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Complaint Details
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Initial Complaint
09/24/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Resolved
On 9/13 I received a notice from Carelon Health saying I needed to recredential in 7 days or else. I never received an initial request. I did fax this to the number provided on 9/17. As of 9/21 I discovered that I was listed as out of network for Military OneSource and could not be assigned new clients. When I called the National Provider hotline I was told nothing had been received because I was given the wrong fax number. I had also sent these documents by email. When I called on 9/24 I was then told because I did not meet that 7-day deathline that I would now have to be totally recredientaled like I was a new provider and this process would take anywhere from 90 to 100 days! This was not my fault. I actively work for Military Onesource and I am now cut off until next year. I also fear with the incompetence I will not be placed back on the panel at all. I am one of their go-to providers and they need me and have now been cut off for months for new referrals. Luckily I am still able to work with my active clients. This company's incompetence will cost me thousands of dollars!
Business response
09/26/2024
Attached is Carelons response to ********.Customer response
09/30/2024
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Better Business Bureau:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved. Actually it was a canned answer that said absolutely notice, but on my own I finally got Carelon thru Military OneSource to finally listen!!!
Regards,
****** *****Initial Complaint
09/14/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I am in a dispute with Carelon as they seem to be blocking my access to care. In 2023, they told me that they didn't even have a grievance process. I had looked online and it seemed to be true. I tried to complain to my primary insurer, but they claimed that Carelon provides behavioral health and I would need to file the complaint with them. Again, Carelon claimed that there was no grievance process. I finally found a therapist on the list that Carelon had given me with an opening in July 2024, but the provider said that my insurance was declined, leading me to suddenly lose that therapist. I reached back out to Carelon at that point only to find out that they suddenly did have a grievance procedure. I gave an operator my information, but when I received the written response, it was clear that I was misrepresented. So, I also responded in a writing. They did call my home, but I was frankly a little tired of being lied to and misrepresented over the phone. I expected them to read my written communication. I just received a notice dated 9/10/24 claiming that I never responded to any of their attempts to reach me and thus they have closed my grievance. It is clear that they are claiming they didn't receive my written communication. I am certain that I mailed this envelope on 8/24/24 - the same day that I also emailed the information to the ** DHHS Ombudsmen. I actually needed to purchase extra postage due to the contents being 1.75 ******** the end, all of this is about a $177 bill that they haven't covered. I have been able to restart with the therapist now that their billing team knows how to submit the claim. There is another bill from a different treatment center that they need to cover, too.This seems like weaponized incompetence at this point and I need help interacting with them.Business response
09/17/2024
Attached is Carelons response to ********.Initial Complaint
09/11/2024
- Complaint Type:
- Delivery Issues
- Status:
- Resolved
Ordered and paid $380 for medication needed to live. I had doses for 4 days. I was promised delivery in 4 days. Found out that it was shipped on Day 3 with delivery expected on Day 7. I was supposed to start vacation on Day 5. Vacation ruined.Heart potentially ruinedBusiness response
09/15/2024
Attached is Carelons response to 22273060Customer response
09/15/2024
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Better Business Bureau:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved.
Regards,
***************************Initial Complaint
09/07/2024
- Complaint Type:
- Customer Service Issues
- Status:
- Answered
This company is awful. I am trying to get credentialed with BCBS/Anthem. My understanding is that they were recently bought out by Carelon, as I am required to be credentialed with Carelon in order to be credentialed with BCBS or Anthem. My application was completed on 7/26/2024 and since then it just sits, and sits, and sits. I have the name and email of my "contact **** but any attempt to reach the him falls on deaf ears and the response I do get to emails is an auto generated email with nonsense. The phone number they provide is unusable as you need a claim number to get through, but you can't have a claim number if you are not credentialed. It's a NEVER ENDING circle! I have searched the internet to find other solutions and was disappointed to learn that providers have waited upwards of 15 MONTHS before they are credentialed. This is unacceptable and I don't have the luxury of that sort of time to wait to be paid. I have many patients under these insurances plans and I will have to turn them away soon if this is not resolved. I just can't work for free. The company's delay in processing my application prohibits me from earning an income and they should not be allowed to do this to providers, but yet they are...nationwide. I need help getting the attention of someone who can get my credentialing completed....like yesterday! Some providers reported that a formal complaint to the BBB helped move things along, so here I am. I hope you can help.Business response
09/12/2024
Attached is Carelons response to 22254406.
Thank you,
Initial Complaint
08/26/2024
- Complaint Type:
- Order Issues
- Status:
- Answered
I am a licensed psychologist in *************. By November 2023, it became clear that Carelon Behavioral Health typically leaves claims unpaid. Carelon instructed me to fill out a new application, which was approved on December 29, 2023. However, the approval letter was not accompanied by a contract. I called Carelon, and they told me the contract matters are assigned to an agent. Carelon provided a reference number and told me to call the agent in a few weeks. When I spoke to the agent, I was given another reference number and informed that they are still working on it. In February, I called again and gave them my reference number; they told me my case had been closed. They reopened my case, gave me another reference number, and told me to call back in two weeks. I have called every two weeks since February 2024, and we are still without a contract. When I asked to speak to a supervisor, they claim they are not allowed to do so and will escalate my concerns. To date, I have provided Carelon with over $23,000 of claims for patients I have continued to treat, assuming Carelon would follow through on the promises of a contract. Beacon Health Strategies previously managed claims for these same patients, and they were reimbursed without difficulty. Please advise how you can help me with this matter and what my next course of action might be. Thank you in advance for your attention to this matter.Business response
08/28/2024
Attached is Carelons response to *******.Customer response
08/29/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.We reject this letter from Carelon Behavioral Health for they have not worked in good faith over the past year in getting this issure resolved, after numerous calls and reference numbers. Again we were approved by their creditaling **** on December ******* after having to submit a new application. ( we have done business with Beacon now Carelon for +15 years all of sudden there is a problem and we stopped being paid). We are still waiting to receive our new contracts. In the mean time we have over $25,000 dollars in unpaid claims.
So therefore we REJECT this standard letter from the company until our contracts are received, signed and allowing us to continue care with our patients.
FAQ
Regards,***********
Business response
09/03/2024
Attached is Carelons response to ********.Customer response
09/03/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
AGAIN
We reject this letter from Carelon Behavioral Health for they have not worked in good faith over the past year in getting this issure resolved, after numerous calls and reference numbers. Again we were approved by their creditaling **** on December ******* after having to submit a new application. ( we have done business with Beacon now Carelon for +15 years all of sudden there is a problem and we stopped being paid). We are still waiting to receive our new contracts. In the mean time we have over $25,000 dollars in unpaid claims.
So therefore we REJECT this standard letter from the company until our contracts are received, signed and allowing us to continue care with our patients.
Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.
FAQ
Regards,***********
Business response
09/23/2024
Attached is Carelons response to the complainants rejection received on 9/18/24.Initial Complaint
08/19/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I entered my daughter in an out patient treatment facility to treat her diagnosis. This program was out of network. Upon several phone calls to Carelon Behavioral Health they assured me that after meeting the deductible I would be responsible for 20% and the insurance company would reimburse me 80%. I proceeded to borrow $18,000 believing that I would get 80% and would be able to repay most of it. What they failed to inform me is that they charge a 275% rate of ********. I was appalled that this was never communicated to me. Had it been so I would have never enrolled my daughter in the program and borrowed this amount of money. I called them to let them know my frustrations. They insist that this was communicated to me. They said a supervisor would retract my phone calls to verify. A couple of weeks later I get a phone call and the representative informs me that several phone calls were retracted and in each call I was made aware of the ******** rate. I asked to hear the recordings and was informed that this is not allowed. So am I supposed to believe their word? I am seeking the 80% of my payments to the provider based on mis-information. How sad that a behavioral center can take advantage of the unwell in such a selfish mannerCustomer response
08/30/2024
I have not heard from the business in response to my complaint.Business response
09/09/2024
Attached is Carelons response to ********.Initial Complaint
08/14/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Carelon - ***************** of services after repeated requests and filings form doctors office and Home Health Care Providers. My mother is 92 years old. She wants to be at home. I quit my job, left my family in ****** to help her. She has Dementia/Alzheimers. She cannot be left alone for more than 20 minutes or so. I have singlehandedly been caring for her with the exception of a short time when she returned from a stay at hospital and nursing care facility. (Which by the way, extending her stay there to 90 days so I could finish out the school year as an aide in a ***************** Classroom in ******). I am her only care giver. She cannot be left alone because she has had several incidence of hallucinations when she has tried to leave the house. I have been here since the end of May. I have left the house only to run to the local grocery for supplies. I did manage 2, 1 hour outing with friends. Aetna is my mother's ******** supplemental supplier. They have told me that it is definitely part of her plan. I have also read her plan. Her plan includes up to 35 hours a week for home health care aides. Carelon has denied the care after requests from Ohioans (home health care providers) and her doctor's office. Ohio is supposed to be all about care for seniors and the ability to choose to stay at home. I myself taught in **** 23 years, my father was a school superintendent for 35 years, and my mother worked in the school library for 20 years. Knowing that the 3 of us all gave our service to the state of ****, then being denied repeatedly the help that we need now is insulting and egregious to myself and my family. I feel Carelon needs to be held accountable. We are past the point of an apology and I feel I have no alternative other than to file a lawsuit.Business response
08/22/2024
Attached is Carelons response to 22142396.Initial Complaint
07/25/2024
- Complaint Type:
- Order Issues
- Status:
- Answered
I am a mental health provider in *************, and I provide care to patients insured through the state health plan. One year ago, I learned that there was confusion as to the status of my contract with Carelon Behavioral Health. I contacted them, and followed their instructions in order to work toward a resolution. I filled out an new provider application in November 2023. They sent me a provider contract in February, 2024, which I signed and sent back on February 28, 2024. Nearly six months have passed, with no response. I have called approximately 10 times over the past four months. Each time, I receive the same response. I a told that they will enter the content of my call in their system, and give me reference numbers. My guess is that the people with whom I speak are located in a different country, as they have all been difficult to understand. But, it is clear that their response is scripted. I finally got the name of a person in the provider relations department, *************************, and have called her approximately 10 times. I know that she is aware of the specifics of the situation I have left messages each time, requesting a call back, but have never heard from her. At this point, with this issue still not resolved, I have provided over $15,000 of unpaid care to Carelon subscribers. But, I am no longer able to continue to see patients who are in need of care, and with whom I have developed important therapeutic relationships. My complaint has to do with Carelon's refusal to respond to my constant requests for communications. And also my having provided over $15,000 unpaid care. I see that there are 47 complaints with the Better Business Bureau against Carelon. And almost all of the complaints are very similar to mine. And in all of these cases, it isn't only the providers that are disregarded. The care of patients in need, who are covered by the state's health plan are being disregarded.Business response
07/31/2024
Attached is Carelons response to ********.Initial Complaint
07/11/2024
- Complaint Type:
- Delivery Issues
- Status:
- Resolved
My credentialing application was approved on January 26, 2024. While I look forward to providing mental health care, I have not yet received information regarding my Provider Agreement.I have made several calls to the ************************* Line on the following dates: February 29, 2024; March 20, 2024; April 19, 2024; May 6, 2024; May 22, 2024; June 17, 2024; July 5, 2024; and July 9, 2024. I also emailed the Provider ******************** on July 5, 2024.Each time, I received the same response: Your contract is being reviewed. We are submitting a grievance, and you will hear from them within five business days. However, I have not received any follow-up communication via call, letter, or email.Customer response
07/22/2024
I have not heard from the business in response to my complaint.Business response
08/13/2024
Attached is Carelons response to 21976063.Customer response
08/14/2024
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Better Business Bureau:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved.
Regards,
*****************************Initial Complaint
07/10/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
I am filing this complaint because we have had MAJOR difficulties even attempting to get credentialed with Carelon Behavioral Health, without any resolution. I ***own Wishing Well Mental Health Services, providing mental health support services. We initially emailed the application for credentialing on 10/10/23 after being instructed this was the best way for credentialing. After following up in March after no response, we again emailed (to a different email address, as instructed) the application on 3/15/24. We followed up again in May, and were instructed to email AGAIN to yet another email address, which we did so on 5/9/24. We have called on the following dates after this to follow up: 5/17, 5/21, 5/29, 6/13, 6/27, and will call again today. We faxed the application on 5/8/24 and were told it was going to be escalated. We have faxed several times since then as well. Each time, we have been told our application cannot be found, and now that it has been we are looking at another year until we can be credentialed. I am reaching out in a plea to assist us. We have had to turn away MANY referrals because of this difficulty.Business response
07/16/2024
Attached is Carelons response to ********.
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