Complaints

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:04/22/2025

  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.

  I signed up for health insurance with first health but they never mentioned to me that I couldnt go to a primary doctor within 30 days only urgent care, they told me after I paid the first payment of $200 to enroll. After that they mention to me that I couldnt visit a primary doctor until after 30 days, So I decided to cancel the same day. Then they said I had to wait 24 hours to cancel and talk to a supervisor to finish the cancelation process, which I did. They told me I could get a refund as long I didnt use the insurance which I never did. I literally canceled 1 day after I enrolled and now its been around 3 weeks and now they say I cant get a refund, after being told I was going to get refund multiples times. I feel like I got scammed. Never used insurance, literally called 24 hours after I enrolled to cancel insurance.

  Business Response

  Date: 04/22/2025

  Good Morning,

  First Health is not the plan provider but the network associated with the plan.  If you could please provide me a member ID and/or images of the front and back of your card I will do my best to assist you in recouping your refund.

  ******** ******

  Director | *******

• Initial Complaint

  Date:04/18/2025

  Type:Billing 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.

  First Health Network denied my in-patient hospital claim for my 8 month old son when he was admitted for RSV in Oct. of 2023. He was kept for 2 nights then released and put on an oxygen tank for 3 weeks. It was a serious case. First Health spent over a year going back and forth with the hospital saying this was not serious, wanting proof that he needed to be kept overnight, and denied 100% of the claim 7 different times with the hospital. They they re-submitted the claim this past November randomly so that it looked like it was the first time they received it in order to say the claim was submitted outside of the acceptable window. I appealed and they said i was in a limited coverage plan and the benefits did not cover out-patient hospitalization, even though this case was clearly for in-patient care and my benefits did cover that. It is very clear they are just dodging this claim. I had the Med First 3 plan which covered hospitalization ($1000/day maximum 15 days), so at the VERY LEAST, they would need to cover the time we were in the hospital up to the threshold of coverage. The hospital is in network and the care was covered in my benefits package. It is clear from all the other reviews of this company that they are a scam and not real health coverage and are dodging their responsibilities.

  Customer Answer

  Date: 04/25/2025

  see insurance card attached

  Business Response

  Date: 04/28/2025

  Dear Ms.*********,

  This response pertains to the following claim:

  Date(s) of Service:10/27/2023
  Total Billed: $19,369.29 
  Patient Name: ****** ********
  Claim # 202408274397
  Member ID # ***********

  First, please note that the plan in question is not administered through First Health Network. First Health Network solely serves as the network of participating providers and facilities available to members under this plan.
  

  Second, as outlined in our prior response to the appeal submitted, the following policy exclusion applies: "Place of Service Exclusion: This is a limited benefit plan, rather than major comprehensive medical coverage. As referenced in the Schedule of Benefits, services rendered at place of service code 22 (Outpatient Hospital)are not covered under this plan."
  

  While the claim was denied based on this exclusion, the providers in-network status allowed for repricing,reducing the members payment responsibility to $2,685.56 instead of the original billed amount of $19,369.29,  resulting in a significant savings of $16,683.73 for the member.
  

  Because the hospital submitted the claim with place of service code 22, we are obligated to adjudicate the claim in accordance with the terms of the plan. As the plan administrator and claims processor, ********* is committed to ensuring that all claims are processed in strict compliance with the policy's stated terms and conditions.
  

  Attached is a copy of the appeal response sent on 3/12/2025 as well as a copy of the breakdown of benefits to reinforce the statements made regarding the policys coverage.

  We understand that you may be disappointed to hear that the claim in question will not be covered by your policy. However, we want to bring to your attention a service that is available to you as part of your benefits package: Healthcare Ninja. Healthcare Ninja is a valuable service that you can utilize at no cost to help to reduce,and in some cases even eliminate, large medical and hospital bills you may incur. We highly encourage you to contact Healthcare Ninja at **************** for further information on how they can assist you.

  If you have any additional questions or require further clarification, please do not hesitate to reach out.

   

• Initial Complaint

  Date:04/14/2025

  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.

  I can help assist you with extra information if needed but essentially I was promised a plan with coverage. Then I learnt it covered almost nothing of mine except some coverage on prescriptions.THEN I learnt they don't even cover my prescriptions in pharmacy... They only cover SOME prescriptions and they only cover them through home delivery order I can't pick up any drugs under covered amounts.None of this information was in the contract I signed with them its absolutely absurd and they should give me all my money back because i didn't know any of this.

  Business Response

  Date: 04/21/2025

  Good Morning,

  
  First and foremost, thank you for taking the time to submit your concerns. I would like to clarify that the complaint was directed at FirstHealth, which is the network of providers and facilities associated with your plan. ********* handles the claims processing, and I believe I can assist you in obtaining a refund.

  
  I have already reached out to the billing TPA and requested a refund. I will keep you updated through this channel and notify you once I have successfully secured the refund. While MBA, **** does not sell or market the plan, we do support claims processing and assistance in resolving related issues.

  
  Please allow me up to 72 hours to send the request and receive a response from both the Plan and the Billing TPA.

  
  Kind *****************start="811" data-end="814"> ******** ******
  Director | MBA, ****

  Business Response

  Date: 04/24/2025

  Good Afternoon,

  I was secured a refund in the amount of $1,727.94. I have attached the refund log associated with the refund.  Please let me know if here is anything further I can do to assist.

  ******** ******

  Director | MBA

• Initial Complaint

  Date:04/09/2025

  Type:Customer Service 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 bought this program, which came with a guarantee that you can cancel within 30 days and receive a refund. When I initiated the cancellation, I received a phone call that was listed as spam. They left a voicemail saying I needed to speak to a representative to finalize the cancellation. I called back, and the system referred to me as reaching *************** with no company listed. When I asked to verify which company it was, the representative mocked me. I then proceeded to say I wanted to cancel, several times, and each time the representative pushed back and argued with me and wouldn't let me cancel.

  Business Response

  Date: 04/10/2025

  Good Morning, Mr. ************************************ I would like to apologize for the difficulty you are having canceling your plan.  FirstHealth is not the plan but the Network associted with the plan of contracted providers and facilities it is not involved in the sale or marketing nor the refund of premiums.  ******************** is also not responsibile for those items as well. However I have reached out to the intermediary requesting a refund and cancelation on your behalf. I would provide a refund reipt and validation of cancelation as soo as I am able to retreive it from the Billing Administrator.

  I will respond and provide those attachements in my follow up to your complaint. 

  ******** ******

  Director | ************;

  Business Response

  Date: 04/11/2025

  Good Morning, 

   

  I have received confirmation from the billing party that a refund has been issued in the amount of $500.00.  Please see attached.

  ******** ******

  Customer Answer

  Date: 04/11/2025

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ****** ********

• Initial Complaint

  Date:03/20/2025

  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.

  I was told my therapist and medications were covered with the plan I signed up for but all I have is a discount card for dental work that my dentist does not accept, druga are not covered and I can see my therapist to renew my perscription. Please help!

  Customer Answer

  Date: 03/20/2025

  I was told my therapist and medications were covered with the plan I signed up for but all I have is a discount card for dental work that my dentist does not accept, drugs are not covered and I can see my therapist to renew my prescription. I saw many of the same complaints by others on your site, I feel like I got scammed and this really isnt insurance. Now Im out o er $700 and havent been able to schedule any appointments or receive prescriptions.  Please help!

  Customer Answer

  Date: 03/20/2025

  Attached our pictures of the front and back of my insurance card.

  Business Response

  Date: 03/20/2025

  Good Morning,

  
  The plan you purchased is a Limited Medical Plan, meaning it only provides fixed reimbursements for specific services. It is not a comprehensive health insurance policy. Additionally, the ** benefit is a discount plan associated with your chosen medical plan and does not cover mental health services.

  Your plan includes the following benefits:

  Primary Care Visits Up to 3 visits per year with a $25 copay per visit, and a maximum payable benefit of $150 per visit.
  Specialist Visit 1 visit per year with a $50 copay, and a maximum payable benefit of $300.
  Inpatient Hospitalization Pays $1,000 per day, up to 5 days per year.

  This plan does not cover a wide range of medical services and should not be mistaken for a comprehensive major medical policy. If you would like to cancel your plan, please let me know, and I will initiate the cancellation request and process any applicable refund.

  Best regards,
  ******** ******

  Director | *******
  
  

  Customer Answer

  Date: 03/20/2025

   
  Complaint: 23089821
  
  I am rejecting this response because none of the things that I was told would be covered before signing up are true. Since I have not and can not use your services, I expect a full refund for the three payments made to your company and I will go elsewhere for real insurance that I can use. 
  
  Sincerely,
  
  ***** *********

  Business Response

  Date: 03/21/2025

  God **************************************** or First health Network is not the seller or markerter of the plan.  If the plan eas misrepresented to you your first step would be to file ac omplaint againt the agent or agency. There is nothing myself or First Health Network can d to resolve this misonformation as we play no part in the sale of it.  I cannot provide a resolution to your complaint because as the claims procesor I am unable to process claims out of he scope of the plan and we have no relationship or system that allows us to work with pharmacy benefits.  I would again encourage you to contact the enrolling agent or agency for further direction.

  ******** ******

  Director | *******

• Initial Complaint

  Date:03/08/2025

  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.

  They lied about prescription coverage on medications that I absolutely need to take daily. Im being charged thousands for the copay or after being told thr medication was covered when I signed up for the insurance is now conveniently NOT covered at all!! I cant afford to get my medications and I absolutely need them. They are mandatory and I cant take the generic which they keep trying to push on me. The generic formula gives me terrrivle side effects and my other medications dont even make generic brand.

  Business Response

  Date: 03/10/2025

  Good Morning,

  Unforntunatley your complaint is misdirected.  First Health is not an insurance provider but the network of doctors and facilities associated with your plan.  It appears your are secifically outlining the prescription benefits and the presenation by which it was offered to you.  First Health does not engagee in the sale of marketing of your insurance plan. Please contact the enrolling agent or company as First Health is not able to address a complaint ouside our scope of business.

  Kiind Regards,

   

  ******** ******

• Initial Complaint

  Date:03/05/2025

  Type:Billing 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 purchased health insurance coverage ($324.99 preimuim + $100 enrollment) through what was believed to be a broker or assitor for NYS **** of Health Marketplace. The **** of Health has subsequently confirmed they are not in their network. I have tried to file a cancellation and followed up with mulitple phone calls and emails without resolution. Initially I was told to expect a refund in 2-3 business days, then 3-5 business days and now an additional 7-10 business days. It has been 7 business days since the cancellation request was filed and there has been no refund or confirmation of the cancellation request. Phone calls have been repetitive and information has proven to be inaccurate or false. They have used an unsecured gmail address for one communication requesting additional information. I was told I had 30 days to cancel the plan if it was not what I needed. It appears to be impossible to get the refund.

  Business Response

  Date: 03/05/2025

  Good Afternoon,

  First Health is the Network and not the insurance which I believe is why you have encountered issues.  While we do not have a direct relationship with your insurance plan, I have made a request via a third party to cancel and refund your premiums.  I will provide you an update as soon as I receive confirmation.  As we do not receive or process premiums or enrollment.

  Thank you,

  Theo 

• Initial Complaint

  Date:03/05/2025

  Type:Billing 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 a member of the First Health Network since April ********************************** search of better coverage on December 31st, 2024. I paid a monthly fee of $397.90 and never had a problem until I needed a surgery called ablation this is when I discovered that their medical policy has so many over layers of unexplained processes until it became ridiculous to make sense of. I when ************* tried billing, they were told that my surgery not covered which resulting in my having to go back and forth with billing to make sense out of the coverage. Afterwards I found out that a portion of the surgery would be covered under Ninja Health and how this works is the service provided is supposed to provide the cost of the surgery and allow Ninja health to rebill minus what cost that they would cover. All of this was explained after my surgery was cancelled for twice lack of insurance coverage and these terms not being provided beforehand. During my coverage I went to my physician on July 25th for an *** and had bloodwork drawn by ******* both which were within in the date of coverage. Both ******* and **** are now billing me because the only response they get from the First Health Network is that my insurance was terminated. I've been going back and forth with CSR via phone and email. I was asked to have the providers send the bills to Merchants Benefits Admin - PO Box 786 - Arnonld Md ***** or to call ************ I have called several times myself to get this matter resolved and I am stuck with bills amounting to $2,207.54 - $500.40 for Penn Medicine and $1,707.14 for Labcorp none of which they paid anything on. My account was in good standing the entire time that I was with First Health. I am in dire need to getting this matter resolved because I am due to have Surgery in June and will not be able to get the necessary exams done with outstanding bills with the provider that I rely on.

  Business Response

  Date: 03/11/2025

  Good Afternoon,

  
  Upon reviewing your account, I see that it was active from May 1, 2024, until December 31, 2024. Some of the charges in question fall within the first 30 days of your limited benefit plan, which includes a 30-day waiting period. Additionally, other claims related to the attached bills were processed in accordance with the limitations of your policy.

  
  For your reference, I have attached your plan summary to help clarify that your policy is not a comprehensive medical plan. Instead, it provides coverage for specific services at a fixed fee.
  Please also note that First Health Network is not your insurance provider. Rather, it is a network of contracted providers and facilities that offer discounted rates when utilized within your plan.

  
  I hope this explanation helps clarify the limitations and benefits of your policy. If you have any further questions, please let me know.

  
  Best regards,

  ******** ******

  Director, ********

• Initial Complaint

  Date:03/05/2025

  Type:Billing 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.

  Two months of health insurance that I cannot use anywhere, Iv been lied to on the phone over and over again and now being forced to pay thousands In prescription drug costs.

  Business Response

  Date: 03/05/2025

  Dear Mr. ************************** you for reaching out with your concerns. I would like to inform you that First Health serves as a network for providers and facilities and does not directly offer prescription benefits.?
  To assist you effectively, I was unable to locate your plan details in our system due to the absence of a member ID or specific policy information. Could you please provide the following details at your earliest convenience?

  
  Policy Name

  Member ID Number

  Date of Birth

  Contact Phone Number

  
  With this information, I can ensure that your inquiry is directed to the appropriate department for prompt resolution.

  
  Thank you for your attention to this matter. I look forward to your response.

  
  Best regards,
  ******** ******

• Initial Complaint

  Date:03/04/2025

  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.

  12/24 we signed up for First Health Network. We checked to be sure our ** was an in network provider. We paid the deposit and it wasn't supposed to start until 1/25, as we already had insurance through 2024. First payment was set up to go out in 2/25. However, 1/25 a payment went out. We called to find out what happened and learned that the policy started in December Not January as told. 1/25 We call our ** to make an appointment but they don't take the insurance, even though they are on the list of in network providers on the First Health Network website. We call in to complain. The *** was rude, offered no solutions, didn't care. I call a different **. found on First Health Network list of providers, make an appointment. The day before the appointment I have waited weeks for they call to tell me they are out of Network. I call First Health to complain (for the 3rd time) the *** is not helpful, offers no solutions. She says there are ****** providers in network and its our job to find providers in network based on their list, that its not possible for them to maintain their list with current in network providers and they are only able to refund 1 months premiums upon cancellation. Even though we have complained 3x about their deception.I have paid premiums for 4 months, researched in network providers on the First Health list, waited weeks for an appointment (that I'm not going to cancel because I need the medical attention) and now I'll pay another $400 cash out of pocket to be seen by this provider that I found on the First Health Network of providers that is out of network. I was SCAMMED by this company! You are better off being uninsured and paying cash at your appointments. I could have used the money spent on premiums for actual medical care. Ive noted below that I want a refund. I do. ALSO what I really want is for them to honor their list of in network providers for as long as they are listed on their site. Shouldn't be that hard.

  Business Response

  Date: 03/04/2025

  Good Afternoon,

  I believe your complaint is misdirected as First Health is the Network of providers and facilities and does not engage in the sale or marketing of insurance nor is it an insurance company.  Could you provide more comprehensive information regading your insurance such as the name of the insurance, your memeber Id and list any phone numbers provided on your card.  As I am unale to locate any accounts for you within our business.

   

  ******** ******