ComplaintsforPreferredOne

• Initial Complaint

  04/18/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On March 1 - I went to the provider for a blood clot in my leg. Preferred One is my insurance carrier.I got a letter in the mail saying I had to fill it out and send it back. Which I did the same day it came. This had to be stamped by me to send back. It was preferred ones attempt to get out of paying the ****. Was this an accident? Was this a pre-existing condition? EtcSince Obamacare passed, not sure it matters if it is pre-existing. Either way- answered no to all questions. Week later got an explanation of benefits that looks like they paid. 4/13 they send a letter saying they are waiting to process the **** and need to talk to me. They need to pay the ****. I shouldnt have to fill out their form and call them. Scum of the earth, on top of dealing with a major medical condition they pile on stress.

  Business response

  04/25/2022

  Due to the ***** privacy laws that pertain to the release of protected health information, PreferredOne is unable provide a detailed response in this public forum. However, our office has issued a written response to this complaint directly to our member. If the member has any additional questions, they may contact PreferredOne's *************************** at ************ or **************.

• Initial Complaint

  07/19/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Our 4th child was born on 1/22/21. Throughout the process of dealing with PreferredOne and a number of different providers we had a number of "routine" services that were clearly called out as covered in our insurance coverage details come back as not covered. We were able to resolve a few of them (all of which corrected on their end). However the issues continue to happen. This has went so far as PreferredOne telling a provided to change how they submit bills (despite this being an illegal process). This all stems from routine covered procedures being submitted with a diagnosis code that should have no bearing on how the claim is paid. One of the providers has informed us that due to how PreferredOne conducted itself will no longer accept them going forward. These issues are not isolated to one provider. We have used these same providers with a different insurance with the same level of coverage without issue. These issues are all around "well child care" and "prenatal care".

  Business response

  07/27/2021

  Due to the HIPAA privacy laws that pertain to the release of protected health information, PreferredOne is unable provide a detailed response in this public forum. However, our office has mailed our member a written response to this complaint. Upon receipt of our response, should  the member have any additional questions, they may contact PreferredOne's Customer Service Department at ************ ** ************** and request to speak with the Grievance Specialist assigned to their case.

  Customer response

  08/02/2021

   I am rejecting this response because:
  
  While Preferred One has stated they are reaching to to the provider to clarify billing it does not change the process in how they are handling claims.  A routine procedure that is covered should not be subject to coverage should the routine procedure identify items they may/will be address led at a later time.  A finding on a routine procedure does not change the fact that it was still a routine procedure and covered by the policy as described.  This process that they have adopted in to deny claims due to findings during a routine covered procedure is unethical.  Should the better business Bureau like to speak with one of the providers about this process I can gladly provide contact information as they have stated they would assist with disputes due to Preferred Ones business practice.  Please advise if you would like this information.

  Business response

  08/12/2021

  Thank you for forwarding the additional information that you received from our member. Again, due to the HIPAA privacy laws that pertain to the release of protected health information, our office is unable to provide a detailed response in this public forum. However, we can confirm that we have reviewed the information that you provided and, in response, have mailed a second letter to the member addressing their concerns. Should the member have any additional questions, they may contact our Customer Service Department at ************ ** ************** and request to speak to the Grievance Specialist assigned to their case.

*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. ↩