Business ProfileforAutomated Benefit Service

ABS processes health claims for BCBSM for *****/Adventist Health employees. My husband suffered a hemmoragic stroke and we had numerous claims which were processed properly until Sept2020. Note our out of pocket was met with the 1/1-1/11 ********************* for $120K. In September BCBSM audited this **** and determined that Loyola did not process this claim correctly. ABS wiped out our out of pocket costs paid which was 95% of the total out of pocket. Because of this, we started experiencing receiving bills from drs. I called 5 times in October and finally spoke with ****** the supervisor who stated that she would get this resolved. I filed my first appeal 11/26/2021 whereas the claims from September 30th through that date were not even processed correctly as per their benefit listing. On December 14th, ABS finally amended the claim but lowered our our of pocket cost from $7799.05 to $6237.64 which resulted in a refund owed back to us from Loyola. After submitting this new EOB and requesting a refund, we finally received one after filing a complaint with BBB. As we have not been acknowledged of the first appeal, I issued two more appeals on January 19th for in network claims that were not paid 100% as required. Still as of today, one month later and two months after the first appeal, we still have not been contacted or received a refund. I have taken the claims that we take issue with and placed on a spreadsheet. After my analysis, we are owed $1189.52 from ABS and ABS owes *************************** and *************************** Hospitals $575.00. We are tired of waiting for a response, an acknowlegment and finally a refund.