ComplaintsforAPWU Health Plan
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Complaint Details
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Initial Complaint
03/23/2022
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
My doctor ordered a MRI of my brain. My insurance company received the order and told me it takes 7-10 working days for an approval. Waiting that long for an approval can cause more damage to me. This type of procedure should have priority seeing how the longer it takes to get results could prove dangerous to me and I as a retiree pay for my insurance.Business response
06/17/2022
Business Response /* (1000, 7, 2022/04/05) */ The APWU Health Plan is one of the five largest health plans in the Federal Employees Health Benefits (FEHB) Program, and has been protecting APWU members, retirees and federal employees since 1960. We take pride in our comprehensive range of medical benefits, our attention to our members' needs, and the care taken by our Customer Service Department to resolve our members' concerns. The Health Plan will be in contact with the member to address and resolve his concerns. Consumer Response /* (3000, 9, 2022/04/12) */ (The consumer indicated he/she DID NOT accept the response from the business.) I filed on 3/25 and APWU replied on 4/05. The request was for a brain MRI not a MRI of my foot. I was called APWU numerous times to get updates. I explained the reason for the request. I was told pre Covid MRI request went to a dept that reviewed only MRI requests. If calls really are recorded mine should be there. I was told it takes 5-10 business days for an reply. That's too much time for a brain MRI approval. I told APWU I want to know the names and qualifications of the people who reviewed my MRI request . I was told it goes to the doctor. My doctor doesn't pay for my insurance I do. I insured with APWU my entire career as my father was also. "Never" was there an issue with them until now. I had to go see a specialist and they also are requesting an MRI and a MRA. Today is 4/12 and I'm still waiting to hear if my brain tests were approved. Business Response /* (1000, 14, 2022/05/09) */ "The APWU Health Plan is one of the five largest health plans in the Federal Employees Health Benefits (FEHB) Program, and has been protecting APWU members, retirees and federal employees since 1960. We take pride in our comprehensive range of medical benefits, our attention to our members' needs, and the care taken by our Customer Service Department to resolve our members' concerns. The Health Plan will be in contact with the member to address and resolve his concerns." Consumer Response /* (3000, 17, 2022/05/16) */ (The consumer indicated he/she DID NOT accept the response from the business.) First I had the tests performed. My doctor ordered the test on 3/17/22. I finally received the okay the first week of May. According to my doctors office the test was ordered as urgent. APWU told me it was ordered as routine. The test was an MRI of my brain. Seeing how this was not a MRI of my ankle and I am paying for the coverage APWU should automatically contact the ordering doctor and ask if the MRI of my brain was urgent. That should be part of what I'm paying for.Initial Complaint
03/18/2022
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I've been seeing a therapist for a couple of months now, all of the has been approved by my health insurer (Apwu) today my therapist told me that although I have been approved to see the therapist my health insurance is not paying for their end of the visits. So I called my insurance and asked why they weren't paying the therapist office because the therapist office was telling me if they don't get payment from the insurance they would send me a bill. The insurance then said they are keeping from paying the bill because there's a dispute between the insurance and the therapist office with another patient and they are withholding payment from my visits until they recoup overpaid funds from another patient.Business response
05/05/2022
Business Response /* (1000, 7, 2022/04/04) */ The APWU Health Plan is one of the five largest health plans in the Federal Employees Health Benefits (FEHB) Program, and has been protecting APWU members, retirees and federal employees since 1960. We take pride in our comprehensive range of medical benefits, our attention to our members' needs, and the care taken by our Customer Service Department to resolve our members' concerns. The Health Plan will be in contact with the member to address and resolve his concerns.Initial Complaint
03/07/2022
- Complaint Type:
- Billing Issues
- Status:
- Answered
My wife, ****** received a routine mammogram from Lakeside Hospital on August 13,2021. This was supposed to be covered at 100% by our health insurance company.In early November we received a bill from Lakeside Hospital for $223.50 for the mammogram which should have been 100% covered by APWU Insurance. I filed a complaint on November 22,2021 to a person named Tafari(************). He told me that the claim should have been paid and would submit a dispute claim. Since that time nearly 4 months have gone by and I have called this company probably 10 to 15 times and they keep saying that it is some kind of a system issue but nothing gets resolve. A supervisor by the name of Jessica was supposed to have called first a week ago and then again today and we have not received any correspondence from her whatsoever. We have been told by Lakeside Hospital that our bill is due and I plan on paying the bill because I do not want to have any late payment issues with them.Business response
04/07/2022
Business Response /* (1000, 9, 2022/03/30) */ The APWU Health Plan is one of the five largest health plans in the Federal Employees Health Benefits (FEHB) Program, and has been protecting APWU members, retirees and federal employees since 1960. We take pride in our comprehensive range of medical benefits, our attention to our members' needs, and the care taken by our Customer Service Department to resolve our members' concerns. The Health Plan will be in contact with the member to address and resolve any concerns.
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Customer Complaints Summary
3 total complaints in the last 3 years.
0 complaints closed in the last 12 months.