ComplaintsforContigo Health, LLC

• Initial Complaint

  04/18/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I received counseling services for 14 sessions between August 2021 and December 2021 for a total of $2800 spent out of pocket payment to the provider. I had Anthem BCBS and reached out to them prior to starting sessions and made sure that the provider was in network. I submitted 2 claims as instructed: one on 1/19 for $1600 and the other on 2/14 for $1200. I was then told that my provider had to directly submit these claims, which she did on 3/14/22. As an in-network provider, I was told that I would only have to pay $50 per session. As of yet, I have only received $525 from the $1200 claim submitted and no reimbursement was given for $1600 claim. I have called ContigoHealth, who is the 3rd party provider, no less than 6 times and have received no follow up or information re: resolution. I am repeatedly told that "your provider is in-network, but it is being reimbursed as an out-of-network." And when I ask what the next steps are, I am told "we are waiting on Anthem." I have tried to directly contact Anthem without success. I am owed another $1575, and I would like this to be resolved immediately. I have been in contact with ContigoHealth since 2/15/22, regarding this matter, and it is now going on 4 months since the original claim was submitted.

  Business response

  04/25/2022

  From: ************************ <***************************>
  Date: Mon, Apr 25, 2022 at 9:12 AM
  Subject: FW: Your: BBB Complaint Number ********
  To: *************************************** <***************************************>
  
  

  
  
  

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

   

  I write on behalf of Contigo Health, LLC (Contigo Health). Thank you for forwarding the BBB Complaint Number ********. Contigo Health has reviewed the information and your request for Contigo Healths response to include in your complaint file with the Better Business Bureau of Ohio. 

   

  By way of background, Contigo Health is a third party administrator for the complainants employer plan. Contigo Health is the Claims Administrator, not the Plan Administrator or the Plan Fiduciary, and administers the plan in accordance with the employers group health plan. This employer has a self-funded group health plan which is regulated by the Employee Retirement Income Security Act of **** (ERISA), as amended. The Employer is the Plan Administrator, Plan Sponsor, and fiduciary of this Plan.  

   

  Contigo Health takes all complaints and compliance matters seriously. Contigo Health is unable to share information regarding the protected health information of the covered member complainant  with the Better Business Bureau of Ohio to respond to the complaint. Notwithstanding the aforementioned, we have investigated the complaint and have been in contact with the covered member complainant to resolve the situation.

   

  If you have any additional questions or comments regarding this matter, please do not hesitate to contact me directly at *************************** or via phone at ************. Further inquiries of this nature should be directed to ******************************************.

   

  Respectfully,

*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. ↩