ComplaintsforModa Health

• Initial Complaint

  07/28/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I enrolled in Marketplace 2-22and made a poor choice Moda health . The customer ********************** is decent and they are always polite...that's as far as it goes! I was approved for and had total hip replacement on july 18 2022. My prior experience with moda alerted me that I should call prior to the surgery to talk about aftercare. It is a back and forth with the customer ********************** about in network providers. Even if thgey are on the list of innetwork it does not mean the provider will see you. Many of the providers say we have never heard of Moda. A case worker that works for moda told me moda did not take the time to develop the relation with providers and therefore there is no trust that bills will be paid. I was approved for pt with ************ in ********** *****. I had an eval before and after the surgery. Following the second appointment on **** the owner/pt called me and said the **** he submitted was rejected by moda and american specialty health (their associate) Dr. ****** said for my protection he would not see me until this billing was resolved. I had to once again call moda to resolve an issue that I should not have to deal with. I am trying to recover from hip replacement surgery and find myself on the phone hours a day. My frustration is coming through and they have nothing to say If I ask to speak to a supervisor I get put on an endless hold. To say they are GARBAGE would give them too much credit. They expect a patient to lay at home and heal them self following a major surgery which to me is insane I'm really not sure what else to say. I have filed a complaint with ***** **** of insurance as well. I hope someone else does not have to go through this nightmare

  Business response

  08/01/2022

  We have received this same complaint from the ***** ****************** and due to the fact that there are a few issues that need addressing, we will respond to your office by Friday, August 12, 2022.  We can tell you that Moda Health has been in contact with the member to assist him.

  Thank you. 

  *********************, Appeal Supervisor for Moda Health

  Customer response

  08/02/2022

   
  Complaint: 17640709
  
  I am rejecting this response because: Time was/is of the essence after a major surgery . I had called many times before the surgery to try to make sure I would get the care I needed to be able to recover properly. I was met with the same response being there are very few providers in the area. It turns out there are several Home health companies including Cristus, Central ***** HH,St. ***************** the problem being none of them trust that they will be paid for services rendered. The case in point was My July 25 appointment with limitless PT for eval the next day the owner/PT ******************************* called me to say they would have to d/c services to me because payment was rejected. I the person lying in bed in writhing pain has to get on the phone with moda to try and sort out a billing issue. The moda rep said she would resubmit for payment. In the meantime the days go by with no help to me. The PT appointment they rejected was approved in may for apx 10 visits. Mr. ********** said to me The PT would be more effective after the surgery. That is why there was only the single visit....IT WAS A MODA APPROVED VISIT! When I call their CS at moda and ask to speak to a supervisor they state I will get a call back ***** hours but that never happened.  Anyone that listens to the 20 or so calls I was forced to make will hear the sheer inability for moda to make services for me happen. I will not say the entire company. ********************* has been my only lifeline. Without her It would be a big fat ZERO.
  
  Sincerely,
  
  *************************

  Business response

  08/15/2022

  Thank you.  

  Customer response

  08/15/2022

   
  Complaint: 17640709
  
  I am rejecting this response because: The number and time I have spent on the phone with Moda reps in the time since enrolling in the system can only be ascertained by review of phone records. I estimate 45 hours. Much of this time was an exercise in futility. Being polite and actually assisting the customer are two very different issues. *********************** is the only Moda employee that made a difference. It is through her hard work and fortitude I was able to get post surgery care. The issue I have is that the care post surgery should have happened July 19 or the 20th at the latest. Instead while I am suffering the pain of a major surgery I am also suffering the psychological torture of having no aftercare. Take the time and listen to all the calls coming from ************ between 7-1 and 8-5-22 and explain to me why and how this exception with Ranier took so long. The post surgery care is time sensitive and Moda seems to have ignored this fact
  
  Sincerely,
  
  *************************

• Initial Complaint

  03/18/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Enrolled Moda on time. I am extremely diligent and was concerned with having a gap in our healthcare. When I was able to access my billing at Moda it showed that my first **** was a credit for over $ **** I emailed and waited for a reply from Moda as I didnt want to risk not making a payment and getting cancelled. I finally was able to talk to someone on the phone and was told that I did have a credit and to wait for my ****. The first **** came on 3/17 and I tried to login to pay but showed an error message. I called the office today and was told that I had been cancelled for lack of payment I need coverage and so does my husband and would like the opportunity to pay our premium. We were never given a chance but instead were told we had a credit and to wait for a ****

  Business response

  03/21/2022

  We are not able to identify this person in our system.  We woudl need a birth day, correct spelling of last name and or the identification number.  Once we get this and we can identify the member, we can respond.  Thank you.

• Initial Complaint

  08/20/2021

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Doctor writes script for *** to ***** Health, script is not filled. Reason, the insurance has put a mandatory Prior Auth due yearly for a script. The insurance will not pay to refill the script for the *** unless a Prior Auth is compiled by the Doctor and ***** Healthcare. This is a strategy for the insurance not to pay for *** needed yearly for patients nationwide. This patient is exploring a class action lawsuit that will make insurance companies suffer for creating road blocks for patients and doctors. The data will be easy to acquire. Hope the insurance companies are now aware patents and doctors are not going to tolerate this any more.

  Business response

  08/23/2021

  This member has filed a complaint with Moda Health.  We are currently looking into the complaint and will respond to the member within 30 days.  The complaint was received on 8/20/2021. This is a ******** member so we must follow the complaint process outlined by the Oregon Health Authority.  

  Customer response

  08/23/2021

   
  Complaint: 15785075
  

  I dont have access to the answer from Moda health. They are taking 30 days to respond to the complaint. I can not Accept or Disagree with the insurance company if they have not responded yet. 

  BBB this message was a waste of time as we dont have an answer from the other party yet. 

  You need to keep this case open 30 days until they respond. 

  I can also start a class action lawsuit to try and get some results on this issue. 

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

  Business response

  09/03/2021

  As stated, we have this concern and we will be responding to the member in writing.  Thank you.

   

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