ComplaintsforOscar

• Initial Complaint

  03/25/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  This case involves my daughter, whi has "Special Needs" (***** ******* *****). Someone from this Company, had decided (unbenouched too me), to sign my daughter up, as a 3rd party Health Plan. I never signed my daughter for this. This is now blocking me, from getting the medication for her *****/Allergies. When I go to the pharmacy to retrieve her medication, they are charging me $300.00, that I can not afford at this time. I have tried contacting this 3rd party health insurance, to take my daughter off of this plan, but they lie and give me accusses or the run around. This is so "Unprofessional".

  Business response

  04/04/2024

  ***** ** **** ****** ******** ****** ***** ** **************** * **** ***** ********* ** *****  ********* *** ********
  
  Dear Better Business Bureau,
  Thank you for contacting Oscar regarding the members enrollment in an Oscar policy. In the members complaint, they state dissatisfaction that they were enrolled in an Oscar policy without consent.
  

  Kindly note, Oscar does not enroll members directly when they are 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. In order to understand the policy enrollment, the member must contact the *** directly. 
  

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

  
  

• Initial Complaint

  02/20/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Yes the health insurance Oscar is doing bad business practices, there neglecting my calls , there not answering my phone they never created an account in the app or allow me too they also dont answer my calls and there doing organized schemes with my providers and pharmacies

  Business response

  03/15/2024

  ***** *** **** ****** ******** ****** ***** ************************************************************************************** ********* *********
  
  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 their experience when contacting Oscar ****** Services, creating an online account, and accessing in-network providers and pharmacies. 
  Our records indicate that our member has created an online member account during the 2022 plan year. We do not have any inquiries from the member, regarding their online member account access. Additionally, the member has not notified Oscar of any neglected calls. Furthermore, the member only contacted Oscar once since 2022 and our ****** Services Team successfully assisted the member by answering their benefit questions, as well as informed the member how to locate a provider they requested.
  If our member has questions or concerns, they can reach Oscar ****** Services at **************, by email at ********************************* or by secure message, 8am - 8pm Monday through Friday. ****** Services can also assist with restoring access to our members online account. Once access is restored, the member may also search for providers and pharmacies online that are in-network with their plan. Furthermore, our ****** Services Team is always happy to help with any provider or pharmacy network issues.
  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 a provider as well as names of a prescription medication. If our member would like a more detailed response we would encourage him to contact the plan directly for assistance with the grievance he has opened directly with the plan so that we might provide him with a more detailed response in a non-public forum.
  If our member has any questions about this information, we ask that they please contact our ****** Services Team at ************ or *********************************. 
  Respectfully,
  Complaints Grievances & Appeals
  Oscar Insurance Corporation
  
  

  Customer response

  03/25/2024

  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

  02/06/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Hello, I have contacted **** along with my doctors, doctors billing and pharmacy and they are saying you still have not approved the claim. But when I go and log in it pops up these notifications Yet that is not true. I called yall again and confirmed I owe not money . I tried to contact member services but wont let me access member services info and this was my only other option except your pr and broker email. I tried contacting your IG. I just dont know what else to do. I really need my coverage. I have been paying hundreds out of pocket for the past month and I cant continue to afford this.Attached are the error messages that popped up when I tried to sign in.Can you please do the following: 1. Reibeurse me for prescriptions the past month. 2. Contact my doctors that have contacted ****. 3. ********************* *************************************** asap to help get the prescription claim to you and approved 4. Can you give me a monetary apology as this has been a headache and I have never encountered this with an insurance.

  Business response

  02/20/2024

  ***** ********* *********** ***************************** *** *****  ********* ** ***** ************** ********************************* *********** ******** *** **** ****** ******** ****** ***** ************************************************************************************** ********* *** ********
  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 termination of his Oscar policy. 
  On February 6, 2024, we received a complaint from our member about the cancellation of his policy. 
  Oscar confirms that his policy was terminated due to nonpayment. We do not show that he has had an active policy with Oscar. Because his policy was terminated, he does not have access to his online portal. We encourage him to contact Oscar ****** Services at the phone number listed below for further assistance. 
  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 a provider as well as names of a prescription medication. If our member would like a more detailed response we would encourage him to contact the plan directly for assistance with the grievance he has opened directly with the plan so that we might provide him with a more detailed response in a non-public forum.
  If our member has any questions about this information, we ask that they please contact our ****** Services Team at ************ or *********************************. 
  Respectfully,
  Complaints Grievances & Appeals
  Oscar Insurance Corporation
  

  
  

• Initial Complaint

  01/12/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  This insurance company is scamming me because they are not authorizing my prescriptions to go through. Before I even signed up with this company we had asked them over the phone if this was going to work and of course to get the sale they said yes. I have had nothing but problems I have yet to get one thing my doctor has prescribed through them. Just started with this company and having issues immediately. Every time I call their customer service it is someone from ***** who can barely speak english. I don't recommend anybody use this company for anything. They're requiring pre-authorizations and asking me to get more tests done. I have already done this this is why I have the prescriptions now they want me to redo them since they are now the provider this is unacceptable. They want to take your premiums they want you to sign up but they do not want to hold up their end of the bargain.

  Business response

  01/18/2024

  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 authorization requirements for the approval of his prescription provided by Oscar ****** Services representatives. The member stated that Oscar is scamming them because Oscar is not authorizing their prescriptions to go through. The member advised that before they signed up with Oscar he asked over the phone if this was going to work and of course to get the sale Oscar said yes. Furthermore, our member stated that they just started with Oscar and are having issues immediately. Every time the member calls customer service it is someone from ***** who can barely speak english. Additionally, Oscar is requiring a prior authorization requesting that the member get more tests done and that Oscar wants to take premium payments but they do not want to hold up their end of the bargain.
  
  On January 11, 2023, the member contacted Oscar ****** Services to check the status of their prior authorization request for their medication. The Oscar representative informed the member that it could take a day or two because the prior authorization request was submitted as non-urgent. According to our records, the members prior authorization request was received on January 9, 2024 and processed on January 10, 2024 by Oscars Pharmacy Team. **********, the member has not contacted Oscar ****** Services again regarding his prior authorization request.
  
  We apologize for our members experience concerning his prior authorization request. If our member has any questions about this information, we ask that they please contact our ****** Services Department at ************ or *********************************. 
  
  Respectfully,
  Complaints Grievances & Appeals
  Oscar Insurance Corporation
  
  

  Customer response

  01/25/2024

  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:

  [Your Answer Here]

   I have spoken with my doctors about this. The insurance company is requiring that my lab results be lower in order to continue with my prescription. The reason my lab results are the way they are is because I am on the prescription. They want to lower my quality of Health and have my labs tank out in order to fill the prescription. They know that my body can no longer produce what is needed as I have been on this prescription for quite some time. This is a way for the insurance company to get out of paying for necessary prescriptions that I need. My doctors agree with this. My doctors have also sent them in my lab results from before I was on the prescription which showed the levels below normal. So now they want to end my prescriptions which will deplete my energy and make my quality of life significantly lower. This is unacceptable. They are not qualified to make this decision. If they do have a doctor to look at these results I need his or her name and contact information so my doctor can speak directly to them and check they're qualifications and reasoning. This is going to be needed as well for future litigation I am seeking.

   

   

   

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

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

  Business response

  01/29/2024

  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 authorization requirements for the approval of his prescription provided by Oscar ****** Services representatives. The member stated that Oscar is scamming them because Oscar is not authorizing their prescriptions to go through. The member advised that before they signed up with Oscar he asked over the phone if this was going to work and of course to get the sale Oscar said yes. Furthermore, our member stated that they just started with Oscar and are having issues immediately. Every time the member calls customer service it is someone from ***** who can barely speak english. Additionally, Oscar is requiring a prior authorization requesting that the member get more tests done and that Oscar wants to take premium payments but they do not want to hold up their end of the bargain.
  
  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. Authorization determinations consider multiple factors, including the circumstances of the service, medical policy, clinical guidelines, pharmacy and therapeutics guidelines and the setting of the service. Oscars Pharmacy Team processes all prescription drug authorizations based on medical necessity.
  
  On January 11, 2023, the member contacted Oscar ****** Services to check the status of their prior authorization request for their medication. The Oscar representative informed the member that it could take a day or two because the prior authorization request was submitted as non-urgent. According to our records, the members prior authorization request was received on January 9, 2024 and processed on January 10, 2024 by Oscars Pharmacy Team. **********, the member has not contacted Oscar ****** Services again regarding his prior authorization request.
  
  We apologize for our members experience concerning his prior authorization request. If our member has any questions about this information, we ask that they please contact our ****** Services Department at ************ or *********************************. 
  
  Respectfully,
  Complaints Grievances & Appeals
  Oscar Insurance Corporation
  
  

• Initial Complaint

  10/05/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was an Oscar member in 2021 and 2022. I am not a member now. A couple of months ago, a provider I saw in April of 2022, sent me a bill for 2 visits that month. (I had already satisfied my deductible in February.) . I contacted them and then Oscar and was told by the provider that Oscar was sending adjusted claim amounts to them for many many patients. Again, this was from a year and a half after the date of service. I then submitted a grievance and Oscar denied the appeal saying they have the right to audit their records from any year they like. So, I had already paid them over thousands in monthly premiums plus my deductible and copays.I just got a new claim from them for December 2021. They adjusted the contracted amount and it indicated I may owe the provider almost $200. Again, this is from January of 2021.So basically Oscar is going thru many years of claims and adjusting rates, which could result in their members having to pay more money toward their already met deductible, years after the visit. In my opinion this is criminal. We, as members, have no recourse unless we want to *** them. They are taking advantage of ****s of their clients/ex clients bc their company wants to make even more money. I have no idea if they are going to go back even more years and, it is causing a great deal of anxiety money and, again, it is IMO, theft. I am submitting this bc I think you should know what they are doing and I want my money back for the amount I just paid and do not want to be charged in the future for visits I have read paid for, just bc they decided they want to make more money. I also want anyone who is contemplating choosing Oscar to know that they take major advantage of their members and that they should find another provider. They lack integrity and are incredibly greedy.

  Business response

  10/19/2023

  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 adjustment of their claims. Specifically, the member states their claims were readjusted at a later date resulting in an overpayment as their accumulator amounts had been previously met. 
  Oscar can confirm we may review our members claims to ensure they were paid correctly based on the contracted rates with in-network providers, plan benefits or any other circumstances. Please note, if an adjustment is made, the adjusted member cost-share is based on the status of the members accumulators at the time of processing. Charges will apply to the members accumulator on the date that a claim is paid, and will not necessarily correspond to the chronological order of the care that the member received. If claims are adjusted after submission, this may change a members accumulator amounts. 
  To ensure our members cost-share is correct based on their plan accumulators, this feedback has been forwarded to Oscars Claims Team for review.
  Please also note that due to the public nature of this forum Oscar cannot share specific details such as HIPAA protected and PHI information or specific member accounts and financial information such as claim and payment details. If our member would like a more detailed response we would encourage them to contact Oscar directly for assistance with the grievance they have open directly with the Plan so that we might provide our member with a more detailed response in a non-public forum.
  If our member has any questions about this information, we ask that they please contact our ************************** at ************ or *********************************. 
  Respectfully,
  Complaints Grievances & Appeals
  Oscar Insurance Corporation
  
  

• Initial Complaint

  08/29/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  During the summer of 2022, my son's primary care provider indicated that my son would need to see a pediatric ophthalmologist. Since there were none in-network, my son's referring provider worked with my insurance at the time (Oscar Health), and the medical facility (***************************) to get a single case agreement put in place for my son to receive medical services for in-network costs. This took months and many phone calls to get approved. On the day of the appointment, Sept 8, 2022, I received a call from an Oscar Care Guide that stated I was "good to go" to the appointment as it had been officially approved. I would not have gone if I knew I would be fully liable for the cost. I ONLY went because the Oscar staff told me it was approved. After the appointment, we received the bill for the full amount ($460) when we originally expected to pay a copay ($90). I have spent close to 40 hours over the last year on the phone with Oscar, ***** Vision, and *************************** to figure out the issue. I was told the address was wrong on the referral. That was corrected, still not the actual issue. I was told that the doctor ****** the approval after the appointment, and therefore an Oscar care guide submitted an appeal for me when he found that. Still denied by Oscar. I submitted a second appeal begging Oscar to listen to the recorded call from Sept 8th, 2022 where I was told to go to the appointment. I have provided all of these details, and one of my care guides did as well, and the appeals team continues to be negligent, ignore all of these details, not reference them at all, and simply denies with the reason "out of network." I am very close to hiring legal representation to not only get this bill covered as it should have been, but to get reimbursed for the many hours I have had to take off of work to deal with this, as well as the mental strain it has caused me in the process.

  Business response

  09/12/2023

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

  
  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 on her sons behalf regarding the denial of his claim for an eye examination with a specialist. The member stated that prior to her sons eye visit, she contacted Oscar ****** Services and requested for a Single Case Agreement (***) and she was advised by a representative that the *** has been approved and she can continue with her sons appointment and it will be covered. However, the visit was denied by Oscar and even though the member filed a first level and second level of appeal to Oscar in reference to the denial of her sons claim, her appeal request was denied. The member further expressed dissatisfaction regarding the amount of time she spent with Oscar ****** Services regarding her sons *** in follow up telephonic conversation. 

  
  In order to address the members concern, we reviewed the case. Our records indicate that on June 8, 2023 the first level of appeal response was mailed to the member and on August 10, 2023, the second level of appeal response was mailed. Please note that the member has exceeded her internal appeal option with Oscar and the member may appeal externally to the ******* Department of Insurance and Financial Institutions. Additionally, the responses letter mailed on June 8 and August 10 contains an appeals packet where she may find the information regarding the external appeal process. For more information regarding filing an external appeal, member may contact  ******* Department of Insurance and Financial Institutions and may view the following information:   

  
   ******* Department of Insurance and Financial Institutions
  Consumer Assistance Section
  *************************************************************************-2630
  ************
  **************************************
  insurance.**.gov/consumers 

  
  Furthermore, regarding the resolution of the grievance that the member filed to us, we have completed the research of the case and if the member wants to find more information, we encourage her to contact Oscar ****** Services directly, since we are unable to discuss the member and her sons Protected Health Information (PHI) with your organization.

  
  We apologize for any inconvenience that this may have caused, and appreciate the members feedback regarding her experience. If our member has any questions about this information, we ask that they please contact our ****** Services Department at 855-OSCAR-55 or *********************************. 

  
  Respectfully,
  Complaints Grievances & Appeals
  Oscar Insurance Corporation
  

  
  

• Initial Complaint

  06/28/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  In April of this year, 2023, I became an OSCAR customer. I have been unable to make a web account because of an internal server error on the part of OSCAR. Without a web account I cannot use the app/ see my claims , choose a PCP, or advocate for myself as my prescription medications are denied coverage. I have escalated my issue to a supervisor whos name is *******, reference #*****. I have called her repeatedly and was told by her that IT was resolving my issue and she would call me. She did not. Instead, *** called her four times since April. I just called today, June 27, and had a customer service person, whos name I could not understand, tell me that ******* was not available, but she would call me back today. I told them that it was unacceptable that I cannot see my claims or advocate for myself without a web account and that if someone didnt call me back I was filing a complaint with the BBB. I cant even see my OSCAR member handbook/rights and responsibilities to file a complaint with the ************* because when I try to make an account I get a message that says, Internal server error.

  Customer response

  06/28/2023

  Better Business Bureau:
  
  I now have an web account with ********************, I can use the app, see my claims, and access all the info about my coverage. 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

  05/15/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Its a psychiatric facility. ****************** ****** have been my provider for over a year. I tried calling to cancel an appointment and reschedule but they never called me back. I called my pharmacy to get my refill on a medication they have been giving me for a long time which is a benzodiazepine, the pharmacy told me the provider didnt put in refills( they used to give me 3 months refills) when I asked the lady, ****** who is in charge of prescriptions, to set up a new appointment but that I didnt have enough medication until the new appointment and I was afraid because I cant not just stop taking the medication, she proceeded to tell me that she was not gonna put in my prescription until I saw the provider again. I explained is not a new medication and that a benzodiazepine can not be cut off without wining it down and that its a medication they had previously sent refills for previously, she said to me- you then are gonna have to wait to see the provider- I explained I couldnt be without that medication and that since its a controles substance I would have to go to a hospital if I was without it and she said- well, if you get a panic attack then go to the emergency room- I was in shock and explained to her repeatedly that they had sent refills before and she said to do as I most but that she was not gonna give me a prescription. She then hung up on my face. Im trying to communicate with someone at the office and calls are not answered. I suffer from panic attacks and now I do not know what to do. My anxiety level has spiked and no one is calling me back from that facility.

  Business response

  05/23/2023

  *** *** **** ****** ******** ****** ***** **************************************************************************************
  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 her provider experience, specifically with her phone calls not being returned and refilling her prescription medication. 
  

  Our members complaint has been referred to ***** for tracking and trending purposes. This information will be used for future tracking and quality improvement purposes.  Please note that ***** ****** is always happy to help our members locate in-network mental health providers via telephone number at **************, or search for in-network providers 24/7 at ************************ Our member is also welcome to file a complaint through Oscar directly by contacting ** at the number listed below. 
  

  If our member has any questions about this information, we ask that they please contact our ************************** at ************ or *********************************. 
  Respectfully,
  Complaints Grievances & Appeals
  Oscar Insurance Corporation
  

  
  

• Initial Complaint

  03/24/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I have been unable to get claims paid for from Oscar insurance, on behalf of my son, *************************. Member ID: **************. Since the start of this plan on 01/01/2022, claims have been incorrectly, denied as provider out of network for providers who are in network, and listed as so via, Oscars own provider search. Even when, claims have been approved as in network, with no cost to me, payment has not been submitted to the ********** ********************************* I have seen online, that, there is a Class action lawsuit against Oscar insurance, for inaccurately, denying claims, for in-network providers. Oscar is clearly aware, there is a serious issue, impacting the health care of their members.I have contacted them on 8/23/2022 , 09/02/2022, 09/06/2022, 10/2022, 11/2022, 12, 2022 and 3/23/2023 March 2023, my ********** called, indicating they still had not received any payment for services from Oscar. I called Oscarand the rep continued to tell me the ********** needs to resubmit the claims, with the correct information, if that is why they were initially rejected. I then called Health First with Advent Health and begged for their assistance.They took all the claim information to start their own escalation. ****, with Health First, called me around **** on 3/23/2023, to inform me that Oscar refused to assist her without my verbal consent. **** dialed Oscar, and we ended up back on the same call with the same Oscar representative The Oscar employee continued to tell me, I was wrong, and ******************************* had never been in network, keep in mind, Oscar has been contracted by Healthfirst Advent Health during the year 2022, to assist with their Healthcare.gov plans my plan is still a Healthfirst Advent Health plan, being OVERSEEN by Oscar. This ********** has been in network for over a decade with Healthfirst,

  Business response

  04/10/2023

  Dear Better Business Bureau,

  
  Thank you for contacting Oscar regarding the concerns expressed on behalf of our member.
  **************** expresses dissatisfaction regarding the processing of multiple claims.

  
  We can confirm that the claims in question were identified and have been escalated for review currently. We can also confirm that the member has been actively working with their dedicated supervisor regarding this matter. Please kindly note, that due to the public nature of this forum we cannot share specific details such as HIPAA protected and PHI information. If the member would like a more detailed response we encourage them to contact us directly so that we might provide a more detailed response in a non-public forum.

  
  If the provider has any questions about this information, we ask that they please contact our ******************* at ************ or *********************************. 

  
  Respectfully,
  Regulator Case Management 
  Oscar Insurance Corporation
  

  
  

• Initial Complaint

  03/16/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  To whom it may concern,For the last 2 years we have tried unsuccessful to submit a corrected claim for OSCAR patient OSC0573176501, date of service: 12/20/2020.Every time we submitted a corrected claim, the claim was processed as a duplicate. OSCARs system was not able to recognize additional claims as a correction. For original claim Y4532839, we electronically re-submitted a corrected claim with CPT ***** on 09/02/2021. But never heard back from you and assumed the claims were processed now correctly. However, in July 2022 we received a recoupment for the original paid claim. Following, this recoupment we submitted several attempts, provider disputes as well as appeals to have the original claim processed as a corrected claim and not as a new claim.To this date we have had numerous follow up, escalations and phone calls with OSCARs claims team. No solution has been reached yet. We ask OSCAR insurance company to reimburse original claim from 12/20/2020, $147.78 plus interest

  Business response

  03/30/2023

  Dear Better Business Bureau,

  
  Thank you for contacting Oscar regarding the concerns expressed on behalf of provider, *******************. We have researched this case and determined the following: 

  
  ******************* expresses dissatisfaction regarding the timeframe for processing a corrected claim.

  
  We can confirm that the claim in question was identified and has been escalated for review currently under CLAIM-*******. Please kindly note, that due to the public nature of this forum we cannot share specific details such as HIPAA protected and PHI information. If the provider would like a more detailed response we would encourage them to contact us directly for assistance with this claim escalation so that we might provide a more detailed response in a non-public forum.

  
  If the provider has any questions about this information, we ask that they please contact our ******************* at ************ or *********************************. 

  
  Respectfully,
  Regulator Case Management 
  Oscar Insurance Corporation
  

  
  

  Customer response

  04/04/2023

  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:

  [Our office has not heard back from OSCAR insurance yet and we would like to keep the case open. This is a case ongoing for 2 years and we want it to remain open until resolved and paid. Which has not happened yet.]

   

   

   

   

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

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

  Business response

  04/05/2023

  Dear Better Business Bureau,

  
  Thank you for contacting Oscar regarding your follow up about the concerns expressed on behalf of provider, *******************. We have researched this case and determined the following: 

  *********************** expresses dissatisfaction regarding the timeframe for processing a corrected claim.

  
  As previously stated, we have an internal review that is being actively worked. Once the claim in question finalizes, an updated explanation of payment will be sent to the provider.  If the provider would like a more detailed response we would encourage them to contact us directly for assistance with this claim escalation so that we might provide a more detailed response in a non-public forum.

  
  If the provider has any questions about this information, we ask that they please contact our ******************* at ************ or *********************************. 

  
  Respectfully,
  Regulator Case Management 
  Oscar Insurance Corporation
  

  
  

  Customer response

  04/10/2023

  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. We would like to get paid first before we close this case. It has been dragging on for 2 years.
  
  Sincerely,
  ****** ************
  
  
  
   
  
  

*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. ↩