Complaints

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

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• 

  Harvard Pilgrim Healthcare, Inc.

  1 Wellness Way Canton, MA 02021-1166

• 

  Harvard Pilgrim Healthcare, Inc.

  1600 Crown Colony Dr Quincy, MA 02169-0913

• 

  Harvard Pilgrim Healthcare, Inc.

  401 Park Dr Ste 401 Boston, MA 02215-3369

• 

  Harvard Pilgrim Healthcare, Inc.

  55 Capital Blvd Rocky Hill, CT 06067-3927

• 

  Harvard Pilgrim Health Care

  PO Box 29675 Hot Springs, AR 71903

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:04/14/2025

  Type:Order 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.

  Harvard Pilgrim made an initial computer error and denied payment of my services, stating that I was not a provider of behavioral health services for them. I have been a provider for well over a decade. They realized this was an error, but it took several months to update the computer. When I didn't receive payment, I filed again. This time they denied payment for "untimely filing." I sent proof of timely filing, but they said it was not "acceptable" proof. The proof was exactly what they asked for online, the form was filled out correctly. They have not paid what they owe, and when I've called, no one can answer why except to repeat what was said about "acceptable" proof needed. This has gone nowhere. There is a current problem with this company, which I have contracted with as a therapy provider for a long time. They need to be accountable to the providers who offer valuable mental health services to their members.

  Business Response

  Date: 04/14/2025

  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 **************************** at ************ if you need assistance in the meantime. Thank you.

  Customer Answer

  Date: 04/22/2025

  [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,
  
  ******** *******, Licsw

• Initial Complaint

  Date:02/18/2025

  Type:Delivery 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.

  Harvard Pilgrim Healthcare refuses to issue a 1099-HC form for my dependent who lives in ************* for which i have a judge's order to provide health insurance

  Business Response

  Date: 02/18/2025

  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 Answer

  Date: 02/24/2025

  [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:01/07/2025

  Type:Service or Repair Issues
  Status:

  UnresolvedMore 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, My name is ******* ********* and I am a licensed mental health provider offering online/in-person therapy services to clients with the insurance, Harvard Pilgrim Health Plan. In 2021, I was approved as a provider for **** but under a private business' TIN. In February 2024, I applied to have my own private practice approved under a new TIN number and address. As of today, **** has not corrected my address or put in my appropriate TIN. I have made several calls and I keep getting the same response of, "give us 3 to 5 business days to correct your information". I have a client that is not receiving the mental health services that she needs because of this barrier. I have spoken to numerous staff members and supervisors to no success. I am very disappointed in the lack of timeliness in ****'s response especially when it comes to the care and services provided to their own clients. If you can help me address this matter, it would be greatly appreciated.

  Business Response

  Date: 01/08/2025

  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 **************************** at ************ if you need assistance in the meantime. Thank you.
  
  
  

  Customer Answer

  Date: 01/08/2025

  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 # ********.

   

  Thank you for the quick response, however, this is the exact ***** telephone number that I have called several times to have this addressed. I am always told that they are going to investigate and that someone will get back to me and no one has called me yet. This is a typical response from the agency and no follow up has ever been done. As much as I would love to accept this answer, I have heard it before with no success in follow-through

   

• Initial Complaint

  Date:11/22/2024

  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.

  Our son turned 26 and got his own insurance. I filled out a change form retroactive to October 20, 2023 and sent in proof of insurance for him on 11/30/23. They said they would update my account. April 2024, I called in as they had not made any changes and my son turned 26, they insisted they would and that they "missed" the form and they would update and process a credit. The change was then made, but they had billed me (and I paid it to not lose coverage) the higher rate as if my son was still on our plan and not corrected the amount. **************** stated that the credit would be done within 2 weeks and that I had to call back after to request the credit be actually sent to me, which sounded odd. I called back In reaching back out to ******* ****, he requested I email the form again and I again requested the credit be put through. I called back on May 29th and resent the forms to ******* **** as requested by the customer service *** to process the credit they said had not been processed. I then called back June 28th, after sending an email on June 26th, and left ******* a voicemail as I had done in May. I called in August 2nd and left a voicemail and also sent a follow up email on August 19th, with no response as I had done in May and June. I called again September 6th and left a message for ***** *****. I have now spoken to 2 managers whom I was told are the only ones who can help, ***** ***** and ******* **** and they refuse to call or email me back to resolve this, nor have I received a response. I have also called in many times to customer service and they assured me they would call me back after sending me to their voicemails, I am told they are on lunch or in a meeting every time. I am due $2,121.38 for the overcharge from 11/1/23 through 7/1/24. I have also attached the email chain with ******* ****.

  Business Response

  Date: 11/26/2024

  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 Answer

  Date: 11/26/2024

  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 feel that accepting this would be very unhelpful to receiving a reslution as this has been going on for a very long time.  I have reached out to multiple "managers" and have yet to receive a response to both voicemails and many emails, so I don't trust this proposed process.  A written answer in 30 days in totally unacceptable, there was a mishandling on my account which caused me to overpay a lot of money with not a single call or replay back after many months of being ignored.  I have a family to support and I don't have faith that this will be handled properly, nor correctly via a written response.  The credit process, as explained to me by multiple customer service representatives, should be a manager approves the credit for being overcharged, they approve my credit to be sent to me and the process is complete.  I believe that my situation can easily be confirmed, credit processed and a call or notice that the credit is being sent to me is an acceptable outcome and I believe I deserve this to be expedited.
  
  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,

  Shiva

   

   

  Business Response

  Date: 12/03/2024

  Grievances do not qualify for expedited status. This rule applies to all members. For further discussion regarding your complaint, please contact Harvard Pilgrims ************************** at ************. 

• Initial Complaint

  Date:10/09/2024

  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.

  My son had dental surgery in August 2024. We were told what was covered and what was not. We paid our half and now the insurance 2 months later is saying they wont pay what they said they would pay for so now we are left with a giant unexpected and unexplained bill.

  Business Response

  Date: 10/09/2024

  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

  Date:09/30/2024

  Type:Sales and Advertising 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.

  In May 2024, I called Harvard Pilgrim requesting information regarding information about IVF coverage and Harvard Pilgrim's policies. It took multiple phone calls and over 4 weeks for Harvard Pilgrim to provide me with superficial information (yes, they covered up to 6 rounds of *** and yes my provider was included in this coverage). At no point did they share that insurance (**) would not provide coverage when using my eggs past the age of 45 (I was 44 1/4 when I pursued IVF). When seeking information, Harvard Pilgrim was a nightmare with communication. They continued to place roadblock after roadblock with my eligible timeline for coverage dwindling away. It took 4 weeks for Harvard Pilgrim to confirm whether or not my partner's frozen sperm would be covered by insurance, despite his having had chemo and radiation and his oncology team recommending use of his frozen sperm (from before treatment). I informed ** that my partner had previously had bladder cancer, with radiation and chemotherapy therapies provided. ** initially stated that my partner's frozen sperm (prior to chemo and radiation treatment) would be covered. In the ensuing months, ** required that my partner undergo sperm analysis (which showed ZERO sperm), asked that I complete the ****** challenge (which my numbers passed easily), and then when I should have been cleared to begin IVF treatments to use my own eggs, I was informed that AGAIN ** asked for last minute documentation, which meant that I could not pursue IVF treatment this month.....again HP pushed my treatment options out another month....with the months dwindling for which they will cover use of my eggs. This is UNETHICAL, AGEISM, and beyond RIDICULOUS! ** is preying upon their consumers in hopes that their time runs out and they will no longer be eligible for coverage. Please help me rectify this situation ****.

  Business Response

  Date: 10/02/2024

  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 Pilgrim’s Member Service Department at 888-888-4742 if you need assistance in the meantime.  Thank you.

• Initial Complaint

  Date:08/24/2024

  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.

  This is in regards to the recent denial claim under my daughters health insurance for July 1, 2024. I have been in touch with the manager, however I also would like for the higher ops to be involved. There have been recent changes to the healthcare providers. I never received any letter stating of the in network changes. After reviewing the letter when I received it from the customer service manager via email, whom I also recently spoke with those letters would still not have alarmed me to contact your customer service department to inquire about. The reason being is because the letter that was sent to me which I never received was not as vague as it should be just like auto PCP select. Nowhere in the letter that was supposedly mailed to me showed their current doctors office name which is Pediatrics West. In that letter as well does not show their doctors name. In addition to that the change was made because apparently their doctor is affiliated with ***********************. But when the system automatically selected their PCP that new PCP is also affiliated with ******* hospital so I am very confused why their PCP is no longer in network as apparently she was removed because she is affiliated with ******* Hospital. The change was made on July 1, 2024, which is also the same day of the visit. I would really like to have this looked into as I find this very frustrating.

  Business Response

  Date: 08/30/2024

  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 Answer

  Date: 08/30/2024

  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.]

   

  Based on their response they will take 30 days to investigate which means this case isnt closed. As a result I would like to keep this opened until they have a resolution. Thank you.
  
  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,

  Ria

   

   

  Business Response

  Date: 09/03/2024

  For further discussion regarding your complaint, please contact Harvard Pilgrims ************************** at ************. 

• Initial Complaint

  Date:07/24/2024

  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 enrolled in Harvard Pilgrim, into a plan that i chose specifically because they covered my provider and her services. The start date was supposed to be November 2023.Harvard Pilgrim bumbled my enrollment and i ended up with two different accounts. I was retro approved, but since it took months before i even received anything, I had to pay out of pocket for my first appointment in December 2023.I have filed multiple claims for reimbursement, and Harvard Pilgrim keeps denying them citing ridiculous reasons such as not providing the information they needed. I have given them everything including my provider's NPI.After being advised by a customer service rep to send everything i had that was related to it, i sent credit card statements, copies of the receipts from the provider's office, i sent all of the info they asked for. They then denied my claim stating it was a duplicate. I clearly marked on the form that it was for an existing claim. This is getting ridiculous. They took months to even get me my insurance information and card, and it has taken months to receive my claim reimbursement.The claim forms i mailed were signed, the ones i submitted electronically were submitted through their website.

  Business Response

  Date: 07/25/2024

  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 Answer

  Date: 08/15/2024

  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. 

  Hello,

  Thank you, I have been in contact with the analyst assigned to me.
  I would like the case to remain open until I receive the resolution, as in the past, my claims were denied citing insufficient documentation or being a duplicate even though it was a followup.

  *******, the analyst assigned to me has asked for records and information, and has stated that lack of records was part of the reason Harvard Pilgrim denied my claims initially. However, I have sent physical records via mail 2-3 times, and electronically 1-2 times, only to be told I didn't send any records/proof with my claim form.

  I have provided ******* with all the records I've send Harvard Pilgrim, and would like them to have time to review.

  [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,

  *****

   

   

  Business Response

  Date: 08/21/2024

  For further discussion regarding your complaint, please contact Harvard Pilgrims ************************** at ************. 

• Initial Complaint

  Date:07/17/2024

  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.

  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

  Date: 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 Answer

  Date: 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

  Date:06/20/2024

  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.

  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

  Date: 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.