ComplaintsforTotal Plan Concepts
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Complaint Details
Note that complaint text that is displayed might not represent all complaints filed with BBB. See details.
Initial Complaint
02/20/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
Since September 1, 2023 I have added my children to the policy as well as changed my address from ** to **********. My member ID is ********. We have been in contact with them and they have not been helpful. My providers have been in contact with them and they have not been helpful. There are playing games in making sure CIGNA understand we are active and should stop denying all the claims.Business response
03/05/2024
First, I would like to say that we understand your frustration. You and your employer are paying for your health plan, and you elected to enroll your children, but you are experiencing the fallout of a technical glitch in enrollment, which is causing your children's health plan claims to deny. Unfortunately, this is the result of a system error at *****'s end. We have diligently reviewed our files and correspondence with *****, and found that we communicated your enrollment via electronic file feeds on a daily basis. However, due to a system glitch, Cigna is not reading your family's eligibility. This happens occasionally, and we are sorry that you are on the receiving end of this. We opened a ticket to research with Cigna, and have requested IT resources assigned to this matter. However, since that was taking several weeks and you seemed very anxious to resolve the matter without delay, we re-enrolled your family. This occurred several weeks ago. At this time, you should have been notified of your new member ID, and may let your doctors know to file their claims with the new member ID.Customer response
03/12/2024
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:Why was I not told initially that my id changed. I have messagfed dozen of times and you never respnonded that I have a different id. I am not figihting multiple providers toresubmit and not sned it to a collectino agency.
In order for the BBB to appropriately process your response, you MUST answer the question above.
Sincerely,
*******************************
Business response
03/25/2024
We have reviewed your reaction to our response. We have addressed your concern related to the Cigna eligibility file glitch by changing your member ID. Once we changed your member ID, you were notified of the new member ID, and asked to let providers know to resubmit claims accordingly. This was expected to resolve the matter. If you have any questions regarding this matter, we advise that you reach out to a ************** Associate at **************.Initial Complaint
12/20/2023
- Complaint Type:
- Order Issues
- Status:
- Answered
I am a health care provider, and on the provider side, I have had a horrific experience with this company. They manage some payments for Magnacare, and they have for 2 years used old incorrect addresses, given my billers the run-around, declined to allow me to pick up the paper check from their office, and have made a living nightmare for me to collect 2 years of payments. The only recourse if my payments don't come in before **** is legal action. It's truly a shame because the persons who suffer the most at the end are the patients.Business response
12/20/2023
Good Afternoon,
We will be happy to assist, but we would need claims details on the related claims.
Dedicated Service Specialist
************
Initial Complaint
11/09/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Over the past several months I have been paying out of pocket for therapy services. I sent the super bills to Total Plan Concepts for reimbursement. Only receiving a response about a month later, that my claims would be processed and to allow 30 days for payment. 30 days came and went - I inquired about the status and was told to wait another 2 weeks. Nothing. Reach out again and told 3 more days the payment would be out. This past Monday I inquire yet again about the status to which I received no response. Im exhausted with the back and forth. I had to pause therapy services as I can no longer pay out of pocket and was hoping to have the reimbursement back by now in order to continue therapy. I feel I shouldnt have to fight my insurance company for what I am paying them for, it truly upsetting and at this point I feel worried about using my insurance for anything health related. Please, if there is anything you can do to help speed up this process or at least get an honest response from Total Plan Concepts, it would be greatly appreciated! Thank you :)Business response
11/24/2023
Good Morning,
We have looked into this in further detail, paper claims can take up to 60 business days for review, the claims were paid out to the member on 11/14/2023.
We apologize for any inconvenience.
Dedicated Service Specialist
**************Initial Complaint
11/02/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Resolved
They refuse to pay their claims . Have owed money since June. Claim to mail payment and never have. Owe a significant amount of money.Business response
11/16/2023
After researching this information we have found that the claims were mailed to the address provided to us on box 33 of the claim, the provider had called to update the address, so we requested a w9 form which we received. We then updated the address and reissues the payment to the new address provided, the provider has verified that they received the payment at this point. We apologize for an inconvenience.Customer response
11/27/2023
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because The business was given the correct address in August 2023. They refuse to issue the checks and continue to blame it on my lack of appropriate information. Additionally, the organization made payments in a passive aggressive manner and decided to not pay certain claims within the middle of the large trunk of claims that they paid. they continue to not follow up and make payments as per their contract. Look complete lack of actual researching into the problem. Its highlighted by the recent response, which was produced after some payments were made. They continue to eschew their responsibilities. The problem has not been resolved. There are even more claims that are now owed. They continue to blame the issues on My organization, rather than the systems that are their responsibility to maintain. A two minute ****** search will also show that theyve done this refusal to pay with other providers which can be seen either through complaints filed by providers or the subscribers who clearly state theyve gotten in trouble with their providers because their insurance company has not paid their claims. This is still occurring and they still owe me money. The response does not adjust the problem. The response does not include the payment. I do not accept their response. This is a response that is actually a lack of response.In order for the BBB to appropriately process your response, you MUST answer the question above.
Sincerely,
****************************************
Business response
02/13/2024
I apologize for the experience you have had with our company. I am aware that your billing office has sent us claims with an incorrect payment address repeatedly; therefore the payments were made to the incorrect address. It was not belligerence on our company's part, nor are we trying to get out of paying claims on behalf of our employer groups. If you have any other claims at issue, please let us know and we will be happy to get them resolved quickly.Customer response
03/30/2024
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********,The fact that I have accepted the response by no means indicates my satisfaction with the outcome. This organization still owes claims from as far back as October 2023. They have, attempted to pay claims, however they have not paid all of them. I have taken the loss. Please note that my acceptance of this outcome does not mean that they fulfilled their obligation to pay their subscribers claims. Its simply indicating I am tired of going back and forth with this company.
Sincerely,
****************************************
Initial Complaint
01/23/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
Date 2020-2021 Issue of medical coverage, total plan concept states that I am covered for all my visits to *************************** MD of ****** ************. As of today 1/22/2023 I have a debt to *************************** for over 2000$ due to total plan concept not picking up the bill. They do not answer the phones and will not take the blame of being in debt to the medical provider. I have all evidence showing that TPC should have paid these debts. My plan states I only owe a 25$ copay. They do NOT answer emails and the phone service is almost inaccessible. I am refusing to pay the 2000$ balance but take full responsibility for my 25$ copays. Apparently filling a BBB is the best thing to try as of now.Customer response
02/16/2023
Better Business Bureau:
At this time, I have not been contacted by Total Plan Concepts regarding complaint ID ********.
Sincerely,
*******************************Initial Complaint
12/19/2022
- Complaint Type:
- Product Issues
- Status:
- Answered
It concerns various visits to medical providers that have not been addressed. TriHealth (Good *** emergency) called me and said they couldn't even file a claim because my insurance card says "Practitioner only." Mercy Health called me and asked for TotalPlan's phone number so they could try calling them because they were having trouble filing too. I have also contacted TotalPlan through email, and they had me email them copies of some of my bills so they could be taken care of, but still nothing.Business response
01/04/2023
I apologize that your providers are experiencing difficulty or confusion with filing claims. I do see many paid **************, so it seems this issue does not cascade to all providers. Please ask your providers to submit claims electronically to payer id *****.Initial Complaint
08/15/2022
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Total plan concepts incorrectly processed a claim with a portion owed by me stating its my deductible. I have 0 deductible plan and paid extra money for this plan. When calling to get it corrected they told me to call ***** since they priced it for total plan concepts. ***** will only speak with total plan concepts and not **** have no deductible for ANY Service. Total plan concepts needs to contact ***** to have my claim repriced correctly. Claim ************* $45.50 is the amount Im disputing. I have 0 deductible plan.Business response
08/21/2022
Total Plan Concepts apologizes for the processing error. The claim was reprocessed correctly, and we have contacted Quest to explain the issue, and faxed them a copy of the updated explanation of benefits (EOB). Quest has agreed to write off the charge according to their contract with *****.
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Customer Complaints Summary
8 total complaints in the last 3 years.
5 complaints closed in the last 12 months.