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Complaint Details
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Initial Complaint
07/17/2024
- Complaint Type:
- Order Issues
- Status:
- Answered
CAP ************ has been attempting to contract with Harvard Pilgrim Healthcare since December of 2023 and we have still not been provided access to a provider portal allowing us to review patient eligibility and coverage, review and/or dispute unpaid claims, etc. Correspondence is going unanswered, even by supervisors (***************************) and weekly requests for follow up have been ignored.
Business response
07/22/2024
Your complaint has been received. Harvard Pilgrims *************************** team will investigate and outreach to you to discuss the issue. Thank you for bringing this matter to our attention.Please contact Harvard Pilgrims Provider ******************* at ************ if you need assistance in the meantime. Thank you.Customer response
07/22/2024
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
06/20/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I have been going back and forth with Harvard Pilgrim for a month now, I met my deductible and they are refusing to provide all of my claims to the *** company. I have a $5000 deductible where I receive $2500 back from an *** account, if I meet the deductible. Logging on their website it immediately shows me I have met the deductible. Yet the *** provider does not have all the claims to meet the $2500 ***. I have claims in pending since March 11th and it is now June 20th. I've been told numerous times they will resolve the pending claims and send the reports to the *** provider, they have only sent the claims they want to send, and sent the most recent ones. They do not send all the claims. The claims print out from Jan-June shows I am at over $8000 with my deductible but they are not reporting that info. I was also told my *** is only $1500 but that is not true and I have and can provide proof but they just keep saying they are contacting my employer. It doesn't take 7-10 days to make a call. I have asked a few times to speak to a supervisor and they say ok, put me on hold and the same person comes back on the line. I have had some nice conversations with some Reps but am getting absolutely no where and keep being told the same thing over and over again. I probably have met my deductible annually but it was never reported to the *** provider, court is looking like an option.Business response
06/24/2024
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime. Thank you.Initial Complaint
05/30/2024
- Complaint Type:
- Customer Service Issues
- Status:
- Answered
I am reporting Harvard Pilgrim for the use of corrupt *************************** to deny treatment authorizations. I am also disgusted by the heartless way they spoke to me about my chronic, painful condition that I cannot take pain medication for due to gastric ulcers and mental status changes while on opiates. Over the last month, *** has repeatedly denied my surgeon's requests for authorization for an essential spine surgery to prevent my slipping spine from severing the nerves in my back. My surgeon repeatedly sent them documentation and images that provided evidence for the need for surgery. He had multiple peer-to-peer meetings with medical providers from **** one who was a pediatrician (not a neurosurgeon) and another who apparently lost his practice in AZ due to a malpractice lawsuit. As a result, Harvard Pilgrim is refusing to cover any intervention related to this injury, even if I end up in the emergency room because of it. Chronic pain is extremely depressing. I am horrified by the ** customer service rep who told me not to try to get help for my spine. Her approach was negligent and dangerous.Business response
05/31/2024
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime. Thank you.Customer response
05/31/2024
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 issue will not resolved until HP approves my surgery and/or sends me written assurance that if I need to go the the ** for my back, they will cover my ** visit.
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
05/21/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
This company was my choice through the government assistance program for myself and my husband in 2023. My husband turned 65 in june so was picked up by ********* In April of 2023 the company was breached and you could not get through to them, the message was if this is not an emergency call back. I tried several times and received the same info. My husband's ******** began june 1st and nothing after that point was charged to Harvard pilgrim. In july you could finally speak with someone but they still wanted me to pay for my husband even though they didn't insure him. I refused and spoke with them and the state of ***** but with no help from either! I continued to pay my premium for my insurance. In December I contacted Harvard pilgrim on 12/12 to tell them starting 1/1/24 I would not want their insurance as I was going on ******** as I was turning 65, at that point they canceled my insurance as of 10/31 back dated everything, took my premium to pay what they think I owed for ***** and didn't pay any of my Bill's! To date I still receive a bill for $2.31 from them. I realize that the BBB is of NO Value but I want others to know about Harvard pilgrim!Business response
05/22/2024
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime. Thank you.Initial Complaint
05/07/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
I am an in-network provider with Harvard Pilgrim. Harvard Pilgrim stopped issuing payments to my practice, so far the balance they owe me is over $2500. My multiple calls to customer service with an extremely long wait time were fruitless and my requests to speak to a supervisor were not answered. This morning a representative told me that the payments were held because I was required to send 147C letter from the **** I was never notified of this, and the actions of Harvard Pilgrim (not paying for processed claims) have caused a significant financial hardship. I have submitted the requested letter but I have a very low confidence that I will be paid. Unless I hear back within a week with a specific date of the payment in the nearest future, I will file a case in ********** Small Claims Court. This is absolutely unacceptable.Business response
05/23/2024
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims Provider ******************* at ************ if you need assistance in the meantime. Thank you.Initial Complaint
04/29/2024
- Complaint Type:
- Order Issues
- Status:
- Answered
I paid money upfront for health insurance last november, we had a crazy stormy january and february, roads closed, no electricity, trees down etc. I am a self-employed ********* and though I make more than poverty - the price of life and survival is easily 3 times that. Regardless - in winter months in ***** carpenters suffer anyway. I have 2 genetic mutations that require a yearly colonoscopy, bi-annual endoscopes and annually 7 MRI's. These procedures keep me alive and generally cancer free. In February I spoke with Harvard Pilgrim to let them know how difficult things were going and mind you I qualify for zero assistance, and with severe chronic back and other pain, and the constant daily threat of cancer and paragangliomas - it isnt easy to work, or think, or enjoy life while trying to make it to each jobsite. My monthly premiums went from affordable to over 500, plus deductables from 1500 to 7 or 9000.I paid almost 900 in february, after the runaround of having to reapply to services only to be denied ******** etc. March was a zero month, all back and neck pain from helping with emergency things from this years storms and apparently my policy was cancelled at the end of March. However, I recieved the grace ****** and cancellation notice in April at the same time, even though the paperwork was marked 3/13 to notify me that my grace ****** was from 3/01 to 3/30 and after I had maxed out my creditcard twice in April to pay for march premium. Then, after a delay at the pharmacy I found out my policy had in fact been cancelled. April payments went though in 4/02 and 4/11. So I technically only owed April and here I am still in April, got denied re-enrollment and am looking at several hundred thousand dollars worth of medical treatment for this year that I cannot afford.What the h*** is the point of health care if it only provides coverage IF you can afford it? I treat my customers with respect and love and care, and Harvard Pilgrim is treating me with stress.Business response
05/10/2024
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime. Thank youInitial Complaint
03/28/2024
- Complaint Type:
- Sales and Advertising Issues
- Status:
- Answered
Harvard Pilgrim is giving out my email address to a whole bunch of random companies because they're related to health services. Like doctors that are trying to get me to switch to their doctor service and a whole bunch of Spam emails I really don't want. When writing to the companies they say they get my email address directly from Harvard Pilgrim. I wrote to complain to Harvard Pilgrim about it a week ago and zero response. The resolution I would like is for Harvard Pilgrim to absolutely stop giving out my email address, just because I have health insurance from you does not mean I want you to pass my information on to other companies.Business response
05/10/2024
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime. Thank youInitial Complaint
03/20/2024
- Complaint Type:
- Sales and Advertising Issues
- Status:
- Answered
Harvard pilgrim apparently sent a balance to collections with ever telling me I had a bill. I had been to the dr ****** plenty in the time they say they notified me but I have no receipt, no mail and never saw a bill on my account.Business response
03/20/2024
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime. Thank you.Initial Complaint
03/05/2024
- Complaint Type:
- Sales and Advertising Issues
- Status:
- Answered
I have been seeing a foot doctor for the past 5 years and needed surgery on both feet. Last March (2023) I had foot surgery on the right while under my old insurance ***** Navigator. Since the insurance for my work has switched to Harvard Pilgrim. Now that I need surgery for the left t(and also got another injury to the left) am in need of prior xray/****...Harvard is denying the claim for an MRI hence cannot have the surgery. I have filed appeals as ***** as asked for their Dr whom had spoke to mine in regard to the need of the **** I found out that the insurance DR that denied my MRI claim for my FOOT is in fact an oncologist which has no meaning to the authority of my foot DR that I have been seeing for the past 5 yearsBusiness response
03/06/2024
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime. Thank youInitial Complaint
01/19/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
On 11/10/23 I was under the impression I was speaking with someone from Harvard Pilgrim ************ I was prompted to call with a text on my phone about renewing my policy and updating information. The man I spoke with said I could get coverage for the entire year for $1,816 with a 1 time payment. I received a letter from Harvard pilgrim yesterday 1/18/24 which promoted me to call them. When I asked about my 1 time payment for the year they had no record of ever speaking to me and told me I may have been scammed. When I looked at my credit card statement in addition to the $1,816 I was also charged for the months of ****************** for a slightly less amount. I was never told this would happen. I never received anything in the mail and I never got any type of confirmation letter / email for the initial $1,816 I paid. I saw on the credit card statement that Health Program with the number of ************ was charging my card. I called and spoke with someone named ***** who proceeded to let me know they had no record of me calling on 11/10/23 and that was hired out by a third party called Pinacle Sales, LLC ************. I was wrongly charged under false assumptions this was someone from Harvard pilgrim, never received any documentation and never authorized any type of additional payments. *** called that third party and none picks up. ***** from Health program said I could not be refunded because the claim wasnt within 60 days. This company is a scam. They should be sued.Business response
01/22/2024
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime. Thank you
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