ComplaintsforBenefitfocus, Inc.

• Initial Complaint

  01/05/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Paying for monthly insurance through them for the job I had to leave in September until government insurance kicks in February. I pay every month by the due date at the end of the month and every month I have to call because my doctors visits are racking up because the insurance is telling me I'm not covered when Beneditfocus takes my money. I call and call and call and they say that they put it in the system. Weeks go by, i can't go to appointments, I can't get my prescriptions and my Bill's from previous appointments are going to collections. They never resolve the problems. They never call the providers because they are lazy. They never work any faster to resolve your issues. Never call you back and you can never reach out to management. They are taking peoples money who are struggling and mind you at a high price and don't provide the service. I want my insurance to kick in and I want a reimbursement for all the troubles and the times I can't get meds because it's too high and I'm not covered. They owe me some kind of deduction for all their mess ups.

  Business response

  01/12/2024

  January 12, 2024
  
  Better Business Bureau                                                                                       VIA: Uploaded to BBB Portal
  PO Box 8326
  Columbia, SC 29202
  
  Re: Benefitfocus.com, Inc. Response to Complaint by ****** *******; Complaint ID # ********; Date January 5, 2024
  
  Benefitfocus.com, Inc. (“Benefitfocus”) confirms receipt of Ms. ****** *******’s complaint dated January 5, 2024, with the Better Business Bureau regarding Ms. *******’s allegation that Benefitfocus allegedly failed to provide adequate customer service. 
  Benefitfocus is a cloud-based employee benefits administration technology company which provides software-as-a-service to employer groups and health plans who are servicing their employees’ benefits needs. As such, Benefitfocus understands the retroactive nature of COBRA reinstatements and appreciates the fact that COBRA reinstatements must be processed in an expeditious manner.  Accordingly, Benefitfocus’ systems are designed to provide COBRA reinstatement data to insurance carriers the next day once an employee/member’s record is updated. 
  In Ms. *******’s complaint, she specifically alleges that her COBRA coverage was not reinstated timely. 
  Benefitfocus’ standard procedure is to send communications (specifically an electronic file) to insurance carriers whenever an update to a member record occurs.  Those updates include when a member (i) simultaneously elects and enrolls in COBRA coverage; (ii) the member makes a material change to their account; (iii) when the member’s COBRA coverage ends or naturally expires; or (iv) when a member stops paying their premiums to continue coverage.
  Once Benefitfocus receives notification from the member’s employer of an update to a member’s COBRA coverage Benefitfocus then sends a final communication to the employer group’s insurance carrier advising and directing the insurance carrier to update the member’s COBRA coverage.   
  There are instances when some insurance carriers want electronic files in a specific format and the manner of transmission deviates from industry standard parameters. The Benefitfocus software system is not set up to provide files in a non-standard format.  When Benefitfocus sends our standard electronic file it is done in accordance with industry standards and most insurance carriers will typically process requests in 72 hours. 
  In this case, during the fall of 2023, the carrier Blue Cross Blue Shield of Michigan (“BCBSMI”) changed their process for incoming electronic communications. This change was not communicated to Benefitfocus. This material change to BCBSMI’s standard procedure caused Ms. *******’s COBRA coverage to prematurely terminate.  This is the root cause of the issue and explains why Ms. *******’s COBRA coverage was terminated on two separate occasions. We followed our standard process of transmittingelectroinc files containing enrollment information on behalf of Ms. ******* and her spouse to BCBSMI, but BCBSMI terminated their coverage prematurely. 
  More specifically, when Ms. ******* first brought the issue to our attention on 10/10/2023, we immediately contacted BCBSMI who was not responsive.  After four business days Benefitfocus was successful in reinstating the member and her spouse’s COBRA coverage.
  When Ms. ******* contacted Benefitfocus a second time on 12/29/2023, Benefitfocus immediately contacted Ms. *******’s former employer (our client), **** ********* *********** (“****”), and **** immediately contacted and their Third-Party Administrator (“TPA”) who promptly contacted the insurance carrier. In addition, at Benefitfocus’ request and direction, **** and their TPA directed BCBSMI to accept our electronic files  and agree to receive our standard process of transmitting those files which will cause the member records to remain active until Benefitfocus sends BCBSMI a termination notice.
  Please see the summary of events outlined below pertaining to Ms. *******.
  Initially Ms. ******* emailed Benefitfocus on 10/10/2023 stating her coverage was not reinstated.  Benefitfocus provided escalation to all insurance carriers including BCBSMI on 10/13/2023.  The reason for the delay was simply a timing issue. Ms. *******’s payment was not posted until 10/9/2023 and on 10/10/2023 when we received her email, the insurance carrier communication was sent by Benefitfocus but not processed by the BCBSMI. It is important to note that typical processing time for COBRA reinstatements is 48 to 72 hours.  The Benefitfocus service team explained the process to Ms. ******* in our response to her initial email.
  On 10/17/2023 Ms. ******* called Benefitfocus asking about reinstatement for her spouse. On that same day Benefitfocus sent another urgent reinstatement to BCBSMI.  The Benefitfocus service team called Ms. ******* back on 10/19/2023 to advise her that BCBSMI had confirmed that coverage was reinstated. 
  On 12/29/2023 Ms. ******* called Benefitfocus once again requesting an urgent reinstatement of her COBRA coverage.  Our service center explained the process again to Ms. ******* and she disconnected.  The case was sent to Benefitfocus Administrative Services team who then called the carrier directly to confirm coverage and to reconfirm to BCBSMI our file transmission process. Benefitfocus reminded BCBSMI not to cancel coverage until we provide a termination file.  As explained above, our system is set up to send change only files and escalated reinstatement emails. This was the second time we reiterated the process to BCBSMI. 
  In addition, **** had their TPA reconfirm with BCBSMI that all COBRA participants are to remain active until a termination date was sent by Benefitfocus Administrative Services system. The TPA and BCBSMI have acknowledged this we have been advised that a member’s COBRA coverage will not be terminated prematurely.
  Currently, Ms. ******* and her spouse’s COBRA coverage has been fully reinstated, and coverage is active.  The carrier contact for **** confirmed on 1/10/2024 that Ms. ******* and spouse are currently active.   As far as any outstanding COBRA claims, Ms. ******* must contact BCBSMI directly and request that they honor previously submitted claims incurred during this period.  Ms. ******* should only be responsible for premiums; copays as prescribed by their plan documents; and any applicable deductibles.
  Benefitfocus trusts this response clarifies the matter. If you have any further questions, please do not hesitate to contact our services team at (833) 972-4012.
  Sincerely,
  BENEFITFOCUS.COM, INC.
  

• Initial Complaint

  11/16/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  They are a Cobra benefit provider and have consistently failed to send information to the various insurance providers, BCBS IL (health and dental insurance), WEX (FSA), Caremark (Rx). I have called them no less than 10 times in the three months I have been on Cobra and while it took two months to get them to send information to BCBC IL and WEX, I am finding out today that Caremark still has not been properly informed. I have had to pay for several months of Rx out of pocket, and my Cobra benefits paid as part of my exit package are set to end in two weeks.

  Business response

  11/22/2023

  Good morning, please see the Benefitfocus response the this complaint attached.  Thank you,

  Daisy H******
  Principal Consultant
  Benefitfocus for life™
  
  

• Initial Complaint

  07/17/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Unanswered

  More info

  I am a Hospice Nurse. I had to miss a consult for Oral Surgery 01/26/23 with Dr. Cordero because I had a patient who was actively dying that day. I rescheduled for the following week. My last day to work for Gentiva Hospice was 01/27/23. I called Benefit focus on 01/30/23 to confirm that my insurance showed active. I was informed that it was stopped on 01/27/23. After multiple calls & being transferred back & forth between HR and Benefit Focus during the week, I spoke to Ian at Benefitfocus Cobra & set up my account on line. I NEVER missed 1 payment. I told Ian my dentist said I needed the Oral Surgery ASAP. Ian said it would take up to 14 business days to show active & could not be expedited. I spoke to Accolade, a 3rd party company, who contacted Benefitfocus. We spoke to Rebecca who said it would be expedited & show active on FEBRUARY 03, 23. It was not active on 02/06/23. Reuben at Benefitfocus said Rebecca should not have said that but he would contact Humana & ask them to expedite active status. I made multiple phone calls that month to Benefitfocus with no progress. I asked if I should contact Humana myself. Reuben said no there was nothing that I could do & they would notify me when it showed active. I called Humana on MARCH 1, 2023 & was told it was active. I saw Dr. Cordero on 03/03/23. I asked Humana to expedite the surgery and was told it would take 21 calendar days to process. On APRIL 14, 2023, after multiple calls to Humana, I learned Dr. Cordero was no longer in network. I had to pay a $125 consultation fee to see another dentist. As a result of another call related to this, I learned from Trevor that Benefitfocus contacted Humana to tell them my insurance had changed on MARCH 29, 2023. It had NOT changed. I dropped the Medical Insurance ONLY. I spent MANY HOURS on this. The woman at Accolade thinks this is why my dental surgery request was not processed on time.

• Initial Complaint

  05/08/2023

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  I am previously employed as a nurse at *********. When I left, my health insurance was supposed to end. I have coverage at my new employer that began immediately. I received a notice in the mail from Benefitfocus that I had been signed up for continued coverage that they would be facilitating. I never authorized my coverage to be continued. I contacted *********'s benefits coordinator who said that ********* did not authorize Benefitfocus to continue my coverage. I contacted Benefitsfocus, and informed them of the situation. They said that my account with Benefitfocus would be closed in 10 business days and that there would be no charges. It is 30+ days later, and I am still receiving bills from Benefitfocus that I owe X amount for my premium. Again, I did not authorize Benefitfocus to create any account or authorize any form of continued coverage/COBRA. Again, ********* benefits coordinator claims that ********* did not authorize the creation of any form of continued coverage, and even claimed that they have no idea who/what Benefitfocus is. As far as I am concerned, this account through Benefitfocus was fraudulently created. I did not ever authorize its creation. I have never used it. I have never received any information about the alleged account or benefits that Benefitfocus is attempting to get me to pay for. I DID NOT AUTHORIZE ANY OF THIS. I want three things: A) The fraudulently-created account to be closed B) A letter stating that this account is closed and C) A letter stating that I have a zero balance with Benefitsfocus.

• Initial Complaint

  03/01/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I have a flex spending account. I had a debit card and was unable to use it. I was told 10/21/21 by Anthony, Service Rep my remaining balance of 560.73. He also told me to mail those original receipts in which I did. I did not receive my money for the receipts submitted. I called in January and was told that was the wrong place to send those receipt and to email the remaining receipts that I had. January 25, 2022 I was told per Kristin they had not received the items and to resubmit. I have resubmitted those receipts and called to check on the status. I called in February 2, 7, 9, and then on the 16th I was told per Jill that I needed to submit the receipt with a Reimbursement Request Fund. I have never been told I needed this form. I also asked for a manager to call and had not heard from anyone. I submitted the form with receipts on 2/21/22. I received an emailed on 2/22/22 stating they could not open the file. I resubmitted the form and receipts on 2/22/22 in JPEG format. I called today March 1, 2022. The issue still has not been resolved and I was told to send the information in again.

  Business response

  03/14/2022

  Business Response /* (1000, 8, 2022/03/08) */ First and foremost, we apologize for any frustration or inconvenience Ms. ******* has experienced with her flexible spending account. During our review of her experience, we were not able to identify any claims that were submitted via ****. We did identify the reason that her electronic claim submissions were not approved. We have contacted Ms. ******* as of 3/8/2022 to see if she needs any assistance with filing her reimbursement request, and to ensure that this matter has been resolved to her satisfaction.

• Initial Complaint

  02/16/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  We are on ***** insurance. Initially, we did not receive open enrollment information and fought for over two weeks with Benefitfocus and the employer to simply learn if plan options. Once we decided to simply leave things alone and accept the natural roll-over plans, we thought it would all be easy. By 1/13, we had not received medical cards, so I tried online and called around to learn we weren't in anyone's system. I called between these two and Anthem for weeks to try to resolve the issue, since we paid in Dec for Jan coverage. I had to cancel Dr appts multiple times and wasted hours of my time. There was no way I was going to pay out of pocket (living off my substitute teacher income the last few years & have 2 kids) and then have to deal with reimbursements after the messes I have already had to deal with! It took a month from my initial call on the 13th before B forward (employer) told me we were active. Benefitfocus didn't call back until 2/15. I want reimbursement for the $896.86 paid for Jan coverage that we got no actual benefit from. I actually had to move appts from that month and spent hours and hours of my time to resolve a problem that should have just happened naturally along with everyone else's. I am including emails, phone logs, etc.

  Business response

  03/25/2022

  Business Response /* (1000, 16, 2022/03/08) */ First and foremost, we apologize for any frustration or inconvenience Mr. & Mrs. ******* have experienced with their ***** enrollment and coverage. During our review of the *******'s experience, we identified the reason their ***** paid-through date was not updated appropriately. We have made the appropriate updates to resolve this issue and we have reached out to Mrs. ******* directly to help ensure that this matter has been resolved to her satisfaction. Consumer Response /* (3000, 18, 2022/03/13) */ (The consumer indicated he/she DID NOT accept the response from the business.) Their response makes it sound like I called once, they found an error, and fixed it. Done. That is NOT what happened AT ALL. I made NUMEROUS calls and sent NUMEROUS emails trying to get things resolved. It took over a month and am actually appalled to read that it was just a pay through date that was inaccurate. When I called the first time to verify that I had paid, that should have been flagged, or the second, or the third, when they had to check that I was up to date on my payment. I am attaching records of many of the calls and time spent on the phone in addition to the numerous emails already submitted. Additional calls were made from phones not on record. It took over a month to resolve once I made them aware and it was a full month and a half before we had verification of coverage. This is absolutely unacceptable. It is also unacceptable for them to tell me several times that they will notify me when it is resolved and then simply "leave me hanging." I waited a full week before following up on my first call as I was told it would take a couple days, but I had received no information. I truly believe that if I didn't do all the initiation and push to have this resolved, I would likely still not have active coverage, but still have been paying for it. Business Response /* (4000, 21, 2022/03/18) */ We apologize for the frustration and inconvenience Mr. & Mrs. ******* have experienced. While the issue with their coverage has been resolved, we recognize the hardship it created and as a result we will be offering a reimbursement in the amount of premium paid for the month of January. We have reached out to Mr. and Mrs. ******* directly to confirm and to help ensure that this matter has been resolved to their satisfaction. Consumer Response /* (2000, 23, 2022/03/23) */ (The consumer indicated he/she ACCEPTED the response from the business.)

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