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Complaint Details
Note that complaint text that is displayed might not represent all complaints filed with BBB. See details.
Initial Complaint
01/19/2024
- Complaint Type:
- Order Issues
- Status:
- Answered
Harvard Pilgrim is claiming that I had another insurance company while I was working for OHI in ******. I can prove that I did not have another insurance company Aetna because I was only making payments to Harvard Pilgrim at the time that I worked for OHI. AETNA was from previous employer and never did my doctors send them bills. I was notified today that I owe thousands due to their business practices. This is wrong what they are claiming just so they don't have to pay. It's really sad.
Business response
01/23/2024
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
11/27/2023
- Complaint Type:
- Customer Service Issues
- Status:
- Unanswered
I have been seeing patients with Harvard Pilgrim insurance under the Optum umbrella. HP left Optum on 1/1, so I submitted the November claims to Harvard Pilgrim. I have just learned that the first claim was denied for missing a PCP referral; however, we have not received guidance from Harvard Pilgrim that behavioral health claims require a PCP referral. The patients I am currently seeing did not require a PCP referral when they first established care with me. The claim processors are stating that if I want to use the code that reflects the actual service I provided, I need a PCP referral. My other option is to appeal the denied claim with my contract. But I have not received a new contract from Harvard Pilgrim. I am credentialed with their partner, *****, and do not know if that contract applies to Harvard Pilgrim as well. I have also submitted a complaint to the insurance department in MA because the transition from Optum to Point32Health has been very disorganized and chaotic, with very little and confusing guidance.Initial Complaint
11/06/2023
- Complaint Type:
- Product Issues
- Status:
- Answered
I was seen at a hospital for emergency services in ******* on July 22nd, 2023 and spent ***** U.S. dollars and paid with a credit card. I submitted a claim online through Harvard Pilgrim Healthcare on Monday, August 7th 2023 and provided proof of services rendered as well as proof of payment. On Wednesday, September 27th, *************************************************************************************************** diagnosis and a Credit card and/or bank statement.On Tuesday, October 17th, 2023 I spoke with a Harvard Pilgrim Healthcare Representative who told me they would expedite the claim to Case Manager ***************************** who told me that she would see what she could do for me. I did not hear from ***************************** for several days. I called ***************************** on Friday, November 3rd, 2023 and told her that I provided all of the necessary information, documentation, as well as translation, and that it still was not good enough. I told ***************************** that I need help with this claim. I also explained to ***************************** that I suffer from a medical condition, and that she is causing unnecessary stress and anxiety. Stress and anxiety severely affect my physical health, especially my medical condition. After I explained to ***************************** that she refused to help me, and support me through this claim, she began laughing and ridiculing me. ***************************** exhibited unprofessionalism, the inability to help me with a claim as a Harvard Pilgrim Healthcare patient, and caused severe emotional distress which has affected my medical condition. I have been severely sick for over two weeks, and have been losing sleep over this claim. I am currently undergoing testing at a hospital for the pain and suffering I have received over the past several months due to this claim. I am seeking reimbursement for the claim I submitted in August 2023 of ***** U.S. dollars. My expectation is that I will receive a refund within 30 days, or I will be escalating my claim even further.Business response
11/08/2023
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 youCustomer response
11/13/2023
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.
I do expect an answer sooner than 30 days. That would be a reasonable request and its the least you could do for a member of Harvard Pilgrim 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,*******
Initial Complaint
10/28/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I recently moved and was also forced onto this sham of a nonprofit insurance company. A few weeks later, without me providing my address to any businesses I started getting advertisements from healthcare providers with my name and insurance plan printed on them, how bizarre. I called this awful company and a horribly rude and poorly spoken woman confirmed it is within Harvard Pilgrims terms that they can sell your personal information and health history to whomever they choose. How lovely, a nonprofit company that charges exorbitant premiums and deductibles cant make ends meet and sells what should be protected information to the highest (actually, more than likely any) bidder. What a terrible company.Business response
11/01/2023
In order to respond to this concern, we would need additional information that would allow us to accurately identify the member. I would suggest a call to the member services # on the back of your ID card to initiate a grievance with the plan.
Thank you
Initial Complaint
08/18/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
The issue started on 08/30/2022 I had to pay $2,700 ******* Pounds to ***************** Harvard Pilgirm is required to reimburse me for this. It's covered in the plan.I have given them all the proof I have showing that I should be reimbursed. For months they said I need to provide "codes" to get reimbursed. I attempted to get these codes from ***************** and ***************** does not have codes to give me. So there are no codes. They have everything they need to reimburse me. Now my case has been sent to a "appeals" group. They were supposed to contact me months ago. I have tried over and over to get this resolved. I want to be reimbursed. Harvard Pilgrim has had about a year to reimburse me and I have no estimate as to when this will be resolved. I've hit a dead end with them.Business response
09/06/2023
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
07/08/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I just had a baby in Jan 2023. My 4th baby! My second child (daughter) **** was born in 2018 with ******* 21 which put her at risk of congenital heart disease. During my pregnancy with her it was suggested I have a prenatal echo as children w T21 have a 50/50 chance of heart disease. My echo was negative but once **** was born one month old we found out she had CHD and had open heart surgery at 6 months old. My next pregnancy I declined an echo but after my daughter was born she also had congenital heart disease but did not require surgery. My last pregnancy, due to the history of heart disease with the girls as well as my age it was recommended I have an echo. I initially declined the testing. At 36 weeks I had some abnormal findings in enlarged ventricles in the brain so I was sent to MFM. Once I went to MFM they found that the ventricles were normal but the baby may have a hole in the chamber of his heart. MFM recommended I have an echo to confirm. I have delivered the last three babies at **** Israel and since the sister hospital is ****** Childrens that is where I was sent for an echo. After the echo in Dec I received two bills one for 200$ and another for 1400$. I called my insurance company and I was told Since BCH is out of my tier I was charged at that tier level for the services. I called HP and explained that BCH team was present during delivery and BI does not offer Prenatal echo. I then appealed the bill which it was declined. I called to reappeal and I never heard back from HP in regards to the appeal. I reached out to HR department at **** *********************** clinic where I work and they confirmed with HP that the hospital doesnt offer prenatal echo . I am now receiving calls from debt collectors. My previous two echo were 100% covered. I am not sure why this time I am being charged for test. I am also unsure why my second appeal was never responded to. Hope you can help !!! Thank you, ********Business response
07/13/2023
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
06/27/2023
- Complaint Type:
- Order Issues
- Status:
- Resolved
I am a Nurse Practitioner. Harvard Pilgrim (HP) is merging with Point32Health. I signed HP's contract, but they tell me it will not go into effect until November 2023. I am currently a provider in network with HP through Optum, but as of July 1st HP is no longer a part of Optum. HP is saying I will get their paid rates for service start July 1st, despite my contract not starting until November, but my rates are much higher with Optum.Questions I need answered:1. Is HP guaranteeing payment for services I provide to their consumers starting July 1st despite my contact not starting until November?2. What are my actual rates going to be starting July 1st and will that be different in November. I need a full fee schedule with ALL codes for my services. I only got partial rates.3. How can you guarantee that your consumers will have coverage through their current providers without a contract under the new merger. I do not want to take an insurance companies word for it. I would like this in writing.Thank you.Business response
07/03/2023
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 youCustomer response
07/03/2023
[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
06/06/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Since early April Harvard Pilgrim Healthcare's claims processing systems have been down. We have to pay out of pocket for tests AND pay our monthly premium. When we call the company we are told the systems are still down and there is nothing further they can tell us. We are stuck paying as we go and for our COBRA premium and they offer no solutions or workaround. Nothing. They don't even try. Pathetic.Business response
06/22/2023
Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime. Thank youInitial Complaint
05/13/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
So I was prescribed this medicine and was given a prior authorization for Saxenda 18 mg/ 3 ml by doctor. ********************** Pilgrims systems were hacked and I was not able to reach a customer care specialist to answer my question if my medicine would be reimbursed if I paid out of pocket for it. I called the parent company of ********************** Pilgrim which is Point32Health, ***** The agent on the phone reassured me that even if I paid out of pocket for the Saxenda, that I would be fully reimbursed for the medicine regardless of circumstances. I contacted ********************** Pilgrim last week and the agent told me that I would not be receiving a refund for the $1,210 dollars I paid out of pocket for, for the medicine. I feel that I was lied to after be reassured that I would be reimbursed even if there was a prior authorization. It seems to me that the insurance company just did not want to pay. It is not my fault that their systems got hacked and I was not able to reach a live agent. I desperately needed the medicine to help me lose weight. I also feel like my information, including critical information most likely has been stolen or leaked, so I feel I should at least be reimbursed for the medicine as compensation.Business response
05/15/2023
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 youCustomer response
05/24/2023
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.
Hi BBB,
I was contacted by one of the appeal representatives at **************. I'm still waiting on reimbursement from them. I don't feel comfortable accepting the resolution until the proper reimbursement is issued. They had promised reimbursement previously but did not keep their word.
Sincerely,
***************************
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
04/05/2023
- Complaint Type:
- Billing Issues
- Status:
- Answered
Someone else is using my social security number and has an insurance account at harvard pilgrim. I was unable to obtain insurance due to the identity fraudBusiness response
04/07/2023
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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