Complaints

This profile includes complaints for MedCost, LLC's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  MedCost, LLC

  165 Kimel Park Dr Winston Salem, NC 27103-6945

  
• 

  MedCost, LLC

  PO Box 25347 Winston Salem, NC 27114-5347

  

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: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 received medical services in 7/12/2021 through ******************************. At the time my insurance was through Medcost. At the end of 2024 I received a bill for these services for around $300. I did file a complaint with BBB against ****** Regional ( case # ********) in which you never got a response from the bussiness. I have asked more questions and ********************* advised that it is Medcost that did not get the filing to them until over 3 years later. I have now received a larger bill of $1,955.98. I feel there could be a untimely filling by Medcost and now I am being charged due to a mistake on their part. I have not made insurance through medcost in years now. I have requested an itemized bill from ********************* and can send that when I receive it in the mail. Even though the bill is from ****** Regional I feel the issue may be with untimely filing from Medcost after speaking with personel from ******.

  

  Business Response

  Date: 04/15/2025

  ***** **** was covered through a non-grandfathered self-funded employer plan sponsored by Town of Franklin (the Plan) in ***MedCost served as the third-party claims administrator for the Plan. ***** **** was the covered dependent with medical plan coverage beginning on April 1st,2021 and ending June 30th, 2021. Her coverage and claim adjudication are subject to the benefits defined in the Summary Plan Description (SPD).
  
  Thank you for providing ******** request for assistance.
  
  The Town of ******** began using MedCost Benefit Services for medical claims administration 10/1/2017.  The Town ended that arrangement 6/30/2021,and beginning 7/1/2021 MedCost only administered dental claims for this group.  Any medical claims with dates of service 7/1/2021 or later would not be administered by MedCost and should have been filed to the administrator the group moved to.  I do not have any information regarding what administrator the group moved to for medical claims.
  
  Thank you for patience with this response.
  Sincerely,
  **** *******
  Director of Customer Experience and ******************

• Initial Complaint

  Date:01/20/2024

  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.

  In Nov 2023 I attempted to use my Medcost vision plan insurance at fox eye care for an annual exam, contact lenses fitting and contact lenses purchase. My insurance was denied because they said Medcost never paid out the claim from June 2022 which I had never heard. I had to pay $558 out of pocket on November 28 2023 and was told to file the claim myself. Medcost said the provider filed the claim incorrectly and thats why it wasnt paid out previously. The provider disputes that assertion and showed me two documents of when they attempted to file and refile the June 2022 claim. After the claim was resubmitted, instead of paying the provider directly for the entire June 2022 claim, Medcost paid me partially for that they owed ************ and I was told to pay the provider. That amount was still not what the provider said was owed by Medcost and said they would try to work again to find out what the problem was and refused to have me write a check to them for what Medcost paid me to reimburse them from June 2022. In addition Medcost reimbursed me significantly less than what my coverage was for the Nov 28 2023 claim from ************ services. I was paid $188 by Medcost for a $558 bill. I called multiple times and chatted online but received no answer other than a standard I received the maximum. When I explained that my contact lense reimbursement was $200 alone, not including reimbursement for the exam or fitting, no one could explain why my reimbursement check was only $188. Finally, I was told from a team leader on January 4, 2024 that they understood my concern and were going to resubmit for review which would take 7-10 business days. That time period has expired and there is no documentation on my online account of a review or what is currently happening. Please assist with my reimbursement concerns as I dont feel like Im being heard by Medcost customer service.

  

  Business Response

  Date: 02/21/2024

  After our review of the claims in question, we have determined they were initially processed incorrectly due to human error.  They have since been reprocessed, and leadership in the claims department will work to identify any training opportunities that present themselves in this case.

   

  The claim for date of service 6/16/2022 (claim number *************) has been reprocessed to pay the member a total of $298.38.  The claim for date of service 11/28/2023 (claim number *************) has been reprocessed to pay the member a total of $355.22.

   

  This is a total of $653.60 to be reimbursed to the member.  This amount has been issued in two different check payments.

   

  The first, check # **********, was issued 1/5/24 and cashed by the member 1/18/24.  This was for an amount of $382.07.

   

  The second, check # **********, was issued 2/2/24 and has not yet been cashed by the member.  This was for an amount of $271.53.

   

  Thank you,

  ******

   

  AndrewBarker Manager,QualityImprovement P************ F************ ************** 165KimelParkDrive,*************,NC27103 MedCost.com

• Initial Complaint

  Date:12/18/2023

  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.

  We have dental insurance with Medcost through my employer ******. We also have privately purchased insurance through Ameritas. Apparently starting in June 2022 Medcost stopped paying my husbands dental claims. In July 2023 I started questioning the denial of his claims from 6/2022, January and February 2023. I guess my efforts to have his claims paid resulted in Medcost refusing to pay my dental claims starting September 2023. I have called, sent letters sent and faxed multiple copies of EOB's and contacted ****** HR department. I am at my wits end. I have gotten no response from Medcost. Help!! See attached letter. Thank - you. **** *****

  

  Business Response

  Date: 12/27/2023

  Good afternoon,

  Leadership in our claims department has reviewed this account and the documents provided by the policy-holder, and determined that these claims could indeed be processed and released.  Dental claims for both ****** ***** and ********* ***** have been adjudicated to be released with the employer group's next check-run, which will become available for client authorization 12/27/2023.  Once the check-run is authorized, payments will be issued to the provider(s).
  
  Leadership in the claims department is reviewing how these claims were handled initially to identify and act on any training opportunities that present themselves.  Leadership in our customer service department is performing a similar review with communications concerning this account.

   

  Thank you.

• Initial Complaint

  Date:12/12/2023

  Type:Service or Repair 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.

  My daughter had her wisdom teeth removed 3/17/23. This is covered by our insurance, Medcost. The cost I paid out of pocket to the oral surgeon was $3,356.00. Medcost was filed and the claim was denied stating it was filed incorrectly to the dental portion, not medical. I have contacted Medcost fifteen times since April regarding this. I have been told each time they will re-file it correctly for me and to give 10-15 business days. I never received updated information or are contacted by Medcost. I have gone through my employer for assistance also with no response from Medcost. I am told this will covered at 100%, but have never been reimbursed. They keep saying they have a backlog for claims, but we have had multiple claims since then and all have been addressed. The calls have been sent to “supervisors” who I am repeatedly told will contact me, but I have never received a call from Medcost.

  

  Business Response

  Date: 12/20/2023

  We have reviewed the claim in question and have determined this amount was denied as the result of human error.  Claim # ************** was filed with a total billed amount of $3,356.00, and network adjustments reduced this to an allowed amount of $3,287.55.  This claim has now been re-adjudicated to pay the provider $3,237.55, with a patient responsibility of $50.00 in the form of a co-pay.  This payment will be included in the employer groups' next check run, which will become available for client authorization on Friday, December 22, 2023.  
  
  Leadership in our claims department is taking steps to address the training opportunity revealed by this issue.

  Customer Answer

  Date: 12/21/2023

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and I accept it.

• Initial Complaint

  Date:12/04/2023

  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.

  My daughter had oral surgery to remove wisdom teeth 8/22/23. Pre-treatment paperwork was filled out and estimate given from MedCost. I paid my portion of estimate on date of service. On date of service Oral Surgeons office filed claim. I received a bill for $1,502.00 from Oral surgeons office on 10/30/23. Upon calling MedCost I was told the check had been sent to Dr ********s office. I asked if we could call the office in three way because the dentist office said they haven’t received it. I was then placed on hold for 20 minutes and was told after reaching out to funds department that the check wasn’t sent and they would send it now. I specifically asked her to call Dr ********s office to inform them of the mistake and she said no, that I could call them and give them the inquiry number and they could call MedCost if they wanted to. Why should it be that way if MedCost made an mistake?Inquiry #*******. I phoned MedCost to follow up on 11/20/23 because oral surgeons office hadn’t received payment. I was told by Joelynn and her supervisor that what I was told on my initial phone call on 10/30 was false information and that I needed to wait 30 days for claim to process from my first phone call. Inquiry #*******. 11/29/23 the oral surgeons office calls MedCost and was told this claim would be expedited and wait 7-10days inquiry #*******. Fast forward to 12/4/23 I receive a bill from Dr ********s’s office now with interest added because they have not received funds from MedCost. I called MedCost and spoke to Margaret and was told it would be expedited and she would send it to her supervisor and she would call me back once it was processed in 7-10days. I need a resolution asap. This has been a horrible customer experience! I have spent hours on the phone trying to get this resolved and I am tired of being asked to wait 7-10more days. Why should I have to pay interest on MedcCosts bill?

  

  Business Response

  Date: 01/05/2024

  Leadership in our Customer Service department has pulled notes and recordings for calls related to this matter, and will address any training opportunities identified accordingly.
  
  Claim ************* was not filed to MedCost until 10/31/2023.  It was adjudicated 12/27/2023, and processed to the ******** *****'s check run 1/3/2024.  Once the check run is authorized by the ******** ***** the payment can be issued to the provider.
  
  On this member's dental plan, oral surgery falls under "Basic" coverage.  Such services are covered at 80% after the $50.00 annual deductible has been met, up to the plan's maximum annual coverage amount of $1,750.00.
  
  The original billed amount of this claim is $2,595.00.  This was reduced to an allowed amount of $2,550.27 per reasonable and customary charges.
  
  This member had already used some of their maximum annual coverage prior to the processing of this claim.  MedCost has processed to pay the provider $1,161.73.  $290.43 was processed as patient responsibility in the form of coinsurance.  $1,098.11 was non-covered due to the annual maximum coverage amount being reached.

• Initial Complaint

  Date:11/22/2023

  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 had medical services in **** on 9/22/22 and at the time our company had insurance with MedCost. There were two bills filed with them one for the facility visit and the other to the physician. One of the bills was paid per my insurance terms, the other was not (2448.00). After working between the provider and Medcost since January 2023 its become apparent that when Medcost realized my company was going to move our policy to another company they decided NOT to pay out the benefits although they were still collecting the premiums until the time of termination 12/31/22. I have proof I had insurance at the time of the claim. Furthermore, Medcost claims they never received the claim but admits their clearing house denied the claim for inadequate information. After reaching out to the provider and speaking at length with someone on the phone, all of the information was faxed and mailed multiple times to them from the provider which they also have documentation.

  Customer Answer

  Date: 12/04/2023

  I have not heard from the business in response to my complaint.  

  I have been contacted by the company but its not resolved as of yet

   

  ***** ******

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

  Account Manager (***********)

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

  
  

  

  Business Response

  Date: 12/15/2023

  Recently an issue was where a number of claims from providers were not imported properly into the MedCost system - this claim was one of those affected.  We have already put a change in place to prevent this from happening in the future, and are currently working to import, reprice, and process the claims that were affected by this error.
  
  Mr. ******'s claim was pulled in to our system on an urgent basis.  It was then forwarded to ***** ****** ******* for network repricing, as the provider is not in the MedCost Network.  That repricing was received by MedCost on 12/13/2023 and has been adjudicated on claim # *************.  
  
  The billed amount of this claim is $2,448.00, and network adjustments reduced that to an allowed amount of $1,958.40.  This claim is set to pay the provider an amount of $1,837.60.
  
  An amount of $120.80 has been processed as non-pay due to a coding edit.  If the provider feels the coding is correct, we would expect them to file an appeal with *****.  Instructions on how to file such an appeal will be included in the Explanation of Payment the provider will receive.
  
  A special check run is being set up for early next week to issue this payment to the provider.  Once that check run has been authorized by the employer group, the payment will be issued.

• Initial Complaint

  Date:08/14/2023

  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.

  MVC with **** ***** ********* Dept visit 3/27. Hospital is owned by ****** **** ****** ******* which has its own insurance company for employees "MedCost". I am an employee of hospital system = have MedCost insurance. I had outpatient surgery at ****** ****** ********* on 4/4. Contacted MedCost through online portal on 3/28/2023 1:44 PM asking if they needed information from ***** (car insurance company, is not liable for the claim) and was told they did not need anything yet for the ED visit. I got a letter from Elevate Patient Financial Solutions AKA RevCLaims asking for info from ***** to give to hospital and share with Medcost -spoke with them by phone on 4/13 provided accident, ***** and MedCost info to be given to **** ***** billing. 5/10 claims oustanding, called ****** billing -said they were waiting for 3rd party info. 7/3 claims denied (no notification that day) - over $35K. Letter received from Medcost requesting *****/accident info (form was printed on 7/6 received 7/11). Called Medcost 7/11 Ref # 6322996 about **** ***** ED & ********* OR. Accident info uploaded online (again). 7/13 medcost website verified all info received. Call 7/19 to MedCost Ref # ******* -told claims "accidentally closed" & not reprocessed on 11th, reopened reprocessing. Received letter from MedCost in mail 8/14 (printed 8/7) stating "final request for information" for "accident details information". Call medcost ref # ******* 8/14 -states claims still "reprocessing" despite >30 business days they had reported for completion, does not need more info, to ignore letters; would "elevate to a supervisor" to check within 10 days. It has now been 4 months and Medcost has paid some parts of the visit but most has been "DENIED FOR DATE, PLACE & DETAILS OF INJURY". 1.Medcost denied several claims without even requesting the info related to those claim numbers (even though they actually have the information). 2. Isn't this fraud for a hospital to own a health insurance company?

  

  Business Response

  Date: 08/23/2023

  Thank you ***** for bringing this situation to my attention!
  
  Your complaint indicates that Elevate Patient Financial services AKA RevClaims procured accident information for *****.  MedCost does not contract with this company and that information wasn't shared with MedCost.  I was able to review the Accident and Subrogation information provided and contact Erica with ***** to validate third party auto would not be paying for the treatment rendered as a result of the motor vehicle accident.  After receiving this verification, I was able to work with our claims team to get these claims reprocessed for today's (08/23/23) check run. 
  
  I will provide you a separate email with details of the claims payments with EOB's showing any patient responsibility. Additionally, I'm contacting the providers with outstanding payments to make them aware of today's payments so that you will not get turned over to collections.  
  
  I will be working with teams internally to review the root cause for the confusion associated with your claims and evaluate opportunities for improvement to streamline processes to avoid this kind of situation from occurring with other members.  It was good to speak with you earlier and hopefully our conversation about relationship between MedCost and ****** Health makes more sense. 

  At MedCost, we take pride in providing and ensuring our customers’ satisfaction and experience. In this case, we failed to meet that standard. We apologize for any inconvenience this may have caused you. 
  Sincerely,
  Tony C******
  Director of Customer Experience and Quality Management.

• Initial Complaint

  Date:08/01/2023

  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.

  They were my FSA provider and Incontributed $2850 in 2022. Inhave attempted several occasions through CRG, my employer, to submit my EOBs and get reimbursed.

  

  Business Response

  Date: 08/04/2023

  Thank you for sharing this concern. I was able to review the payment status for the FLEX reimbursement.  According to our records, the Flex team processed $2850 for reimbursement to the member in the full contribution amount for 2022. The check run for this amount was released on 6/27/23-check#**********. The check was mailed to:
  ***** ******** *** **** **** ***** **** ***** ** *****
  
  I checked with our Account Payable/Funding team who advised this check has not been cashed as of 8/2/23.  We confirmed with CRG, employer, that the above address is correct (also matches the demographic information provided to BBB). Funding has been notified to void and reissue the check.  
  

  If Mr. ******** receives a check #********** do not attempt to cash it.  We have also requested Funding to mail the new check with a tracking number that we can provide to Mr. ********. 
  
  Let me know if you have any questions.
  Sincerely,
  Tony C******
  Director of Customer Experience and Quality Management.
  
  
  

  Customer Answer

  Date: 08/07/2023

   I am rejecting this response because: They have held onto my money for loner than 20 months and should pay interest - $3200 total expected
  
  
  

• Initial Complaint

  Date:07/24/2023

  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’ve been waiting on two claims to be processed since March. They said they have a backlog. That was in April. I keep getting bills from Dr stating I owe the total amount and they still haven’t received payments from Medcost. Now my credit rating is in jeopardy. I can’t get anyone on the phone. Last call was two weeks ago, and waited an hour just to speak with someone, I had to hang up because I had to go to work.

  

  Business Response

  Date: 07/25/2023

  Good Morning,
  
  Thank you for sharing this consumer concern.  The billing statement image included was helpful.  This gave me an opportunity to review claims with the provider for that billed amount.   I'm showing that MedCost processed this claim was adjudicated on 04/03/2023 and the EOB was issued on 04/18/2023.  Attached is a copy of the EOB showing the claims processed and the member benefits applied.  This provider is a specialist and on page 12 of the attached Summary Plan Description this service type applies to the members deductible.  The amount listed on the billing statement matches up with the EOB.  
  
  Based on concerns about the claims turn around time, I have asked our claims team leaders to review and make sure any outstanding claims are processed for the next check run.  
  
  Let me know if you have any questions.
  Sincerely,
  Tony C******
  Director of Customer Experience and Quality Management.
  
  

  Customer Answer

  Date: 07/25/2023

   I am rejecting this response because:
  I spoke with ***** ******** and they stated they were still waiting on insurance.

  Note, there were two different appointments not one in February.  The next one was in March.

  
  

  

  Business Response

  Date: 07/25/2023

  Thank you for providing additional information!  
  
  I was able to locate a March ************* claim for $367.00.  It looks like the claims was submitted with an Medicare modifier code that is invalid. This invalid modifier code has delayed the processing and required additional time to review.  The in-network allowed amount is $220.00 but the benefits for specialist office visit will still be subject to annual $1500.00 deductible.  I'm showing that you have $766.45 remaining on your deductible prior to this March ************* claim being processed. 
  
  As previously stated, I've requested our claims team to review your account to have any claims processed for next week's check run.   
  
  Let me know if you have any question.
  Sincerely,
  Tony C******

• Initial Complaint

  Date:06/27/2023

  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.

  A screening colonoscopy was performed on 2/9/2023. This service were coded by ****** **** ****** ******* as "surgery" and therefore I was required to pay a deductable. This was a preventative care procedure and should have been covered 100%. There are multiple charges from this single procedure that are now due for payment. I have sent numerous messages through the Medcost website/portal and this is still not resolved. One of their responses agreed with my claim of preventative care but they still have not adjusted the billing. There are multiple charges from this single procedure that are now due for payment. I keep being told to give them more time. First it was 30 days and now it is stretching into almost 90 days. I am worried that this will affect my credit.

  

  Business Response

  Date: 07/14/2023

  Good morning,

  We evaluated the claims received as part of this member’s colonoscopy on date of service 2/6/2023.  5 claims in total were filed to MedCost for this date of service for this member.  1 of these claims initially processed as a routine colonoscopy, which would not include member responsibility.  However, 4 of these claims initially processed as a diagnostic colonoscopy, which would include member responsibility. 

  
  The member indicated this was a routine colonoscopy.  Based upon how the claims were filed, all of these claims have now been reviewed and all have been reprocessed to pay to the provider at 100%, with no patient responsibility.  These payments are scheduled to be included in this group’s next check-run, which will process 7/19/2023.

  
  As a part of this review we are working with senior leadership to ensure that appropriate training and coaching is provided to customer service staff regarding proper escalation procedure.  We are also working with claims leadership to evaluate the cause of these claims processing as a diagnostic colonoscopy.

  Thank you,

  Andrew B*****

  Manager of Quality Improvement