ComplaintsforVantage Health Plan, Inc.

• Initial Complaint

  08/23/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Ok so this insurance is pretty cheap and I love that but I was given a website address so that I could pay my premium however when trying to log into the website, said website just sits there like it’s loading but never does . Leaving me to call a number and make my payment over the phone which I hate and often forget to do . Which is why my balance due is past due . I wish there was a way to auto pay from my debit .

  Business response

  08/24/2023

  Good morning!  A Vantage representative will contact Mr. ****** today to assist with any access or technical issues he is having.  We do support online premium payments and also have the auto-draft options available too.  We will document our conversations with Mr. ****** to ensure understanding and resolution.  Thank you!

• Initial Complaint

  01/10/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Date: 11/23/2022 Amount: $218.85 Prescribed GENERIC drug - "Tadalafil 20 mg. qty. 90 I got a call from St John Pharmacy saying the drug was being mailed & checking my address to be correct. (All of my Rx's from them has always been free or very cheap) When I got the Rx the amount charged was $218.85. I called them & said if I knew it was that expensive, I wouldn't have gotten it. I wanted to return it & they said I couldn't return a drug. I asked them if they could please credit my Discover card because I couldn't afford it. Walmart pharmacy price for same drug & amount is $32.09. They told me they had told me the price & I told them they didn't tell me the price or I would have told them not to send it. I talked to Discover & they told me to call BBB. I am 83 years old & on Social Security. I need & would appreciate if I could get credited for this GENERIC drug. They did not tell me the price on the phone nor did I sign anything saying anything about that price. Enclosed please see the attachments of this dispute.

  Business response

  03/13/2023

  Business Response /* (1000, 11, 2023/02/13) */ Saint John Pharmacy (SJP) contacts members for approval prior to any credit card transaction. Member's wife provided updated credit card information and was advised of the cost of the drug prior to the filling of the prescription. This particular drug was not covered under member's health plan, so he was charged the cash price of the drug. After the drug was delivered to his home, the member's wife contacted SJP to dispute the drug. Unfortunately, we cannot legally accept returned drugs due to federal regulations. The member's wife then filed a fraud review with Discover (credit card). Discover's resolution supported SJP's approval of and handling of this drug purchase. Consumer Response /* (3000, 13, 2023/02/22) */ (The consumer indicated he/she DID NOT accept the response from the business.) When Saint John Pharmacy (SJP) called & told my husband the drug was ready to be mailed, they DID NOT tell him the price $218.85 of the drug or he would've told them to keep it & we would order it (same drug & quantity) from Walmart pharmacy for $32.09. My husband or I were advised of the price, which id ridiculous for a GENERIC DRUG. I can understand them not accepting the drug back but I can't understand why they won't credit my Discover card since they did not tell us that it was so expensive! We have done business with SJP for years but NEVER had this happen before. I can't believe they are so inconsiderate, especially for my Husband which is 83 (eighty three) years old & we can't afford this price. Plus this is only one of the 3 (three) drugs, he takes for this health problem. Business Response /* (4000, 16, 2023/02/27) */ SJP's records indicate that the price was provided to the member, and the member verbally consented to the price and also provided his updated credit card information for the charge. His consent to the charge was noted on 11/23/2022, and because of the Thanksgiving holiday, the charge and prescription was processed on 11/29/2022.

• Initial Complaint

  12/20/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  In August of 2022 I was starting a new job. I opted to take out a short term health plan while waiting for my insurance at my new job to kick in. I chose to use Vantage. I paid my first month's premium in August of 2022 for an effective date of September 1, 2022. In September I paid my premium for the policy to remain active in October. My health insurance with my new employer was set to start on November 1, 2022 so on October 11, 2022 I called Vantage to cancel my policy because this is not something I was able to do online. The premium payment was not yet due. I had my policy set to auto draft from my bank account at the time. When I cancelled, they failed to remove the auto draft. The day I noticed it pending on my bank account, October 21, 2022, I called Vantage. I asked them why it was still drafting if I cancelled in advance & she advised me that they "forgot" to remove the auto draft when cancelling the policy. I asked them to stop the charge or refund it same day to which they stated they were unable to do but would refund it. This pending payment of $106.56 eventually posted to my bank account on October 24, 2022. On November 3, 2022 I spoke to Vantage again about a refund & was once again told I would receive a refund but no one could/would tell me when it would be but that it would be within a "couple weeks". During this time I was calm & friendly with them. On November 7, 2022 I missed a call from Vantage at 9:42 AM & I returned the call at 9:48. I was told during that call that my refund would be sent out to me & I should have it "soon". Still no definite dates but that led me to believe that it would be in the mail within the week. I tried to be patient as I know that USPS has ran a little slower being the holidays. I waited to call Vantage again until December 15, 2022. I was told that it was still "in progress" at that time which is unacceptable. Their customer service is sub par because they are unable to help me & I still have no refund after 2mos.

  Business response

  01/27/2023

  Business Response /* (1000, 8, 2023/01/06) */ Contact Name and Title: ******* Self VP, VHP Contact Phone: XXX-XXX-XXXX Contact Email: *****@vhpla.com Vantage documentation does support these communication dates between the member and our customer service department. On 10/11, the date of cancellation request, the customer service representative should have advised the member that the cutoff date for stopping drafts is the 10th of each month. When a draft is cancelled after the 10th, the system will not accept a term date of draft, the draft will proceed, and a member refund will be issued. A manual request for termination was requested on 10/21 (a customer service rep spoke with accounting and advised that we would need to process this request for the member). At that time, the refund process began with the 30-45 day window which would have ended at the 45 day mark on December 5th. Accounting was much later processing this refund than originally expected which resulted in the member's refund processing on 12/21. On 12/28, Member Services reached out to the member and advised that her refund had been charged back to her card. The member advised that her card had been cancelled and upon checking her bank account, did see that her refund was available. We sincerely apologize for the delay in processing her refund and internal processes will continue to be monitored to ensure timely payment to members in the future.

• Initial Complaint

  12/10/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I made two appeals to Vantage for medical claims they said they'd pay, both of which were then denied. In both cases, I purchased medical devices Vantage representatives told me/doctor's office were covered. In the end, they were not. I know it was just an honest mistake on behalf of the folks I talked to initially, and everyone makes mistakes, and this is just such a stressful time for everyone. I don't want this to reflect negatively on them at all but I do think it's only fair I be compensated. I bought a cervical traction device from Zynex Medical for $295 and I was told that I would receive reimbursement at my usual percentage - I was not told it needed to be from a covered device vendor (they didn't say there were specific vendors at all to buy from). I also bought $425 orthotics that Vantage told both my doctor's office and me were covered, multiple times. They were not, and I was not reimbursed. It feels unfair to be paying over $700 for mistakes that Vantage made in conveying their plan information - if a store charged someone $700 for something with a price tag of $100, that would be considered bad business practice and unfair. This feels unfair, too.

  Business response

  01/31/2022

  Business Response /* (1000, 8, 2022/01/04) */ Ms. ****** is a Vantage Exchange member with both in- and out-of-network benefits. In a call in March 2021, a Vantage representative quoted her Durable Medical Equipment (DME) benefit as provided by an in-network provider. No additional information was provided by the member regarding her selected DME provider or the DME needed. Vantage also spoke with this member's ordering provider in March 2021 for an out-of-network DME with the out-of-network benefits and the requirement for authorization. Vantage learned later in the Summer of 2021 that the DME was, in fact, provided by an out-of-network provider and without authorization. Details around the member's DME benefit, in- and out-of-network providers and benefits, and benefit exclusions are found in her Certificate of Coverage document. Ms. ****** is correct in that this denial was appealed and reviewed by our Medical Directors, and then also the larger Appeals Committee. Both teams review appeals for medical necessity and against clinical guidelines for appropriateness and consistency. The appeals were denied as not covered as the DME obtained did not meet medical necessity criteria and no authorization was granted. Consumer Response /* (3000, 10, 2022/01/09) */ (The consumer indicated he/she DID NOT accept the response from the business.) Though I appreciate Vantage's time and consideration, their response does not address the core of the issue - my complaint is not about medical evaluation but business practice. (The response also does not seem to distinguish between two cases of DMEs that were denied coverage.) Vantage made an error in explaining their coverage, and they are requiring me to pay for it. In one claim, for a pair of orthotics, my doctor's office called vantage and was told the orthotics would both be covered as in-network and did not need authorization. Vantage has said this was a mistake on the Vantage rep's part - that they were not covered for me, as I do not have diabetes. This was not specified to the doctor's office, and so they thought, and told me, they were covered. I would not have bought them otherwise. I was separately told this as well by a vantage rep. With the other claim for a DME, the cervical traction device, I called and asked if these were covered. The rep I spoke to said they were, if I used the correct code. I was not told that there are in network and out of network device companies. I am not taking issue with Vantage's policy of what is and isn't covered. I am taking issue with Vantage providing incorrect information, and charging me for that error. If an insurance company tells someone "this is covered," and does not specify required networks or conditions, a client or doctor's office will assume it is covered. It feels unethical akin to a store clerk mistakenly putting a $20 price tag on something that was meant to be $200, then, upon realizing their error, sending the buyer a bill for $180 extra, with no option for the buyer to return what they bought. Thank you, BBB and Vantage, for your consideration and help in this matter! I know everyone makes mistakes, and I understand you have to have rules with the policy - I just think in this case, it's unfair to make me pay for the company's error.

*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. ↩