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:01/20/2024

  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.

  Carelon Behavioral Health is a company that administers mental health insurance in the Emblem Health GHI Network. I filed a claim at the beginning of December for out-of-network mental health services reimbursement, a process that at the latest is allowed to take 30 days from the date of claim filing to resolve, although never before has it taken more than two weeks. I waited patiently for weeks, checking my patient portal and seeing that nothing was being done on the claim while payments were promptly being disbursed to my in-network providers. After calling a couple weeks ago, I was told that there was a back up in payments (never communicated to me) and that my check should be paid on Friday, January 12th, which was over the 30 day limit. Im writing this complaint on January 20th because I have yet to receive my claim check for the hundreds of dollars that Carelon Behavioral Health owes me and I am extremely worried that this will become a pattern of refusing to reimburse patients for the allowances they are owed. I am seeking the timely payment of the $580 dollars that Carelon Behavioral Health owes me and timely resolution of my claims going forward.

  

  Business Response

  Date: 02/01/2024

  Dear Better Business Bureau:                  
  
   
  
  We are responding to your correspondence dated Jan. 20, **** regarding the above-referenced file.
  
   
  
  It is Carelon Behavioral Health, **** policy to comply with all applicable laws and ethical standards. We are obligated to preserve the privacy of individuals health and healthcare information, including all information about claims we receive. The federal Health Insurance Portability and Accountability Act of **** (HIPAA), along with other laws and regulations and our internal policy, requires protection of protected health information (PHI). PHI is defined as information that relates to the past, present or future physical or mental health or condition of an individual.
  
   
  
  In compliance with the above-referenced Act, Carelon Behavioral Health neither admits or denies that it administers the complainants benefits in this letter.
  
   
  
  However, Carelon Behavioral Health takes our customer complaints very seriously.  We will contact the complainant directly to address any and all issues within our purview.
  
   
  
  We look forward to serving all of our members well.
  
   
  
   
  
  Sincerely,
  
   
  
  
  
   
  
   
  
  *******************************
  
  Appeals and Grievance Coordinator
  
   

• Initial Complaint

  Date:01/16/2024

  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.

  We are an outpatient mental health group and we have been trying to get contracted/credentialed by Carelon so that we can accept mbhp and other masshealth clients.Carelon has been very unresponsive. Our application has been stuck in review for 79 business days. Their provider services reps have been telling us that there is no specific wait time for reviewing and even after they review our application we have to wait for another 120 business day to get any response. I think this is very unfair to all the clients that we have been turning away from care because the area our practice is located most of the Masshealth clients are covered under MBHP.We have not had this issue with any other panels.We have an appointment with the local congress person to try and figure out why it is becoming so difficult for our clients to receive the mental health services they desperately need and we have the availability and clinicians available to provide the care.

  

  Business Response

  Date: 01/24/2024

  Dear Better Business Bureau:                  
  
   
  
  We are responding to your correspondence dated Jan. 16, ****, regarding the above-referenced file.
  
   
  
  It is Carelon Behavioral Health, **** policy to comply with all applicable laws and ethical standards. We are obligated to preserve the privacy of individuals health and healthcare information, including all information about claims we receive. The federal Health Insurance Portability and Accountability Act of **** (HIPAA), along with other laws and regulations and our internal policy, requires protection of protected health information (PHI). PHI is defined as information that relates to the past, present or future physical or mental health or condition of an individual.
  
   
  
  In compliance with the above-referenced Act, Carelon Behavioral Health neither admits or denies that it administers the complainants benefits in this letter.
  
   
  
  However, Carelon Behavioral Health takes our customer complaints very seriously.  We will contact the complainant directly to address any and all issues within our purview.
  
   
  
  We look forward to serving all of our members well.
  
   
  
   
  
  Sincerely,
  
   
  
  
  
   
  
   
  
  *******************************
  
  Appeals and Grievance Coordinator

• Initial Complaint

  Date:01/15/2024

  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 needed to obtain a neuropsych for my son. Providers that took his insurance were scheduling out until ****. Carelon approved an out of network provider but its been 2 months since they said they would send a " single case agreement". They did say there was no time frame but 2 months is a really long time. I mean, its sending along paperwork?

  Customer Answer

  Date: 01/25/2024

  I have not heard from the business in response to my complaint.

  

  Business Response

  Date: 01/28/2024

  Dear Better Business Bureau:                  
  
   
  
  We are responding to your correspondence dated Jan. 15, **** regarding the above-referenced file.
  
   
  
  It is Carelon Behavioral Healths policy to comply with all applicable laws and ethical standards. We are obligated to preserve the privacy of individuals health and healthcare information, including all information about claims we receive. The federal Health Insurance Portability and Accountability Act of **** (HIPAA), along with other laws and regulations and our internal policy, requires protection of protected health information (PHI). PHI is defined as information that relates to the past, present or future physical or mental health or condition of an individual.
  
   
  
  In compliance with the above-referenced Act, Carelon Behavioral Health neither admits or denies that it administers the complainants benefits in this letter.
  
   
  
  However, Carelon Behavioral Health takes our customer complaints very seriously.  We will contact the complainant directly to address any and all issues within our purview.
  
   
  
  We look forward to serving all of our members well.
  
   
  
   
  
  Sincerely,
  
   
  
  
  
   
  
   
  
  *******************************
  
  Appeals and Grievance Coordinator

• Initial Complaint

  Date:01/05/2024

  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.

  Carelon Behavioral has made it impossible for me to submit my insurance claims through their website and they offer no other submission pathway that I can find (ie an email address for admission). The acvount I am trying to submit a claim for is imacknikconde. I require a fax number or email address provided where I can send my claims without using their broken web-based system.

  

  Business Response

  Date: 01/09/2024

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

• Initial Complaint

  Date:12/02/2023

  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 was given medication by the provider at the time, *******************************. The provider put me on a medication called Armitripiline and it made me rapidly cycle, causing severe insomnia, restlessness, irritability, and anger issues. When I called the provider and voiced my concerns and adverse reactions the provider said, "I'll do this the easy way, I'll throw you in the hospital or we can do this the hard way and I'll call you back in a week. That provider sent me a letter after I talked to her about getting sick. The letter said I refused services, which wasn't true, and by ********** law the provider abandoned me. She didn't provide a different psychiatrist and refused to send my medical records in a timely manner. I reached out to my insurance company Carelon and they protected the provider, not their patients. I have been to Fair State hearings to get my new psychiatrist approved and even after court, my insurance company gave me the runaround. They didn't approve my psychiatrist until 42 days later after the court hearing. I have paid for a private psychiatrist for 1 1/2 out of pocket. My insurance got me sick and nowhere to be found now. This incident happened back in July of 2021. I'm out of money, physical health and mental health worse than ever because of my insurance company. This has been the most dehumanizing experience ever in my life. I would have been better off not asking for help from my insurance company.I want a few questions answered from my insurance company for closure. 1. Is it appropriate to treat patients this way? Is this treating patients with dignity and respect?2. Why did they wait 42 days after the court to approve the *********** Agreement for my psychiatrist?3. Why aren't there any consequences for the providers who made me sick? If the provider broke the Hippocratic oath, shouldn't there be consequences for their actions?4. Why hasn't my insurance done anything for me in over 2 years?

  

  Business Response

  Date: 01/01/2024

  We are responding to your correspondence dated Dec. 3, 2023 regarding the above-referenced file.
  
   
  
  It is Carelon Behavioral Health, **** policy to comply with all applicable laws and ethical standards. We are obligated to preserve the privacy of individuals health and healthcare information, including all information about claims we receive. The federal Health Insurance Portability and Accountability Act of **** (HIPAA), along with other laws and regulations and our internal policy, requires protection of protected health information (PHI). PHI is defined as information that relates to the past, present or future physical or mental health or condition of an individual.
  
   
  
  In compliance with the above-referenced Act, Carelon Behavioral Health neither admits or denies that it administers the complainants benefits in this letter.
  
   
  
  However, Carelon Behavioral Health takes our customer complaints very seriously.  We will contact the complainant directly to address any and all issues within our purview.
  
   
  
   
  
  Sincerely,
  
   
  
  
  
   
  
   
  
  *******************************
  
  Appeals and Grievance Coordinator

  Customer Answer

  Date: 01/03/2024

  [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:11/30/2023

  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 my application for credentialing with Carelon on 7/27/23. I have called once a month since applying to check on my application because the status has not moved at all and clients without out of network benefits are paying in cash while they wait. Anthems website says to wait 45 days for credentialing. ***************************************************** I called, they told me it would be 120 days, which is 3x longer than expected. When I called this last time because 120 days has now passed, they told me it would be 120 business days which could be another 2 months. This is ridiculous as my clients will have to pay out of pocket the remainder of the year that their policy is in effect when they should have coverage. Mental health counselors are not easy to find, so its not like they can just find another counselor. Also, many other providers that I know are having this same problem. I have been credentialed by 3 other insurances in the time Ive been waiting for Carelon. There is no reason clients should have to wait this long.

  

  Business Response

  Date: 01/31/2024

  Dear Better Business Bureau:                  
  
   
  
  We are responding to your correspondence dated Jan. 4, **** regarding the above-referenced file.
  
   
  
  It is Carelon Behavioral Health, **** policy to comply with all applicable laws and ethical standards. We are obligated to preserve the privacy of individuals health and healthcare information, including all information about claims we receive. The federal Health Insurance Portability and Accountability Act of **** (HIPAA), along with other laws and regulations and our internal policy, requires protection of protected health information (PHI). PHI is defined as information that relates to the past, present or future physical or mental health or condition of an individual.
  
   
  
  In compliance with the above-referenced Act, Carelon Behavioral Health neither admits or denies that it administers the complainants benefits in this letter.
  
   
  
  However, Carelon Behavioral Health takes our customer complaints very seriously.  We will contact the complainant directly to address any and all issues within our purview.
  
   
  
  We look forward to serving all of our members well.
  
   
  
   
  
  Sincerely,
  
   
  
  
  
   
  
   
  
  *******************************
  
  Appeals and Grievance Coordinator

• Initial Complaint

  Date:11/24/2023

  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.

  I was sent a letter from your company last year about funds that were to be refunded to me in the amount of $617.04. I made about 10 phone calls where representatives told me the payment will be processed and several months have gone by and still I have only received one check for the amount of $186.72. Nobody at the company responds to emails and when I get someone on the phone I'm assured it will be handled properly "this time". This complaint is in a response to a letter from YOUR company telling me you owe me money but when I try to collect it, I get nowhere. Fix the problem, send me the money that is owed and stop wasting my time. I spoke to *****************************, she is the only one who even tried to help me but still ultimately it went nowhere as I only received partial payment. ****** hasn't responded to any emails since, so I am unsure is she is still with the company. I attached a picture of the letter you sent me stating I had unclaimed funds. I tried many times to contact you in a professional manner however I feel that no business should treat its customers this way especially a mental health company. I look forward to hearing from you or receiving my check in the mail soon. The check should be in the amount of $430.32 as indicated on the letter you sent me.

  Customer Answer

  Date: 12/05/2023

  I have not heard from the business in response to my complaint.

• Initial Complaint

  Date:10/21/2023

  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.

  On 12/23/2023 I submitted a provider demographic change to Anthem BCBS who contracts with Carelon Behavioral Health (formerly Beacon Health Options) for claims processing. I have repeatedly submitted this information, which inlcudes a W9 form and updated address information, to Carelon Behavioral Health for processing since February 2023. I have submitted the forms via fax and email. I have called checking on the status of my application weekly. Carelon is unable to give me an update on the status of my credentialing application despite being previously credentialed with this company for years. As a result of their delay in processing paperwork, all of my provider claims are being processed as out of network or denied-- essentially the financial responsibility is being dumped onto my patients. Additionally, patients that I have been seeing for years are now in jeopardy of losing me as a provider because of this error. There is no grievance process or timeframe for me to be credentialed. I do not want to be forced to transfer or discharge my patients because Carelon is unable to process basic paperwork. Many providers are choosing to stop accepting this insurance because of this significant ongoing problem. I have explained to my patients that they have the right to complain about this problem to their insurer or change plans during open enrollment this fall. Many patients have reported calling and receiving misleading information from Carelon, including the suggestion to simply just stop seeing me as a mental health provider or that I chose to be out of network. A simple ****** search will yield other major News stories about this same issue. I don't know what more I can do to continue working with this provider to preserve my patient's continuity of care. This was a simple transition other Insurances made within 2-3 weeks from start to finish. I have also filed with the *** attorney general and *** department of financial services.

  

  Business Response

  Date: 11/06/2023

  Attached is Carelons response to 20763590.

  Customer Answer

  Date: 11/07/2023

  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 provided by Carelon Behavioral Health implies that I am complaining as a member. There is no PHI involved in credentialing me as a provider in their network. This response is another illustration of how difficult it is to work with this company. There is no indication in this response that they have any logical command the problems stated. I encourage ******************************* and or *****************************, Esq. to reach out to me directly at the following email address ******************************. 
  
  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,

  Cayla

   

   

  

  Business Response

  Date: 01/07/2024

  Attached is Carelons response to the providers not satisfied dispute notice of 11/7/23 & 12/4/23.

• Initial Complaint

  Date:10/12/2023

  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 writing to lodge a formal complaint against Carelon Insurance for a series of discrepancies, inconsistencies, and communication lapses that not only threaten the financial sustainability of our psychotherapy group practice but also the well-being of the patients who rely on our services. I believe this situation signifies a broader pattern of internal miscommunication and breach of contract practices within Carelon.**Background:**1. **Requested Network Status Change:** On July 27, 2023, my conversation with a representative named **** (inquiry number 07142023-9858419-01) resulted in a request to change our network status from in-network to out-of-network for certain Carelon plans. Despite following all prescribed protocols and awaiting official communication, no notification was received.2. **Inconsistencies in Network Status:** Claims were incorrectly processed or denied starting late June 2023. Interactions with Carelon representatives highlighted gross inconsistencies in understanding and processing our request. It appears our termination was backdated without proper notification, a breach of our contractual agreement.3. **Financial Repercussions:** $39,000 worth of claims remain unaddressed. They have neither been denied nor paid, placing a significant financial burden on our operations.4. **Impact on Patients:** Many of our patients now face unanticipated out-of-pocket expenses due to Carelon's mishandling of our network status. Their mental and emotional well-being is at stake due to the financial and administrative challenges arising from these discrepancies.It's worth noting that our concerns with Carelon are echoed by other providers. Such patterns of miscommunication and breaches not only damage Carelon's reputation but also endanger the very fabric of trust between providers and insurance management entities.**Resolution Sought:**- Immediate processing of all outstanding claims as in-network.- A formal termination notification that respects our agreed-upon timelines.- Restoration of our in-network status for specific plans and reprocessing of related claims as such.Our relationship with Carelon was built on mutual trust and professionalism. It is our sincere hope that this situation can be resolved promptly, ensuring the well-being of patients and maintaining the professional integrity of our association.

  Customer Answer

  Date: 10/22/2023

  I have not heard from the business in response to my complaint.

  

  Business Response

  Date: 10/31/2023

  Attached is Carelons response to 20729544.
  
   

  Customer Answer

  Date: 11/01/2023

  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:10/11/2023

  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.

  BCBS and Carelon have confirmed a start date of 6/15/2023 for being in network. I also have out of network claims that have been deleted multiple times doe to apparently not being in their system, which was contradicted by **** who verified and confirmed to me via a phone call that we were indeed entered into both systems. As of right now BCBS and Carelon have failed to follow through with the signed contract for service to the tune of more than $60,000. I am not asking for anything more than for them to follow through with an agreed upon written contract for services. I should not have to wait more than 4 months past the start date for resolution or payment for services.

  Customer Answer

  Date: 10/21/2023

  I have not heard from the business in response to my complaint. The business continues to avoid effective communication or answer questions about when we can expect a resolution and payment.  We reach out almost daily for updates. 

  

  Business Response

  Date: 10/29/2023

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

  Customer Answer

  Date: 10/30/2023

  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.]

  The provided documents agree with what the complaint is. They agree that the contract was in effect on June 15, 2023 and should have been paid out. However, they have not  provided  a resolution or time frame in which they can provide payment for all claims including out of network prior to 6/15/23.
  
  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,

  *******