Complaints

This profile includes complaints for Health Alliance Medical Plans, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Health Alliance Medical Plans, Inc.

  3310 Fields South Dr Champaign, IL 61822

  
• 

  Health Alliance Medical Plans, Inc.

  301 S Vine St Urbana, IL 61801-3347

  

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:04/04/2025

  Type:Billing 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.

  January 2024 I switched insurance companies. When I filled a prescription, Health Alliance covered it. However, I was not covered by Health Alliance at this time. They did not realize this until January 2025 and now are trying to collect $1100 from me when my other insurance would have paid this claim last year. However, since Health Alliance did not catch this, ***** will not pay this claim now. This is a Health Alliance error and I should not be held responsible 13 months later for their error.

  

  Business Response

  Date: 04/15/2025

  Thank you for the opportunity to review Ms. *******’ concern. We have reviewed the claim in question and have the following information to share. We understand the concerns Ms. *******’ has outlined and are working with various departments to resolve this complaint. As this member’s former plan was a self-funded plan, this complaint requires additional research and efforts to resolve. We would like to assure BBB and Ms. ******* that we are making every effort to resolve this timely. We will send final confirmation of our research to Ms. ******* as soon as possible and no later than 05/15/2025.
  

  Customer Answer

  Date: 04/18/2025

  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.  If nothing is resolved by 5/15, I will recontact. 

• Initial Complaint

  Date:02/17/2025

  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.

  2/17/25 I went to sams to pick up my Mounjaro prescription and asked the pharmacy tech why was my prescription 120.00 and they thought it was I didn’t have the mounjaro coupon added ,they added it and the price went to 1000 dollars ****(pharmacy tech)called Health Alliance with no success and I decided I was going to call Health Alliance ,spoke to **** and she stated it was a glitch on their part. She offered to call the marketplace to change plans. as of 10:46 am we have been on hold for. Over 1 hour ,My problem is I need a plan that fits my financial needs. I have went to the doctor at least 2x since January 1 /2025. The billing is not correct because everytime I asked about a copay(receptionist)would say they didn’t see 1 needed?I am very upset, this should not happen to anyone. I am a diabetic,joint issues. Etc

  

  Business Response

  Date: 02/27/2025

  Thank you for the opportunity to review Ms.******** concern. We have reviewed the Mounjaro claims from last year and this year and have determined that the claims were processed correctly.  The reason the claim is higher this year is because Ms. ****** changed plans.
  Last year Ms. ****** was on a plan with a $5700 deductible that would have applied to tiers 4-6. As Mounjaro is a tier 3 preferred brand drug, that is how the claims were processed (11/27/24 $40 and 12/26/24 $40). 
  This year Ms. ****** moved to a plan that has a $7500 deductible that applies to tiers 3-6. 
  There was a claim on 1/21/25 for Mounjaro, and it was $1047.81, all of which is applied to the deductible. There was a claim on 02/18/25 for a 28-day supply at $1047.81, all of which is applied to the deductible. These claims are processing appropriately according to the plan Ms. ****** selected.
  
  
  We are happy to speak with Ms. ****** should she have any further questions.

  Customer Answer

  Date: 03/05/2025

   I am rejecting this response because:
  The wrong plan was on the gov website. Health Alliance admitted to the mistake that was noticed in December. Health Alliance has helped me change to the correct plan,(which is 60.00 a month. I was paying 157.00. I am owed money and any claims should be adjusted
  
  

  

  Business Response

  Date: 03/11/2025

  Thank you for the opportunity to review Ms. ******** concern. On 02/25/2025 Ms. ****** changed her plan. She moved to the POS 6500 Elite Bronze plan retroactively as of 01/1/25.
  We have submitted a case to ***** on the member’s behalf to have any claims that we paid on her old plan reviewed and asked that they be reprocessed under her current plan.  The member would receive reimbursement for any difference in cost from *****.
  
  We are happy to speak with Ms. ****** should she have any further questions.

  Customer Answer

  Date: 03/11/2025

   I am rejecting this response because:
  It was an error by health alliance  I should be reimbursed also for the higher premiums that I incurred for the wrong plan who is **********? Contact information?
  
  

• Initial Complaint

  Date:01/10/2025

  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.

  My complaint is about getting them to give me my medicine. I can't seem to get through to them. When I call them they put me on hold forever. The problem is that it is between my doctor and my insurance getting me the medicine. It shouldn't have to be like this. I want my medicine issued to me.

  

  Business Response

  Date: 01/22/2025

  Thank you for the opportunity to review Mr. *********** concerns. Upon receipt of this complaint, our Pharmacy Department reviewed his claims and any applicable notes on his account. The medication in question requires Prior Authorization.  As Prior Authorization has not been initiated by this member’s provider the claim is rejected. Our Customer Service Team spoke with Mr. ********* on 01/10/2025 several times and explained that we were waiting for a Prior Authorization request for this medication from his provider. Our Customer Service Team contacted his provider on 01/10/2025 to explain that Prior Authorization is required. The provider said they would fax us this information. We also contacted the pharmacy and explained that Prior Authorization is required. Once we receive all the necessary information from the prescriber, we will review for determination within 72 hours. Our Customer Service team is happy to speak further with Mr. ********* should he have any further questions.

• Initial Complaint

  Date:01/08/2025

  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.

  Check multiple times with company four months before switching insurance was told my medication would be covered as i have a high bmi and health issues, It would be covered and would not be a problem. After signing with the Health Insurance company, they immediately refused to cover the medication. I am now stuck paying a substantial amount for a policy with a health insurance policy that does not cover ********. Bait and switch clear as day. They are defrauding people of knowing whether or not their health conditions will be covered.

  

  Business Response

  Date: 01/09/2025

  Thank you for the opportunity to review Ms. ******** concerns. Upon receipt of this complaint, our Pharmacy Department and Customer Solutions Department pulled all records related to this member and have provided the following information.
  
  The only contact Health Alliance has received from this member was to our Customer Solutions Department on 01/06/2025, regarding the denial of the medication in question. During that call the member was informed that this medication is not covered under their plan. This call was recorded, and we are happy to provide this information if it would assist in the review of this complaint. Our Customer Solutions Department searched our system for other calls from this member’s number, and no other calls were received. 
  
  Our Pharmacy Department has no record of a call from this member.  However, they did review the claim and confirmed that the request was correctly denied as a benefit exclusion. They also confirmed that this medication does not appear as covered on our formulary.
  
  As there is only one record of this member contacting Health Alliance, it is possible the contact could have been with the Marketplace, as this is an On-Exchange plan.
  
  Please let us know if anything further is needed to assist Ms. ****** or BBB with this complaint.

• Initial Complaint

  Date:11/05/2024

  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.

  Health Alliance PPO is my insurance provider since April 1, 2023. May 2023 -- All 3 kids well visit with Dr. ***** ***** (*********** clinic). Charged $120 per kid. Out of network. Dec 2023 -- ****** saw Dr. ***** (*********** Clinic) 12/27/23. Charged $20 copay, in network. Feb 14 and 20 2024 -- ***** saw Dr. ***** (*********** Clinic). Charged $20 copay, in network for each date of service. May 2024 -- ****** Dr. *****. Charged entire visit $409. out of network, must pay deductible. July 2024 -- ****** Dr. *****. Charged entire visit $409. Out of network, must pay deductible. I received the explanation of benefits (EOB) for the May appointment after I had already gone to the July appointment so I began conversations with *********** Clinic and Health Alliance to understand why sometimes I am charged in network and other times out of network and now there would be no payment until deductibles were met. *********** clinic stated they were in network with Health Alliance and provided an NPI number for me to call Health Alliance with. I called Health Alliance and they stated that *********** clinic is in network but ***** Corporation (my employer) had identified certain providers as in network within the clinics. None of the providers at this *********** Clinic were in network. *********** Clinic worked with me and discounted my bills from May and July so I paid $133 per visit instead of the $409. In September 2024 I received an updated/revised EOB from the visit in February 2024. This new EOB showed out of network charges and put me responsible for $409 instead of a $20 copay as previous sent and paid. I received a bill from *********** Clinic for the amount of the visits. I spoke to *********** Clinic about how insurance changed their EOB and *********** Clinic said they were still honoring the adjustments and I would need to pay $133.62. In addition Health Alliance has denied an antibiotic, cardiac MRI, and ECHO for me.

  

  Business Response

  Date: 11/13/2024

  Thank you for the opportunity to review and respond to Ms. ********** concerns.

  We have reviewed the claims in question, and they were processed correctly. Our Customer Service department only has record of Ms. ******** calling after the services were completed.  
  We received calls on 8/1/23 and 9/5/24 on those dates, and she was advised that *********** Clinic was out of network. We received a call on 9/6/24, and on that date she was advised that Dr. ***** was out of network.

  We have contacted Ms. ******** today to help explain how each claim was processed and to answer any further concerns she may have.

• Initial Complaint

  Date:09/10/2024

  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.

  This complaint is in regards to Health Alliance Medical plan. My 95 year old mother fell and broke a bone in her lower pelvis. She was taken to a hospital and was there for 1 week. Health Alliance denied her physical therapy at the hospital because they did not think it was necessary to pay a doctor to overlook her physical therapy. We found a rehab nursing home to take care of her and to do both physical and occupational therapy. She has been there for 10 days. Physical therapist sent a report to Health Alliance and told them she does not have an IV in her arm (which she does not) and that she can walk 92 feet. My 95 year old mother CAN NOT get in or out of bed or a chair without help. Health Alliance has denied any further physical or occupational therapy all because she can walk. They have not considered the fact that she can not get up without assistance or get into a chair or bed without assistance. Now my 95 year old mother is on the verge of getting kicked out of the rehab nursing home. Health Alliance has denied my mother any chance of getting better and living her life. My mother has paid for this insurance for many many years, and now they are denying a woman her life

  

  Business Response

  Date: 09/20/2024

  This member was receiving care at ***** ***** for skilled nursing care and was advised services will end 9/11. They requested review thru ******* ***** and the decision was upheld as there were no medical issues to support the need for daily skilled nursing care and discontinuation was appropriate. They have 60 days from the date of the notice of 9/12 to file a reconsideration with *******. I have attached the ******* decision letter. Please let me know if there is any other information required. (Q** **** ************ ******)
  
  9/9- Notice of Medicare Non-Coverage (NOMNC) was issued by Health Alliance (UM) that *** coverage will end 9/11
  9/9- Signed NOMNC received to UM
  9/9- Member Relations received notification member has filed appeal through ******* (QIO)
  9/10- Detailed Explanation of Non-Coverage (DENC) sent to mbr and SNF
  9/10- Case file with clinical documentation was uploaded to QIO portal for review
  9/12- QIO decision received- Upheld decision (Mbr responsibility starting 9/12/24) Letter indicates to contact ******* if reconsideration is requested.
  
  

• Initial Complaint

  Date:03/21/2024

  Type:Customer Service 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.

  My daughter, ***** (I am her mother), who has Type 1 Diabetes, is in college in Colorado. Before she left, I phoned Health Alliance--our health insurance provider, to ask for a list of endocrinologists in the Fort Collins area who would be covered. They gave us the name of Dr. ****. Each time ***** has had a medical appointment with Dr. ****, Health Alliance has refused to cover it and I have appealed. Each time they have covered it after the appeal has gone through. Now they have written to say they will not cover any future visits. Just to reiterate: Health Alliance gave me the name of this doctor and told me she was covered on our extended plan (I signed ***** up for the college plan), and now they declare that they will, henceforth, not cover this doctor? I have explained all of this in a letter to Health Alliance. I respectfully ask the Better Business Bureau (who has accredited Health Alliance in the past--I saw the BBB plaque when I was in their office) to intervene and request that Health Alliance cover the doctors they themselves suggested we turn to for medical help. Thank you so much.

  

  Business Response

  Date: 04/03/2024

  Thank you for the opportunity to respond to Ms. ******** complaint.

  Since ***** is in our Student Extended Network Program, she would use our ***** ****** extended network of providers while away at school in Colorado.  After reviewing the complaint with several of our internal departments as well as ***** ******, we have determined the cause of the issue. This issue was created because this provider was incorrectly not included in the ***** ****** online directory. ***** ****** indicated that there was a directory update on 03/11/24 that impacted the directory flag for Dr. **** at **** ***** ** ****** ************* in Fort Collins, Colorado. They have confirmed that the provider is participating and will re-enable the directory flag.

  Additionally, Health Alliance's Claims Department has taken steps to remedy the issue to ensure future claims are adjudicated appropriately through this extended network system. The previous letter indicating future visits will not be covered is inaccurate.

  We apologize for any inconvenience this may have caused. 

  Customer Answer

  Date: 04/04/2024

  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. Thank you for helping me to receive a fair response and a fair adjustment. I understand that Health Alliance will henceforth cover Dr. **** for my daughter. Thank you. 

• Initial Complaint

  Date:06/27/2023

  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.

  We have contacted Health Alliance several times regarding the fact that we cannot find a local--within 30 miles--dentist who accepts the ***** ****** PPO that is bundled in with the health plan for our kids. All the dentists listed as being "in network" no longer accept this insurance. We purchase our health insurance plan through **********.*** as we are self-employed and pay over $20,000 in premiums every year. Please see our first correspondence with Health Alliance below. Thank you. Mar 15, 10:29 AM Topic: Eligibility (Effective/Termination Dates, Add/Remove Dependents). Hello, My wife spoke to your representative, ******, earlier today regarding the pediatric ***** ****** benefits through our Health Alliance POS plan. He was very helpful and went above and beyond trying to solve our issue. However, we have learned new information and would like to make someone at Health Alliance aware. Per ***** ******, we have searched for participating providers on their website. The ***** ****** rep said that we need to choose a provider that lists ***** ****** PPO. We have done this, but when we call the providers, they are saying that they no longer accept the "Pro" version of the PPO and only accept "Premier." Apparently the version of the ***** ****** PPO we have through Health Alliance is "Pro" only. The dentists offices have mentioned that this is a corporate decision. Our current dentist said they received notice on March 1, 2023 that "Pro" is no longer accepted. Another dentist we called stated that they will no longer accept "Pro" as of May 1, 2023. This seems to be a trend, and we are left wondering: WHO CAN WE GO TO within a reasonable distance from our home? This seems to be an issue best suited to higher management, and I ask that someone from management contact us please. We pay a lot of money for our Health Alliance plan and expect the benefits to be active for the term of the policy. Thank you, ****** * ****** ******* ************

  

  Business Response

  Date: 07/05/2023

  Thank you for the opportunity to respond to Mr. ********* concerns. Health Alliance partners with ***** ****** to provide dental benefits for this member’s plan.  ***** ****** is held to state mandated network adequacy requirements for their product and maintains those requirements. 
  
  Health Alliance reached out to ***** ****** with the list of dental offices Mr. ******* contacted to review his concerns.  ***** ****** provided us with the following information:
  
      All but one of the offices noted by the member are with ********* Clinics.  *********** business model no longer supports the PPO standard that ultimately provides our members the      greatest cost savings, so they have moved to our ******* network only.  While ********* is moving to ******* only, we recently (in March) added 3 PPO locations through *******        Health Clinic. They have 2 offices in Champaign and 1 office in Urbana.  
  
      While we are always actively recruiting Central and Southern IL area providers, there are ample PPO options in the Champaign/Urbana area to service members.  
  
      ***** ****** provided a list of 5 offices in Champaign, 2 offices in Urbana, and one in Tolono.
  
  We also conducted a search on ***** ******’s website. We searched within 50 miles of Gibson City for the ***** ****** PPO product. It does appear to have some providers in the Bloomington area as well as Champaign/Urbana. 
  
  We reached out to Mr. ******* on 6/28 and shared the information that ***** ****** provided.  He has indicated he will be following up with the providers.
  
  We understand that the member would like compensated, however, as the pediatric benefits are embedded in their plan and premium there is no method to facilitate this request.  Additionally, as there are providers available and since ***** ****** continues to meet their network adequacy requirements we do not agree compensation is warranted.

• Initial Complaint

  Date:02/28/2023

  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.

  2/28/23 ANY AND ALL OF MY HEALTH INSURANCE TERMED & ENDED 12/31/22 WITH ***** HEALTH ALLIANCE. PER MARKETPLACE 834 ESCALATIONS REF# ****** AND MARKETPLACE REPRESENTATIVE ******. THE MARKETPLACE INSURANCE ************ CONTACTED ***** IN WRITING BEFORE 12/31/22 AND TOLD HELATH ALLIANCE I WAS NOT GOING TO HAVE ***** AS MY INSURANCE CARRIER FOR 1/1/23. HEALTH ALLIANCE ************ SHOULD NOT MAIL ME ANY PREMIUM BILLS FOR 1/1/23 AND 2/1/23. FURTHERMORE, SO WHATEVER 1/1/2023 & 2/1/23 PREMIUMS ***** IS TRYING TO BILL ME IS FRAUD BECAUSE ALL OF MY PREMIUMS/BILLS ETC HAVE BEEN PAID WITH ******HEALTH ALLIANCE FOR 2022, 2021, AND 2000 ETC. MY NEXT STEP IS TO REPORT ******HEALTH ALLIANCE TO THE ATTORNEY /INSPECTOR GENERAL'S OFFICE AND INSURANCE COMMISSION IF ***** DOES NOT CORRECT THEIR PREMIUM BILLING MISTAKES ASAP!!! I ALSO SENT AN EMAIL TO HELATH ALLIANCE MANAGERS. ******************************** and *********************************

  

  Business Response

  Date: 03/03/2023

  Thank you for the opportunity to review and reply to *** ******** complaint. The Marketplace dictates all eligibility rules for members on Marketplace plans.  This means we are required to follow all effective dates and termination dates provided by the Marketplace via the **** system.  We have received two notifications from the Marketplace for this member for plan year 2023.  We received a request from the Marketplace on 01/12/2023 to reinstate this member.  This is why this member was effective.  Then on 02/25/2023 we received a request from the Marketplace that stated this member should not have coverage and that we should terminate them. We processed this termination immediately, but it was processed after billing ran.  The next statement the member receives from us should be reconciled and should reflect a $0 balance and show she is not effective for plan year 2023.
  

  Customer Answer

  Date: 03/07/2023

   I am rejecting this response because: HEALTH ALLIANCE REPORTS FALSE INFORMATION WAY BACK LAST YEAR HEALTH ALLIANCE RECEIVED WRITTEN NOTIFICATION FROM ME AND MARKETPLACE THAT MY ***** COVERRAGE WOULD END 12/31/22 AND ***** WAS NOT CHOSEN AS MY HEALTH INSURANCE FOR ANY OF 2023 PERIOD!!! ***** NEEDS TO STOP THEIR FALSE BILLING FOR FOR 2023 ETC BECAUSE i DON'T OWE ***** ANY MONEY & DO NOT TRY & REPORT TO CREDIT BUREAU BECAUSE I HAVE NOTIFIED THE CREDIT BUREAU ALSO ABOUT ***** FALSE BILLS. IF NEEDED, I WILL REPORT ***** TO THE ONS COMMISSION & ATTORNET GENERAL'S OFFICE...

  
  

  

  Business Response

  Date: 03/14/2023

  As indicated in our 3/3 response, we agree that *** ****** does not owe any outstanding premiums for her Health Alliance policy, and that her policy terminated effective 12/31/2022. *** ****** should receive a statement from Health Alliance, mailing on 03/20/2023, showing that any balances outstanding for plan year 2023 were adjusted and her outstanding balance is $0. Since *** ******’s coverage terminated on 12/31/2022, any claims or services received after that date would be denied as not covered and this member would need to submit them to her current insurance carrier.
  This is not a “false billing” situation. As mentioned in our 3/3 response, we are unable to terminate Marketplace plans without direction from the *** via the **** system. When we received notification from the *** to terminate *** ****** effective 12/31/22, received on 02/25/23, we processed it immediately. If it would be helpful to BBB, we are happy to provide screen shots from the **** system that would illustrate when the termination notice for *** ****** came in. We have not reported anything to the credit bureau for this member, as she has no outstanding balance to report. *** ******’s complaint references potential escalation to external commissions and/or offices. Health Alliance remains willing to cooperate in partnership with the BBB and/or any other commission or office with whom *** ****** would like to partner to bring resolution.

  Customer Answer

  Date: 03/16/2023

  Better Business Bureau:
  I have reviewed the response made by the business in reference to complaint ID 19512182, and find that this resolution is satisfactory to me. BBB please have ***** health alliance give me screen shots of **** 12/31/22 stating ***** isn’t my health insurance carrier. Also, have ***** health alliance notify *** that I have no outstanding money owed to health alliance. *** Medical
  

  

  Business Response

  Date: 03/23/2023

  We have attached the **** case from the *** showing *** ******** coverage terminated with Health Alliance as of 12/31/2022. *** ****** also had a gap in coverage with Health Alliance between 05/01/22 and 06/01/22. Her provider may be billing her for claims for services received during that gap in Health Alliance coverage.
  As indicated in our previous response, as *** ******** coverage with Health Alliance ended on 12/31/2022; due to this she would need to submit claims for services received after that date to her current insurance carrier. She would need to work with her current insurance carrier to resolve any outstanding claims after 12/31/2022. Health Alliance is not responsible for payment of claims incurred after a member’s termination date, or during a time that a member does not have coverage with us.
  As part of a previous BBB Consumer Complaint #********, we made significant efforts to resolve balances due with ***, which we determined must have due from when *** ****** was covered by another plan between 05/01/22-06/01/22.  *** ****** did not engage in our request through the BBB response to provide additional information on the outstanding balance.        
  We do not discuss member’s premium balances with providers or carriers.  As indicated in our previous response, her premium balance owed is $0 and her premium statement reflecting a $0 balance was mailed on 03/20/2023.

• Initial Complaint

  Date:11/20/2022

  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.

  HAVE HEALTH ALLIANCE AS MY MEDICAL INSURANCE CARRIER AND THE FOLLOWING MEDICAL IN NETWORK BILLS NEED TO BE PAID TO *** ******* ***** PROVIDERS BY HEALTH ALLIANCE: $812.11, $171.94, $148. I SHOULD NOT RECEIVE ANY MEDICAL BILLS WHEN I HAVE ***** AS MY MEDICAL INS. IN ADDITION, THERE SHOULD NOT BE ANY NEGATIVE CREDIT BUREAU REPORTING ON MY BEHALF EITHER. I HAVE ALSO COMMUNICATED THIS TO HELATH ALLIANCE REPRESENTATIVE ***. BBB PLEASE ASSIST.

  

  Business Response

  Date: 11/29/2022

  Thank you for the opportunity to discuss this member’s concern.
  On 11/18/22 we received a call from this member. She stated she received multiple billing statements from *** ******* ***** that she thought should be paid by Health Alliance. 
  The following amounts are what the member is stating she is being billed for:
  
  $812.11
  $171.94
  $148.00
  
  When we asked for clarification about the billing and for her to provide the dates of service, she stated no dates of service were on the billing statements from **** To assist the member, we called ****  They reviewed the member’s account they were able to match the amount owing of $812.11 on her October Statement. *** was able to confirm that the charges had been billed and that Health Alliance had paid on the claims.  The dates of service were from 06/29/22 through 09/28/22.  The balance that was showing owing was members copay/coinsurance responsibility. They also noted that for the month of May, the member had a lapse in coverage with Health Alliance and had **** ********** ****** for those dates of service. Per *** member also owes copays for services during the month of May 2022.
  
  *** was able to match the amount owing of $171.94.  They confirmed that the charges had been billed and that Health Alliance had paid on the claims. The billing received for member in the amount of $171.94 was for dates of service 3/3/2022 – 3/4/2022.  The total billed amount was $51,405.25.  The member’s copay/coinsurance responsibility was $171.94.
  
  *** and Health Alliance were unable to locate the last amount $148.00 that member has received a statement for. 
  
  On 11/22/2022 we made call out to member and attempted to explain that we can send her a copy of her EOB’s showing her responsibility for the above listed dates of service and that we would also need more detailed information to be able to assist with the charges being billed for $148.00. The member stated that *** should be billing her insurance instead of billing her and hung up the call.
  
  We will send the member copies of the EOB’s for the dates of service we were able to identify, but we can only show what members responsibility was for and can’t comment on what the member has or has not paid to the facility for services rendered.  If member would like to provide us with more details regarding the $148.00 charge we would be happy to assist with that charge.

  Customer Answer

  Date: 12/01/2022

   I am rejecting this response because:
  
  *** STATES THEY SENT *****-HEALTH ALLIANCE MY IN-NETWORK MEDICAL BILLS FOR $812.11, $171.94, AND $148 TO PAY. *** ALSO STATES THAT THE ACOUNT NUMBERS ARE ON ALL THE ABOVE-MENTIONED BILLS. SO, ***** NEEDS TO PAY THE BILLS BECASUE I WON; T AND WILL BE REPORTING HALL TO THE OFFICE OF INSPECTOR GENERAL, INSURANCE COMMISSION, AND HREALTHCARE MARKETPLACE BECAUSE I PAY THE MARKETPLACE AND *****-HELATH ALLIANCE FOR INSURANCE.

  

  Business Response

  Date: 12/08/2022

  Thank you for allowing us to review and reply to this member’s concern.
  As previously explained, we made several attempts to assist this member with their concerns. Her claims were processed appropriately and according to her plan.
  The balances of $812.11 and $171.94 are amounts owed after Health Alliance processed her claims. These amounts are her copayments, coinsurance and/or deductible. This cost sharing responsibility is clearly illustrated throughout all of her member materials, such as her policy, description of coverage and SBC documents.
  We contacted *** again on 12/1 and are still unable to locate a bill with a member responsibility totaling $148.00. We would be happy to assist with any questions or further review if the member would like to provide us with more details regarding the $148.00 bill.
  In order to ensure this member has a full picture of how her claims have processed, we have mailed her Patient Profile documents from 01/01/2022-04/30/2022 and 06/01/2022-11/30/2022. These documents outline items included on the members EOB, such as the following:
  Date of service
  Provider Name
  Procedure Code
  Billed amount
  Allowed amount
  Copay amount
  Not covered amount
  Deductible amount
  Withheld amount
  Net amount
  
  We are happy to help this member with any questions, but thus far our efforts to assist her have not been well received.