ComplaintsforMagnaCare

• Initial Complaint

  04/26/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I handle the billing for a Licensed Mental Health Counselor in ***********, **. In July 2023 we discovered that a number of EFT checks for services rendered were deposited in a closed account. To rectify the situation we reached out to Magnacare through the Provider Hotline and was told the best course of action would be to email the *** team ******************************************* After a few emails and follow up phone calls the account was sorted through their provider website and we were told the checks would be re-depostied in 6-8 weeks per an email from ********************* (using **************************************************** on September 8,2023; they were not. We continued to reach out and the Provider Hotline and on February 1, 2024 I spoke with Destiny who ensured the best way to follow up was more emails. On February 2, 2024 we received an email saying the checks would be reissued and could ***********-8 weeks; it has now been 12 weeks. On April 16, 2024 I spoke with **** at the Provider Hotline and after attempting to manually reprocess the checks she let us know she was unable and the *** Team would have to do it. I have emailed every day since (and almost 30 times since this started) and have not received any communication. This delay has been difficult for our small business and was difficult to manage when filing 2023 taxes. We are looking to finally have this matter sorted and receive some answer on the next steps.

  Customer response

  05/20/2024

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

• Initial Complaint

  12/11/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I received treatment at *** for $225 on 8-10-23. Because the *** had issues looking up my eligibility I had to pay out of pocket. I contacted Magna Care a few days later and was told my copay was ***** and that I should be receiving a refund for ******. When I called back a week later for an update i was told .y claim was missing and i had refile another the claim. I was told by this representativei had a copay of 50 and would be receiving a ****** refund. For months I have been calling and emailing. I was told today that the claim is being finalized for a refund of ******. The representative could not explain why my refund is being reduced or when I would even be receiving a refund.

  Business response

  12/13/2023

  We are in receipt of the below complaint. We would like to respond, however, we will need a HIPAA Authorization from the member stating that we can review the members Protected Health Information (PHI) to properly review and respond to the compliant.

  Customer response

  12/15/2023

  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:

  [Your Answer Here]

   I have not received a refund for treatment I received in August 2023. I sent Maganacare the ***** authorization form that was requested. 

   

   

   

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

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

  Customer response

  01/22/2024

  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 called AFC ****** care. I was told that request form,  and a copy of the medical release form I completed needs to be sent to *************************.

   

   

   

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

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

  Business response

  01/25/2024

  Dear ********,
  

  We take all complaints seriously and are sorry that you had a negative experience. Unfortunately, we did not receive the claim from your provider until 1/9/24 for your treatment on 8/10/23, which caused the delay. We are now processing your claim so that you can receive the appropriate refund for your out-of-pocket payment.
  

  Thank you,
  MagnaCare Customer Service

• Initial Complaint

  06/09/2023

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I am a nurse practitioner who was in network with Northwell Direct. They use Magnacare to administer their health plan. They owe me dating back to September 2022 for 40 claims. They evade calls and will not provide email addresses. They say they are working hard to resolve my issue and have been saying so for three months. I have called and emailed approximately 40 to 50 times and get different answers every time. I am finally speaking to a "Senior VP" ************************************* who asked me to shred documents showing they were refusing to pay for my services. I would like BBB to be aware because they business practices are fraudulent and unfair to the patients who rely on them for health care. I also want other health care providers to beware because they are extremely disorganized which is dangerous when dealing with patient's lives and health care. I cannot upload documents because they have protected health information and patient's names. I would like Magnacare to be contacted by BBB so they know they cannot do business this way. It is unfair to consumers and a waste of healthcare providers time. Please call me with any questions at all.

  Customer response

  07/04/2023

  At this time, I have been contacted directly by MagnaCare regarding complaint ID ********, however my complaint has NOT been resolved because:

  They sent by direct deposit partial payment and left a message that they needed to speak to me. However, when I call back I either get no response or get told I will get a call back and I do not. 

  They sent me a small portion of what we are owed for medical services but many of the claims remain unpaid. 

  Thank you for your attention to this matter. 

   

   

   

   

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

  Sincerely,

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

  Business response

  08/22/2023

  Dear *** ********
  
  We take all complaints seriously and are sorry that you had a negative experience.
  
  The claims you referenced were not submitted in an industry-standard manner. Your practice used incorrect identifying information and extensive work was required to identify and calculate applicable payments. This in turn caused the delay in proper payment.
  
  A senior level executive attempted to assist you in resolving the matter. She explained the various options and the time frames it would take to adjust claims paid in error due to the incorrect and conflicting identifying information in what was submitted by your practice. No MagnaCare representative refused to correct the claims, and any reference to “shredding” documents was related to disposing of the prior incorrect claims and resubmitting them with the proper identification information.
  
  We’d also like to note that MagnaCare is a third-party administrator. In in its role as an administrator, MagnaCare is not financially responsible for payment of claims. It simply remits the payments which are made by the underlying group health plan that covers the patient.
  
  We are working to resolve this issue as quickly as possible. The claims have been adjusted and applicable payments made.
  
  Thank you,
  MagnaCare Customer Service

  Business response

  08/22/2023

  Dear *** ********
  
  We take all complaints seriously and are sorry that you had a negative experience.
  
  The claims you referenced were not submitted in an industry-standard manner. Your practice used incorrect identifying information and extensive work was required to identify and calculate applicable payments. This in turn caused the delay in proper payment.
  
  A senior level executive attempted to assist you in resolving the matter. She explained the various options and the time frames it would take to adjust claims paid in error due to the incorrect and conflicting identifying information in what was submitted by your practice. No MagnaCare representative refused to correct the claims, and any reference to “shredding” documents was related to disposing of the prior incorrect claims and resubmitting them with the proper identification information.
  
  We’d also like to note that MagnaCare is a third-party administrator. In in its role as an administrator, MagnaCare is not financially responsible for payment of claims. It simply remits the payments which are made by the underlying group health plan that covers the patient.
  
  We are working to resolve this issue as quickly as possible. The claims have been adjusted and applicable payments made.
  
  Thank you,
  MagnaCare Customer Service

  Customer response

  08/22/2023

  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

  03/30/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  At the start of December 2022 I noticed on my credit report that there was a collection for an MRI from March 1, 2021 so I reached out to Magnacare regarding the unpaid *********** explained to me that there was an error made that showed I did not have insurance at the time the claim was submitted but that the issue was resolved & the bill would be paid. Supposedly the LONGEST it would take for the bill to be paid was ***** business days & only after the 45 days could the process be expedited- regardless of the fact that due to no fault of my own was this now on my credit report! I called several times during the 45 days to check the progress of the ************* was no progress being made. On day 46 I called & asked to speak to a manger who conveniently wasn't available & never called me back! Two days later (February 10th) I called yet again & was told that a manager had expedited my claim & it should be paid within 2 weeks. Here we are now March 29th, 2023 & the issue is STILL not resolved. If this is their idea of expedited I would hate to see what taking their time looks like! I spoke to yet another manager on 3/24, ********, who says she has expedited the claim and it should be paid soon (she couldn't give me a time frame as to how long because she doesn't know). I have called Magnacare probably 20x since December regarding just this ONE claim and I still have claims from 4/13/22, 08/04/22, 09/04/22, and 6 more claims from months ago that haven't yet been paid! One company has already sent me 3 notices even though I've already called them and explained the situation to them already. If Magnacare doesn't pay them soon they'll probably send me to collections too. I've dealt with many companies in my day but they are by far the absolute worst! This has been a waste of my ************* & has caused a great deal of stress. They clearly do not care about helping their customers and only pass the blame off onto someone else- in this case my husbands union.

  Customer response

  04/24/2023

  Better Business Bureau:
  
  At this time, I have not been contacted by MagnaCare regarding complaint ID ********.
  
  Sincerely,
  
  ***************************
  

• Initial Complaint

  03/29/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Magna is my ******** supplemental insurance and is not paying all my claims. They say they do not have the information even though my doctor's ****** has submitted the claims multiple times. This is both aggravating and embarrassing. I can give you the specific ******** claim numbers if necessary.

  Customer response

  03/30/2023

  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

  01/26/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I've been with Magnacare for over 25 years and really never had a problem but the pass year I had foot surgery and had 8 visits way back starting from last April 2022 ... .Not one claim as been paid yet from Magnacare ...I've been getting calls front desk from billing from my foot surgeon that they have not had any claims paid for and there still waiting ... I called the Magnacare and they told me because my health insurance is through a union its a slow process for them to pay the claims and it could be months .. and it can be 160 days after the claims are put though to be paid . I am very frustrated because this most the time I do not have a problem with this healthcare but it's extremely embarrassing for me because i still have to do my other foot to fix a bunion this summer at the same foot doctor and nothing still as not been paid from previous claims .... It's disgusting ! and humiliating ! Most places I had visits for medical care have been good about claims from Magnacare taking there time paying claims but at the same time it's been almost a year ... I feel like now I have to go to another foot doctor ! Just really upset about this ..

• Initial Complaint

  08/02/2022

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  My insurance company Magnacare is refusing to pay for services provided to me back in March 2022by my doctor. I've made several call's to Magnacare, I was placed on hold for well over 45-minutes, with in that time the phone hung up. Yesterday I received a revised bill from my provider that the bill has been placed with collections for non-payment from my insurance company.

  Business response

  08/17/2022

  Thank you for your feedback. Were sorry for your experience.Please know, we take every complaint seriously. Our records show that we do not have any of your claims or customer calls on file. Based on our information,your health plan accesses the ********************** provider network. However, your claims and customer service are handled by a separate third party administrator, whose contact information should be on your member ID card. Please reach out to either your employer or health plans third party administrator for assistance.Were sorry we couldnt help you resolve your complaint, but if we can help you in some other way please contact us at ********************************

• Initial Complaint

  11/22/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My son had surgery with an in-network doctor, at an in-network hospital. I received an surprise out of network **** for anesthesia services. Ive contact my insurance company several times inquiring about this. They said they would take care of it. I also sent a nys out of new work assignment of benefits form to both my insurance company and the anesthesia company. This was done several times in a timely fashion over the past 6 months. However to date it is not resolved. Now I am receiving letters from a debt collector (C.tech) on behalf of the anesthesia company (North ***************** in Anesthesia). To the best of my knowledge Ive done my due diligence to stay in network, as well as follow ** in a professional and timely fashion. This is a problem between the anesthesia company and my insurance, not me. Ive met all my financial obligations and magma care is not following up with this company or myself to assure it is being worked on. This shouldnt *********** months. I work in healthcare and this feels morally wrong.

  Business response

  12/14/2021

  Dear ********:
  

  Thank you for taking the time to bring your inconvenience to our attention. We appreciate your phone call on November 11,2021, to help us further understand your frustration and want you to know its our goal to provide the best solution possible to resolve your issue in a timely manner.
  

  To address your concerns, our team has reprocessed your claim as a Tier 1 benefit, which is now paying. Additionally,we will call you to confirm when the payment details are available.
  

  We hope you will find this response helpful. If not, please reach out to our call center from 8:30 a.m. until 6 p.m. Monday through Friday at ************.
  

  Sincerely,
  

  *******************, Vice ********** ******** Service

• Initial Complaint

  10/27/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I work for a large Orthopedic practice and am responsible for monitoring payments for medical and surgical claims. The wait time to speak with a live representative is usually an hour or more. Today, I am still on hold after 102 minutes exactly. All I need to check is the status of an appeal I submitted. I have experienced this with Magnacare multiple times within my 8 year career doing medical billing and it is completely unacceptable to leave providers on hold for extensive amounts of time. This company needs to hire more employees to handle the amount of members they have.

  Business response

  11/15/2021

  Dear Provider:

  Thank you for taking the time to communicate to us about your inconvenience. We understand your frustration and want you to know its our goal to provide the best solution possible to resolve your issue in a timely manner.
  

  To address your concerns, I have reached out to you on three separate occasions October 29, 2021; and November 4, and November 10, 2021. Because we werent able to connect, I emailed you an explanation on our clients, claims self-service information and details about our ********************** Clients Provider line that is now open from 8:30 a.m. to 6 p.m.
  

  We hope you will find these resources helpful.If not, please feel free to call me directly by phone or email using the information I emailed to you. 
  

  Sincerely,
  *******************, Vice ********** ******** Service

*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. ↩