Complaints

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

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• 

  Carelon Behavioral Health., Inc.

  200 State St Ste 302 Boston, MA 02109-2672

• 

  Carelon Behavioral Health., Inc.

  9925 Federal Dr Colorado Springs, CO 80921-3604

• 

  Carelon Behavioral Health., Inc.

  PO Box 1864 Hicksville, NY 11802-1864

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:04/18/2024

  Type:Product 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.

  RE: Request for Amended Fee Schedule to Include all ******** services: called repeatedly and submitted electronic requests as directed. Still waiting on the requests submitted in 2021. Every time we follow up on the status of submissions, according to the ***** ********** are in progress. Florida ******** Health Care Alert dated 8/4/22 increased FFS rates retroactive to 7/1/22 (ex- ***** to $*****/unit). Florida ******** Health Care Alert dated 12/8/23 increased FFS rates retroactive to 10/1/23 (ex- ***** to $21.87). Reimbursements slowly increased following the ******** increases July 2022 and applied to some reimbursements from Jan-September 2023. The Oct 2023 increase has not been applied to any reimbursements. When called, the rep indicated fee schedule rates were managed by Nat'l Provider Services. She said the request for fee schedule increase must be reviewed by the contracting team; we should receive an acknowledgement email in ***** days with full turnaround for response in ****** days. She also reported it may/may not be retroactive, if even approved. [ref#********-2470691-01] This is absurd considering the already unrealistic time frames we've been operating under with Beacon/Carelon. On the surface, this appears to violate their contractually stated obligation to comply with any and all applicable AHCA and CMS laws and regulations, as well as applicable state laws.We have claims submitted with the 9 CPT codes, as required by their plan. The claims were denied due to not being on the fee schedule. The 9 CPT codes are listed, & included, within our contract. As you can imagine, its extremely frustrating to be given a runaround response when resubmitting denied or unprocessed claims, only to be told the fix could take approximately 3-6 months, thereby making the appealed claims exceed the window of allowed time given by Beacon/Carelon to appeal claims. Many letters have been mailed, emails sent and calls made- all to no avail.

  

  Business Response

  Date: 04/21/2024

  Attached is Carelons response to ********.

  Customer Answer

  Date: 05/01/2024

  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. 

  We have awaited some sort of communication or contact from Carelon to address these concerns but still have not heard from them.
  
  
  
  FAQ
  
  Regards,

  Heather

   

   

  

  Business Response

  Date: 05/12/2024

  Attached is Carelons response to our correspondence of May 7, 2024

• Initial Complaint

  Date:04/16/2024

  Type:Service or Repair 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.

  I submitted a request to join Carelon Behavioral Health as an Sole Provider on July 2023, I received a letter indicating that I was approved in September 2023, I have attached the letter. I made several calls to get contract information to be able to start to see patients, after being told for several months I was enrolled and good to provide services, someone noticed that the enrollment they were seeing approved was through an old agency I worked for and not my current request, the business information was not listed on the letter they sent me, only my name and NPI. At this point I already had 5 Anthem clients I was seeing weekly, they said submit a request for a Single Case Agreement which were denied because they are ******** Anthem clients. Since January Ive been told I would receive a call back in 2-3 days from each one of my calls so they can fix my issue but I have yet to get a call back. In March I was told someone was already looking at my case and to wait a few more days, it has been 4 weeks and I called twice to hear "no updates, but they have it on their file". No call backs, no progress on the issue that they made, and now its been passed 90 days since I started to see these clients and the billing will be impacted as they only have a 90 day backbilling policy. Attached are some the reference numbers I received from them.Reference #********-1575903-01 reference #********-1967283-01 03192024-2187421-01 04022024-2316402-01 04162024-2450236-01

  

  Business Response

  Date: 04/22/2024

  Attached is Carelons no disclosure response for ********.

• Initial Complaint

  Date:04/11/2024

  Type:Service or Repair 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.

  I was credential fine when it was Beacon than carelon happened last year and we reapplied and got credential on 7/21/2023 and since then we have not fully be activated full under carelon. i have more reference number dating back to sept to today. it is damaging my business and i am not paying employees but through my personal account. i have reenrolled several times and it has been told to me since january that it has been escalated to data entry and blah blah powers at be will fix it but then i wait 2 weeks and call back and nothing is done and again they tell me they are sending it high priority. i have a credential bunisess REVIVE that even been doing the same as I - as i was thinking maybe they would have better luck then carelon dealing with my the provider. i need to be credential fully. i work as LADC 1 Substance and mental health counselor and my business is suffering becuase they have fix their problem.

  

  Business Response

  Date: 04/21/2024

  
  
  Attached is Carelons response to ********.

  Customer Answer

  Date: 04/22/2024

  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.
  
  FAQ
  
  Regards,

  ******

   

   

• Initial Complaint

  Date:04/02/2024

  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.

  I am a Licensed Mental Health Counselor in private practice for 16 years. I interact with insurance companies regularly with few problems. I received a contract from Carelon Behavioral Health on 2/9/24. Im writing this complaint on 4/2/24. The body of the contract was in large and bold font. The fee schedule was less than half of the smallest font on my iPhone. I couldn't find the codes that I bill let alone the fees being offered. I contacted the National Provider Services Line. They were off shore. They couldnt see my contract and therefore couldnt help me. I spoke to a supervisor and they couldnt see my contract. I then emailed the regional representative who signed the cover letter and described the interaction I had with the ***** She responded by saying that was incorrect, that they were trained to see my contract. She argued this point several times in subsequent emails and kept referring me back to the ***** I found out the fee was that they were offering which was $35 less than other insurance companies. She insisted that the rates were standard but that she would have a regional manager who negotiates rates contact me. I never heard from this person. Two weeks went by and I I tried to confirm that we were on the same page, that a manager was going to be contacting me. I got no response. I waited another couple of weeks and asked for the contact information for the manager. I received no response. I then asked to speak with her supervisor. I received no response. I asked again to speak with her supervisor and got no response. Over the course of 6 wks I never got a response from her or anyone else. Then I was able to reach an onshore manager who I thought was genuinely going to help me. I reached out to her when I hadnt heard back for 2 wks, never heard back. I want to provide services to lower income patients. Carelon appears to be untouchable & unethical. I tried unsuccessfully to report them to a MA ****************

  

  Business Response

  Date: 04/08/2024

  Attached is Carelons response to ********.

• Initial Complaint

  Date:03/22/2024

  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 are a provider group contracted with Carelon. Since August of 2023, my office has tried to get our tax id changed. We have emails going back to Aug 23 2023 with ****************************************** We have submitted an updated W-9 several times with no response. Every time we ask for an update, we get a response to submit a W-9.

  

  Business Response

  Date: 04/14/2024

  Attached is Carelons response to ********.

  Customer Answer

  Date: 04/16/2024

  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. 

  Yes, we were sent an email and yes we responded and sent another W-9 and have again received NO RESPONSE.

  We submit requests for authorizations and Carelon does not respond. CA SB 221 is a landmark mental health law that guarantees Californians the right to timely mental health and substance use disorder therapy sessions.
  

  Carelon is impeding patient access to mental healthcare.
  
  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,

  Al

   

   

  

  Business Response

  Date: 05/21/2024

  Attached is Carelons response to the providers dispute dated 4/22/24.

  Customer Answer

  Date: 05/29/2024

  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. 

  The "response" letter from Carelon is anything but a response.

  Since August of 2023 we have been exchanging emails with Carelon
  including submitting a **9 multiple times, the latest being 4/3/24. I
  received another email dated 5/20/24 asking for the **9.

  Carelon certainly knows how to send emails, but there is absolutely ZERO follow up.

  
  

   

  [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.
  
  FAQ
  
  Regards,

  Al

  Since August of 2023 we have been exchanging emails with Carelon including submitting a **9 multiple times, the latest being 4/3/24. I received another email today asking for the **9.
  

   

• Initial Complaint

  Date:03/19/2024

  Type:Service or Repair 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.

  I represent my husband, ***************************. ************** is a psychiatrist in private practice. He had been credentialed and contracted to provide services to Beacon Health members, now known as Carelon. **************** is one of the plans under Carelon. Fallon has a commercial plan as well as a public ********** plan. We found out that for some unknown reason, ************** was in network with the commercial plan but not with the public plan and claims were being denied. I was advised by a Carelon representative to send new app with letter of intent. I completed this on 3/29/2023 -- almost ONE YEAR ago. I can provide all the details of interactions with Carelon that have happened over the last year, if needed, but the end result is that on 3/14/2024 I was advised that it will take another 10 more weeks. I simply don't believe it because I have been told a fix is coming multiple times before. ************** has been providing services without pay, due to continuity of care concerns. I'd like Carelon to confirm which plans ************** is contracted with and I'd like to ensure that *************** is one of them.

  

  Business Response

  Date: 04/01/2024

  Attached is Carelons response to ********.

  Customer Answer

  Date: 04/03/2024

  [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

  Date:03/18/2024

  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.

  I applied for credentialing on 6/28/23. Today is 3/18/2024. The case has been escalated over 10 times. I have had clients and patients that I cannot provide valuable and needed services for. I have been provided with over **************************************************** this date.Is this company a scam? Due to not being able to be fully credentialed I have to apply for *** (Single Case Agreements). The *** unit are now back logged and overwhelmed due to the contracting unit outright refusal to draft and execute the contracts. Why are they still allowed to be in business?

  

  Business Response

  Date: 03/20/2024

  Attached is Carelons response to ********.

• Initial Complaint

  Date:03/12/2024

  Type:Service or Repair 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.

  Hello, I am a Licensed Clinical Social Worker in private practice. 1) Since 2022 my last name legally changed from *********** to *****. I have repeatedly provided Carelone my divorce papers, W-9 form, written requests and spoken to Supervisors/Reps to update my Provider AND Payee name to ******************, and to date this has not been completed. I have received 2 checks ($100, $57) for services provided in Jan 2024 but under the name ****************************** which I can't deposit since my last name is *****. I resubmitted yet another request to update my last name on 2/26/24 and was told it would take 10 days and after speaking with yet another Supervisor, it still has not been completed (TRACKING# ********; practice address ******************************************* and billing address *************************************************************************). So I am owed money from Carelon in addition to their long overdue process of updating my legal last name to *****.I have also requested a rate increase, and was told the process would take about 120 business days, however, that was around 6 months ago with no response.

  

  Business Response

  Date: 03/13/2024

  Attached is Carelons response to ********.

  Customer Answer

  Date: 03/13/2024

  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. 

  [I AM A BEHAVIORAL HEALTH PROVIDER AND BUSINESS PARTNER WITH A SIGNED CONTRACT WITH CARELON BH. MY COMPLAINT HAS NOTHING TO DO WITH MY BENEFITS BUT USING MY LEGAL NAME AS ONE OF THEIR BEHAVIORAL HEALTH PROVIDERS SO THAT I CAN CASH THE CHECKS RECEIVED FOR SERVICES I PROVIDED TO ONE OF THEIR MEMBERS. THIS IS NOT AN ISSUE OF A HIPAA VIOLATION. I SIMPLY WANT THEM TO UPDATE MY LAST NAME WHICH LEGALLY CHANGED FROM *********** TO ***** SINCE 2022 AND DESPITE REPEATED REQUESTS, I'M STILL RECEIVING PAYMENTS WITH MY OLD LAST NAME. THIS IS GOING ON 2 YEARS OF MAKING THIS SIMPLE REQUEST. I ALSO HAVE LITTLE FAITH THAT A CALL FROM THEIR REPS WILL BE HELPFUL AS I HAVE SPOKEN TO NUMEROUS REPS AND SUPERVISORS AND UNFORTUNATELY THE ***** OF BUREAUCRACY REQUIRES OUTSIDE ASSISTANCE ]
  
  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,

  Adeyola

   

   

  

  Business Response

  Date: 03/18/2024

  Attached is Carelons response to ********.

  Customer Answer

  Date: 03/19/2024

  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. 

  [I HAVE NOT RECEIVED ANY OUTREACH TO RESOLVE THIS ISSUE EVEN FOLLOWING THIS COMPLAINT TO THE BBB. NO ONE HAS CONTACTED ME NOR HAS MY LEGAL NAME BEEN UPDATED. THEREFORE, I HAVE STILL NOT RECEIVED PAYMENT FOR SERVICES I PROVIDED CARELON MEMBER SINCE JANUARY 2024. I HAVE NOT RECEIVED CHECK OR ELECTRONIC PAYMENTS DUE TO ME SINCE THE CHECKS I RECEIVED WERE IN MY OLD NAME - ***********, AND THAT WAS LEGALLY CHANGED SINCE 2022. I AM OWED PAYMENT BY CARELON AND THIS ISSUE REQUIRES THEIR URGENT ATTENTION AND CORRECTION. I AM A CARELON PROVIDER AND I NEED TO BE PAID FOR SERVICES I PROVIDED TO ONE OF THEIR MEMBERS.]
  
  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,

  Adeyola

   

   

• Initial Complaint

  Date:03/07/2024

  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.

  Carelon Behavioral Health has failed to process my Provider application to become a credentialed provider within their network according to their promise to do so per the following letter they sent on:09/19/2023 ***************************** ******************************************************************************** NPI NUMBER: ********** PROVIDER NUMBER: ******* MBHP PROVIDER NUMBER: No MBHP Provider Number Re: Credentialing Application Approval Dear Valued Provider,We are pleased to inform you that your application for credentialing to participate in our network has been approved by our ********************************* effective 09/19/2023.What happens next?Now that you are approved to join our network, please ensure you have a fully executed agreement with us. Your effective date to provide services to members is your credentialed date or your executed agreement date, whichever is later.Your provider agreement is sent to the email noted on your application and/or your practice group administrator.

  

  Business Response

  Date: 03/10/2024

  Attached is Carelons response to ********.

  Customer Answer

  Date: 03/11/2024

  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 # ********. 

  [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.]

   

   

   I am a Licensed Clinical Social Worker who has been approved by the Carelon *************************** to become an enrolled Behavioral Health Provider, within the Carelon Behavioral Network, however, I have yet to receive an official Provider contract as required from Carelon, in order to review and sign the contract then submit, in order to begin treating patients who have this insurance.

  I request a status update on my contract and why I have not recieved it to date.

   

  
  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

  Date: 03/12/2024

  Attached is Carelons response to ********.

  Customer Answer

  Date: 03/13/2024

  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 # ********. 

  The response is unacceptable as I am a licensed clinical social worker who has been approved by the medical director to become an in network credentialed provider, last year and no action has been taken by the noted company to provide me with a provider contract. 
  

  I respectfully request a contact name and phone number, in addition to a provider contract to be emailed to me promptly, in order to resolve my formal complaint.
  
  
  
  Regards,

  *******

   

   

• Initial Complaint

  Date:03/06/2024

  Type:Service or Repair 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.

  Starting 1/1/24 Carelon began handling my clients' behavioral health insurance. Since 1/1/24 I have contacted Carelon on at least 15 occasions and they have still not resolved my issue. They did not get the clients their new ID cards until early February (many clients were without mental health services during this time) and and have not paid mental health clinicians providing services so far this year (2024).They do not respond to phone calls or emails inquiring about how bills can be submitted or contracting questions. Their customer services **** is confused and disorganized and gives different responses every time I call.

  

  Business Response

  Date: 04/01/2024

  Attached is Carelons response ********.