Complaints

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

close

Find a Location

Oscar has 3 locations, listed below.

*This company may be headquartered in or have additional locations in another country. Please click on the country abbreviation in the search box below to change to a different country location.

BBB accredited

Near

Country

USUnited States

Please enter a valid location.

Filter

• 

  Oscar

  75 Varick St Fl 5 New York, NY 10013-1917

• 

  Oscar

  295 Lafayette St Fl 6 New York, NY 10012-2722

• 

  Oscar

  PO Box 278 New York, NY 10013-0278

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:02/27/2025

  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 cancelled my Oscar plan 1.3.2025 I was told I would not be charged for the month of January because of this. They charged me for the month of January, February, and are now trying to charge me for March. And this new charge is OVER 10x what I paid for my plan initially (with less money made by me annually). When I try to call the line (3 separate occasions, Im playing keypad merry go round where the menu lists number associated with options, I click said options, and after 5-6, Im brought back to main menu, causing me to continuing going for minutes on end. My last attempt was 20 mins of trying any number to get someone on the line to no avail. This is insane. Ive cancelled almost 2 months ago, Im getting charged, and I cant even call someone about it?? And I can only CALL because my account was CANCELLED and I cant get into the app anymore because my account was cancelled.

  Business Response

  Date: 02/27/2025

  ******** *** **** ****** ******** ****** ***** *************************************************** ************************
  Complaint ID: ********
  
  
  Dear Better Business Bureau,
  
  Thank you for contacting Oscar regarding a member's experience with being charged for a premium on a cancelled policy.
  
  During our investigation, Oscar has confirmed that the member was enrolled in a 2025 policy through the federal health insurance exchange, referred to as the Federally Facilitated Marketplace (***). Oscar does not have any ability to make changes to our members policies if they are enrolled through the ***, without first receiving explicit instruction from the **** We rely on data sent to us electronically from the ***, and when we receive notification pertaining to a members policy, we make the requested plan adjustment to reflect any information exactly as relayed in the data transmission.
  
  Upon investigation, the member was enrolled in a policy starting January 1, 2025, which was then terminated by the *** for an end date of January 31, 2025. A premium payment was initially charged for the month of January but has since been returned. At this time, Oscar can confirm that a premium payment is not on file for the month of January. 
  
  However, the *** has not yet directed Oscar to retroactively terminate the January enrollment and as a result, there is an outstanding premium balance. If the member disagrees with their enrollment with Oscar and would like a refund of the January premium, we suggest contacting the *** directly to request any enrollment changes as we are unable to refund any premiums payments for the time that a policy is enrolled or active.
  
  We apologize for any inconvenience that this issue may have caused, and appreciate you bringing this matter forward for our review. If our member has any questions about this information she can contact our ************************** at ************ or *************************************************************. 
  
  
  Thank you,
  ****** ** ********* ******* ***** ********* ***********
  
  

• Initial Complaint

  Date:02/25/2025

  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 keeping getting letters from oscar health care even after explaining to them that i have never heard or singed up for health care insurance. when i spoke to them last month i was assured the policy would be cancelled and they had me speak to someone named ******** in the marketplace. during our conversation she told me that she sent this to be investigated. meanwhile i have been getting denied coverage from my actual insurance company. i called oscar back last week and they kept saying i needed to provide my bank account info in order to proceed, to which i replied i had already spoken to them and my policy was cancelled. they replied and said according to your account, based on my phone number only, they showed an active policy. i told them again i never signed up for them, they said they had a glitch in their system and to cancel id have to call back in 30 minutes and hung up. i notified my insurance company and they are investigating. i am receiving multiple letters of money owed and EOBs to which is a direct violation of my hippa rights.

  Business Response

  Date: 02/27/2025

  ******** *** **** ****** ******** ****** ***** *************************************************** ************************ ********* *** ********
  
  
  Dear Better Business Bureau,
  
  Thank you for contacting Oscar regarding the members enrollment in a 2025 Oscar policy.
  
  Upon investigation, Oscar confirms the members policy was enrolled through the federal health insurance exchange, referred to as the Federally Facilitated Marketplace (***). Oscar does not have any ability to make changes to our members policies if they are enrolled through the ***, without first receiving explicit instruction from the **** We rely on data sent to us electronically from the **** and when we receive notification pertaining to a members policy, we make the requested plan adjustment to reflect any information exactly as relayed in the data transmission.
  
  Oscar confirms that the *** has sent Oscar updated information terminating the members policy for no coverage for the 2025 plan year. Furthermore, Oscar confirms that the member is not responsible for any premium payment amount due. 
  
  We apologize for any inconvenience that this issue may have caused, and appreciate you bringing this matter forward for our review. If our member has any questions about this information she can contact our ************************** at ************ or *************************************************************. 
  
  
  Thank you,
  ****** ** 
  ********* ******* ***** ********* ***********
  
  

• Initial Complaint

  Date:02/21/2025

  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.

  We are healthcare providers without access to a dedicated provider relations representative. Instead, we are forced to rely on offshore representatives who provide no clear answers or resolutions, leaving us stuck in an endless loop of misinformation. Our claims continue to be denied in error, yet we have no access to a U.S.-based representative who can properly investigate and resolve these issues. Despite these challenges, we remain committed to our patients, but the ongoing claim denials create unnecessary obstacles to delivering care.

  Business Response

  Date: 02/21/2025

  ******** *** **** ****** ******** ****** ***** *************************************************** ************************ ********* *** ********
  
  Dear Better Business Bureau,
  
  Thank you for contacting Oscar regarding the concerns expressed on behalf of our provider. We have researched this case and determined the following: 
  
  An Oscar contracted provider expresses dissatisfaction regarding Oscars Provider Relations representatives. The provider stated that their office is forced to rely on offshore representatives who provide no clear answers or resolutions. Furthermore, the provider advised that their claims continue to be denied in error and they have no access to a U.S.-based representative who can properly investigate and resolve their issues which creates unnecessary obstacles to delivering care.
  
  We appreciate our provider for bringing this matter to our attention. Their feedback has been shared with the appropriate team for potential future improvements. Oscar has taken note of our providers concerns and forwarded their feedback so that coaching may be provided to the representatives involved. We want to ensure that our representatives appropriately and promptly address our providers needs, and we regret that their experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value feedback to continually help us improve our processes and procedures. 
  
  Due to the public nature of the BBB forum and the sensitive nature of this matter as it pertains to claims the Plan cannot provide details in this response.  This is not an appropriate or secure forum to discuss claims issues in detail with the provider. Kindly note, we are responding in good faith with the limited information we can provide on a public forum. If our provider would like a more detailed response we would encourage them to contact Oscar directly for assistance so that we might disclose more detailed response in a non-public forum.
  
  If our provider has any questions about this information or specific , we ask that they please contact our ***************** at ************* 
  
  Respectfully,
  
  ****** *

  Customer Answer

  Date: 02/26/2025

  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:  This is not an acceptable response. I still dont have access to a US represetnative.  The phone number you list is the same number i call and get the claims representatives that dont help .  The response saying that they will better train their **** does not help with anything since that was my first point of contact.   I will open a complaint with the insurance commissioner and see if they can help. 

   

   

  [Your Answer Here]

   

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  **** ******
  
  
  
  
   
  

  Business Response

  Date: 03/19/2025

  ***** *** **** ****** ******** ****** ***** *************************************************** ************************ ********* *** ********
  
  Dear Better Business Bureau,
  Thank you for contacting Oscar regarding a providers experience with Oscars Provider Relations Team. We have researched this case and determined the following:
  An Oscar contracted provider expresses dissatisfaction regarding Oscars Provider Relations Team representatives. The provider stated that their office is forced to rely on offshore representatives who provide no clear answers or resolutions. Additionally, the provider advised that their claims continue to be denied in error and they have no access to a U.S.-based representative who can properly investigate and resolve their issues, which creates unnecessary obstacles to delivering care.
  As stated in the previous response, the providers feedback has been shared with the appropriate team for quality improvement. We want to ensure that our representatives properly address our providers needs, and we regret that this experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value provider feedback to continually help us improve our processes and procedures.
  Furthermore, as stated in the previous response, if the provider is in need with a higher level of support, they may contact our Provider Relations Team and request a supervisor. Our supervisors are U.S.-based and can assist with complicated issues. The provider may also request disputes for any claims in question. At this time, we have verified that the provider's concerns are being investigated further by Oscar representatives. 
  Please note that due to the public nature of this forum, Oscar cannot share specific details such as HIPAA protected PHI information. This includes specific member accounts and financial information. If our provider would like a more detailed response, we encourage them to contact Oscar Provider Relations directly for assistance. 
  
  If the provider has any questions about this information, we ask that they contact our ************************** at ************ or *************************************************************. 
  
  Thank you,
  ****** *. 
  ********* ******* ***** ********* ***********
  
  

  Customer Answer

  Date: 03/19/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and feel we are just going in circles. I was never able to speak to a US representative but will continue to appeal my claims and hope for the best. 
  
  Sincerely,
  
  **** ******
  
  
  
   
  
  

• Initial Complaint

  Date:02/12/2025

  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.

  Good faith payments made to Holy Cross/Trinirty Health wating on Oscar Insurance to Assignment the payment for Medical procedures reciecved on 9/5/2023 totalling $ ****** Waiting for refund.Oscar finally said they were going to pay the claim after all the appeals and the final Maximus review ruled in my favor, It was a covered service by the plan and they must pay, The billed amount is $3716.00 from **********/ Trinity Health, ** **** **, Pain Management. They have paid all other previous claims for the exact same medical procedures except for the service date oif 10/25/2023 and I had to file the Appeals and go through the whole process and they were told it was a covered service and to pay and they in fact did. Dont understand why they are continuing to distract, delay and attempt to pay portions in addition to attemtping other unfounded reasons to try and not pay the claim. The person *** from the ************ even topld me over the phone that in late November 2024, they (Oscar Insurnace) Had mailed the payment out to **********/Trinity Health. Then checking in with the ************** at ********** Day after day after day, they never recieved the payment. Oscar was not being truthful. I still feel like a ping pong ball going back and forth being mislead, put off, delayed and played with, This has to stop. I have done everything that has been asked or requested of me from Day 1 and still there has been no finalization. Please help This is definetely abusive.

  Business Response

  Date: 02/19/2025

  ***** ********* *********** *************************** ****************** ************** ************************************************************* **************************** ******** *** **** ****** ******** ****** ***** *************************************************** ************************ ********* *** ********
  
  Dear Better Business Bureau,
  Thank you for contacting Oscar regarding the concerns of our member. 
  In this complaint, our member states they made good faith payments to Holy Cross/Trinity Health totaling $600.00 and are seeking a refund.
  Additionally, he states we have not been truthful in payments sent to the provider.
  Our Grievance Team has investigated this complaint and found that no misinformation was provided regarding coverage or payments sent to the provider.
  We have verified that we received a message from 1-800-medicare. Due to this, a Complaints, Grievances and Appeals Team liaison is currently investigating the mentioned claim. A response letter will be issued by our representative via mail to our member with more detailed information. 
  Due to the Health Information Portability and Accountability Act (HIPAA), we are not permitted to provide any details on claims or member information in our response to the Better Business Bureau. 
  We apologize for any inconvenience that this issue may have caused, and appreciate our members feedback regarding his experience. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures.
  If our member has any questions about this information he can contact our ************************** at ************ or *************************************************************. 
  
  Thank you,
  ***** ** ********* ******* ***** ********* ***********
  
  

  Customer Answer

  Date: 03/07/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. Holy Cross/Trinity Health Billing did recieve full payment ON 2/28/2025 for the 9/5/2023 claim from Oscar Insurance Company.  I am still waiting to hear back from **********/ Trinity Health Billing as to when the payment will be completed and exactly how much of a refund I will be receiving. I spoke with the ************** today and I was advised that they would be in contact with me on Monday, March 10, 2025 with all the final details.  Then the account will be settled and closed.  . 
  
  Sincerely,
  
  ****** *******
  
  
  
   
  
  

• Initial Complaint

  Date:02/12/2025

  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.

  Oscar insurance likes to provide a list of in net work doctors who actually aren't in network. When I called a handful of drs that were listed on my in network available doctors, when I called that office I was told that that specific practice and/or that specific location which I needed to go to, weren't participating in network with Oscar insurance. When I've previously called Oscar to discuss this, the 'care team' that I'm forced to work with is comprised of low level educated persons who have ZERO experience in health care and aren't trained properly to be dealing with matters related to health. I've called Oscar before and the person I had to speak with on my 'care team' told me that the only resolution she could offer me was for me to hang up the phone and hopefully get another 'care associate' because she wasn't going to do her job. So why do I pay a monthly premium if I'm getting scammed by an insurance provider? What's the point of paying a monthly premium if my visits don't get coded correctly from the drs office, oscar hires inept and incapible people of doing a job, which causes me great amounts of time lost, lost money when I take off time from work, and bills being sent to me which I shouldn't have to pay for, even after I confirmed with Oscar and Advent about how much was going to be due. I'm tired of being scammed by both Advent health and OSCAR insurance. Both of these people have a requirement to offer their policy holders and consumers a good faith estimate which they don't adhere to and double what I owe. This is fraud and medical gaslighting. It doesn't help that NP ****** ***** gaslighted me into taking a test I didn't actually need and her whole office for charting fraud and refusing to fix my patient notes. OSCAR and Advent Health need to be stripped of anything they can do, because they obviously can't do anything correct except scam their policyholders. Do better and start training your people instead of stealing from me!

  Business Response

  Date: 02/19/2025

  ***** ********* *********** *************************** ****************** ************** ************************************************************* ****************************
  ******** *** ****  ****** ******** ****** ***** *************************************************** ************************ ********* *** ********
  
  Dear Better Business Bureau,
  Thank you for contacting Oscar with our members complaint regarding our provider network and their experience with ***************.
  In our members complaint, she expresses dissatisfaction concerning the inaccuracy of our provider directory. She also expresses dissatisfaction concerning the level of service she received from *************** representatives. 
  We were unable to find this information in our records. Our records found that on January 3, 2025, she spoke with a representative regarding the accuracy of our care router regarding the network status of our members providers. The *************** representative attempted to assist our member in locating in-network providers that she was seeking. Our member declined assistance from our *************** representative and requested to speak to a supervisor instead.
  We verify it is our policy to introduce a supervisor to a member if one is available within 5 minutes. If a supervisor is not available, it is our policy to inform the member that they will receive a call back from a supervisor when available.
  We have verified that a supervisor did not contact our member or return her call. We greatly apologize for the inconvenience this caused and want to make sure our member receives the assistance she needs. We have escalated this issue to a supervisor to assist our member further.
  We verify that on January 17, 2025, we requested our member to refrain from using verbiage considered abusive per our policy via a secure message. We verify that throughout her conversations with us, our member used verbiage considered to be inappropriate and we kindly ask our member to refrain from the use of verbiage considered inappropriate or offensive. We verify our employees have the right to disconnect a call if they are found to be using abusive verbiage. 
  Our member expresses dissatisfaction regarding the network status of providers in our care router. If a provider shows as in-network in our care router and the provider informs a member that they are out-of-network, we urge our members to contact *************** at ************ for assistance in this matter.
  On February 11, 2025, we sent our member a message regarding an issue we found within our systems which may have caused her to see an incorrect cost-share for her deductible and maximum out-of-pocket limit. We were happy to inform our member that this issue was corrected on February 8, 2025.
  We verify that our members time is valuable and acknowledge her dedication to speak with us about any existing issues there might have been. 
  If our member has any questions about this information she can contact our *************** Department at ************ or *************************************************************. 
  
  Thank you,
  ***** *. 
  Grievance Liaison
  Oscar Insurance Corporation
  
  

• Initial Complaint

  Date:01/21/2025

  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 have *******************. I've been using the same medication, *******, for several years. It is very effective, and before finding a suitable medication, I tried several others that had side effects and did not lower my eye pressure. In December, I purchased new health insurance with Oscar. Before selecting this plan, I checked and confirmed that my eye drops were covered. The policy confirmed they were covered. When I tried to fill the medication, they refused it. My ophthalmologist requested preapproval, which was also refused. I'm stuck with no medication, which is very risky for my condition. How can I get Oscar to approve my eye drops, which I was told they would cover before I signed up? It seems they are in breach of contract.

  Business Response

  Date: 01/22/2025

  ******* *** **** ****** ******** ****** ***** *************************************************** ************************
  Complaint ID: ********
  
  Dear Better Business Bureau,
  
  Thank you for contacting Oscar regarding the concerns expressed on behalf of our member. We have researched this case and determined the following: 
  
  Our member expressed dissatisfaction regarding the prior authorization requirement for the prescription medication *******. The member stated that they have been using the same medication, *******, for several years and it is very effective. Furthermore, the member advised that before finding a suitable medication they tried several others that had side effects and did not lower their eye pressure. In December, the member purchased new health insurance with Oscar but before selecting the Oscar policy they checked and confirmed that the eye drops were covered. Oscar confirmed the medication was covered, however, when the member tried to fill the medication Oscar denied the medication for lack of an approved prior authorization on file. 
  
  Oscar confirms that certain prescription drugs that are highly-regulated, cause specific side effects, or have a high cost may have additional requirements, such as a prior authorization. These requirements ensure that our members use these medications in a safe, effective way. Oscar confirms that the prescription drug ******* requires an approved prior authorization from Oscars Pharmacy Team, in order to be eligible for coverage by the plan. Prescription drug requirements and/or limits can be found by reviewing our 2025 preferred drug list at *******************************************************************. Kindly note, Oscars Pharmacy Team processes all prescription drug authorizations based on medical necessity.
  
  We encourage our members to speak with their prescribing provider regarding their prescription needs.
  
  We apologize for our members experience concerning his 2025 policys medical necessity criteria for prescription drugs. If our member has any questions about this information, we ask that they please contact our ************************** at 855-OSCAR-55 or *************************************************************. 
  
  Respectfully,
  Complaints Grievances & Appeals
  Oscar Insurance Corporation
  
  

  Customer Answer

  Date: 02/11/2025

  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:

  I reject Oscars response for the following reasons. I have been fighting with them sinse I signed up in December 2024.For medication they said they would cover. And is on their list of provided medications.
  
  *******, has been essential for managing my *******************.
  
  I have been using ******* for several years,
  
  ******* has proven to be highly effective for my condition. 
  
  Prior to selecting my current health insurance plan with Oscar of NJ, I confirmed during the sign-up process that my eye drops were covered, as indicated on the sign-up screen.
  
   Unfortunately, when I attempted to fill my prescription, the pharmacy refused to dispense the medication .
   Additionally, my ophthalmologist submitted a request for pre approval in December 2024, which was also denied.
  
  As a result, I am currently without the necessary medication to manage my condition, putting my health and vision at significant risk. 
  
  I believe this denial constitutes a breach of contract, as the coverage was confirmed during the enrollment process. Furthermore, my ophthalmologist, Dr. ******* J. ***** of the ******************************, has documented my treatment history and the trials I underwent before determining that ******* is the most appropriate medication for me.
  
  Subjecting me to the trial and failure process again would not only be inhumane but could also have detrimental effects on my health.
  I kindly request that Oscar review my case and reconsider the incorrect decision regarding my coverage for *******.
  Thank you for your attention to this urgent matter. I look forward to your prompt response.
  Sincerely,
  
  ***** *****.

  
  Sincerely,
  
  ***** *****
  
  
  
  
   
  

  Business Response

  Date: 02/12/2025

  ******** *** **** ****** ******** ****** ***** *************************************************** ************************ ********* *** ********
  
  Dear Better Business Bureau,
  
  Thank you for contacting Oscar regarding the concerns expressed on behalf of our member. We have researched this case and determined the following: 
  
  Our member expressed dissatisfaction regarding the prior authorization requirement for the prescription medication *******. The member stated that they have been using the same medication, *******, for several years and it is very effective. Furthermore, the member advised that before finding a suitable medication they tried several others that had side effects and did not lower their eye pressure.On February 11, 2025, the member submitted another complaint through the Better Business Bureau stating that they reject Oscars response for the following reasons. They have been fighting with Oscar since they signed up in December 2024 Additionally, the member stated this is for medication that Oscar said they would cover which is on their list of provided medications. *******, has been essential for managing the members *******************.
  
  Oscar confirms that certain prescription drugs that are highly-regulated, cause specific side effects, or have a high cost may have additional requirements, such as a prior authorization. These requirements ensure that our members use these medications in a safe, effective way. Oscar confirms that the prescription drug ******* requires an approved prior authorization from Oscars Pharmacy Team, in order to be eligible for coverage by the plan. Prescription drug requirements and/or limits can be found by reviewing our 2025 preferred drug list at *******************************************************************. Kindly note, Oscars Pharmacy Team processes all prescription drug authorizations based on medical necessity.
  
  We encourage our members to speak with their prescribing provider regarding their prescription needs and whether a prior authorization or appeal should be pursued. The prescription prior authorization or appeal process is managed by our Pharmacy Team, meaning, if a member disagrees with our decision to deny a prescription, then their provider may submit additional supporting clinical information for our Pharmacy Team to re-review your request. Additionally, the reason for any prior authorization decision is provided to our members and their provider detailing our clinical rationale.
  
  Please note, due to the public nature of this forum, the plan cannot share specific details such as HIPAA protected and PHI information or specific member accounts and financial information such as names of the provider as well as names of the prescription medication. If our member would like a more detailed response we would encourage her to contact the plan directly for assistance with the grievance she has open directly with the plan so that we might provide her with a more detailed response in a non-public forum.
  
  We apologize for our members experience concerning his 2025 policys medical necessity criteria for prescription drugs. If our member has any questions about this information, we ask that they please contact our ************************** at 855-OSCAR-55 or *************************************************************. 
  
  Respectfully,
  Complaints Grievances & Appeals
  Oscar Insurance Corporation
  
  

  Customer Answer

  Date: 02/13/2025

  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:

  Prior to signing up with Oscar, I confirmed that this medication would be covered by Oscar. Given my long-standing reliance on this medication, I'm concerned that Oscar may not be upholding their contractual obligations, therefore putting my eye health at risk. 

  Thank you,

  Sincerely,
  
  ***** *****
  
  
  
  
  

   

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  
  
  
  
   
  

• Initial Complaint

  Date:12/27/2024

  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.

  My doctor recommended a soft tissue ultrasound, and I called Oscar Insurance for the cost. The representative found it was $0, but he thought this was incorrect -- although most insurance companies do cover the procedure in full. I ended up calling Oscar three times and getting three mutually contradictory answers.Eventually, I called and explained the problem to an Oscar representative, and she initiated a conference call, bringing in the caregiver. The date was November 20. The caregiver provided their cost. The Oscar representative applied a percentage and obtained the amount of $92. Based on this information, I had the procedure done. Afterwards, I was charged $188.46, more than double the amount Oscar had said.Oscar often charges more than they say they will, arguing that extra services were provided. Other insurance companies don't seem to have this issue with extra services. In this case, I checked my bill, and the ultrasound is the only service listed.On being charged $188, I called Oscar Insurance yet again. The representative said he was going to escalate the issue, and it would take several days to resolve. Several days later, I hadn't heard back, so I called again. A representative again said she would escalate the issue, and it would take a few days. I still haven't heard back. At this point, I doubt that Oscar has any intention of resolving the ********** a resolution, I would like to be charged $92 as Oscar said. My premium is more than $1,000. The least Oscar can do is provide an accurate cost when a customer asks. I can provide the representative's name if it would be helpful.

  Business Response

  Date: 01/02/2025

  ***** ********* *********** *************************** ****************** ************** ************************************************************* **************************** ******* ** **** ****** ******** ****** ***** *************************************************** ************************ ********* *** ********
  Dear Better Business Bureau,
  
  Thank you for contacting Oscar with regarding the concerns of our member. In this complaint, our member states that our representatives provided them with an incorrect cost estimate resulting in an unexpected financial responsibility for an ultrasound. 
  
  Our Grievance Team has investigated this complaint and found that no misinformation was provided in regards to a cost estimate. 
  
  We have verified that the member was provided the following disclaimer with the cost estimate:
  
  Please keep in mind that you may receive more or fewer procedures based on your doctors discretion and your final cost may be more or less than this estimate. This estimate takes into account the amount you have already paid towards your deductible and max-out-of-pocket (excluding any pending claims).
  
  Please note that due to changing circumstances, this estimate may be subject to changes outside of our control. Note that we do not guarantee that your coverage will match the description provided today.
  
  Oscar *************** may provide a cost estimate range to our members, based on average costs for similar services in their area. Please note that these quotes are estimates only, and may vary.
  
  We apologize for any inconvenience that this issue may have caused, and appreciate your feedback regarding your experience. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures.
  
  If our member has any questions about this information she can contact our *************** Department a* ************ ** *************************************************************. 
  
  
  Thank you,
  ***** *.
  ********* ******* ***** ********* ***********
  
  

  Customer Answer

  Date: 01/02/2025

  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 company did not propose a resolution. In addition, several easily verified facts belie the claims made in the company's response. My bill shows that no additional procedures were provided, and that the cost charged by the caregiver did not increase. The Oscar representative stated that she obtained her result by applying a percentage to that cost. This result was not an estimate range and could not have been based on average costs for similar services. Therefore, it cannot truthfully be described as an estimate as quoted in Oscar's response. Oscar simply said one thing and did another.

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  ******* ******
  
  
  
  
   
  

  Business Response

  Date: 01/06/2025

  ***** ********* *********** *************************** ****************** ************** ************************************************************* **************************** ******* ** **** ****** ******** ****** ***** *************************************************** ************************ ********* *** ********
  Dear Better Business Bureau,
  Thank you for contacting Oscar regarding the concerns of our member. In this complaint, our member states that a resolution was not provided.
  Our Grievance Team has investigated this complaint response and we stand by our findings. We found that no misinformation was provided regarding a cost estimate. 
  On November 20, ********************************************************************************************************************************************************** less depending on whether you receive more or fewer procedures at your provider's discretion. Additionally, we advised you because this is a cost estimate, to please reach out to your provider for the actual cost of your procedure.
  Our Grievance Team found you had an additional interaction via secure messaging on November 20, 2024. In that interaction you were advised that a cost estimate is based on the information you have provided. 
  Additionally, you were informed that your final cost may be more or less than this estimate. This estimate takes into account the amount you have already paid towards your deductible and max-out-of-pocket (excluding any pending claims).
  We noted and informed you that due to changing circumstances, this estimate may be subject to changes outside of our control and that we do not guarantee that your coverage will match the description provided today.
  In a call with your provider on November 20, 2024 and our *************** Team, we advised you that because you have not met your deductible, you will need to pay the allowed contracted amount.
  The allowed amount is an agreed contracted amount and the most your provider will be able to charge you for services rendered.
  In your call, we verified that your provider did not have the information available to provide you an accurate cost-estimate as they did not have fee schedule information yet. They state the full cost of your procedure is $354.00.
  We verify that this is the full amount the provider charged in your claim and the allowed amount your provider was able to charge you per our contract is $188.46. We verify that because your deductible was not satisfied at the time of claim processing, your cost-share is correct and no misinformation was provided.
  We sincerely apologize for any inconvenience this may have caused, and appreciate your feedback regarding your experience. We want to ensure that we meet our members needs and we regret that your experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value member feedback such as your own to continually help us improve our processes and procedures.
  If our member has any questions about this information she can contact our *************** Department at ************ or *************************************************************. 
  
  Thank you,
  ***** *.
  ********* ******* ***** ********* ***********
  
  
  

  Customer Answer

  Date: 01/07/2025

  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:

  As before, Oscar Insurance has not proposed a resolution, but has only attempted to defend its previous actions. Nothing in the disclaimers that Oscar quoted previously and has now reiterated provides a legal or ethical basis for citing a cost of $92 before a procedure but charging the customer $188 afterwards. There is no need to continue debating the matter. The time and money Oscar took to prepare its responses would have been better spent making this right.
  
  Oscar acknowledges that the full cost of the procedure, as stated by the caregiver on November 20, was $354. On receiving this amount, the Oscar representative applied a percentage and obtained a cost to me of $92. After the procedure was completed, the full cost, as printed on the bill, was still $354. Therefore, the cost to me should also have been the same. Instead, it was more than double.
  
  Oscar mentions a contract that it says supports the larger amount. An Oscar representative obtained the cost of $92, even if it was erroneous. Therefore, Oscar must honor that cost.
  
  Most insurance companies cover this procedure in full. Even $92 is exorbitant; $188.46 is beyond reason.

   

  Sincerely,

  
  ******* ******
  
  
  
  
   

  
  

• Initial Complaint

  Date:12/19/2024

  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 received a bill for a service I never requested. An account was opened in my name without my consent. I spent over half an hour navigating the customer service phone network to talk to a person who said they could not cancel my account because some Agent opened an account through the government marketplace without my consent.

  Business Response

  Date: 12/27/2024

  ******** *** **** ****** ******** ****** ***** *************************************************** ************************
  
  Complaint ID: ********
  
  Dear Better Business Bureau,

  Thank you for contacting Oscar regarding our members enrollment into an Oscar policy.

  In the members complaint, she expresses dissatisfaction regarding her enrollment into an Oscar policy without her consent.

  Kindly note, Oscar does not have the ability to make changes to our members policies if they are enrolled through the Federally Facilitated Marketplace (FFM) without first receiving instruction from the ***. We rely on data sent to us electronically from the **** when we receive an update about a members policy, we must adjust their policy to reflect the information as relayed exactly in the data transmission. Upon investigation of the 834 communication sent by the ***, our members policy has been cancelled at this time and if she has additional concerns regarding her enrollment, the *** can be contacted at **************.
  Oscar sincerely apologizes for any inconvenience this issue may have caused, and appreciates our members feedback regarding her experience. We want to ensure that we meet our members needs and we regret that her experience did not reflect that expectation. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures.

  Please note, due to the public nature of this forum, the plan cannot share specific details such as HIPAA-protected and PHI information or specific member account and financial information such as specific policy details and dates. If our member would like a more detailed response, we would encourage her to contact the plan directly for assistance with the grievances she has opened directly with the plan so that we might provide her with a more detailed response in a non-public forum.
  If our member has any questions about this information she can contact our ************************** at 855-OSCAR-55 or *************************************************************. 
  
  Thank you,
  Complaints, Grievances & Appeals
  Oscar Insurance Corporation
  

  
  

• Initial Complaint

  Date:12/10/2024

  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.

  Oscar hasn't paid claims submitted to them for health care I've received from doctors that are in their own network. Oscar is now saying that I owe thousands of dollars that I don't owe to them. Lastly a collection agency is now sending me threatening letters, because of their non payment of claims

  Business Response

  Date: 12/23/2024

  ***** ********* *********** ********************************************************************************************** ************** ************************************************************* **************************** ******** *** ****  ****** ******** ****** ***** *************************************************** ************************ ********* *** ***************** 
  
  Dear Better Business Bureau,

  
  Thank you for contacting Oscar regarding the concerns expressed on behalf of our member. 

  
  In the members complaint, he  expresses dissatisfaction regarding the processing of his claims and Open Enrollment for the 2025 plan year.

  
  We have escalated the members concerns in regards to the claims internally for review. Should there be an adjustment, the member will receive a new Explanation of Benefits to his residence on file. Due to all BB responses being public, we are not legally able to discuss the details of our findings with you due to the Health Information Portability Accountability Act (HIPAA). 
  Oscar values the privacy of our members and works to ensure that confidential information is only shared with authorized individuals. In order to protect our members personal health information and to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Oscar requires that appropriate authorization be obtained for individuals requesting information about another individuals health history, prior authorizations or claims. This authorization is required regardless of the individual or business relationship with the individual.

  
  Additionally, if the member is seeking to enroll with alternative health insurance providers, we encourage the member to contact their state marketplace by calling Georgia Access **************.

  
  Oscar does not have the ability to make changes to our members policies if they are enrolled through the Federally Facilitated Marketplace (FFM) without first receiving instruction from the **** We rely on data sent to us electronically from the **** when we receive an update about a members policy, we must adjust their policy to reflect the information as relayed exactly in the data transmission.

   

  We apologize that we are unable to adjust your policy without first receiving direction from the ****

  
  We apologize for any inconvenience that this issue may have caused, and appreciate your feedback regarding your experience. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures.

  
  If our member has any questions about this information she can contact our ************************** at ************ or *************************************************************. 
  
  Thank you,
  ***** **  ********* ******* ***** ********* ***********
  

  
  

• Initial Complaint

  Date:11/18/2024

  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.

  I was recently diagnosed with endocrine pancreatic insufficiency. A disease that causes chronic diarrhea and is countered by a medication that requires prescription. My insurance has this new system where all Prescriptions go through a pre authorization process. The issue here is that while my ** agrees i need medication to treat my condition and urged insurance, they chose to deny it. No proof no reason just that they didnt have enough information even though there are stool tests that show a clear endocrine pancreatic insufficiency

  Business Response

  Date: 11/21/2024

  ***** ********* *********** ********************************************************************************************** ************** ************************************************************* **************************** ******** *** **** ****** ******** ****** ***** *************************************************** ************************ ********* *** ********
  
  Dear Better Business Bureau,
  Thank you for contacting Oscar with your recent concerns regarding the prior authorization of your medication. Our Grievances Team has reviewed your concerns and determined the following:
  In your complaint, you express dissatisfaction regarding the prior authorization process of your medication.
  On November 20, 2024 our Grievances Team confirmed with your provider that they received a request for more information from our Pharmacy Team to make an informed decision about your prior authorization for your medication.

  Your providers office informed our team they will be submitting the requested information for review. 
  Oscar confirms that certain prescription drugs that are highly-regulated, cause specific side effects, or have a high cost may have additional requirements, such as a prior authorization. These requirements ensure that our members use these medications in a safe, effective way. Oscar confirms that your prescription drug requires an approved prior authorization from Oscars Pharmacy Team, in order to be eligible for coverage by your plan.

  Kindly note, Oscars Pharmacy Team processes all prescription drug authorizations based on medical necessity. 

  Please kindly note, a determination for coverage of your medication has not been made at this time. You will be notified via mail once a determination has been made.
  We apologize for any inconvenience that this issue may have caused, and appreciate member feedback regarding member experiences. Oscar strives to maintain a high standard of service, and we value member feedback to continually help us improve our processes and procedures.
  
  If our member has any questions about this information she can contact our ************************** at 855-OSCAR-55 or *************************************************************. 
  
  Thank you,
  ***** **  ********* *******
  Oscar Insurance Corporation