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Business Profile

Health Insurance

Oscar

This business is NOT BBB Accredited.

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Complaints

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Complaint Details

Note that complaint text that is displayed might not represent all complaints filed with BBB. See details.

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Complaint Type
  • Complaint Type:
    Service or Repair Issues
    Status:
    Answered
    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

    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 response

    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

    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 response

    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,


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




     


  • Complaint Type:
    Billing Issues
    Status:
    Answered
    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

    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


  • Complaint Type:
    Billing Issues
    Status:
    Answered
    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

    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,
    ***** **  ********* ******* ***** ********* ***********


  • Complaint Type:
    Service or Repair Issues
    Status:
    Answered
    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

    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


  • Complaint Type:
    Service or Repair Issues
    Status:
    Resolved
    On 08/05/24, I participated in a Virtual Health Screening with Oscar Insurance wherein afterwards I was to receive a $25 Amazon Gift Card via Email. On 09/04/24 I received the $25 Amazon Gift Card via Email and on 09/12/24 when I tried to redeem the Gift Card via my Amazon Account I received a note at the top of the screen saying that the Gift Card has already been applied to another account. There is no one else on my Account and so I called Amazon to see what the problem was and they could not redeem the Gift Card either. ******* can also verify the fact that I am the only member on my Amazon account and that I was unable to redeem the Gift Card!So I contacted Oscar Insurance and spoke with Shan. After placing me on hold several times, she told me that she was doing a Ticket (#********) to escalate/investigate the matter and that it would **** *-8 weeks for an answer.On 11/08/24, (after waiting 8 weeks) and not hearing back from **** (no surprise there), I contacted Oscar Insurance and spoke with *****. She said that the Ticket had been CLOSED WITH NO RESOLUTION! I obviously was livid and I want this matter resolved! The fact that Oscar sends out emails telling customers they will send a Gift Card if we do a Virtual Health Screening yet provide a Gift Card that does not work or that someone else has stolen, not to mention not even bothering to resolve the issue for a customer is beyond unacceptable! This is not a good way to do business Oscar! I want my promised Gift Card that is actually REDEEMABLE!!

    Business response

    11/19/2024

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

    Dear Better Business Bureau,

    Thank you for contacting Oscar regarding our member not receiving a redeemable Amazon gift card for participating in a virtual health screening.

    Oscar confirms that we run programs that use data from member health histories and claims to offer incentives and rewards to specific subsets of members at risk for health issues. This is done to encourage members to complete wellness visits and routine care that can help them avoid adverse health outcomes. One of the free health visits offered under this program contains a phone health check up with one of our virtual Oscar primary care providers and a $25.00 Amazon gift card code reward. Members may also schedule an in-home assessment (IHA) led by a licensed nurse practitioner through our partner Signify and qualify for a $25.00 Amazon gift card code.

    Throughout the year, Oscar sends out notifications to members via mail, secure messaging, and email about the free health check up and $25.00 Amazon gift card code. In exchange for our member's time, they will receive a $25.00 Amazon gift card code within 6-8 weeks of their completed appointment.
    Upon investigation, Oscars Complaints, Grievances and Appeals Team has confirmed our member has received their Amazon gift card as of November 14, 2024 through email. 

    We sincerely apologize for our members experience with Oscar Health as well as the delay in receiving the Amazon gift card. We want to ensure that we meet our members needs and we regret that this 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 names of a provider as well as names of a 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 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 ************ or *************************************************************. 

    Thank you,
    ***** **  ********* ******* ***** ********* ***********


    Customer response

    11/20/2024

    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,

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



     

  • Complaint Type:
    Billing Issues
    Status:
    Answered
    Im writing about multiple medical claims submitted to ***** Oscar by *** Rehabilitation between 10/17 and 4/9. They've been ***eatedly denied for my sons, despite my healthcare plan stating these services are covered. I've been reassured multiple times by different ***** Oscar ***resentatives these services are covered and I should only be paying a $30 co-pay. Ivy Rehab has submitted 3-4X and been rejected each time without a clear reason why. Most recent phone calls were: 3/12 with Oscar *** ******** 4/8 with ********* 4/12 with ********** 5/2, 5/16, and 6/26 with *****. ***** Oscar ***resentatives have been unable to explain why they are being denied to me, coming up with different possibilities every time that always are not the actual reason. *** rehab ***resentatives and ***** Oscar ***resentatives have talked together on the phone in three-way call with me multiple times to try to address this situation. In my last call (reference # ********************* # ********), it was revealed that a third company ASH was processing the claims and rejecting them. The Cigna-Oscar *** was unaware they even employed this company. *** gave me yet another reason the claims were denied. Now I'm being told because it is past 180 days, I can no longer recuperate the thousands I've had to sped out of pocket to get my children medical care while I waited for the submittals to be processed. There has been no mention of this 180 day policy until now. In fact, I was ***eatedly told by Cigna-Oscar ***s to wait because submittals were processing and processing takes 8 weeks. I recently filled an official grievance claim with Oscar-***** but that has also gone unanswered. It appears Oscar-***** has intentionally stalled in paying these medical claims so they can get past the 180 day window and not have to pay for medical services covered under my contract.

    Business response

    08/02/2024

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

    Dear Better Business Bureau,


    Thank you for contacting ***** + Oscar on behalf of our member. In the members complaint, they state dissatisfaction on behalf of their child concerning their member experience related to the denial of multiple physical therapy claims. 


    Kindly note, Oscar has joined together with ***** to provide our *********** and National *********** plans with accommodations built to better suit their business needs. However, due to ***** and Oscars partnership, claims are required to be submitted directly to ***** first, to allow for proper pricing. Once pricing is determined, the claim is submitted to Oscar for completion. When claims are submitted to Oscar, prior to being priced by *****, they will be denied.
    ***** + Oscar sincerely apologizes for any inconvenience that our members' interaction with *************** may have caused, and appreciate their feedback regarding their experience. ***** + Oscar has taken note of our members' concerns and forwarded their feedback so that coaching may be provided to the representative involved. We want to ensure that our representatives properly address our members needs, and we regret that their 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.


    As ***** + Oscar has stated in previous responses, according to our records, the provider should have submitted the claims to ***** + Oscar, at the address located on your member ID card. Furthermore, we have notified the provider with an Explanation of Payment (EOP) for each denied claim with the rationale behind the denial and the claim submission address as well as the electronic payor ID number for claim submissions. The address and electronic payor ID number have also been reproduced on the following page below:

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

    ***** + Oscar is unable to instruct a provider how to bill for a service, as doing so can be interpreted as insurance fraud. If it is believed that the claim is billed incorrectly, we encourage our members to contact the provider to request that a corrective claim be sent to ***** + Oscar for reprocessing. As of today's date, we have not received any corrective claims from the provider. 

    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 her 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 she can contact our *************** Department at ************ or *********************************. 

    Thank you,
    ******** ********* ******* ***** ********* **********n


    Customer response

    08/07/2024

    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:

    The first submittal went to the wrong location. Something multiple Oscar ***** representatives said is a very common error because of the way the company was listed on the old health card. Initially we were told the second group of submittals also went to the wrong location because the Oscar ***** representative couldnt find the submittal in their database. However after multiple phone calls, an Oscar ***** representative confirmed that this assumption was not true. The medical submissions had been sent to the correct location but were being denied for some other reason. It was acknowledged at the time by ***** that their representatives could not access Oscars database system and that was an ongoing issue for customer representatives in determining if they received medical submissions, whether they were processed, and for what reason they were denied. After more phone calls, an Oscar ***** representative was able to confirm it was sent to the correct location, however it was denied again despite the service being covered under my insurance plan. It was again stated by Oscar ***** representatives that these types of rejections are common occurrences because it is a convoluted process to submit with their company. Note this was a national company submitting these medical claims which was very familiar with how to submit claims and they were baffled as well why my claims kept getting rejected. The supposed error was corrected and the company resubmitted the claims a third time. This time it was also rejected. Again the representative attempted to say it was sent to the wrong location. (It wasnt) After multiple phone calls and waiting, an Oscar ***** representative admitted they were wrong and that the claims had been sent to the correct location but for some reason only a few had been approved, while others were denied. But it was unclear why certain submittal were being processed and others were not. I must ask you how a medical provider or myself is supposed to figure out what error is being made on a medical claim submission to cause it to be denied if your own Oscar ***** representatives dont know. It took investigating on my part to find out that my claims were not being processed by ***** or Oscar, but rather by another company ASH (a company your agent was unaware Oscar ***** even used). This is why Oscar ***** and myself did not have access to the claims or the reasons why they were being denied. A third company was being used to convolute the process even more .After a phone call to ASH with one of Oscar Cignas representatives, it was determined too much time had passed since my initial inquires into these submittals and now I could not resubmit the claims despite the services being covered under my plan. Note everytime I called your company I was told to wait 8 weeks for everything to process with no mention of their being a time limit for approval. They also encouraged me to wait and not fill out the official complaint form on your website as I was told I needed to first wait for the current claims to process (8 weeks ) and then for the resubmitted claims to process (another 8 weeks) AND then for the 3rd submission of claims to be processed before filing an official complaint. Each time the claims were denied no one from your company could initially tell me why they were denied, throwing out lots of different options to see if one would stick. Im still not sure what the actual reason is as it has changed so many times. Your claim process appears to be intentionally convoluted if your own representatives dont understand the process . Your customer service regarding complaints is non existent evidenced by the fact that I still have not been contacted by your company (outside of this response to my BBB complaint) regarding my submittals and ongoing plea to get them processed. The services my children received were covered under my plan yet I have not been reimbursed for thousands of dollars in out of pocket expenses.


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


    Sincerely,

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




     

    Business response

    08/15/2024

    ****** *** **** ****** ******** ****** ***** ***************************************************
    ***********************;


    Complaint ID: ********

    Dear Better Business Bureau,


    Thank you for contacting ***** + Oscar on behalf of our member. In the members complaint, they state dissatisfaction on behalf of their children concerning their member experience related to the denial of multiple physical therapy claims.


    As previously stated, Oscar has joined together with ***** to provide our *********** and National *********** plans with accommodations built to better suit their business needs. However, due to ***** and Oscars partnership, claims are required to be submitted directly to ***** first, to allow for proper pricing. Once pricing is determined, the claim is submitted to Oscar for completion. When claims are submitted to Oscar, prior to being priced by *****, they will be denied.

    ***** + Oscar sincerely apologizes for any inconvenience that our members' interaction with *************** has caused, and appreciates their feedback regarding their experience. We can confirm ***** + Oscar has taken note of our members' concerns and forwarded their feedback so that coaching may be provided to the representative involved. We want to ensure that our representatives properly address our members needs, and we regret that their 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. 

    As ***** + Oscar has stated in previous responses, according to our records, the provider should have submitted the claims to ***** + Oscar, at the address located on the members ***** + Oscar ID card. Furthermore, we have notified the provider multiple times with an Explanation of Payment (EOP) throughout 2023 and *********************************************************************************************************************************** number for claim submissions. Kindly note, that ***** + Oscar has also spoken to the provider directly to advise the address and electronic payor ID number have also been reproduced on the following page below:

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


    ***** + Oscar is unable to instruct a provider how to bill for a service, as doing so can be interpreted as insurance fraud. If it is believed that the claim is billed incorrectly, we encourage our members to contact the provider to request that a corrective claim be sent to ***** + Oscar for reprocessing. As of today's date, we have not received any corrective claims from the provider. We have confirmed that ***** + Oscar has correctly informed our member of the claim denial reason as well as advised the correct payor information listed above. We also did not find any evidence of misinformation provided by our *************** Team in relation to the reason for the claim denials. The provider is encouraged to contact us for assistance with the claim submissions and as of todays date, there is no contact on file regarding the claim submissions.

    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 her 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 she can contact our *************** Department at 855-OSCAR-55 or *********************************. 

    Thank you,
    ******** 
    Grievance Liaison
    Oscar Insurance Corporation


  • Complaint Type:
    Service or Repair Issues
    Status:
    Answered
    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


  • Complaint Type:
    Service or Repair Issues
    Status:
    Resolved
    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,

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



     

  • Complaint Type:
    Billing Issues
    Status:
    Answered
    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


  • Complaint Type:
    Service or Repair Issues
    Status:
    Answered
    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

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