ComplaintsforEmblemHealth
Health Insurance
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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
01/16/2024
- Complaint Type:
- Order Issues
- Status:
- Resolved
I am writing to you regarding the above captioned bills #********** for $19.62 and ********** for $510.09, with a date of ******* of *** 26,2023 from Quest ***************************** provided the incorrect information to Quest when processing my blood work with the following info:************************* **** ****************************************************** Insurance Carrier: Oxford I have contacted Quest and provided the correct name, address, and insurance information.************************* ***** ********************************************** ***** Insurance Carrier: Emblem Health (GHI)Member ID: *********** Despite my good faith efforts of updating all my information, I am continuing to receive bills directing from Quest with denials from my insurer. I am happy to pay my patient responsibility after my insurer has processed the claim.Emblem Health GHI - on your side per Quest you keep denying the bills because you cannot identify me as a member. Also states that you may not have a record of my claim as it may have been rejected before entering into your claims system.Customer response
01/26/2024
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 and the matter has been resolved.
Sincerely,
*************************
Initial Complaint
11/01/2022
- Complaint Type:
- Order Issues
- Status:
- Resolved
We are an out of network provider. Most of our claims are ******** crossovers. Most of our patients get paid directly, some do get paid to the provider. Emblem paid a member directly and are recouping the blanace from several of our accounts. There is no explaination. I have appealed this and filed grievances with no resolution and it is *********** into many patient accounts. This is an impossible problem to resolve at this point as all of my letters, faxes and Emails go unanswered. When you call you are on perma hold for 90 minutes an they disonnect the call over and over. I ask for details and am told we need a finacial report and this can take up to 30 days time to receive- this is unfair to the doctor and our staff who spends countless hours on the phone with this impossible insurance companyBusiness response
11/16/2022
Attached is a copy of the acknowledgment letter which was mailed to your department on 11/9/2022Customer response
11/16/2022
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is not satisfactory to me and the matter has not been resolved.
Sincerely,
*************************
Initial Complaint
11/01/2022
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I requested a refund for premium payment I made for September,2022. I terminated health insurance effective 8/31/22. I requested the refund $30 in July, 2022. Emblemhealth never sent my refund. Although I provided my updated address when I requested the refund, they claimed they mailed it to my old address. I have been calling since 11/1/22, and they still have not issued a refund for $30.Business response
11/16/2022
Attached is a copy of the acknowledgment letter mailed to your department on 11/15/2022. Thank youInitial Complaint
07/08/2022
- Complaint Type:
- Order Issues
- Status:
- Resolved
my name is ************************* my subscriber # is ***********, I have been trying for the past year to have my Granddaughter (*******************************) removed from my health care plan so she can obtain her own health care. During this time time ******************** Required me to submit papers to have her removed first, which I have successfully done at this point and the papers have been forwarded to Emblem health to note. She can not obtain her own health care until I provide her with documentation that she is no longer on my plan. i have tried unsuccessfully several times, even asking for a supervisor to email me a copy. Emblem health claims to have mailed a copy, that I never received. They Emailed me something that is in a format I could not open. I need your assistance in resolving this simple matter. Thank you *************************Customer response
07/15/2022
Better Business Bureau:
I have resolved my complaint made against Emblem Health ID ********, they have issued me the proper documentation as requested for my granddaughter to receive insurance. Thank you for your assistance.
Sincerely,
*************************
Initial Complaint
02/11/2022
- Complaint Type:
- Billing Issues
- Status:
- Unanswered
Services were rendered by our provider and claims submitted within timely filing. Emblemhealth delayed/ denied payment on our valid claims for reason that services require authorization. Prior to rendering services and throughout the course of care for their covered member, our office confirmed with the health plan that radiation therapy services did not require authorization for outpatient, office setting. We are an outpatient, office setting. We have multiple calls to EmblemHealth Provider Services stating authorization was not required. After appeal submission and unproductive calls to the health plan, claims were paid late without interest calculated, as per NY Prompt Pay Law. Interest owed remains outstanding.Initial Complaint
01/27/2022
- Complaint Type:
- Sales and Advertising Issues
- Status:
- Unanswered
As of 2020, the ***************** has mandated that IVF (3 rounds of embryo transfers) be covered for people diagnosed with infertility. I was diagnosed as such and had treatments between November 2020 and April 2021. Emblem and their underwriter Montefiore has refused to pay out what the state has mandated. I have been left with a $12k ****. My doctor has submitted the **** on multiple occasions. It comes back with a rejection stated that I have exceeded my lifetime allotment. The state mandates three transfers. I have only had three transfers.Initial Complaint
12/01/2021
- Complaint Type:
- Service or Repair Issues
- Status:
- Resolved
I went to *************************************** in January of 2021 to be assessed for Invisalign dental liners to fix my teeth. My orthodontist office contacted Emblem Health to see what my dental benefit for the Invisalign liners would be. On 2/16/21, they were told that the ortho benefit was $1998.00 and it was available to me and there was no age limit to this benefit.Emblem denied all of my claims. My orthodontist office and I each contacted Emblem multiple times, and each time we were told different things by different customer service representatives. Some said I was over the age limit for the benefit. Some said they age limit didn't matter since I was the policy holder.I filed an appeal and received notice from Emblem that due to inconsistent information given to me by Emblem Health, my claim was re-sent to the claims team.I called again on 11/27 and once again, I was told that I am denied due to being over the age limit.I would never have agreed to this expensive procedure if i knew that Emblem would deny my claim when initially they agreed to pay it. This has been going on for almost a year. I pay dutifully into this dental insurance and I want them to pay my claim, as they said they would.thank you for your assistance in this matter.**************************************Business response
12/22/2021
This is to acknowledge receipt of your inquiry submitted on behalf of Elise ******* ***** that was received by the Grievance and ***************** on 12/01/2021.
In order to protect the members confidentiality, we must confirm that the member is aware that this inquiry has been filed on her behalf. We require a signed statement affirming that she is aware. We cannot disclose confidential information until we receive authorization from the member.
Should we receive this authorization from the member,you will be advised of the outcome of the inquiry. If the member does not give the consent for the outcome of the investigation to be disclosed to you, we will respond to the member directly with our findings.Customer response
12/24/2021
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 and the matter has been resolved.
Sincerely,
**************************************
Initial Complaint
09/20/2021
- Complaint Type:
- Product Issues
- Status:
- Unanswered
FIRST OF ALL WE ARE OUT OF NETWORK PROVIDERS: WE SUBMITTED A SURGERY AND WERE PAID AT OUT OF NETWORK RATES- THEN WITHOUT OUR KNOWLEDGE, NO LETTER , NO NOTIFICATION EMBLEM TOOK IT UPON THEMSELVES TO START TAKING ALL OF THE MONEY BACK STATING THEY PAID INCORRECTLY. THIS IS NOT TRUE. THIS IS COMPLETELY INCORRECT. WE HAVE TRIED ON SEVERAL OCCASIONS APPEALING TO THEM, WE HAVE TRIED TO CONTACT THE CEO, WE HAVE FILED COMPLAINTS ETC. NOTHING HAS BEEN DONE AND THIS HAS GONE ON FOR MONTHS. THIS IS VERY WRONG... THIS IS CONTINUING... EVERY CLAIM WE SUBMIT THEY TAKE THE MONEY AWAY. RECOUPMENTS ARE CONTINUING. THIS IS THE WORST EXPERIENCE WE HAVE HAD WITH ANY INSURANCE COMPANY. WE HAVE TRIED TO GET OUR PROVIDER PROFILE CORRECTED ALSO AND WE CANNOT GET THROUGH TO THEM. HOLD TIME IS OVER 2 HOURS AND THEN YOU GET DISSCONNECTED. THIS IS COMPLETELY APPAULING AND UNFAIR. PLEASE BEWARE OF THIS INSURANCE!!!!! THEY ARE THE WORST. WE WANT TO BE REIMBURSED FOR ALL CLMS INVOLVED AND THIS TO STOP IMMEDIATELY!Customer response
11/01/2021
Better Business Bureau:
At this time, I have not been contacted by EmblemHealth regarding complaint ID ********. THE CEO OF EMBLEM HEALTH IS ***** ******* AT ****************************** AND THE PHONE IS ###-###-####. I TRIED WRITING HER AND TRIED CONTACTING HER AS WELL AND NO RESPONSE. I HOPE YOU HAVE BETTER LUCK THAN ME. THANKS SO MUCH FOR YOUR REPLY.
Sincerely,
****** ************
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Customer Complaints Summary
59 total complaints in the last 3 years.
17 complaints closed in the last 12 months.