ComplaintsforProvidence Health Plan

• Initial Complaint

  08/25/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My father was taken to the hospital because he fell. He stayed in the hospital for two weeks without caring for his leg and back. Instead they gave him a colonoscopy because his blood test showed he was anemic and gave him a heavy dose of medicine to keep him sleeping and it made his dementia ***** times worse. He has since been moved to a rehabilitation center and has fallen out of bed and while we were visiting he had a stroke and was taken to the ** still no answer and Providence claimed he came into the hospital weak and unwell. Not the case ! He had fallen and was supposed to be treated for that and now hes at the point of totally bed ridden and full blown dementia!!!! The hospital has been no help what so ever!! Our health care is broken.

  Business response

  09/09/2024

  Dear BBB,

  A Providence Health and Services representative spoke with the complainant on Friday 9/6/2024.   Based on their feedback we requested the name and date of birth of the patient so that we could forward the information to our Providence **************************** so they could perform a clinical review.

  Unfortunately, the complainant declined to provide this information during the call and as such we cannot determine the identity of the patient and are unable to review.

  Providence sincerely hopes that upon reflection, the complainant will reconsider and provide patient information so that we may clinically review.

  Please let me know if you need anything else.

  Sincerely,

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

  Customer Experience Manager 

  ********************************************* and Services

   

   

   

• Initial Complaint

  06/27/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  In December of 2023, I renewed my insurance with Providence Medical Advantage. In addition, I checked that I wanted an extra dental plan with Providence. I was very careful to do that because the previous healthcare year, Providence Medical Advantage mislead me to believe that I had an additional dental plan. They said I was too late to get a dental plan when I questioned it. So now, I called to make a dental appointment today. I was told I did not have an additional dental plan. They have now denied two years in a row to not get an additional dental plan. I would like a dental health plan as I have intended for two years in a row. This office has been incompetent when dealing with me. I love my primary doctor and love the service. I do not appreciate the office with the health care plans.

  Business response

  09/13/2024

  Dear BBB

  .Our review found that our member was previously directed to contact **************** and Membership accounting to request to have dental added. Unfortunately, we have not heard back from our member, We respectfully request that our member follow up with Providence Health Assurance so that dental coverage can be added.

  We apologize for any inconvenience to our member in their resolution of this concern.

  Please let me know if you need anything else.

  Sincerely,

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

  Providence Health and Services

   

  Customer response

  09/14/2024

   
  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.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  05/31/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  acct sent to collections,but paid in full

  Business response

  06/07/2024

  Dear BBB,

   

  Thank you for this communication. We were unable to locate this patient/account in our database. A Providence Health and Services representative was able to connect with the spouse of the patient.   We were able to determine this complaint was for a Providence ************** located in ***********, ** and is part of Prime Healthcare. 

  Providence Health Center/Prime Healthcare have no connection or affiliation with Providence Health and Services. We ask that you forward this concern to the correct organization, Providence Health Center, so that they may address this concern with their patient.

  Sincerely,

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

  Customer Experience Manager

  Providence Health and Services

   

   

   

   

• Initial Complaint

  04/26/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I submitted a claim for reimbursement for services received from 1/4/23-12/27/23 in February of '24. It was approved for reimbursement on 3/1/2024. March 14th I emailed asking if the check had been issued, it had but it was issued in the wrong name so they were going to reissue it and I should have received it no later than 4/5/24. On 4/14/24 I called member services, and after some digging found out that there was a hang up on their end and that an internal form hadn't been filled out but that now it was resolved and I should get the check in 7-10 business days. I called today on 4/26/2024 and was told that it was still at accounting and that they only cut checks on Fridays so that it should be cut next Friday but that I could call to confirm that. I want to make it very clear that the people who I talked with on the phone were very helpful and I am not frustrated at them. I am however ****** that Providence Accounting has yet to issue a fairly large check and only cuts them once a week. Whomever manages that department should be under review and retraining needs to happen. I was informed my only course of action is to call next Friday or the Friday after that until I receive the check, which seems a **** poor way of operating a business

  Customer response

  05/22/2024

  I have provided my full name above, here it is again. 

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

• Initial Complaint

  04/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  In 2021, my family purchased a health care plan for Providence through the Providence Health Plan website directly. At the time, I was unaware of getting insurance through Healthcare.gov or state exchanges. As a result, I lost a lot of money to Providence through the loss of this tax credit. I filed a claim against Providence through the Oregon ******************************** but it was denied. I had a plan in ****** and in Washington. PHP should have the ability to direct patients/families to state or federal exchanges to assist with their premiums. Providence's "values" on their webpage are Compassion, Dignity, Justice, Excellence, Integrity. The denial of assisting a previous member who paid Providence thousands of dollars during their years of membership isn't serving with excellence or compassion. We would have purchased Providence directly through the exchange anyways because I thought they were a quality organization. I am now past the grievance period (which is extremely convoluted to file anyways). I want assistance with this and reimbursement of the credits I am due but cannot file because of PHP.

  Customer response

  04/03/2024

  This has been resolved. Please close this complaint and let the company know as well. 
  
  Thank you,
  ***
  

  
  

• Initial Complaint

  11/25/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  My spouse and I have a Providence employer sponsored health plan. I did not use any healthcare in 2023. I did not go to the doctor. I did not fill a prescription. I got my vaccines from the hospital where I work. I just got a bill from Providence staying I owe $139. Theres no way for me to look up an itemized bill on their app or at the website listed on the bill. I have no services listed for 2023 because I used no healthcare. When I go to the app, it shows that only my husband has used healthcare this year. I think bill might be from using Providence urgent care in Sept, 2022 which I thought was covered. If its from a service thats over a 12 months old, Providence is not allowed to bill me per Oregon state law. Not only is it illegal, but it would be too late for me to claim it on my taxes (which I itemized for 2022 d/t health expenses) and too late to claim on 2022 FSA. *****************************, group # ******, ID # ************, the bill says date issued: 11/17/2023, balance $139. Acct ******** By the way, I tried to see my PCP this year for a check up and she was booked out to May next year. I was unable to find another in network pcp to schedule an annual exam but couldnt find anyone accepting new patients. The Providence rep even told me I should switch to another health plan for ****. (I switched to ******)

  Business response

  11/27/2023

  Dear Sirs,

  Thank you for this notification. A Providence Health and Services Representative spoke with our patient today, 11/27/2023. Our representative explained that the delay in billing was due to a credentialing issue with our patient's insurance and the provider who treated our patient on the date of service in question.

  We apologize for the delay in the billing resolution and any inconvenience to our patient. As a resolution, we have made a courtesy adjustment to the patient balance. Our patient indicated they were satisfied with this resolution and will pay the remaining balance due on their Providence account.

  Please let me know if you need anything else.

   

  Sincerely,

   

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

  Customer Experience Manager

  ********************************************* and Services.

  Customer response

  11/29/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********.

  A rep called me. I dont believe her explanation that an in network Providence clinic was considered to be non-PAR with Providence health plan and that it took them 14 months to resolve. I am unhappy that I got a bill 15 months after the date of service. Im not going to keep arguing it because I cant afford a lawyer. 
  I guess for profit health insurance companies and **** are going to keep squeezing their members dry while their CEOs rake in tens of millions in compensation.
  
  *****************************

• Initial Complaint

  10/25/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Depending on who answers the phone, you get different answers. The number I called for resolution for health insurance information is ************. Providence Health insurance is sending me bills that do not belong to me. I am listed as the guarantor? This problem was taken care of a couple of months ago, but Providence Health Plan is up to its old tricks to get anyone to pay for health insurance bills when other person who is responsible for bills are not paying. Be aware that PHP does not get ahold of your mailing address! I would not give them your address for an identifier ever! They will mail you bills that do not belong to you.

  Business response

  11/02/2023

  Dear Sirs,

   

  Thank you for this notification. The complainant has requested that we change the Providence Health and Services guarantor of a minor child from the complainant to the child's father.  On October 25,2023 in a call to the Providence Health and Services business office, the complainant was informed that we are unable to change the guarantor to the father without his permission. Upon receipt of the BBB notification, a Providence representative did reach out to the father, who declined the change of guarantor to him. 

  Payment for services for a minor child does need to be worked out between the parents as we are unable to make this change without permission of the patient's father.

  Please let me know if you need anything else.

  Sincerely,

   

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

  Customer Experience Manager

  ********************************************* and Services

   

   

   

   

   

• Initial Complaint

  10/20/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  We received a bill for full price from my minor daughter's doctor. After reaching out to the doctor's ******* they said Providence required a "Medical Home" to be be set. This is something only the low tier plans require, apparently. I set her Medical Home to her doctor and was informed by Providence that they would not back date anything for us. The bill is twice as much as her monthly premium, so I informed Providence we would be canceling our policies in order to pay the bill with the doctor's ******* They had no problem with that. I am very disappointed with them and have since learned they will actually back date those payments, but they wouldn't for me. I think it's a scam that they only require this of the low tier plans. Anything to not have to pay out when they pretend they care about people and their health.

  Business response

  10/20/2023

  To whom it may concern, in order to research the stated concerns, we need to have the specific member information. 

  Customer response

  10/27/2023

  The matter is not resolved. What information is needed? Subscriber number was ***********

  Business response

  11/01/2023

  On September 29, 2023, PHP received a request to review a statement about the requirements for a Medical Home.  This was an email string.  In that request, the member was educated on needing to add a medical home within the first 30 days of coverage.  If this is not done, the Plan will select and Medical Home for the family. 

  There were no claims submitted on the account for services.   However, after the review and resolution of the complaint submitted by the member, additional information was reviewed, including a denied claim submitted under a previously covered account.   A decision was made to approve the payment for the claim, on the most current account.   The member has been contacted and advised on this decision.  

  We hope that this favorable decision has eased the way of the member.

   

• Initial Complaint

  08/24/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had a hand surgery that was done incorrectly. Pause my nerve damage and I've let it go. I've had a disability by your hand surgeon in *******, **********. And it, it bothers me the worst part of it is. You billing me for the last year? When I have full coverage? ********** Blue Shield coverage. What is the problem here? I talk to the headmanager of ********** Blue Shield. They had called me and said they took care of the big bill that you decided to take advantage of me. Which was $6500? I have a 100% coverage now. That was taken off, and then you build me now. This moment for **** dollars, what's going on? The surgery was over a year and a 1/2 ago. June, the eighth 2022 a surge read. That really destroyed my left hand anyway.

  Business response

  09/05/2023

  Dear Sirs,

   

  Thank you for this notification. A Providence Health and ***************** Service Supervisor has been working with our patient and their insurance carrier on resolution for this concern. We will update once this matter has been resolved.

  Please let me know if you need anything else.

   

  Sincerely,

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

  Customer Experience Manager

  ********************************************* and Services.

   

• Initial Complaint

  08/15/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  On May 10th I needed an emergency transport which is covered by my insurance as in network at 80%. They received the claim on June 29th. Most of my claims are processed within a day or two, but this claim 231800HHSL00 is still being processed. I messaged Providence last week to check for an update and the agent said there would be an update this Monday. I messaged them today which is Tuesday and they still do not have an update for me.

  Business response

  08/23/2023

  August 23, 2023

   

  Thank you for contacting Providence.  I did look into the concern addressed by *********************** and found that a claim, 231800HHSL00 was process and paid on August 18, 2023.  As mentioned, there is a 20% coinsurance applied according to the benefits as listed in ***********************'s member materials.   If there are further questions about this claim or other concerns about this coverage, please contact the **************** Team at ************.

  Thank you again,

  Providence Health Plan

  Customer response

  08/23/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, though the business response was not satisfactory as they mentioned my deductibles which was not relevant to the situation and did not process the claim until I submitted a complaint, the issue is now resolved. 
  
  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. ↩