to me several months after the service and if I had known, I would have obviously contacted Ameriben sooner. I'm not sure what it matters if my first contact was in March, and I do not agree that it was this late, but is likely insignificant. After contacting Ameriben, about their claim denials, I contacted my provider, children's hospital, and CU medicine who then corrected the billing to correctly reflect that they were individual therapy and they resubmitted the claims. Ameriben then denied the claims  stating I did not have coverage at the time which is incorrect as I clearly did have coverage. I have contacted them multiple times and they say they will get back to me and never do. The last time I contacted them they stated it was conveniently too late for them to cover this bill. I have submitted statements of the bills with the corrected code and itemized documentation. Ameriben appears to have put me off repeatedly in order to avoid paying the claim and then provided incorrect information to the ****** to state I was not covered. 


      Sincerely,

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

    • Complaint Type:
      Service or Repair Issues
      Status:
      Answered
      AmeriBen assigned "member contact for health care admin" this year for my Anthem BCBS health insurance policy. Since then, my husband and I have had constant issues with bills not being covered correctly as in network, 100% covered visits not being covered 100%, and authorized items suddenly not being authorized. There is a discrepancy between what the oustanding deductible and out of pocket amounts are from AmeriBen to Anthem, causing providers to be charging incorrect amounts. When I call AmeriBen I receive different explanations from each rep. I even called AmeriBen once and the rep told me we all hate the Big Lots policy, it is so complicated to figure out. We have had multiple 3-way conversations between AmeriBen and the providers, with the providers stating everything was billed correctly, and AmeriBen comes up with ridiculous explanations for the excess charges. Several of the craziest have been that a 100% covered wellness annual visit only covers the office visit, not the urinalysis that is standard annual wellness visit procedure; and that an annual Pap smear is covered 100%, but that they didn't pay 100% to have the Pap test actually read. The hours and hours we have wasted contacting AmeriBen and these providers is ridiculous and has led to unhealthy stress levels from both my husband and I. Recent issues have led to almost $5000 in inaccurate medical bills. We are living in fear of these bills going into collections. I have attached a summary of these bills as well as the bills themselves. We need all of these bills fixed and all future insurance claims processed accurately.

      Business response

      12/27/2022

      I reviewed our members 2 part complaint regarding herself and her spouse. Additionally, I reviewed all of the communication calls AmeriBen received and confirmed they were regarding medical benefits, eligibility and claim status. Neither member nor spouse ever submitted a request for appeal regarding any claim determinations.  Attached are details addressing the processing of the claims referenced in the complaint.  

      Customer response

      12/27/2022

       
      Complaint: 18522408

      I am rejecting this response because:

       

      I appreciate the response, however this does not address all of the issues.   The urinalysis was part of a wellness visit, not a diagnostic test, and should be covered 100%.   The pap smear was part of an annual well woman visit and should be covered 100%.   The Quest bills for ******************* were at an in-network provider and should be billed at the in-network rate.

        You can see many calls to Ameriben complaining about these charges- if that does not suffice as an appeal, let me know what does, as no other method was told to us other than there was nothing Ameriben could do.   Each time we called in, different Ameriben employees giving different answers to the same question- sometimes they said it should be covered 100%, sometimes they said something different.  They seem very confused about the Big Lots benefit plan and have stated as much.

        Another issue is that the phone # on the back of our insurance card for providers to verify benefits goes to Anthem, not Ameriben.  This has caused discrepancies in the amount of out of pocket/deductible charged to us.

      Sincerely,

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

      Business response

      01/19/2023

      Dear Resolution Specialist:

      Thank you for the opportunity to respond to the follow up complaint received from Ms. ********* In response to this inquiry AmeriBen would like to share the following information.
      AmeriBen reexamined the charges in question and the employer's plan document.  This additional review resulted in an adjustment to reprocess Ms. ********* charges under the 100% wellness benefit of the plan. A corrected explanation of benefits issued on January 11, 2023.  The claim under complaint for Mr. ******************* was also adjusted to process under the In-network benefit level, and a corrected explanation of benefits issued on January 11, 2023.


      The complaint regarding discrepancies with information provided by AmeriBens phone representatives, and out-of-pocket/deductible amounts, could be due to variety of reasons, such as human error or a system glitch. 


      At the time of the original claim determinations, Ms. ********* & ************** explanation of benefits provided specific information regarding written appeal options, however neither elected to submit a written request for appeal as defined in their plan document.


      AmeriBen strives to address members concerns and properly pay eligible claims. Please let me know if you require additional information from us. Again, we appreciate the opportunity to respond to the concerns raised.


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


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