ComplaintsforAllied Benefit Systems

• Initial Complaint

  10/11/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Had a colonoscopy done. Was told that everything would be covered due to family medical history. Now they are telling me that I owe for the whole procedure. They have been giving me the run around and I have wasted countless hours trying to resolve this issue. It has been on going for two months now and I feel like I am being bullied by a major corporation. It is a shame that this happens to so many people on a daily basis in *******. It is hard enough with all of the taxes. Something needs to be done about the ************* health care system. A stand needs to be made, and the people need to stand up against this tyranny.

  Business response

  10/11/2023

  Dear *****,

  We received your complaint, which is currently under review. After review, a customer service representative may contact you directly for more information.

  If you have any questions, please call us at the phone number listed on your subscriber ID card.

  Thank you,

  Allied Member Services

• Initial Complaint

  07/31/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  On Mar 25th of 2023 I had a Mammogram at Promedica, As of today July 31, 2023 Allied Benefit Systems has not paid the ***** ***** June 21st they have been "processing" my account to no avail...I have called Allied and Promedica several times trying to get this resolved, i was told by Promedica it was going to collections in August for non pmt..... Allied stated on July 24th they would approve a pmt of $244.00 out of the $602.00 that Promedica wants and will take 7 to 10 business days, i was told i would have no patient responsibility by both Promedica and Allied, Allied also stating the Mammogram was covered at 100% but then at a later date they denied that statement and stated they go according to ******** Scale, I was also told by them that i could go anywhere for tests and they would negotiate but did not fulfill their obligations of the 100% coverage for a Mammogram. I called Promedica July 31st to see if they received any pmt from Allied and did not, They told me that because they do not have a contract with Allied but all along they continued to accept my insurance card, As well i am filing a complaint against Promedica as well as they told me i had no pt responsibility for the remainder *** but today they said i do. I wanted to keep it out of collections, ****** from ********* said if i made a pmt today it would keep it from going into collections (when asked)... I made a pmt of $200.00 over the phone, they said they would be sending me a bill of $177.00. My complaint to Promedica was given that they should not accept my insurance card if they do not have a contract nor should they tell me i will have no pt responsibility then change their minds. My acct number is ****** guarantor number.

  Business response

  08/14/2023

  Dear *****************************,

  We received your complaint, which is currently under review. After review, a customer service representative will contact you directly. 

  In the meantime, if you have any questions, please call us at the phone number listed on your subscriber ID card. 

  Thank you,

  Allied Member Services

• Initial Complaint

  05/16/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  This occurred from 12/1/2021 to 12/31/2022. My employer *********** contracted Allstate as our health insurance provider for the 2022 year. This plan went through the third-party administrator Allied Benefits System. We were told in the benefits meeting that mental health benefits would be 100% covered and that we wouldn't have to switch doctors because they use reference-based pricing. Knowing that the plan was switching upon the new year, I was proactive and reached out to my therapist's office to get the ball rolling. I was never able to get a straight answer from Allied and neither was the ******. Repeatedly, we were told different information depending on who we spoke to. I was not alone in my complaints about Allied at ***********, to where KH negotiated the Cigna rate with Allied and noted that we would not be using them next year. Come November/December 2022, ***** informed us all that they would be using our new broker to help remedy the situation and that legal was involved because Allied said they would not be paying any claims after 1/1/2023 when the contract expired. Come 5/16/2023, I have learned that the therapist's office still has not received payment, and that Allied will not speak about any of the claims because the contract has expired. This means that there are 16 claims that have not been paid going back to 7/1/2022, that I paid a $35 copay for, and with the Cigna rate an amount owed of $1,136.00. Once again, we were supposed to receive mental health coverage for no more than $35. This entire experience has been exhausting, perpetuated for well over a year, and frankly predatory in the lack of clarity and explanation from Allied - every call was a different answer. I'm happy to provide emails, EOBs, and get the ****** in contact with the BBB. This issue has persisted across providers so I don't even really know how much I paid out of pocket that should have been covered. I've attached one email chain from another provider to show.

  Business response

  05/19/2023

  Dear *******************************,

  We have received your complaint which is currently under review. 

  Thank you.

  Customer response

  05/25/2023

   
  Complaint: 20065481
  
  I am rejecting this response because: the business said they are actively reviewing the matter and I need to keep the complaint open. 
  
  Sincerely,
  
  *******************************

  Business response

  06/14/2023

  Dear ****************, 
  
  We appreciate your patience while our team reviewed the details of your complaint. Our service team has made several attempts to reach you directly, but we have not heard back from you. If you have any other questions, please do not hesitate to call our ****** Services team at the phone number listed on your ID card. 
  
  Thank you.
  

  
  

• Initial Complaint

  03/21/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On February 2, 2023, I visited an Otolaryngology (Ear, Nose and Throat) physician at the **************** ********* ******************** after having a series of ear infections and severe ear pain for 6 weeks and based on recommendation from my primary care physician. Before the visit I confirmed with Allied Health that both the provider, physician, and facility my appointment was scheduled with were in network and covered. As outlined in my insurance policy, I expected a $20 copay for a specialist visit. When the claim was processed, it was denied because the diagnosis of TMJ joint disorder was not covered by the plan. There was no way for me to know that the visit and affiliated tests would lead to a condition that wasn't covered by my insurance or that the exact same test could have led to a different diagnosis that would have been covered by my insurance. Furthermore, I was not treated for the condition of TMJ joint disorder, it was only identified during the evaluation. I now have a bill for over $1,000 that the insurance will not cover and both my insurance company and the **************** admitted that there was no way for me to know that it would not be covered.I have spoken to my insurance company and the **************** multiple times and both continue to suggest that I call the other. Additionally, during one phone call with an Allied representative, I was told that the claims would not be covered because they were billed as an outpatient hospital visit rather than an in office visit, so the answers that I am getting don't even line up. I am looking for help coming to a resolution, as the costs affiliated with this visit were unexpected even after doing my due diligence ahead of the visit.

  Business response

  04/04/2023

  *******,
  We have received your complaint which is currently under review.

  Thank you.

• Initial Complaint

  02/28/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  02/24/23,02/28/23. On these dates I spoke with representatives of Allied Benefit Systems after multiple denied claims through caremark for pharmacy benefits over a 2 week period. I was told by the original representative that my doctor's ****** would need to complete a prior authorization form and that they would need to mark it as urgent and my claim would be reviewed and processed in ***** business hours after I advised I only had 4 daily pills left. Upon checking back with Allied on 02/28 I was told by the first rep I spoke with that they were escalating the case to be worked immediately and I could check back by end of day to make sure it had been communicated to the pharmacy after advising that I only had 1 pill left. Speaking with a rep and supervisor the same day as instructed I was told that was not the case and that they didn't even know if documents had been received and I could pay for this very expensive medication out of pocket with no other resolution being provided and that I would have to wait **** business days to be reviewed. I asked for corporate contact information and was only given an address of the building. This company that I have paid premiums for has now endangered my health and well-being and provided no urgent response to the predicament they created and seemed to have no concern. I have never in 7 years experienced these issues of receiving medication and been disregarded with no additional protocol to escalate and help me to remain healthy without missing several days if not weeks of doses possibly endangering my body's acceptance of this medication and the withdrawal issues that *** follow. Allied Benefit Systems seems to have no actual benefits or care for their clients.

  Business response

  03/13/2023

  Dear ***************************** - Our team has investigated your complaint and provided the following explanation. After contacting Allied in response to receiving a rejection at the pharmacy for medication requiring retail authorization, Allied advised that in order to obtain the medication, to please complete the retail authorization form, submit completed form to Allied, and allow **** days for determination.  On 2/28/23 the Pharmacy Benefit Manager was contacted and communicated the medication requires retail authorization process review with Allied and when Allied received the follow-up call the same day, Allied sent the retail authorization review to Allied's pharmacy advocate for priority review. However, since coverage terminated on 2/28/23, the authorization determination was denied.  

• Initial Complaint

  12/21/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had health insurance covered from Allied between January 1, 2022 and April 30, 2022. I have submitted claims for coverage via both certified mail and fax between August 2022 and December 2022. The representative told me my certified mail claims were received, but lost by them. The faxed claims were never located. I have had four or five calls to service reps to make sure my claims are received and processed with no resolution except being told to send in the claims paperwork yet again.

  Business response

  03/14/2023

  Dear *********************:
   
  Our team investigated your complaint and confirmed the claims in question were received and processed.
   
  If you still have questions regarding this matter, please call Allieds ****** Services at ************.

• Initial Complaint

  11/04/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was seen by my primary care provider, ***************, NP, on 9/28/21 to have a preventative IUD placed. I was seen on 10/5/21 for follow up on that IUD. This same provider/office provided prenatal care and labor/delivery services in the year 2021, and all those visits were billed through my insurance as in network. For some reason, Allied/CIGNA have altered/typo'd the tax ID number on the visits from 9/28/21 and 10/5/21 and they are processing as out of network. I have been calling ***** since August to get these claims processed correctly. My provider has filed an appeal, faxed over the contract they have with Cigna MULTIPLE times, and Allied proceeds to say they can't find the fax, they can't change the tax ID, etc etc. The ******************** representatives I have talked to on the phone all say this provider is indeed in network and they supposedly to send it back to Cigna for reprocessing as well. My provider and I are helpless in this situation as we have verified the CORRECT tax ID, filed an appeal, resubmitted claims, made NUMEROUS phone calls, etc. and Allied cannot get me a solution to this issue leaving the $1207.44 balance MY responsibility when it shouldn't be. These were not only preventative visits but I also met my deductible and was $83 short of my out of pocket **** ***** is responsible for these IN NETWORK bills and needs to take responsibility. Allied has a history of this according to your website. I expect them to process the claims properly, pay their share of these visits, and then send me an accurate bill for the remaining balance. To avoid going to collections, I have paid $10 to my provider today.

  Business response

  03/01/2023

  Both appeals were responded to, stating the claim was paid correctly as out-of-network per the network and tax ID number billed. The appeal responses were both emailed to the member. This complaint has been resolved. 

   

• Initial Complaint

  10/12/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  1. I have made 2 payments (the second unwillingly) both of $115 for medical coverage.2. I was lied to about the coverage I would be receiving for life changing medications, and lied to about this being a copay plan (it turned out I had a deductible) so not only have I been unable to receive necessary medication, but I was unable to get a needed MRI due to a deductible making it unaffordable.3. The most they have offered me is "sincerest apologies for the misinformation" when I asked about reimbursement since this is medical coverage I was not only lied to about, but unable to use in any capacity.

  Business response

  03/01/2023

  We were unable to find a claim such as the one described under the only member we could identify with this name. We would need the member ID to investigate further. Please have the member call our ****** Services Team. 

  Customer response

  03/01/2023

   
  Complaint: 18204885
  
  I am rejecting this response because: This was insurance through my employer from last year, I don't have the member ID anymore as I have long since canceled coverage with the company. I can provide screenshots from the company I work for stating they talked with you guys stating refund isn't available despite being lied to by a direct representative about essential medication coverage and continued to charge me until I signed up with new insurance. 
  
  Sincerely,
  
  Trinity ******

  Business response

  03/13/2023

  Dear Trinity ******:

  We reviewed your complaint further and unfortunately, we were still unable to locate any records in order for us to investigate.  We ask that you please call Allied ****** Services at ************ so we can assist you. 

   

  Thank you. 

• Initial Complaint

  10/10/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Hello. My name is *****************************. Last year I got pregnant and because of my age (38 at the time) and the fact that I was diagnosed as a Fragile X pre-mutation carrier, I was referred by my OBGYN doctor for a genetic testing of the fetus, testing called Prenatal Chromosome Microarray that was performed by Labcorp on 11/17/2021. Unfortunately my insurance company at the time, Allied Benefits Systems refused to cover the cost even if the doctor issued a ****** of Medical Necessity and considering my age and the diagnostic of Fragile X pre-mutation carries, I understand that these tests are very common. There are two bills, first in amount of $2,520 and the second for $714.20 that the insurance company refuses to cover and I am disputing. I am attaching the copy of my insurance card, the two lab bills, the doctor's ****** of Medical necessity and my entire communication with the insurance company including their initial denial and the appeal denial.

  Business response

  03/01/2023

  We were unable to identify this member in our system to investigate. We would need the member ID to investigate and respond. Please have the member call our customer service team. 

  Customer response

  03/01/2023

   
  Complaint: 18194088
  H
  I am rejecting this response because: the information required was already available in the submitted documents.
  
  Sincerely,
  
  *****************************

  Business response

  03/13/2023

  Dear ***************************** - Thank you for providing the additional documents. Our team was able to investigate this complaint and found that the claims under reference numbers ********** and ********** were properly denied as charges for genetic testing are not covered under your Employer's Health Plan per exclusion 24a, regardless of circumstance. Allied received an appeal on 06-06-2022, and issued a response letter to the Member on 07-15-2022.

  Customer response

  03/14/2023

   
  Complaint: 18194088
  
  I am rejecting this response because: not a generic testing but a doctor requested testing for high risk pregnancy due to dual factors, age and genetic history. 
  
  Sincerely,
  
  *****************************

• Initial Complaint

  06/16/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  In March 9th 2021 I went to the hospital at ******************* in *******, **. They used Quest Diagnostics to run some tests relating to abdominal pain I had. Starting 5/14/21 with claim # ********** Quest started submitting claims to Allied Benefit Systems for another ********************************* using my insurance information. I discovered this in the fall and notified Allied to remove them and block any future claims and they declined the claims. Additional claims were made on dates with claim numbers on 6/11 (3635929301), 7/09 ***********), 8/06 (3604356901) 9/07 ***********), 10/08 (3629215401), 11/05 ***********), 12/03 (3692818401), and 12/30 (**********) of 2021 and then 2/21/22 (**********). I contacted Quest and was able to secure a refund and they said they would withdraw the claims. I called back to Quest and verified with ******* on 5/03/22 that a void claim letter was sent to Allied on 3/30/22. I called back today 5/16/22 and was told they would investigate again but their procedure was to have me send in a letter and do an investigation on their end before they can have it removed, which they have done before. I have to obtain a security clearance for the ********** of ****** as my new job and this could negatively impact my job and being able to provide for my child as a single father. My next step would be legal action at this is a HIPAA violation as from Quest I have seen the address and through Allied a diagnosis. Allied as well as Quest have been complicit in this matter and the refusal to correct the records of someone that has done nothing wrong astonishes me.

  Business response

  03/01/2023

  We have investigated this complaint and no documentation was found to support the allegation or situation. Our system records every call through our contact center. No calls were found that matched this complaint. Please advise the member to contact Allied Member Services. 

*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. ↩